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Exercise as it relates to Disease/The Effect of High Intensity Resistance Training on Glycemic Control in Older Type 2 Diabetics

Title - The Effect of High Intensity Resistance Training on Glycemic Control in Older Type 2 Diabetics

(Dunstan DW, Daly RM, Owen N, Damien J, Courten M, Shaw J, Zimmet P. High-Intensity Resistance Training Improves Glycemic Control in Older Patients with Type 2 Diabetes. DiabCare. 2002 October; 25 (10): 1729-1736) [1]

Research BackgroundEdit

  • Type II Diabetes - Type II Diabetes is a lifestyle disease[2] in which the pancrease gradually loses the ability to produce enough insulin.[3] According to Diabetes Australia and Better Health Victoria, type II diabetes can be caused by lifestyle and genetic factors including: older age, being overweight/obesity, high blood pressure, cardiovascular disease, little or no physical activity and smoking.[2]
  • Glycemic Control - Glycemic control is maintaining blood glucose levels[4] within a range of 6-8 mmol/L[5] (for type 2 diabetics) to help treat and regulate diabetics mellitus. Glycemic control can be controlled through a variety of methods, some include: continuous home monitoring of glucose,[6] Exenatide (Exendin-4),[7] and resistance training.[8]
  • High Intensity Resistance Training - According to Better Health Victoria, resistance training (also known as strength or weight training) uses resistance to build strength throughout muscular contraction. High Intensity resistance training involves more weight and a higher intensity of sets of reps.[9]

Research InformationEdit

  • Where is the research from? - This study was held in Victoria, Australia and conducted by researches from the International Diabetes Institute, School of Health Sciences - Deakin University and School of Population Health - University of Queensland. This study was published in Diabetes Care Journal in 2002.
  • What kind of research was this? - This study was a clinical controlled trial to assess whether high-intensity resistance training has an effect in improving glycemic control in older type II diabetics.
  • What did the research involve? - This study investigated the effects of high-intensity resistance training (HIRT) on glycemic control in older type II diabetes. 29 overweight men and women aged 60–80yrs were randomly split into two groups:
  • High-Intensity Progressive Resistance Training + Moderate Weight-Loss [RT & WL]
  • Moderate Weight-Loss + Control Program [WL]
 
The leg press is one of the exercises used throughout the training program.

Each participant attended 3 exercise sessions per week for 6 months in a laboratory setting under supervision.

RT & WL group goal was to achieve 75-80% of their 1RM with a program consisting of 5min warm-up, 45min HIRT and 5min cool-down. Various exercises were used including: bench press, leg extension, dumbbell seated shoulder press, bicep curl and abdominal curls. The workload for each exercise was regularly increased to achieve 3 sets of 10 reps. 1RM was tested every 12 weeks to set a new baseline measure.

The WL group goal was the achieve weight loss. There program consisted of 5min stationary cycling and 30min static stretching.

Both groups also undertook a healthy eating plan for the first 4 weeks designed to cause 0.25 kg weight loss per week. After 4 weeks, participants met with a dietitian to complete a weekly food checklist. 3 day food records were taken at 3 and 6 months to compare nutrients changes across the trial.

  • Pre & Post Testing Procedures - Pre and Post testing procedures included: anthropometry, muscle strength (using 1RM), habitual physical activity, resting blood pressures and a blood sample to measure different blood markers.

ResultsEdit

Resistance Training & Weight Loss Weight Loss & Control
Subject Characteristics No differences from baseline No differences from baseline
Adherence to Interventions 88% attendance to sessions 85% attendance to sessions
Metabolic Variable Changes 0.5% reduction of HBLA1c at 3 months

0.8% reduction of HBLA1c at 6 months

No detectable changes in HBLA1c
Fasting Insulin 1.4 mmol/L reduction after 6 months No change
Anthropometric Measurements Reduction in body weight and waist circumference at 3 and 6 months

Reduction in fat mass at 6 months Increase in Lean Body Mass

Reduction in body weight and waist circumference at 3 and 6 months

Reduction in fat mass at 6 months Decrease of lean body mass

Muscular Strength Upper Body – 22.9% increase at 3 months and 41.7% increase at 12 months

Lower Body – 5.8% increase at 3 months and 28% increase at 6 months.

