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Diabetes

de volta à pg sobre diabetes

1: J Physiol. 2006 Sep 28; [Epub ahead of print]

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Reversal of diet-induced insulin resistance with a single bout of exercise: The role of PTP1B and IRS-1 serine phosphorylation.

Ropelle ER, Pauli JR, Prada PO, de Souza CT, Faria MC, Picardi PK, Cintra DE, Fernandes MF, Flores MB, Velloso LA, Saad MJ, Carvalheira J.

Departamento de Clinica Medica, FCM- Universidade Estadual de Campinas (UNICAMP).

Lifestyle interventions including exercise programs are cornerstones in the prevention of obesity-related diabetes. In this study, we demonstrate that a single bout of exercise inhibits high-fat diet-induced insulin resistance. Diet-induced obesity (DIO) increased the expression and activity of the protein tyrosine phosphatase 1B (PTP1B) and attenuated insulin signaling in gastrocnemius muscle of rats, a phenomenon which was reversed by a single session of exercise. In addition, DIO was observed to lead to serine phosphorylation of IRS-1, which was also reversed by exercise in muscle in parallel with a reduction in JNK activity. Thus, acute exercise increased the insulin sensitivity during high-fat feeding in obese rats. Overall, these results provide new insights into the mechanism by which exercise restores insulin sensitivity.

PMID: 17008371 [PubMed - as supplied by publisher]

1: Wien Med Wochenschr. 2006 Sep;156(17-18):515-9.

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The metabolic effects of long term exercise in Type 2 Diabetes patients.

Cauza E, Hanusch-Enserer U, Strasser B, Kostner K, Dunky A, Haber P.

Department of Internal Medicine V, Department of Diabetes and Rheumatology, Wilhelminenspital, Vienna, Austria. edmund.cauza@wienkav.at

INTRODUCTION: The effectiveness of physical exercise in the management of diabetes mellitus type 2 is well established. The purpose of this investigation was to evaluate the effect of long term exercise on glycemic and metabolic control measured after eight months in contrast to patients who had ceased their training after four months. METHODS: After an effective 4 months' strength training or endurance training period, ten patients (5 male and 5 female, mean age +/- SE:57.1 +/- 1.6 yr) were randomised to a further 4 months of combined endurance and strength training, while a control group of 10 patients (5 male and 5 female, mean age +/- SE:56.9 +/- 1.6 yr) ceased training. RESULTS: Long term glycemic control improved and HbA1C values fell from 6.9 +/- 0.4 to 6.2 +/- 0.2 in active patients and increased from 7.5 +/- 0.4 to 8.7 +/- 0.6 in control patients (p = 0.002). Baseline levels of total cholesterol significantly decreased in training group (205.5 mg/dl +/- 14.1 to 177.5 +/- 13.3) and increased in controls (185.9 +/- 14.1 to 220.2 +/- 15.8) [p = 004]. In addition, significant decreases in LDL-cholesterol and triglyceride levels (both p < 05) were observed in the training group compared to controls. CONCLUSION: This study showed that in addition to a 4 month training period, continuation of training proved highly beneficial with further reductions in fasting blood glucose, HbA1C, total cholesterol, LDL-cholesterol, triglyceride, and an elevation in HDL-cholesterol concentrations in diabetes mellitus type 2 patients, thus resulting in a reduced atherogenic lipid profile. In contrast, patients who ceased training after 4 months developed an atherogenic lipid profile and a worsened glycemic control. The results of this study indicate that long term exercise plays an important role in the treatment of diabetes mellitus type 2 and may protect against the development of cardiovascular diseases.

PMID: 17041809 [PubMed - in process]

: Effects of resistance training on insulin sensitivity in overweight Latino adolescent males.

Shaibi GQ, Cruz ML, Ball GD, Weigensberg MJ, Salem GJ, Crespo NC, Goran MI.

Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90033, USA.

PURPOSE: Insulin resistance is thought to be a core defect in the pathophysiology of obesity-related comorbidities in children, such as type 2 diabetes. Exercise training is known to improve insulin resistance and reduce the risk of type 2 diabetes in adults. However, very little is known regarding the effects of exercise on insulin resistance in youth. Therefore, we examined the effects of a 16-wk resistance training exercise intervention on insulin sensitivity in youth at high risk for developing type 2 diabetes. METHODS: Twenty-two overweight Latino adolescent males were randomly assigned to either a twice-per-week resistance training group (RT=11) or a nonexercising control group (C=11) for 16 wk. Strength was assessed by one-repetition maximum, body composition was quantified by dual-energy x-ray absorptiometry, and insulin sensitivity was determined by the frequently sampled intravenous glucose tolerance test with minimal modeling. RESULTS: Significant increases in upper- and lower-body strength were observed in the RT compared with the C group. The RT group significantly increased insulin sensitivity compared with the C group (P<0.05), and this increase remained significant after adjustment for changes in total fat mass and total lean tissue mass (P<0.05). Compared with baseline values, insulin sensitivity increased 45.1+/-7.3% in the RT group versus -0.9+/-12.9% in controls (P<0.01). CONCLUSION: A twice-per-week 16-wk resistance training program can significantly increase insulin sensitivity in overweight Latino adolescent males independent of changes in body composition.

PMID: 16826016 [PubMed - in process]

: Skeletal muscle sodium glucose co-transporters in older adults with type 2 diabetes undergoing resistance training.

Castaneda F, Layne JE, Castaneda C.

Max Planck Institute for Molecular Physiology, Dortmund, Germany. francisco.castaneda@mpi-dortmund.mpg.de

We examined the expression of the sodium-dependent glucose co-transporter system (hSGLT3) in skeletal muscle of Hispanic older adults with type 2 diabetes. Subjects (65+/-8 yr) were randomized to resistance training (3x/wk, n=13) or standard of care (controls, n=5) for 16 weeks. Skeletal muscle hSGLT3 and GLUT4 mRNA transcript levels were determined by real time RT-PCR. hSGLT3 transcripts increased by a factor of ten following resistance training compared to control subjects (0.10, P=0.03). There were no differences in GLUT4 mRNA expression levels between groups. Protein expression levels of these transporters were confirmed by immunohistochemistry and Western blotting. hSGLT3 after resistance exercise was found not to be co-localized with the nicotinic acetylcholine receptor. The change in hSGLT3 transcript levels in the vastus lateralis muscle was positively correlated with glucose uptake, as measured by the change in muscle glycogen stores (r=0.53, P=0.02); and with exercise intensity, as measured by the change in muscle strength (r=0.73, P=0.001). Group assignment was be the only independent predictor of hSGLT3 transcript levels, explaining 68% of its variability (P=0.01). Our data show that hSGLT3, but not GLTU4, expression was enhanced in skeletal muscle after 16 weeks of resistance training. This finding suggests that hSGLT3, an insulin-independent glucose transporter, is activated with exercise and it may play a significant role in glycemic control with muscle contraction. The hSGLT3 exact mechanism is not well understood and requires further investigation. However its functional significance regarding a reduction of glucose toxicity and improvement of insulin resistance is the subject of ongoing research.

PMID: 16761076 [PubMed]

: Effects of aerobic and resistive exercise training on glucose disposal and skeletal muscle metabolism in older men.

Ferrara CM, Goldberg AP, Ortmeyer HK, Ryan AS.

