Minimal difference between aerobic and progressive resistance exercise on metabolic profile and fitness in older adults with diabetes mellitus: A randomised trial

Department of Physiotherapy, Singapore General Hospital, Singapore.
Journal of physiotherapy (Impact Factor: 3.71). 09/2010; 56(3):163-70. DOI: 10.1016/S1836-9553(10)70021-7
Source: PubMed


Is progressive resistance training as effective as aerobic training of similar duration in sedentary older adults with diabetes mellitus?
A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis.
Sixty people with Type 2 diabetes mellitus with glycosylated haemoglobin (HbA1c) between 8% and 10% in the past month.
One group undertook progressive resistance exercise and the other group undertook aerobic exercise. Both groups completed 18 sessions over 8 weeks. In each session, the progressive resistance exercise group did nine resistive exercises while the aerobic exercise group did 50 minutes of aerobic exercise.
HbA1c, blood glucose, lipid profile (total, high- and low-density cholesterol and triglycerides), weight, body mass index, body fat, waist circumference, waist:hip ratio, blood pressure, and peak oxygen consumption.
Forty-nine (82%) participants completed the intervention. HbA1c reduced by a similar amount in both groups (MD 0.1%, 95% CI -0.3 to 0.5). However, significant between-group differences occurred in change in waist circumference in favour of progressive resistance exercise (MD -1.8 cm, 95% CI -0.5 to -3.1), and in change in peak oxygen consumption in favour of aerobic exercise (MD 5.2 ml/kg, 95% CI 0.0 to 10.4).
Progressive resistance exercise has similar effects to aerobic exercise and therefore offers a useful alternative for patients unable to participate in aerobic exercise.

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    • "26 30 57 0 3 R Tv s AET 48 h after last exercise tests AET: ↓ HbA 1c ; ↑ V ⋅ O 2max RT: ↓ WHR, HbA 1c Ng et al 2010 [38] "
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    ABSTRACT: Aims/hypothesis: This study aimed to systematically review randomised controlled trials comparing the effects of aerobic exercise training (AET), resistance training (RT) and combined training (CT) on glycaemic control and blood lipids in patients with type 2 diabetes mellitus. Methods: Searches were performed in MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria were: type 2 diabetes mellitus, adult, supervised training and a minimum intervention period of 8 weeks. Pooled effects were calculated by fixed/random effect pairwise and Bayesian fixed/random effects network meta-analyses. Results: A total of 14 trials enrolling 915 participants were included. AET was more effective than RT in improving HbA1c levels (mean difference [MD] -0.20% [-2.2 mmol/mol]; 95% CI -0.32, -0.08; p = 0.0007, 10 trials/515 participants) and fasting glucose (MD -0.9 mmol/l; 95% CI -1.71, -0.09; p = 0.03, 8 trials/245 participants). Compared with AET, CT resulted in a significantly more pronounced reduction in HbA1c (MD -0.17% [-1.87 mmol/mol]; 95% CI -0.31, -0.03; p = 0.02, 9 trials/493 participants). Compared with RT, the MD of the change in HbA1c (MD -0.62%, [-6.82 mmol/mol]; 95% CI -0.95, -0.30; p = 0.0002, 5 trials/362 participants], fasting glucose (MD -1.99 mmol/l; 95% CI -3.07, -0.90; p = 0.0003, 3 trials/99 participants) and triacylglycerols (MD -0.28 mmol/l; 95% CI -0.46, -0.10; p = 0.003, 4 trials/213 participants) were all in favour of CT. The exclusion of trials with a high risk of bias yielded only non-significant results. Conclusions/interpretation: The present data suggest that CT might be the most efficacious exercise modality to improve glycaemic control and blood lipids. Interpretation with respect to clinical relevance is limited by the low quality of the studies included and the limited information on the clinically important outcomes or adverse effects of exercise.
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    • "The results also suggested that PRT resulted in a greater reduction in WC than non-exercising control group. A previous study also demonstrated a significant reduction in WC,[13] but the average reduction was 1.6 ± 2.6 cm compared to 1.84 ± 2.7 cm observed in the present study. WC has been considered as a robust predictor of abdominal visceral fat,[29] hence, it could be hypothesized that reduction in WC also lead to the changes observed in HbA1c in response to PRT. "
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    ABSTRACT: Previous studies in diverse ethnic groups have reported that progressive resistance training is effective for glycemic control. However, it is unknown whether this form of exercise therapy leads to clinically meaningful changes in metabolic, cardiovascular and anthropometric parameters in Asian Indians. The study was designed to investigate the efficacy of progressive resistance training on glycemic, musculoskeletal, anthropometric and cardiovascular variables in untrained middle-aged type 2 diabetic patients living in North India. Forty-eight untrained patients, 35 men and 13 women (mean ± SD age, 44.7 ± 4.2 years), with a diagnosis of type 2 diabetes were randomly divided into 2 groups: A group receiving progressive resistance training and a control group who provided participative involvement. The primary outcomes were glycemic control and muscle strength. Additionally, anthropometric and cardiovascular risk parameters were evaluated at baseline and after intervention or control program at 8 weeks. Mixed ANOVA revealed a significant group-by-time interaction for the main outcomes of the study. Change in glycosylated hemoglobin was mean ± SD, 0.6 ± 0.5 in progressive resistance training group compared to no change in control group (P < .001). Progressive resistance training group showed a greater improvement in upper and lower body muscle strength (P < .001), waist circumference (P = .008), and high density lipoprotein cholesterol (P = .004). However, no significant group-by-time interaction was detected on body weight, total cholesterol, triglycerides, low density lipoprotein cholesterol, and systolic and diastolic blood pressure. A short-term progressive resistance training program leads to clinically meaningful improvements in glycemic control and muscle strength in untrained middle-aged type 2 diabetic patients of Asian Indian ethnicity.
    No preview · Article · Aug 2012 · North American Journal of Medical Sciences
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    • "Systolic blood pressure as well as aerobic fitness in the form of peak oxygen consumption (VO2peak) favoured the AT group more by 9 mmHg (95% CI 2 to 16) and 5.2 ml/kg (95% CI 0.0 to 10.4) respectively [8]. The PRT group showed a greater reduction in waist circumference by 1.8 cm (95% CI 0.5 to 3.1) [8]. In this secondary analysis, we report on the impact of PRT and AT on health status as measured by the SF-36 questionnaire. "
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    ABSTRACT: A prior study showed positive effects of resistance training on health status in individuals with diabetes compared to aerobic or no exercise, the exercise regimens were either different in volume, duration or rate of progression. We aimed to compare the effects of progressive resistance training (PRT) or aerobic training (AT) of similar volume over an 8-week period on health status (measured using the Short-form 36 Questionnaire) in middle aged adults with type 2 diabetes mellitus (T2DM). Sixty subjects aged 58 (7) years were randomised to PRT (n = 30) or AT (n = 30). General health and vitality were significantly improved in both groups (mean (SD) change scores for PRT were 12.2(11.5) and 10.5(18.2), and for AT, 13.3(19.6) and 10.0(13.1), respectively) and exceeded the minimally important difference of 5 points. The PRT group also had improved physical function and mental health status (mean (SD) change scores: 9.0(22.6), p < 0.05 and 5.3(12.3), p < 0.05, respectively), which was not observed in the AT group. However, the between group differences were not statistically significant. Both exercise regimens have positive impact on health status that correlated well with clinical improvement in patients with T2DM. PRT may have some additional benefits as there were significant changes in more domains of the SF-36 than that observed for the AT group.
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