Glycative Stress Research
Online edition : ISSN 2188-3610
Print edition : ISSN 2188-3602
Received : December 23, 2015
Accepted : February 19, 2016
Published online : June 30, 2016

Original Article

Effective training of squat exercise -- HiSquat trial for patients with diabetes -Hiroshi Bando 1, 2), Masao Kan 3), Yuko Takenaka 2, 4), Hiroki Yokoyama 5), Takumi Nakamura 2, 6),
Kiyoshi Konoike 2)
1) The University of Tokushima / Kitajima Taoka Hospital, Tokushima, Japan
2) Japan Masters’ Association, Japan
3) Japan Ship Machine Tool Co. Ltd., Japan
4) Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
5) Jiyugaoka Yokoyama Clinic, Obihiro, Hokkaido, Japan
6) Nakamura Orthopedic Clinic and Anti-aging Center, Kawanishi, Hyogo, Japan

Abstract

Background: Recent clinical problems in primary care medicine include metabolic syndrome (Met-S) as well as otherproblems, such as diabetes mellitus, locomotive syndrome (Loc-S) and flailty in middle-age to older people. Regarding
exercise therapy for patients with Met-S and Loc-S, aerobic exercise and also resistance (anaerobic) exercise have been
considered as necessary. Thus, simple and effective resistance exercise methods should be clarified.
Subjects and Methods: The subjects were 61 patients (male 36, female 25) with diabetes mellitus (66.9 ± 13.5 years old,mean ± SD). Subjects were instructed to perform a continuous squat exercises 5 minutes in morning and evening every day
for 6 months, using the small exercise equipment ‘HiSquat”. The movements included 1) walking or jogging, 2) inner thighexercise, 3) outer thigh exercise, 4) straight thigh exercise. Parameters were height, body weight, body mass index (BMI),
abdominal circumference, thigh circumference and blood HbA1c value. The treatment of the subjects were not changed
during the 6 months. HbA1c value was compared between 0 and 6 months.
Results: The fundamental data before the study were as follows: height 159.4 ± 8.4 cm, body weight 62.5 ± 13.8 kg, BMI
24.5 ± 4.7 kg/m 2, abdominal circumference 86.8 ± 10.7 cm, thigh circumference 42.9 ± 6.4 cm, HbA1c 6.8 ± 0.9%. HbA1cvalue at 6 months was 6.4 ± 1.0%, with a statistically significant decrease of 0.4%. As for the correlation analyses, a positive
significant correlation was observed between BMI and the thigh/height ratio, and a negative significant correlation wasobserved between age and thigh/waist ratio.
Conclusion: In this study, the HbA1c value was significantly decreased, which suggests the exercise effect of HiSquat. Our
study provides fundamental data for the value of waist/thigh circumference in the exercise therapy, and also the efficacy of
HiSquat; consequently it suggests the efficacy of HiSquat use for Met-S, Loc-S and flailty, which are increasing concerns in
anti-aging medicine of Japan.

KEY WORDS: HiSquat, squatting, diabetes mellitus, HbA1c, exercise therapy
Introduction

Recent clinical problems in anti-aging medicine include
metabolic syndrome (Met-S) as well as other problems, suchas diabetes mellitus (DM), locomotive syndrome (Loc-S) in
middle-age people and frailty in older people. For patientswith Met-S and Loc-S, exercise therapy, such as aerobic
exercise, and also resistance (anaerobic) exercise therapy
have been considered necessary. Thus, a simple and effective
resistance exercise is awaited.
The relationship between sedentary condition and chronic
disease has been a controversy for years. Several guidelines

for physical activity have been reported 1- 5). Systematic review
and meta-analyses of these guidelines were studied, and they
demonstrated that too much sitting poses a risk for chronic
disease and premature death, and controlling of time spentin leisure exercise or moderate to vigorous physical activity
would promote the health 6, 7) .
Recent investigation of systematic reviews and metaanalyses revealed that people with a prolonged sedentary time
have a higher risk for all-cause mortality, cardiovasculardisease mortality, cardiovascular disease incidence, cancer
mortality, and cancer incidence 8 ) . In particular, the hazard

Contact Address: Hiroshi BANDO, MD, PhD
Affiliation: The University of Tokushima, Graduate School of Internal Medicine /Kitajima Taoka Hospital
Phone: +81-90-3187-2485 Fax: +81-88-603-1030 E-mail: pianomed@bronze.ocn.ne.jp
Co-authors: Masao Kan: nihonsenpaku@road.ocn.ne.jp
Yuko Takenaka: yuko-373@mail.goo.ne.jp Hiroki Yokoyama: dryokoyama@yokoyamanaika.com
Takumi Nakamura: takumi-e@sb3.so-net.ne.jp Kiyoshi Kounoike: jt-master-o@j-master.gr.jp_ 65 _