Division of Gerontology, University of Maryland, Baltimore, and Baltimore Department of Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), USA. Cynthia_Ferrara@uml.edu

BACKGROUND: Aging is associated with insulin resistance, primarily as a result of physical inactivity and increased abdominal obesity. We hypothesized that aerobic (AEX) or resistive (RT) exercise training would result in comparable improvements in glucose disposal in older men, but that there would be different metabolic adaptations in skeletal muscle. METHODS: Thirty-nine older (63+/-1 years, mean+/-standard error of the mean), overweight and obese (body mass index=30.3+/-0.4 kg/m2) men were assigned to AEX (treadmill walking and/or jogging, n=19) or RT (upper and lower body, n=20) programs 3 d/wk for 6 months, with 9 completing AEX and 13 completing RT. Testing before and after the exercise programs included body composition, euglycemic-hyperinsulinemic clamps, and vastus lateralis muscle biopsies. RESULTS: Maximal oxygen consumption (VO2max) increased by 16% after AEX (p<.01), while leg and arm muscle strength increased by 45+/-5% and 27+/-5% after RT (p<.0001). Although participants were monitored to maintain their body weight during the exercise program, body weight decreased by 2% after AEX (p<.05), and increased by 2% after RT (p<.05). Whole-body glucose disposal, determined during the last 30 minutes of a 2-hour 480 pmol/m2/min euglycemic-hyperinsulinemic clamp, increased comparably by 20%-25% after AEX (51+/-5 to 61+/-5 microM/kgfat-free mass/min, p<.05) and RT (49+/-3 to 58+/-3 microM/kgfat-free mass/min, p<.05). The increase in vastus lateralis muscle glycogen synthase fractional activity in response to insulin stimulation was significantly higher after AEX compared to after RT (279+/-59% compared to 100+/-28% change, p<.05). Neither AEX nor RT altered muscle glycogen synthase total activity, glycogen content, or levels of phosphotidylinositol 3-kinase. CONCLUSION: These results suggest that AEX and RT result in comparable improvements in glucose metabolism in older men, whereas an increase in insulin activation of glycogen synthase occurred only with AEX. These improvements in insulin sensitivity could reduce the risk of metabolic syndrome and type 2 diabetes and attenuate the development of cardiovascular disease.

PMID: 16720745 [PubMed - indexed for MEDLINE]

: Effect of an exercise training program on endothelial dysfunction in diabetic and non-diabetic patients with severe chronic heart failure.

Miche E, Herrmann G, Nowak M, Wirtz U, Tietz M, Hurst M, Zoller B, Radzewitz A.

Rehabilitationszentrum Gernsbach/Schwarzwald, Langer Weg 3, 76593, Gernsbach, cardiol@hkz-gernsbach.de.

BACKGROUND: Endothelial dysfunction is found both in patients with chronic heart failure and in patients with insulin-treated type 2 diabetes mellitus. This endothelial dysfunction leads to a significant reduction in endothelium-derived vasodilation. Physical exercise can have a positive effect on endothelial dysfunction in patients with coronary artery disease, chronic heart failure and diabetes mellitus. It is not clear, however, whether an exercise program influences endothelial function in diabetics with chronic heart failure. Our study was thus aimed at investigating whether a special exercise program would affect endothelial function. Comparisons were made with insulintreated type 2 diabetics and with non-diabetics suffering from chronic heart failure. METHODS: 42 patients with severe chronic heart failure (LVEF</=30%), insulin-dependent diabetics (n=20, mean age 67+/-6 yrs, 16 male, 4 female), non-diabetics (n=22, mean age 68+/-10 yrs, 20 male, 2 female) participated in a 4-week exercise program consisting of ergometer and special muscle strength training. Before (T1) and at the end (T2) of the training program endothelium-dependent and endothelium-independent vasodilatory capacity were assessed by brachial artery diameter measurement. RESULTS: At the end of the training program, there were no significant results within the two groups. The endothelium-dependent vasodilation changed between T1 and T2 as follows: In the diabetic group, the endothelium-dependent vasodilation at T1 and T2 was 5.1+/-3.6 and 4.9+/-2.5%, respectively. For the non-diabetics, the endothelium-dependent vasodilation was 6.8+/-4.5 and 7.6+/-4.0% at T1 and T2, respectively. The endotheliumindependent vasodilation in the diabetics was 10.5+/-5.6 at T1 and dropped to 8.7+/-4.1% at T2. The results for the non-diabetics were 13.2+/-5.8 and 12.3+/-6.3% at T1 and T2, respectively. The LVEF in the diabetics was 24.2+/-3.4% at T1, increasing to 27.8+/-5.8% at T2. In the non-diabetics, the LVEF was 22.9+/-3.8 at T1 vs. 28.6+/-6.9% at T2. In the groups of diabetics, the maximum oxygen uptake (VO(2)-max) was 10.3+/-3.9 at T1 vs. 11.4+/-2.8 ml/kg/min at T2 and in the group of non-diabetics 10.0+/-3.1 vs. 13.5+/-5.0 ml/kg/min. No correlations were found between the change in endothelium-dependent vasodilation and the increase in oxygen uptake. CONCLUSION: In our study, a program of physical exercise had no influence on endothelium-dependent or endothelium-independent vasodilation in insulin-treated type 2 diabetics or in non-diabetics with considerably reduced ejection fraction. In both groups, however, an exercise-related influence on medical parameters and physical performance could be observed.

PMID: 16598538 [PubMed - as supplied by publisher]

6: Eur J Clin Invest. 2005 Dec;35(12):745-51.

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Strength and endurance training lead to different post exercise glucose profiles in diabetic participants using a continuous subcutaneous glucose monitoring system.

Cauza E, Hanusch-Enserer U, Strasser B, Kostner K, Dunky A, Haber P.

Department of Internal Medicine V, Wilhelminenspital, Vienna, Austria. edmund.cauza@wienkav.at

BACKGROUND: Although both strength training (ST) and endurance training (ET) seem to be beneficial in type 2 diabetes mellitus (T2D), little is known about post-exercise glucose profiles. The objective of the study was to report changes in blood glucose (BG) values after a 4-month ET and ST programme now that a device for continuous glucose monitoring has become available. MATERIALS AND METHODS: Fifteen participants, comprising four men age 56.5 +/- 0.9 years and 11 women age 57.4 +/- 0.9 years with T2D, were monitored with the MiniMed (Northridge, CA, USA) continuous glucose monitoring system (CGMS) for 48 h before and after 4 months of ET or ST. The ST consisted of three sets at the beginning, increasing to six sets per week at the end of the training period, including all major muscle groups and ET performed with an intensity of maximal oxygen uptake of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min three times a week. RESULTS: A total of 17,549 single BG measurements pretraining (619.7 +/- 39.8) and post-training (550.3 +/- 30.1) were recorded, correlating to an average of 585 +/- 25.3 potential measurements per participant at the beginning and at the end of the study. The change in BG-value between the beginning (132 mg dL(-1)) and the end (118 mg dL(-1)) for all participants was significant (P = 0.028). The improvement in BG-value for the ST programme was significant (P = 0.02) but for the ET no significant change was measured (P = 0.48). Glycaemic control improved in the ST group and the mean BG was reduced by 15.6% (Cl 3-25%). CONCLUSION: In conclusion, the CGMS may be a useful tool in monitoring improvements in glycaemic control after different exercise programmes. Additionally, the CGMS may help to identify asymptomatic hypoglycaemia or hyperglycaemia after training programmes.

Publication Types:

Randomized Controlled Trial

PMID: 16313250 [PubMed - indexed for MEDLINE]

: Association of muscular strength with incidence of metabolic syndrome in men.

Jurca R, Lamonte MJ, Barlow CE, Kampert JB, Church TS, Blair SN.

The Cooper Institute, Dallas, TX 75230, USA. djurca@cooperinst.org

PURPOSE: To examine the association between muscular strength and incidence of metabolic syndrome. METHODS: Participants were 3233 men (20-80 yr) initially free of metabolic syndrome who had two or more clinical examinations between 1980 and 2003, including baseline muscular strength and cardiorespiratory fitness assessment. Metabolic syndrome was defined according to NCEP-ATP III criteria. Muscular strength was quantified by combining body weight-adjusted one-repetition maximal measures for leg and bench presses. Cardiorespiratory fitness was assessed by maximal treadmill test. RESULTS: A total of 480 men developed metabolic syndrome during a mean follow-up period of 6.7 +/- 5.2 yr. In a Cox regression analysis adjusted for age, the hazard ratios (95% confidence intervals) of metabolic syndrome associated with the incremental categories of muscular strength were 1.00 (referent), 0.88 (0.69-1.12), 0.77 (0.60-0.98), and 0.54 (0.42-0.71), respectively (linear trend P < 0.0001). The inverse trend persisted after adjustment for smoking, alcohol intake, number of baseline metabolic syndrome risk factors, family history of diabetes, hypertension, and premature coronary disease (P = 0.004), but was attenuated (P = 0.06) when further adjusted for cardiorespiratory fitness. Compared with the lowest strength category, the highest strength category was associated with 44 and 39% lower risk (P < 0.05 each) of incident metabolic syndrome among normal weight body mass index (BMI < 25) and overweight or obese (BMI > or = 25) men, respectively. An inverse association of incident rates was also seen within stratum of age (20-39 yr, P < 0.001; 40-49 yr, P < 0.01; and 50+ yr, P < 0.05). CONCLUSIONS: Muscular strength was inversely associated with metabolic syndrome incidence, independent of age and body size. Potential benefits of greater muscular strength presumably through resistance exercise training should be considered in primary prevention of metabolic syndrome.

