# 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)

## Research Background

* Type II Diabetes - Type II Diabetes is a lifestyle disease in which the pancrease gradually loses the ability to produce enough insulin. 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.
* Glycemic Control - Glycemic control is maintaining blood glucose levels within a range of 6-8 mmol/L (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, Exenatide (Exendin-4), and resistance training.
* 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.

## Research Information

* 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]
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.

## Results

| | 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 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, 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.

## Conclusions

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, 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 reading

* Exercise and Sports Science Australia - Diabetes Position Statement
* Resistance Exercise in Type Ii Diabetics (Pages 309-310)

## References

* ↑ 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 2 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
* ↑ Diabetesaustralia.com.au. Type 2 diabetes [Internet]. 2015 [cited 24 September 2015]. Available from: https://www.diabetesaustralia.com.au/type-2-diabetes
* ↑ TheFreeDictionary.com. glycaemic control [Internet]. 2015 [cited 24 September 2015]. Available from: http://medical-dictionary.thefreedictionary.com/glycaemic+control
* ↑ Diabetesaustralia.com.au. Blood glucose monitoring [Internet]. 2015 [cited 24 September 2015]. Available from: https://www.diabetesaustralia.com.au/blood-glucose-monitoring
* ↑ 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
* ↑ 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
* ↑ 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
* ↑ 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
* ↑ Warburton DER, Nicol CW, Bredin SSD. Health Benefits of Physical Activity: the evidence. CMAJ. 2006 March 14; 174 (6) 801-809
* 1 2 Eves ND, Plotnikoff RC. Resistance Training and Type 2 Diabetes.DiabCare. 2006 August; 29 (8) 1933-1946.
* ↑ 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
* ↑ Diabetes Australia. Diabetes in Australia – Diabetes Australia [Internet]. 2015 [cited 24 September 2015] Available from: https://www.diabetesaustralia.com.au/diabetes-in-australia
* ↑ 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