Glycative Stress Research 2016; 3 (2): 65 - 73(c) Society for Glycative Stress Research

Squat Exercise for Diabetes Using HiSquat

ratio for type 2 diabetes incidence was extremely high, at
1.910. Thus, sedentary life seems to have a great influence on
the development of metabolic syndrome and arteriosclerotic
diseases.
On the other hand, regarding the necessity of
exercise for the shortage of physical activity and sports
has been emphasized. Exercise is classified into aerobic
and anaerobic (resistance) exercise. Resistance exercises(muscle-strengthening activities) should be done involving
major muscle groups on two or more days according to
the guideline of WHO and other countries 1, 2). Resistance
exercise (muscle training, weight training) has effects on
muscle hypertrophy, muscle power and muscle endurance 9).
Furthermore, it has positive effects on the aging decrease of
muscle volume, decrease of bone mineral density, decreaseof muscle metabolism and increase of body fatty tissue 10),leading to a better performance of physical activity in daily
life 9). According to the meta-analysis results of the resistance
exercise for aged people, muscle power would be recoveredby approximately 20-30% 11).
Recently, the management for Met-S, Loc-S and frailty
has been a focus and an educational movement has started in
the Japanese Orthopaedic Association and in other medical
societies 12, 13). In the guideline of locomotive syndrome, asquatting exercise has been recommended, because squatting
is a simple use of one’s body weight without special
equipment, and it is expected to be effective for daily QOL
and ADL 14, 15).
In these clinical fields, we have investigated several
published studies concerning anti-aging medicine, diabetes
and diet and exercise therapy 16 -18). Here, we have evaluatedthe effect of squatting exercise in the clinical setting. We useda new squat equipment ‘HiSquat’ and applied it for patientswith diabetes mellitus, and analyzed the effect of 6 monthsof exercise 19, 20).

Subjects and Methods
Subjects

The subjects of this study consisted of 61 patients(males: 36, females: 25) with diabetes mellitus (66.9 ± 13.5
years old, mean ± SD), who were outpatients of a primarycare clinic in Tokushima, and who were enrolled in our
research program for 6 months. DM therapy included dietand exercise without medication in 7 patients, oral anti-

diabetic drugs in 46 patients and insulin therapy in 8 patients.
The following oral anti-diabetic drugs were used: insulin
stimulators, 9 patients; glucose absorption blocking, 17
patients; insulin resistance modulators, 28 patients; incretinrelated drugs, 39 patients and SGLT2 blockers 2 patients.
We excluded the subjects who were not allowed to perform
exercise therapy due to retinopathy or nephropathy.

MethodThe subjects have continued squat exercise 5 minutes
in morning and evening every day for 6 months. They used
the small sport equipment ‘HiSquat (trademark registration
number 3179684) ( Fig. 1 ) 19, 20). The depth of squat was fromquarter to half. One leg was extended to the back and thenthe opposite leg was extended to the back, in turn. The
exercise included the following movements: 1) walking or
jogging on the HiSquat for 2 minutes with the hip level as
usual, while grasping the back of a chair nearby with hands,
2) inner thigh exercise: the position of bilateral knees was
close and squat movement was performed 10 round times
for about 1 minute, 3) outer thigh exercise: the same as 2),
and 4) straight thigh exercise: the same as 2), in total about
5 minutes from 1) to 4). The details of the squat exercise
have been shown in a textbook and on the homepage 19, 20).
Regarding the clinical management of each subject, theirdiet and pharmacological treatment were not changed, as a
general rule, during the 6 months period of the study.

Parameters

The parameters of the subjects included stature, bodyweight, BMI, abdominal circumference (horizontal levelat the navel), thigh circumference (10 cm upper level fromthe upper ridge of the patellar), and blood HbA1c value. We
compared the HbA1c levels before and after the project. The
data before was the value of 0 month, and the data after was
the average the data at 6 and 7 months. From these data,
including thigh circumference/height ratio and thigh/waist
circumference ratio, we analyzed the correlation among
various factors.