PMID: 16286852 [PubMed - indexed for MEDLINE]

8: Harefuah. 2005 Oct;144(10):717-23, 750.

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[Exercise prescription for diabetics: more than a general recommendation]

[Article in Hebrew]

Constantini N, Harman-Boehm I, Dubnov G.

Medical Committee, The Olympic Committee of Israel, Tel Aviv. naamacon@tapuz.co.il

Physical activity (PA) offers numerous benefits in diabetes prevention and management. These include better glycemic control, reduction of co-morbidities such as hypertension, dyslipidemia and cardiovascular disease, decreased mortality and improved quality of life. Many caretakers are unaware of the specific recommendations and restrictions regarding PA in diabetic patients. This may result in the withholding of an important therapeutic tool from patients, the unnecessary limitation of PA in patients keen to undertake it, or, on the other hand, in adverse reactions to exercise which may be prevented. This review presents PA recommendations in both type 1 and 2 diabetics, which include aerobic activity and strength training. Several safety points before commencing or increasing the intensity of a PA program are also addressed; assessment of the cardiovascular response to exercise, the presence of retinopathy, neuropathy, nephropathy, and proper foot care, are essential.

Publication Types:

Review

PMID: 16281765 [PubMed - indexed for MEDLINE]

9: Diabetes Obes Metab. 2005 Nov;7(6):745-54.

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Role of skeletal muscle-fibre type in regulation of glucose metabolism in middle-aged subjects with impaired glucose tolerance during a long-term exercise and dietary intervention.

Venojarvi M, Puhke R, Hamalainen H, Marniemi J, Rastas M, Rusko H, Nuutila P, Hanninen O, Aunola S.

Department of Physiology, University of Kuopio, Kuopio, Finland. mika.venojarvi@btk.fi

AIM: The aim of this study was to investigate the role of skeletal muscle fibre type in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance (IGT) during a 2-year exercise and dietary intervention. METHODS: Muscle biopsies (musculus vastus lateralis) were taken from 22 subjects belonging to the intervention group of the Finnish Diabetes Prevention Study [1]. According to their myosin heavy chain (MHC) profile at the baseline, the subjects were divided into two groups: IGT(slow) (n=10) with a high proportion of MHC I isoforms and IGT(fast) (n=12) with a high proportion of MHC II isoforms in the vastus lateralis muscle. The intervention consisted of dietary counselling, strength and power training and/or aerobic exercise. The amount of exercise was the same in both groups; the exercise frequency was 5.1+/-2.7 h/week in the IGT(slow) and 5.1+/-2.8 h/week in the IGT(fast) group. RESULTS: Fasting glucose (p<0.05), 2-h glucose (p<0.05), fasting insulin (p<0.05), haemoglobin A1c (HbA(1c)) (p<0.01) and insulin resistance (p<0.05) [homeostasis model assessment for insulin resistance (HOMA-IR)] decreased in the IGT(fast) group, whereas only the 2-h glucose and HbA(1c) concentrations decreased in the IGT(slow) group. The amount of the glycogen synthase kinase-3-alphabeta (GSK-3-alphabeta) decreased in the IGT(fast) group (p<0.05). Exercise training increased the lactate dehydrogenase (LDH) (p<0.01), LDH-1 (p<0.05) and citrate synthase (CS) (p<0.05) activities in the vastus lateralis muscle in the IGT(slow) group, but only the CS activity (p<0.05) in the IGT(fast) group. CONCLUSIONS: The glucose metabolism improved both in the IGT(slow) and IGT(fast) group during the 2-year exercise and dietary intervention. The change was more prominent in the IGT(fast) group than in the IGT(slow) group, associated with the decrease of the GSK-alphabeta protein expression in skeletal muscle. The exercise training improved both glycolytic and oxidative capacity in the vastus lateralis muscle. The glycolytic capacity improved in the IGT(slow) group and the oxidative capacity in both groups.

Publication Types:

PMID: 16219019 [PubMed - indexed for MEDLINE]

10: Arch Phys Med Rehabil. 2005 Aug;86(8):1527-33.

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The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.

Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, Wagner O, Georg P, Prager R, Kostner K, Dunky A, Haber P.

Department of Internal Medicine V, Department of Diabetes and Rheumatology, Wilhelminenspital, Vienna, Austria. edmund.cauza@wienkav.at

OBJECTIVE: To compare the effects of a 4-month strength training (ST) versus aerobic endurance training (ET) program on metabolic control, muscle strength, and cardiovascular endurance in subjects with type 2 diabetes mellitus (T2D). DESIGN: Randomized controlled trial. SETTING: Large public tertiary hospital. PARTICIPANTS: Twenty-two T2D participants (11 men, 11 women; mean age +/- standard error, 56.2+/-1.1 y; diabetes duration, 8.8+/-3.5 y) were randomized into a 4-month ST program and 17 T2D participants (9 men, 8 women; mean age, 57.9+/-1.4 y; diabetes duration, 9.2+/-1.7 y) into a 4-month ET program. INTERVENTIONS: ST (up to 6 sets per muscle group per week) and ET (with an intensity of maximal oxygen consumption of 60% and a volume beginning at 15 min and advancing to a maximum of 30 min 3x/wk) for 4 months. MAIN OUTCOME MEASURES: Laboratory tests included determinations of blood glucose, glycosylated hemoglobin (Hb A1c), insulin, and lipid assays. RESULTS: A significant decline in Hb A1c was only observed in the ST group (8.3%+/-1.7% to 7.1%+/-0.2%, P=.001). Blood glucose (204+/-16 mg/dL to 147+/-8 mg/dL, P<.001) and insulin resistance (9.11+/-1.51 to 7.15+/-1.15, P=.04) improved significantly in the ST group, whereas no significant changes were observed in the ET group. Baseline levels of total cholesterol (207+/-8 mg/dL to 184+/-7 mg/dL, P<.001), low-density lipoprotein cholesterol (120+/-8 mg/dL to 106+/-8 mg/dL, P=.001), and triglyceride levels (229+/-25 mg/dL to 150+/-15 mg/dL, P=.001) were significantly reduced and high-density lipoprotein cholesterol (43+/-3 mg/dL to 48+/-2 mg/dL, P=.004) was significantly increased in the ST group; in contrast, no such changes were seen in the ET group. CONCLUSIONS: ST was more effective than ET in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that ST may play an important role in the treatment of T2D.

Publication Types:

PMID: 16084803 [PubMed - indexed for MEDLINE]

11: Osteoporos Int. 2005 Dec;16(12):1703-12. Epub 2005 Jun 4.

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Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?

Daly RM, Dunstan DW, Owen N, Jolley D, Shaw JE, Zimmet PZ.