No change
Blood Pressure Reduction in Diastolic and Systolic at 6 months No change
Energy intake & Habitual Physical Activity Decreased total energy intake at 3 & 6 months

No change in habitual activity.

Decreased total energy intake at 3 & 6 months

No change in habitual activity.

  • Interpreting Results - The researchers concluded that a high-intensity resistance training program has a positive effect in improving glycemic control in older type II diabetics. Participants also achieved a reduction in fat mass making the training program a valid source of research therefore opening more areas for further investigation/research.
  • Implications of Research- The implications of this research along with previous studies[10][11][12] suggest that high intensity resistance training has a positive effect in improving glycemic control in older type II diabetics and moderate weight loss.
  • Further Research - Type II diabetes is currently responsible for 85% of diabetes in Australia,[13] therefore this study suggests further research options for improving glycemic control in older type II diabetics utilizing high intensity resistance training: training periods longer than 6 months, sessions held outside a lab-based setting and identifying the optimal intensity of resistance training to safety train and gain maximal effects.[11]

ConclusionsEdit

This study investigated the effects on glycemic control in older type II diabetics throughout a high-intensity resistance training program. Results demonstrated that the program was effective. The RT & WL group showed a 0.8% decrease in HBLA1c therefore improving glycemic control. Both groups experienced a reduction in body weight and fat mass. Alongside supporting evidence,[14] this study shows glycemic control in older type II diabetics can be controlled with a high-intensity resistance training program and a moderate weight loss.

Further readingEdit

ReferencesEdit

  1. Dunstan DW, Daly RM, Owen N, Damien J, Courten M, Shaw J, Zimmet P. High-Intensity Resistance Training Improves Glycemic Control in Older Patients with Type 2 Diabetes. DiabCare. 2002 October; 25 (10): 1729-1736
  2. a b Better Health Channel. Diabetes type 2 - Better Health Channel [Internet]. 2015 [cited 24 September 2015]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/diabetes_type_2
  3. Diabetesaustralia.com.au. Type 2 diabetes [Internet]. 2015 [cited 24 September 2015]. Available from: https://www.diabetesaustralia.com.au/type-2-diabetes
  4. TheFreeDictionary.com. glycaemic control [Internet]. 2015 [cited 24 September 2015]. Available from: http://medical-dictionary.thefreedictionary.com/glycaemic+control
  5. Diabetesaustralia.com.au. Blood glucose monitoring [Internet]. 2015 [cited 24 September 2015]. Available from: https://www.diabetesaustralia.com.au/blood-glucose-monitoring
  6. Garg SK, Kelly WC, Voelmle MK, Ritchie PJ, Gottlieb PA, McFann KK, Ellis SL. Continuous Home Monitoring of Glucose. DiabCare. 2007 December; 30 (12) 3023-3025
  7. Buse JB, Henry RR, Han J, Kim DD, Fineman MS, Baron AD. Effects pf Exenatide (Exendin-4) on Glycemic Control over 30 Weeks in Sulfonylurea-Treated Patients with Patients with Type 2 Diabetes. DiabCare. 2004 November; 27 (11) 2628-2633
  8. Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME. A Randomized Controlled Trial of Resistance Exercise Training to Improve Glycemic Control in Older Adults with Type 2 Diabetes. DiabCare. 2002 December; 25 (12) 2355-2341
  9. Better Health Channel. Resistance Training – Health Benefits – Better Health Channel [Internet]. 2015 [cited 24 September 2015]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Resistance_training_the_health_benefits?open
  10. Warburton DER, Nicol CW, Bredin SSD. Health Benefits of Physical Activity: the evidence. CMAJ. 2006 March 14; 174 (6) 801-809
  11. a b Eves ND, Plotnikoff RC. Resistance Training and Type 2 Diabetes.DiabCare. 2006 August; 29 (8) 1933-1946.
  12. Honkola A, Forsen T, Eriksson J. Resistance Training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabet. 1997 December; 34 (4) 245-248
  13. Diabetes Australia. Diabetes in Australia – Diabetes Australia [Internet]. 2015 [cited 24 September 2015] Avaliable from: https://www.diabetesaustralia.com.au/diabetes-in-australia
  14. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus. JAMA. 2001 September 12; 286 (10) 1218-1227