Ethical Considerations

The present study was conducted in compliance with the
ethical principles of the Declaration of Helsinki and Japan’s
Act on the Protection of Personal Information, and with

Fig. 1. HiSquat (the exercise equipment for squat movement)_ 66 _Glycative Stress Researchreference to the Ministerial Ordinance on Good Clinical
Practice (GCP) for Drug (Ordinance of Ministry of Healthand Welfare No. 28 of March 27, 1997). No ethics committee
meeting was held. We obtained informed consent from thesubjects concerning this questionnaire.

2) Changes in value of HbA1c:

The value of HbA1c was 6.4 ± 1. 0% (mean ± SD) at 6
months. The decreased level of HbA1c for 6 months was 0.4%,
which was statistically significant (Fig. 3). The decreased
level of HbA1c for 61 subjects is shown in Fig. 4, and 32/61(52.4 %) showed decrease more than 0.3%.

Results

3) Correlations among obtained data:

1) Data of subjects:

Several meaningful correlations among these data
are shown in Fig. 5. Significant positive correlations wereseen between waist and thigh circumference (a), body massindex and thigh/height ratio (b,c), and a significant negative
correlation was seen in age and thigh/waist ratio (e). In
contrast, there was no significant correlation between BMI
and thigh/waist ratio (d), or among HbA1c values (before orafter study, changed) and other factors (f ).

The fundamental data at start of the study revealed
that body mass index (BMI) was 24. 5 ± 4.7 kg/m 2, andHbA1c (before) was 6.8 ± 0.9 % (mean ± SD) (Table 1). BMI
distribution of 61 subjects before the project is shown in
Fig. 2, and the median value was 23.5 kg/m 2 and 23/61(37.8%) showed BMI more than 25 kg/m 2.

Table 1. fundamental datamean ± SD
height159.4 ± 8.4 cm

body weight62.5 ± 13.8 kg

body mass index (BMI)

24.5 ± 4.7 kg/m2

abdominal circumference

86.8 ± 10.7 cm

thigh circumference

42.9 ± 6.4 cm

HbA1c (before)

6.8 ± 0.9 %HbA1c (6 months)

6.4 ± 1.0 %

(n)
15

10

10

10

9
8

8
7

6
5
3

0

16 〜

18 〜

20 〜

22 〜

23 〜

25 〜

27〜

B M I (k g /m )2

Fig. 2. Body Mass Index (BMI) distribution of 61 subjects.
_ 67 _

29 〜

Squat Exercise for Diabetes Using HiSquat

HbA1c
(%)

7

6.8 %

6.4%

6

5

before6 months

Fig. 3. The changes of HbA1c value in 61 patients with diabetes mellitus
There was a significant difference between the two (P< 0.05, paired-t test).

(n)
20

15

15

13
11

10
8

5

0

5

5

- 0.1〜- 0.2

04≦ - 0.3

0.1〜
0.2

0.3〜
0.4

0.5〜
0.9

1.0 ≦

Decrease of HbA1c (%)

Fig. 4. The distribution of the decrease of HbA1c value in the patients with diabetes mellitus_ 68 _Glycative Stress Researcha.

45

y = 0.39x + 9.27
r = 0.46
p = 0.02

60
55
50
45
40

35
30
25
20
15

35
30

50

60

70

80

90

100

110

120

b.

130

waist circumference (cm)y = 1.29x + 22.9
r = 0.57
p<0.001

80
70
60
50
40
5

10

15

20

25

30

35

40

20

25

30

35

40

45

35

40

45

Body Mass Index

y = 0.09x + 47.9
r = 0.14, p = 0.28

55
50
45

d.

45

35

5

10

15

20

25

30

Body Mass Index

2.5

65

2

60

1.5

decreased HbA1c (%)

thigh/waist ratio (％)

15

60

70

55
50
45

y = - 0.17x + 61.7
r = 0.41
p = 0.04

40
35

e.

10

40

Body Mass Index

30

5

65
thigh/waist ratio (%)

waist/height ratio (％)

c.

10

70

90

30

y = 0.69x + 10.1
r = 0.52
p< 0.001

40
thigh/height ratio (%)

thigh circumference (cm)

70
65

0

20

40

60

80

1
0.5
0
- 0.5

- 1.5
30

f.