Center for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Australia. rmdaly@deakin.edu.au

The aim was to investigate whether the addition of supervised high intensity progressive resistance training to a moderate weight loss program (RT+WLoss) could maintain bone mineral density (BMD) and lean mass compared to moderate weight loss (WLoss) alone in older overweight adults with type 2 diabetes. We also investigated whether any benefits derived from a supervised RT program could be sustained through an additional home-based program. This was a 12-month trial in which 36 sedentary, overweight adults aged 60 to 80 years with type 2 diabetes were randomized to either a supervised gymnasium-based RT+WLoss or WLoss program for 6 months (phase 1). Thereafter, all participants completed an additional 6-month home-based training without further dietary modification (phase 2). Total body and regional BMD and bone mineral content (BMC), fat mass (FM) and lean mass (LM) were assessed by DXA every 6 months. Diet, muscle strength (1-RM) and serum total testosterone, estradiol, SHBG, insulin and IGF-1 were measured every 3 months. No between group differences were detected for changes in any of the hormonal parameters at any measurement point. In phase 1, after 6 months of gymnasium-based training, weight and FM decreased similarly in both groups (P<0.01), but LM tended to increase in the RT+WLoss (n=16) relative to the WLoss (n=13) group [net difference (95% CI), 1.8% (0.2, 3.5), P<0.05]. Total body BMD and BMC remained unchanged in the RT+WLoss group, but decreased by 0.9 and 1.5%, respectively, in the WLoss group (interaction, P<0.05). Similar, though non-significant, changes were detected at the femoral neck and lumbar spine (L2-L4). In phase 2, after a further 6 months of home-based training, weight and FM increased significantly in both the RT+WLoss (n=14) and WLoss (n=12) group, but there were no significant changes in LM or total body or regional BMD or BMC in either group from 6 to 12 months. These results indicate that in older, overweight adults with type 2 diabetes, dietary modification should be combined with progressive resistance training to optimize the effects on body composition without having a negative effect on bone health.

Publication Types:

Randomized Controlled Trial

PMID: 15937634 [PubMed - indexed for MEDLINE]

: Current Treatment Options for the Metabolic Syndrome.

Deedwania PC, Volkova N.

Cardiology division, VACCHCS/University of California San Francisco, 2615 E. Clinton Avenue, Fresno, CA 93703, USA. deed@ucsfresno.edu.

The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests that the first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity). The treatment should be based on two major components: behavioral change to reduce caloric intake and an increase in physical activity. A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months. The general dietary recommendations include low intake of saturated fats, trans fats and cholesterol, and diets with low glycemic index. Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia. Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome. Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes. An equal balance between aerobic exercise and strength training is advised. Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals. There is no single best therapy and the treatment should consist of treatment of individual component(s). Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe. Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category. Some evidence suggests that angiotensin-converting enzyme inhibitors and b blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome. Patients with metabolic syndrome also have elevations in fibrinogen and other coagulation factors leading to prothrombotic state and aspirin may be beneficial for primary prevention in these patients. The new developments in the treatment of metabolic syndrome with drugs, such as peroxisome proliferator-activated receptor agonists, will broaden the horizons of the current treatment options in metabolic syndrome.

PMID: 15913505 [PubMed - as supplied by publisher]

: Effects of endurance exercise-training on single-fiber contractile properties of insulin-treated streptozotocin-induced diabetic rats.

Sanchez OA, Snow LM, Lowe DA, Serfass RC, Thompson LV.

School of Kinesiology, University of Minnesota Medical School, 420 Delaware Street, Minneapolis, MN 55455, USA.

The purpose of this study was to characterize the contractile properties of individual skinned muscle fibers from insulin-treated streptozotocin-induced diabetic rats after an endurance exercise training program. We hypothesized that single-fiber contractile function would decrease in the diabetic sedentary rats and that endurance exercise would preserve the function. In the study, 28 rats were assigned to either a nondiabetic sedentary, a nondiabetic exercise, a diabetic sedentary, or a diabetic exercise group. Rats in the diabetic groups received subcutaneous intermediate-lasting insulin daily. The exercise-trained rats ran on a treadmill at a moderate intensity for 60 min, five times per week. After 12 wk, the extensor digitorum longus and soleus muscles were dissected. Single-fiber diameter, Ca(2+)-activated peak force, specific tension, activation threshold, and pCa(50) as well as the myosin heavy chain isoform expression (MHC) were determined. We found that in MHC type II fibers from extensor digitorum longus muscle, diameters were significantly smaller from diabetic sedentary rats compared with nondiabetic sedentary rats (P < 0.001). Among the nondiabetic rats, fiber diameters were smaller with exercise (P = 0.038). The absolute force-generating capacity of single fibers was lower in muscles from diabetic rats. There was greater specific tension (force normalized to cross-sectional area) by fibers from the rats that followed an endurance exercise program compared with sedentary. From the results, we conclude that alterations in the properties of contractile proteins are not implicated in the decrease in strength associated with diabetes and that endurance-exercise training does not prevent or increase muscle weakness in diabetic rats.

PMID: 15831797 [PubMed - indexed for MEDLINE]

: [Endurance training in adults with diabetes mellitus type 2]

[Article in Spanish]

Munoz Canche KA, Salazar Gonzalez BC.

Escuela Superior de Enfermeria, Universidad Autonoma de Campeche, Campeche, Mexico. kmunozc@hotamil.com

OBJECTIVES: Test the effects of an endurance training exercise on glycosylated hemoglobin (HbA1c) levels, muscle strength and perceived muscle strength. Explore the influence of diet, exercise, medication and manifestations of hypo or hyperglycemia in the blood glucose control of adults with diabetes mellitus type 2, who attended endocrinology clinics at two public hospitals in Monterrey, Mexico. BASIC PROCEDURES: A 12-week non equivalent control group design was used. At baseline, the experimental group consisted of 14 participants and the control group 11. The exercise sessions were held twice a week for one hour. All participants had received a verbal recommendation from their physician. RESULTS: The experimental group displayed a significant decrease in HbA1c levels and increases in muscle strength and perceived muscle strength (p < .001). Eight participants out of eleven achieved normal HbA1c values after the intervention. No effect of the co-variables was found. CONCLUSIONS: This type of intervention can be of help to control blood glucose levels in adults with diabetes mellitus type 2.

PMID: 15761575 [PubMed - indexed for MEDLINE]

15: Diabetes Care. 2005 Mar;28(3):662-7.

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Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes.

Ibanez J, Izquierdo M, Arguelles I, Forga L, Larrion JL, Garcia-Unciti M, Idoate F, Gorostiaga EM.

Studies, Research and Sports Medicine Center, Government of Navarra, Pamplona-Navarra, Spain. jibanezs@cfnavarra.es

OBJECTIVE: To evaluate the influence of a twice-weekly progressive resistance training (PRT) program, without a concomitant weight loss diet, on abdominal fat and insulin sensitivity in older men with type 2 diabetes. RESEARCH DESIGN AND METHODS: Nine older men (aged 66.6 +/- 3.1) with type 2 diabetes participated in a 16-week PRT supervised program (50-80% of the one repetition maximum), for all main muscle groups. Basal glycemia, HbA(1c), diet, habitual physical activity, body composition, and upper/lower maximal strength were measured. Insulin sensitivity was determined according to Bergman's minimal model procedure and abdominal fat was obtained by computed tomography. The measurements were taken 4 weeks before training (-4), immediately before training (0), and at 8-week intervals (i.e., weeks 8 and 16) during the 16-week training period. RESULTS: No significant variation was observed in any of the above selected parameters during the 4-week control period. After PRT, both leg and arm maximal strength increased significantly by 17.1 and 18.2%, respectively. Visceral and subcutaneous abdominal fat decreased significantly by 10.3% (from 249.5 +/- 97.9 to 225.6 +/- 96.6 cm(3), P < 0.01) and by 11.2% (from 356.0 +/- 127.5 to 308.6 +/- 118.8 cm(3), P < 0.01), respectively, while no changes were observed in body mass. PRT significantly increased insulin sensitivity by 46.3% (from 2.0 +/- 1.2 to 2.8 +/- 1.6 . 10(4) . min(-1) . muU(-1) . ml(-1), P < 0.01), whereas it significantly decreased (-7.1%, P < 0.05) fasting blood glucose (from 146.6 +/- 28.3 to 135.0 +/- 29.3 mg/dl). Finally, a 15.5% increase in energy intake (from 2,287.1 +/- 354.7 to 2,619.0 +/- 472.1 kcal/day, P < 0.05) was observed. CONCLUSIONS: Two sessions per week of PRT, without a concomitant weight loss diet, significantly improves insulin sensitivity and fasting glycemia and decreases abdominal fat in older men with type 2 diabetes.

