Effects of Aerobic and Resistance Training on Hemoglobin A(1c) Levels in Patients With Type 2 Diabetes A Randomized Controlled Trial

Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Rd, Baton Rouge, LA 70808-4124, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2010; 304(20):2253-62. DOI: 10.1001/jama.2010.1710
Source: PubMed

ABSTRACT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination.
To examine the benefits of aerobic training alone, resistance training alone, and a combination of both on hemoglobin A(1c) (HbA(1c)) in individuals with type 2 diabetes.
A randomized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c) levels of 6.5% or higher were enrolled in the 9-month exercise program between April 2007 and August 2009.
Forty-one participants were assigned to the nonexercise control group, 73 to resistance training 3 days a week, 72 to aerobic exercise in which they expended 12 kcal/kg per week; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week. Main Outcome Change in HbA(1c) level. Secondary outcomes included measures of anthropometry and fitness.
The study included 63.0% women and 47.3% nonwhite participants who were a mean (SD) age of 55.8 years (8.7 years) with a baseline HbA(1c) level of 7.7% (1.0%). Compared with the control group, the absolute mean change in HbA(1c) in the combination training exercise group was -0.34% (95% confidence interval [CI], -0.64% to -0.03%; P = .03). The mean changes in HbA(1c) were not statistically significant in either the resistance training (-0.16%; 95% CI, -0.46% to 0.15%; P = .32) or the aerobic (-0.24%; 95% CI, -0.55% to 0.07%; P = .14) groups compared with the control group. Only the combination exercise group improved maximum oxygen consumption (mean, 1.0 mL/kg per min; 95% CI, 0.5-1.5, P < .05) compared with the control group. All exercise groups reduced waist circumference from -1.9 to -2.8 cm compared with the control group. The resistance training group lost a mean of -1.4 kg fat mass (95% CI, -2.0 to -0.7 kg; P < .05) and combination training group lost a mean of -1.7 (-2.3 to -1.1 kg; P < .05) compared with the control group.
Among patients with type 2 diabetes mellitus, a combination of aerobic and resistance training compared with the nonexercise control group improved HbA(1c) levels. This was not achieved by aerobic or resistance training alone. Identifier: NCT00458133.

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Available from: William D Johnson, Sep 26, 2015
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    • "The importance and the role of physical activity in type 2 diabetes have been widely reported by previous studies [1]-[3]. Specifically, aerobic and resistance exercises demonstrated their effectiveness in terms of metabolic (glycosylated hemoglobin (HbA1c), fasting blood glucose, blood pressure, glycemic control), physical (muscle strength, endurance, weight, body mass index (BMI), waist circumference, abdominal fat), and psychological (quality of life) indicators [4]-[9]. "
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    ABSTRACT: Context: Physical exercise is a key component of treatment and management of people with Type 2 Diabetes, but the role of strategies and interventions to increase and promote physical activity is unclear. Objective: To conduct a systematic review of intervention studies assessing the effects of physical activity counselling on health outcomes in subjects with type 2 diabetes mellitus. Data sources: The Cochrane Library, MEDLINE, EMBASE, CINAHL, LILACS, databases were used for the literature search. Data Selection: Studies that assessed the effects of interventions mainly based on physical activity counselling strategies, on physical activity level and glycosylated hemoglobin (HbA1c) were included in the review. Data Extraction: Two independent reviewers extracted the data. Data Synthesis: A total of 23 studies out of 1425 retrieved from databases search, were included in the review. The global number of subjects included in the selected studies was 9913, and the mean age of participants was 58.8 (±8.2) years (min = 46.3; max = 73.6). The most part of the studies (19) reported values of physical activity level; 13 of them (68.4%) found a significant effect after the counselling intervention, while 6 (31.6%) did not found significant changes. Among the 17 studies reporting data on HbA1c 9 (52.9%) described a significant decrease in the counselling intervention group, while 7 (41.2%) did not find any statistically significant change and 1 (5.9%) reported a significant HbA1c reduction in the comparison group rather than the counselling group. Conclusions: The results presented in this systematic review seem to affirm the usefulness of physical counselling interventions on physical activity and HbA1c, however the lack of homogeneity in the intervention protocols and the contrasting results limit the comprehension of the usefulness of such an approach in patient with type 2 diabetes.
    Journal of Diabetes Mellitus 05/2015; 5(2):97-110. DOI:10.4236/jdm.2015.52012
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    • "Identification of these risk factors not only provides an assessment of diabetes risk, but also acts as an important first step providing awareness and education with the goal of eliciting healthy lifestyle changes. As it pertains to disease management [7, 8], the type and volume of physical activity has been widely studied among those with type 2 diabetes but little is known about the result of physical activity interventions for those with prediabetes. Also, programs that are designed to be culturally specific and community-based may provide a unique opportunity to offer screening and intervention opportunities to individuals at highest risk [9], although the effectiveness of such programs as interventions has yet to be studied. "
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    ABSTRACT: Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada. Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data. Mean (±SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c. Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications.
    BMC Public Health 09/2014; 14(1):929. DOI:10.1186/1471-2458-14-929 · 2.26 Impact Factor
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    • "Therefore, studying postprandial glucose fluctuations has high physiological and clinical relevance. Aerobic exercise is prescribed clinically to prevent and treat T2D because it improves glycemic control (Church et al. 2010) and insulin sensitivity (Coker et al. 2009; Slentz et al. 2011) in obese and hyperglycemic individuals. However, exercise training is commonly accompanied by improvements in aerobic fitness and weight loss which independently influence glucose metabolism (Ivy 1997; Coker et al. 2009). "
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    ABSTRACT: We investigated glucose tolerance and postprandial glucose fluxes immediately after a single bout of aerobic exercise in subjects representing the entire glucose tolerance continuum. Twenty-four men with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or type 2 diabetes (T2D; age: 56 ± 1 years; body mass index: 27.8 ± 0.7 kg/m2, P > 0.05) underwent a 180-min oral glucose tolerance test (OGTT) combined with constant intravenous infusion of [6,6-2H2]glucose and ingestion of [U-13C]glucose, following 1 h of exercise (50% of peak aerobic power) or rest. In both trials, plasma glucose concentrations and kinetics, insulin, C-peptide, and glucagon were measured. Rates (mg kg−1 min−1) of glucose appearance from endogenous (RaEndo) and exogenous (oral glucose; RaOGTT) sources, and glucose disappearance (Rd) were determined. We found that exercise increased RaEndo, RaOGTT, and Rd (all P < 0.0001) in all groups with a tendency for a greater (~20%) peak RaOGTT value in NGT subjects when compared to IGT and T2D subjects. Accordingly, following exercise, the plasma glucose concentration during the OGTT was increased in NGT subjects (P < 0.05), while unchanged in subjects with IGT and T2D. In conclusion, while a single bout of moderate-intensity exercise increased the postprandial glucose response in NGT subjects, glucose tolerance following exercise was preserved in the two hyperglycemic groups. Thus, postprandial plasma glucose responses immediately following exercise are dependent on the underlying degree of glycemic control.
    08/2014; 2(8). DOI:10.14814/phy2.12114
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