Publication Types:

Clinical Trial

PMID: 15735205 [PubMed - indexed for MEDLINE]

: 5'AMP activated protein kinase expression in human skeletal muscle: effects of strength training and type 2 diabetes.

Wojtaszewski JF, Birk JB, Frosig C, Holten M, Pilegaard H, Dela F.

The Institute of Exercise and Sport Sciences, The Copenhagen Muscle Research Centre, University of Copenhagen, 13 Universitetsparken, 2100-Copenhagen, Denmark. jwojtaszewski@aki.ku.dk

Strength training enhances insulin sensitivity and represents an alternative to endurance training for patients with type 2 diabetes (T2DM). The 5'AMP-activated protein kinase (AMPK) may mediate adaptations in skeletal muscle in response to exercise training; however, little is known about adaptations within the AMPK system itself. We investigated the effect of strength training and T2DM on the isoform expression and the heterotrimeric composition of the AMPK in human skeletal muscle. Ten patients with T2DM and seven healthy subjects strength trained (T) one leg for 6 weeks, while the other leg remained untrained (UT). Muscle biopsies were obtained before and after the training period. Basal AMPK activity and protein/mRNA expression of both catalytic (alpha1 and alpha2) and regulatory (beta1, beta2, gamma1, gamma2a, gamma2b and gamma3) AMPK isoforms were independent of T2DM, whereas the protein content of alpha1 (+16%), beta2 (+14%) and gamma1 (+29%) was higher and the gamma3 content was lower (-48%) in trained compared with untrained muscle (all P < 0.01). The majority of alpha protein co-immunoprecipitated with beta2 and alpha2/beta2 accounted for the majority of these complexes. gamma3 was only associated with alpha2 and beta2 subunits, and accounted for approximately 20% of all alpha2/beta2 complexes. The remaining alpha2/beta2 and the alpha1/beta2 complexes were associated with gamma1. The trimer composition was unaffected by T2DM, whereas training induced a shift from gamma3- to gamma1-containing trimers. The data question muscular AMPK as a primary cause of T2DM whereas the maintained function in patients with T2DM makes muscular AMPK an obvious therapeutic target. In human skeletal muscle only three of 12 possible AMPK trimer combinations exist, and the expression of the subunit isoforms is susceptible to moderate strength training, which may influence metabolism and improve energy homeostasis in trained muscle.

PMID: 15718261 [PubMed - indexed for MEDLINE]

: [Effect of dynamic strength training on insulin sensitivity in men with insulin resistance]

[Article in Czech]

Hejnova J, Majercik M, Polak J, Richterova B, Crampes F, deGlisezinski I, Stich V.

Oddeleni telovychovneho lekarstvi 3. LF UK, Praha. jindra.hejnova@lf3.cuni.cz

BACKGROUND: Physical activity is generally accepted as a part of the nonpharmacological therapy of the insulin resistance. Endurance training is generally recommended as an appropriate approach. The aim of this study was to assess the effect of three-month dynamic strength training on the insulin sensitivity in middle-aged men with insulin resistance. METHODS AND RESULTS: 10 men (5 obese non diabetics and 5 overweight patients with diabetes mellitus type 2 (age 51.36+/-7.25 years, average weight 110.16+/-13.56 kg and BMI 33.22+/-3.52 kg/m2 underwent a three-month dynamic strength training at the level of 60 to 70 % of their maximum muscle strength (one-repetition maximum 1-RM). Insulin sensitivity was determined using the hyperinsulinic euglycemic clamp before and after the training period. Training promoted to increase the muscle strength (p<0.001). It did not induce changes in body weight, body composition and maximum aerobic capacity. The training induced an increase in insulin sensitivity (glucose disposal M: 3.0 vs 4.0 M - mg/min/kg, p<0,01). CONCLUSIONS: Dynamic strength training improves insulin sensitivity in men with insulin resistance independently on weight loss or increase in aerobic capacity. Our results suggest that the dynamic strength training is an appropriate physical activity for management of the insulin resistance.

PMID: 15628572 [PubMed - indexed for MEDLINE]

18: Am J Prev Med. 2005 Jan;28(1):9-18.

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Exercise and risk factors associated with metabolic syndrome in older adults.

Stewart KJ, Bacher AC, Turner K, Lim JG, Hees PS, Shapiro EP, Tayback M, Ouyang P.

Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. kstewart@jhmi.edu

BACKGROUND: Older people with elevated blood pressure (BP) often have metabolic syndrome, a clustering of central obesity, insulin resistance, dyslipidemia, and hypertension. Exercise reduces many of these risk factors. This study examined whether the benefits of exercise on cardiovascular and metabolic disease risk factors are mediated by exercise-induced changes in fitness or body composition. METHODS: Randomized controlled trial, comprising 6 months of exercise training, conducted between July 1999 and November 2003. Participants included men and women (n =115) aged 55 to 75 years with untreated systolic blood pressure (SBP) of 130 to 159 or diastolic blood pressure of (DPB) 85 to 99 mm Hg. Fitness measures included BP, lipids, lipoproteins, insulin, and glucose; peak oxygen uptake and muscle strength; and body composition measured by anthropometry, dual-energy x-ray absorptiometry, and magnetic resonance imaging. RESULTS: A total of 51 men and 53 women completed the trial. Exercise significantly increased aerobic and muscle fitness, lean mass, and high-density lipoprotein cholesterol and reduced total and abdominal fat. DBP was reduced more among exercisers. There were no associations among changes in fitness with risk factors. Reductions in total body and abdominal fat and increases in leanness, largely independent of weight loss, were associated with improved SBP, DBP, total cholesterol, very low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), and insulin sensitivity. At baseline, 42.3% of participants had metabolic syndrome. At 6 months, nine exercisers (17.7%) and eight controls (15.1%) no longer had metabolic syndrome, whereas four controls (7.6%) and no exercisers developed it (p =0.06). CONCLUSIONS: Although exercise improved fitness, the reductions in total and abdominal fatness and increase in leanness were more strongly associated with favorable changes in risk factors for cardiovascular disease and diabetes, including those that constitute metabolic syndrome.

Publication Types:

PMID: 15626550 [PubMed - indexed for MEDLINE]

19: Diabetes Care. 2005 Jan;28(1):3-9.

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Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes.

Dunstan DW, Daly RM, Owen N, Jolley D, Vulikh E, Shaw J, Zimmet P.

International Diabetes Institute, Melbourne, Victoria, Australia. ddunstan@idi.org.au

OBJECTIVE: To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training. RESEARCH DESIGN AND METHODS: We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months. RESULTS: Compared with the WL group, HbA1c decreased significantly more in the RT&WL group (-0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months. CONCLUSIONS: In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.

Publication Types:

PMID: 15616225 [PubMed - indexed for MEDLINE]

20: Diabetes Care. 2004 Dec;27(12):2988-9.

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Effects of 8 weeks of flexibility and resistance training in older adults with type 2 diabetes.

Herriott MT, Colberg SR, Parson HK, Nunnold T, Vinik AI.

ESPER Department, Old Dominion University, Norfolk, VA 23529, USA.

Publication Types:

PMID: 15562222 [PubMed - indexed for MEDLINE]

: Strength training. The misunderstood form of exercise.

Braunstein JB.

PMID: 15317094 [PubMed - indexed for MEDLINE]

22: Eur J Appl Physiol. 2004 Aug;92(4-5):437-42.

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The effects of a combined strength and aerobic exercise program on glucose control and insulin action in women with type 2 diabetes.

Tokmakidis SP, Zois CE, Volaklis KA, Kotsa K, Touvra AM.

Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini , Greece. stokaki@phyed.duth.gr

The purpose of the present study was to investigate the short- and long-term effects of a combined strength and aerobic training program on glycemic control, insulin action, exercise capacity and muscular strength in postmenopausal women with type 2 diabetes. Nine postmenopausal women, aged 55.2 (6.7) years, with type 2 diabetes participated in a supervised training program for 4 months consisting of two strength training sessions (3 sets of 12 repetitions at 60% one-repetition maximum strength) and two aerobic training sessions (60-70% of maximum heart rate at the beginning, and 70-80% of maximum heart rate after 2 months). Anthropometrical measurements, percentage glycated hemoglobin, a 2-h oral glucose tolerance test, exercise stress testing and maximum strength were measured at the beginning, and after 4 and 16 weeks of the exercise program. Significant reductions were observed in both the glucose (8.1% P<0.01) and insulin areas under the curve (20.7%, P<0.05) after 4 weeks of training. These adaptations were further improved after 16 weeks (glucose 12.5%, insulin 38%, P<0.001). Glycated hemoglobin was significantly decreased after 4 weeks [7.7 (1.7) vs 7.1 (1.3)%, P<0.05] and after 16 weeks [7.7 (1.7) vs 6.9 (1.0)%, P<0.01] of exercise training. Furthermore, exercise time and muscular strength were significantly improved after 4 weeks (P<0.01) as well as after 16 weeks (P<0.001) of training. Body mass and body-mass index, however, were not significantly altered throughout the study. The results indicated that a combined training program of strength and aerobic exercise could induce positive adaptations on glucose control, insulin action, muscular strength and exercise tolerance in women with type 2 diabetes.

Publication Types:

Clinical Trial

PMID: 15232701 [PubMed - indexed for MEDLINE]

: Metabolic effects of the addition of resistive to aerobic exercise in older men.

Ferrara CM, McCrone SH, Brendle D, Ryan AS, Goldberg AP.

Department of Physical Therapy, University of Massachusetts Lowell, Lowell, MA 01854-5124, USA.

The metabolic changes associated with the addition of 4 months of resistive exercise to an existing aerobic exercise program (AEX+RT, n = 7) were compared to a maintenance aerobic exercise program (AEX, n = 8) in overweight, older men. The subjects in this study had recently completed a 6-month aerobic exercise program (treadmill walking, 45 min/d, 2 d/wk). The AEX+RT group added 6 exercises on upper- and lower-body pneumatic-resistance machines (2 sets, 15 repetitions each, 2 d/wk) to an aerobic exercise program at > or = 70% heart rate reserve for 30-40 min, 2 d/wk on treadmill, while the AEX group continued the same maintenance treadmill AEX program. There were no baseline differences in body weight, VO2max, or glucose metabolism between groups. The AEX+RT group increased upper- and lower-extremity strength by 28 +/- 4% and 46 +/- 6%, respectively (p < .05), despite a 9% decrease in VO2max (p < .05). VO2max did not change in the AEX group. There was no change in the fasting glucose or insulin levels, or the 3-h glucose responses to an oral glucose load in either group. The insulin responses decreased by 25 +/- 4% in the AEX+RT group (p < .01) but did not change in the AEX group. In conclusion, the addition of resistive exercise training to an existing aerobic exercise program may improve insulin sensitivity in overweight, older men, and thus prevent the development of type 2 diabetes.

PMID: 15129931 [PubMed - indexed for MEDLINE]

24: Metabolism. 2004 Mar;53(3):284-9.

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Influence of resistance exercise training on glucose control in women with type 2 diabetes.

Fenicchia LM, Kanaley JA, Azevedo JL Jr, Miller CS, Weinstock RS, Carhart RL, Ploutz-Snyder LL.

Department of Exercise Science, Syracuse University, Syracuse, NY 13244, USA.

The objective of the study was to evaluate the effects of acute and chronic resistance training on glucose and insulin responses to a glucose load in women with type 2 diabetes. Subjects consisted of type 2 diabetic women (n = 7) and age-matched controls (n = 8) with normal glucose tolerance. All subjects participated in 3 oral glucose tolerance tests: pretraining, 12 to 24 hours after the first exercise session (acute) and 60 to 72 hours after the final training session (chronic). Exercise training consisted of a whole body resistance exercise program using weight-lifting machines 3 days per week for 6 weeks. Resistance training was effective in increasing strength of all muscle groups in all subjects. Integrated glucose concentration expressed as area under the curve (AUC) was 3,355.0 +/- 324.6 mmol/L. min pretraining, improved significantly (P <.01) after the acute bout of exercise (2,868 +/- 324.0 mmol/L. min), but was not improved with chronic training (3,206.0 +/- 337.0 mmol/L. min) in diabetic subjects. A similar pattern of significance was observed with peak glucose concentration (pre: 20.2 +/-1.4 mmol/L; acute: 17.2 +/- 1.7 mmol/L; chronic: 19.9 +/- 1.7 mmol/L). There were no significant changes in insulin concentrations after any exercise bout in the diabetic subjects. There were no changes in glucose or insulin levels in control subjects. An acute bout of resistance exercise was effective in improving integrated glucose concentration, including reducing peak glucose concentrations in women with type 2 diabetes, but not age-matched controls. There were no significant changes in insulin concentrations for either group. Resistance exercise offers an alternative to aerobic exercise for improving glucose control in diabetic patients. To realize optimal glucose control benefits, individuals must follow a regular schedule that includes daily exercise.

Publication Types:

Clinical Trial

PMID: 15015138 [PubMed - indexed for MEDLINE]

: Simple steps to fitness. Secrets of strength. Strength training is as important to weight loss and fitness as aerobic exercise is, but many people ignore it. Here's how to get started.

Roberts SS.

PMID: 14765458 [PubMed - indexed for MEDLINE]

26: Diabetes. 2004 Feb;53(2):294-305.

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Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes.

Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JF, Dela F.

Department of Medical Physiology, the Panum Institute, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

Strength training represents an alternative to endurance training for patients with type 2 diabetes. Little is known about the effect on insulin action and key proteins in skeletal muscle, and the necessary volume of strength training is unknown. A total of 10 type 2 diabetic subjects and 7 healthy men (control subjects) strength-trained one leg three times per week for 6 weeks while the other leg remained untrained. Each session lasted no more than 30 min. After strength training, muscle biopsies were obtained, and an isoglycemic-hyperinsulinemic clamp combined with arterio-femoral venous catheterization of both legs was carried out. In general, qualitatively similar responses were obtained in both groups. During the clamp, leg blood flow was higher (P < 0.05) in trained versus untrained legs, but despite this, arterio-venous extraction glucose did not decrease in trained legs. Thus, leg glucose clearance was increased in trained legs (P < 0.05) and more than explained by increases in muscle mass. Strength training increased protein content of GLUT4, insulin receptor, protein kinase B-alpha/beta, glycogen synthase (GS), and GS total activity. In conclusion, we found that strength training for 30 min three times per week increases insulin action in skeletal muscle in both groups. The adaptation is attributable to local contraction-mediated mechanisms involving key proteins in the insulin signaling cascade.

Publication Types:

PMID: 14747278 [PubMed - indexed for MEDLINE]

27: Int J Sports Med. 2003 Aug;24(6):419-23.

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Resistance training improves glycaemic control in obese type 2 diabetic men.

Baldi JC, Snowling N.

The University of Auckland, Department of Sport and Exercise Science, Auckland, New Zealand. j.baldi@auckland.ac.nz

The purpose of this investigation was to determine whether moderate intensity resistance training (RT) improves glycaemic control in obese, type 2 diabetic men. Eighteen subjects were randomly assigned to a 10-week RT program, or a non-training control group (C). Glycosylated haemoglobin (HbA 1c ), fasting glucose and insulin, glucose and insulin 120 minutes (2h) after a 75 g oral glucose load, body composition and muscular strength and endurance were measured before and after the 10-week experimental period. In the RT group fasting glucose and insulin decreased with training (p < 0.05) and decreases in HbA 1c approached significance (p = 0.057). 2-h glucose and insulin did not change in either group. Fat free mass (FFM) increased by 3.5 % after RT but was unchanged in the controls. Fat mass (FM) increased 6.9 % in C but was unchanged in RT. Percent body fat was unchanged in both groups. Muscular strength and endurance increased by 25 to 52 % in the RT group but was unchanged in controls. Changes in fasting glucose and HbA 1c were inversely related to changes in FFM. These results suggest that RT is an effective form of exercise training which modestly improves glycaemic control and lowers fasting insulin levels in obese type 2 diabetics.

Publication Types:

PMID: 12905089 [PubMed - indexed for MEDLINE]

28: J Physiol. 2003 Sep 15;551(Pt 3):1049-58. Epub 2003 Aug 1.

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Resistance training and insulin action in humans: effects of de-training.

Andersen JL, Schjerling P, Andersen LL, Dela F.

Department of Molecular Muscle Biology, Copenhagen Muscle Research Centre, Rigshospitalet, Denmark.

Aerobic endurance training increases insulin action in skeletal muscle, but the effect of resistance training has not been well described. Controversy exists about whether the effect of resistance training is merely due to an increase in muscle mass. We studied the effect of cessation of resistance training in young, healthy subjects by taking muscle biopsies and measuring insulin-mediated whole body and leg glucose uptake rates after 90 days of heavy resistance training (T) and again after 90 days of de-training (dT). Data on leg glucose uptake were expressed relative to accurate measures of leg muscle mass by MRI scanning. Muscle strength (239 +/- 43 vs. 208 +/- 33 N m), quadriceps area (8463 +/- 453 vs. 7763 +/- 329 mm2) and glycogen content (458 +/- 22 vs. 400 +/- 26 mmol (kg dry weight muscle)(-1)) decreased, while myosin heavy chain isoform IIX increased 4-fold in dT vs. T, respectively (all P < 0.05). GLUT4 mRNA levels and enzyme activities and mRNA levels of glycolytic, lipolytic and glyconeogenic enzymes did not change with de-training. Likewise, capillary density did not change. Whole body glucose uptake decreased 11 % and leg glucose uptake decreased from 75 +/- 11 (T) to 50 +/- 6 (dT) nmol min(-1) (mm muscle)(-2) (P < 0.05) at maximal insulin, the latter decrease being due to decreased arterio-femoral venous glucose extraction. The decrease was mainly due to reduced non-oxidative glucose disposal. We have thus shown that 90 days after the termination of heavy resistance training, insulin-mediated glucose uptake rates per unit of skeletal muscle have decreased significantly.

Publication Types:

Clinical Trial

PMID: 12897182 [PubMed - indexed for MEDLINE]

29: Diabetes. 2003 Jul;52(7):1837-42.

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Exercise training improves baroreflex sensitivity in type 2 diabetes.

Loimaala A, Huikuri HV, Koobi T, Rinne M, Nenonen A, Vuori I.

South Karelian Central Hospital, Department of Clinical Physiology and Nuclear Medicine, Lappeenranta, Finland. antii.loimaala@ekshp.fi

Type 2 diabetes is a strong risk factor for coronary heart disease and sudden cardiac death. It is associated with reduced baroreflex sensitivity (BRS) and heart rate variability (HRV), which are indicators of increased risk for mortality and morbidity in various patient populations. This study was designed to assess the effects of exercise training on BRS, HRV, and hemodynamics in patients with type 2 diabetes. Subjects (50 men, mean age 53.3 +/- 5.1 years) with type 2 diabetes were randomized into either a control group, in which they received conventional treatment only, or an exercise group, in which they received conventional treatment together with heart rate-controlled endurance training twice a week and supervised muscle strength training twice a week for 12 months. Measurements taken at baseline and follow-up included VO(2max), standard time and frequency domain measures of HRV during 24-h recording, and BRS by the phenylephrine method. Cardiac index, systemic vascular resistance index, stroke index, and pulse wave velocity were measured by whole-body impedance cardiography. Significant improvements in VO(2max) (exercise group: +2.3 ml x kg(-1) x min(-1); P < 0.005 vs. control group), muscle strength, and glycemic control (exercise group: HbA(1c) -0.9%; P < 0.001 vs. control group) were observed in the exercise group. BRS increased in the exercise group, from 6.8 to 8.6 ms/mmHg, and decreased in the control group, from 7.5 to 6.4 ms/mmHg (95% CI for the difference between 0.05 and 4.36 ms/mmHg; P < 0.05). No significant changes in the time or frequency domain measures of HRV or in systemic hemodynamics were observed. We concluded that exercise training improves BRS sensitivity in type 2 diabetes subjects in addition to increasing the exercise capacity and muscle strength and improving glucose control. These beneficial effects in reflectory autonomic regulation and glucose control caused by exercise may be associated with improved prognosis of type 2 diabetes patients.

Publication Types:

PMID: 12829654 [PubMed - indexed for MEDLINE]

30: Diabetes Care. 2003 May;26(5):1580-8.

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Battling insulin resistance in elderly obese people with type 2 diabetes: bring on the heavy weights.

Willey KA, Singh MA.

School of Exercise and Sport Science, the University of Sydney, Lidcombe, Australia.

Exercise improves insulin resistance and has beneficial effects in preventing and treating type 2 diabetes. However, aerobic exercise is hindered in many type 2 diabetic patients because of advancing age, obesity, and other comorbid conditions. Weight lifting or progressive resistance training (PRT) offers a safe and effective exercise alternative for these people. PRT promotes favorable energy balance and reduced visceral fat deposition through enhanced basal metabolism and activity levels while counteracting age- and disease-related muscle wasting. PRT improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles. PRT also alleviates symptoms of anxiety, depression, and insomnia in individuals with clinical depression and improves exercise tolerance in individuals with cardiac ischemic disease and congestive heart failure; all of these aspects are relevant to the care of diabetic elders. Moreover, PRT is safe and well accepted in many complex patient populations, including very frail elderly individuals and those with cardiovascular disease. The greater feasibility of using PRT over aerobic exercise in elderly obese type 2 diabetic individuals because of concomitant cardiovascular, arthritic, and other disease provides a solid rationale for investigating the global benefits of PRT in the management of diabetes.

Publication Types:

Review

PMID: 12716822 [PubMed - indexed for MEDLINE]

31: Diabetes Care. 2002 Oct;25(10):1729-36.

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High-intensity resistance training improves glycemic control in older patients with type 2 diabetes.

Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P.

International Diabetes Institute, Melbourne, Australia. ddunstan@idi.org.au

OBJECTIVE: To examine the effect of high-intensity progressive resistance training combined with moderate weight loss on glycemic control and body composition in older patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Sedentary, overweight men and women with type 2 diabetes, aged 60-80 years (n = 36), were randomized to high-intensity progressive resistance training plus moderate weight loss (RT & WL group) or moderate weight loss plus a control program (WL group). Clinical and laboratory measurements were assessed at 0, 3, and 6 months. RESULTS: HbA(1c) fell significantly more in RT & WL than WL at 3 months (0.6 +/- 0.7 vs. 0.07 +/- 0.8%, P < 0.05) and 6 months (1.2 +/- 1.0 vs. 0.4 +/- 0.8%, P < 0.05). Similar reductions in body weight (RT & WL 2.5 +/- 2.9 vs. WL 3.1 +/- 2.1 kg) and fat mass (RT & WL 2.4 +/- 2.7 vs. WL 2.7 +/- 2.5 kg) were observed after 6 months. In contrast, lean body mass (LBM) increased in the RT & WL group (0.5 +/- 1.1 kg) and decreased in the WL group (0.4 +/- 1.0) after 6 months (P < 0.05). There were no between-group differences for fasting glucose, insulin, serum lipids and lipoproteins, or resting blood pressure. CONCLUSIONS: High-intensity progressive resistance training, in combination with moderate weight loss, was effective in improving glycemic control in older patients with type 2 diabetes. Additional benefits of improved muscular strength and LBM identify high-intensity resistance training as a feasible and effective component in the management program for older patients with type 2 diabetes.

Publication Types:

PMID: 12351469 [PubMed - indexed for MEDLINE]

: American College of Sports Medicine position stand. Exercise and type 2 diabetes.

Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS.

Physical activity, including appropriate endurance and resistance training, is a major therapeutic modality for type 2 diabetes. Unfortunately, too often physical activity is an underutilized therapy. Favorable changes in glucose tolerance and insulin sensitivity usually deteriorate within 72 h of the last exercise session: consequently, regular physical activity is imperative to sustain glucose-lowering effects and improved insulin sensitivity. Individuals with type 2 diabetes should strive to achieve a minimum cumulative total of 1,000 kcal x wk(-1) from physical activities. Those with type 2 diabetes generally have a lower level of fitness (VO2max) than nondiabetic individuals. and therefore exercise intensity should be at a comfortable level (RPE 10-12) in the initial periods of training and should progress cautiously as tolerance for activity improves. Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2 diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result, ratings of perceived exertion rather than heart rate may need to be used for moderating intensity of physical activity. Although walking may be the most convenient low-impact mode, some persons, because of peripheral neuropathy and/or foot problems, may need to do non-weight-bearing activities. Outcome expectations may contribute significantly to motivation to begin and maintain an exercise program. Interventions designed to encourage adoption of an exercise regimen must be responsive to the individual's current stage of readiness and focus efforts on moving the individual through the various "stages of change."

PMID: 10912903 [PubMed - indexed for MEDLINE]

33: Sports Med. 1999 Jun;27(6):381-91.

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Exercise and the treatment of type 2 diabetes mellitus. An update.

Eriksson JG.

National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland. johan.eriksson@ktl.fi

Exercise has long been considered a cornerstone in the treatment regimen for patients with type 2 (non-insulin-dependent) diabetes mellitus. Aerobic endurance exercise has traditionally been advocated as the most suitable exercise mode. Several exercise studies have evaluated the effect of exercise on insulin sensitivity and glycaemic control in patients with type 2 diabetes mellitus. However, the results obtained have been highly heterogeneous regarding the effect of exercise on insulin sensitivity and glycaemic control. Only in certain subgroups (e.g. patients with type 2 diabetes mellitus under 55 years of age, those with diabetes treated through diet and those who have diabetes with fairly good metabolic control), does exercise seem to be beneficial with regard to improvement in glycaemic control. There has been little research into the effects of resistance training on glucose metabolism in patients with type 2 diabetes mellitus compared with the amount of research involving aerobic endurance exercise. The incidence of type 2 diabetes mellitus increases with increasing age, partly because of the decline in muscle mass associated with aging. This corresponds with a decline in metabolic function, supporting the usefulness of resistance training. Available studies support the usefulness of resistance training in the treatment of type 2 diabetes mellitus. Therefore, based on the published studies reviewed, this author proposes that an optimal exercise programme for individuals with type 2 diabetes mellitus should include components that improve cardiorespiratory fitness, muscular strength and endurance, i.e. a combination of aerobic endurance training and circuit-type resistance training. Programmes combining various modes of exercise positively influence patient compliance with the exercise programme. The vast majority of patients with type 2 diabetes mellitus can undertake an individualised exercise programme without significantly increased risks of complications.

Publication Types:

Review

PMID: 10418073 [PubMed - indexed for MEDLINE]

: Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake.

Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S.

Department of Internal Medicine, Osaka City General Hospital, Japan.

OBJECTIVE: To examine the effect of resistance training on insulin sensitivity in nonobese NIDDM patients. RESEARCH DESIGN AND METHODS: Previously sedentary nonobese NIDDM patients were enrolled in a resistance training group (RT; n = 9) or used as sedentary control subjects (SED; n = 8). SED subjects did not perform exercise training because of orthopedic disorders. The training program consisted of two sets of nine exercises with 10-20 repetitions. Subjects trained five times a week for 4-6 weeks. Insulin sensitivity, as assessed by the hyper-insulinemic-euglycemic clamp technique, HbAJc, and body composition, was measured before and after the training period. Maximal oxygen uptake (VO2max) and quadriceps strength were measured in the RT group. RESULTS: The two groups did not differ significantly on any variables before participation in the program. The glucose disposal rate during the hyperinsulinemic-euglycemic clamp increased 48% in the RT group (6.85 +/- 1.86 to 10.12 +/- 3.15 mg.kg-1 lean body mass.min-1; P < 0.05), but remained unchanged in the SED group (5.95 +/- 1.63 to 6.36 +/- 1.61 mg.kg-1 lean body mass.min-1). There was no significant change in body composition in either group. In the RT group, a 16% increase in quadriceps strength (191.1 +/- 45.8 to 216.9 +/- 42.8 Nm; P < 0.05) but no significant change (27.6 +/- 5.0 to 28.6 +/- 6.5 ml.kg-1.min-1) in VO2max was observed. CONCLUSIONS: Moderate-intensity, high-volume resistance training improves insulin sensitivity in nonobese NIDDM without altering VO2max.

PMID: 9702447 [PubMed - indexed for MEDLINE]

35: J Nutr. 1997 May;127(5 Suppl):998S-1003S.

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Functional and metabolic consequences of sarcopenia.

Evans W.

Pennsylvania State University, University Park 16802, USA.

The capacity of older men and women to adapt to regularly performed exercise has been demonstrated by many laboratories. Aerobic exercise results in improvements in functional capacity and reduced risk of developing type II diabetes in the elderly. High intensity resistance training (above 60% of the 1 repetition maximum) causes large increases in strength in the elderly, and resistance training significant increases muscle size. Resistance training also significantly increases energy requirements and insulin action of the elderly. We recently demonstrated that resistance training has a positive effect on multiple risk factors for osteoporotic fractures in previously sedentary post-menopausal women. Because the sedentary lifestyle of individuals in a long-term care facility may exacerbate losses of muscle function, we applied this same training program to frail, institutionalized elderly men and women. In a population of 100 nursing home residents, a randomly assigned high intensity strength training program resulted in significant gains in strength and functional status. In addition, spontaneous activity, measured by activity monitors, increased significantly in those participating in the exercise program; there was no change in the sedentary control group. Before the strength training intervention, the relationship of whole-body potassium and leg strength was relatively weak (r2 = 0.29, P < 0.001), indicating that in very old persons muscle mass is an important but not the only determiner of functional status. Thus exercise may minimize or reverse the syndrome of physical frailty prevalent among very old individuals. Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise training than the elderly.

Publication Types:

PMID: 9164283 [PubMed - indexed for MEDLINE]

: Resistance training guidelines for individuals with diabetes mellitus.

Soukup JT, Maynard TS, Kovaleski JE.

Resistance/strength training is added to an exercise regimen to create a well-rounded program that enhances muscular conditioning and improves health, physical fitness, and/or athletic performance. This article presents resistance training guidelines for individuals with diabetes mellitus, with and without vascular complications. The existing literature concerning exercise prescription and the acute and chronic physiological responses to resistive-type exercise is discussed. The educator is provided with principles that govern resistance training so that safe and effective programs can be prescribed for individuals with diabetes.

PMID: 7851226 [PubMed - indexed for MEDLINE]

37: Diabetes Educ. 1993 Jul-Aug;19(4):307-12.

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A review of the effects of resistance training for individuals with diabetes mellitus.

Soukup JT, Kovaleski JE.

Although the effectiveness of exercise as a treatment modality for the management of diabetes mellitus has long been recognized, a vital component of the exercise prescription has been overlooked. In addition to endurance training, resistance training may provide physiologic benefits to the individual with diabetes that, in some cases, may equal or exceed those gained through aerobic training. These benefits may include improved blood lipid profiles, increased absolute left ventricular wall contractility, decreased resting blood pressure, improved insulin sensitivity and glucose tolerance, improved glycemic control, improved muscular strength and endurance, and increased bone and connective tissue strength. By utilizing a combination of aerobic and resistance training, the individual with diabetes experiences a more comprehensive exercise program that can improve most areas of health and physical fitness. In addition, having a greater number of exercise modality options may enhance exercise compliance.

Publication Types:

Review

PMID: 8370334 [PubMed - indexed for MEDLINE]