100

age (y.o.)y = - 0.0006x + 0.42
r = 0.34, p = 0.06

-1
35

40

45

50

55

60

65

70

thigh/waist ratio (%)

Fig. 5. Correlation among body mass index (BMI), waist circumference, thigh circumference,thigh/waist circumference ratio, thigh/height ratio and age.
a. Correlation between thigh and waist circumference (significant correlation, p< 0.05)
b. Correlation between BMI and thigh/height ratio (significant correlation, p< 0.001)
c. Correlation between BMI and waist/height ratio (significant correlation, p< 0.001)
d. Correlation between BMI and thigh/waist ratio (no significant correlation)e. Correlation between age and thigh/waist ratio (significant correlation, p< 0.05)
f. Correlation between thigh/waist ratio and decreased HbA1c (no significant correlation)

Discussion

Physical activity and diabetes

As for the relationship between sedentary condition andchronic diseases, systematic reviews and meta-analyses were
investigated in 48 reports 6), 18 reports 7), and 47 reports 8).
Biswas et al. showed the disease and hazard ratio (HR):cardiovascular disease mortality (1.179), cardiovasculardisease incidence (1.143), cancer mortality (1.173), cancer
incidence (1.130), and type 2 diabetes incidence (1.910) 8).

The relationship between physical activity and type 2
diabetes, as investigated in 45,668 cases for 11 years 21),reported an incidence rate ratio of 1.86 (95% CI: 1.54, 2.24)
for 5 hours relative to <1 hour of television per day.
Intervention studies of interrupting sitting time with shortbouts of light - or moderate-intensity walking showed lowered
postprandial glucose and insulin levels 22). Considering thesereports, Lynch and Owen 23) stated in an editorial that further
studies should consider the effects within population subgroups.

_ 69 _

Squat Exercise for Diabetes Using HiSquat

Several guidelines on physical activity for healthhave recently been shown 1, 3 -5). WHO reported the Global
Recommendations on Physical Activity for Health in 2010 1).
In the 18 to 64 years old group and also in the older than 65
years old group, the recommended levels of physical activity
for health included the following: 1) 75-150 min/week ofmoderate to vigorous intensity aerobic physical activity, andalso 2) muscle-strengthening activities involving major muscle
groups on two or more days a week.
Furthermore, the demerit of daily sedentary behavior
such as sitting or lying down has been emphasized. Australian
Bureau of Statistics (ABS) 2013 showed “Make your Move-- Sit less -- Be active for life!” on the front cover of theguideline 3). Recently, Mayor reported that prolonged sitting
time would lead to great risk, regardless of exercise habit 24).
In Japan, the impact of daily total physical activity levelon premature deaths has been investigated in a large-scale
population-based cohort study in Japan (JPHC study) with
83,034 Japanese citizen ages 45-74 years. Compared withsubjects in the lowest quartile, increased daily total physicalactivity was associated with a significantly decreased risk of
all-cause mortality in both sexes (hazard ratios for the second,
third, and highest quartiles were: men, 0.79, 0.82, 0.73 andwomen, 0.75, 0.64, 0.61, respectively) 25). As for the cancer
risk of the subjects performing leisure-time sports or physicalexercise >1 day /week in the JPHC study, the hazard ratio(HR) in each quartile was 0.80, 0.81, 0.61, respectively 26).
Thus, daily physical activity with sports or exercise showeda merit of health and wellness in the investigation forJapanese such as in the JPHC study.

Data analysis

We compared the current study with previous reports
concerning physical activity, metabolic syndrome anddiabetes. Based on the stature of 61 subjects ( Table 1 ) and
BMI distribution ( Fig. 2 ), the obesity ratio was 23/61 (37.7%),
which seems to be the average frequency in typical primarycare out-patient setting. According to 0.4% decrease of
HbA1c ( Fig. 3 ) and the distribution of decreased HbA1c( Fig. 4 ), we analyzed the factors influencing the value of
HbA1c.
As a result, it was not BMI, but the HbA1c level at 0
months that seemed to influence the decrease degree of HbA1c.
We classified the 61 cases into the following two groups
based on the HbA1c value at the start of our project: group
A (less than 6.55%, n = 30), and group B (more than 6.6%,
n = 31). The decrease of HbA1c value was 0.11 ± 0.35% andmedian 0.175% in group A, and 0.69 ± 1.08% and median
0.65% in group B. Taking all 61 cases together, the decreaseof HbA1c was 0.41 ± 0.86 % and median 0.30 %.
Consequently, the effect of HiSquat seemed to be small
in group A, and greater in group B. In other words, poorly
controlled patients with diabetes mellitus would seem to havea greater effect by performing squatting, and are recommended
to try exercise therapy on HiSquat equipment.
Correlation analyses yielded the following speculation( Fig. 5 ): 1) BMI, waist and thigh circumferences have amutual correlation, and several factors would be clinicallyand statistically useful factors in future studies, such as thigh/waist ratio, thigh/height ratio, waist/height ratio (Fig. 5a,b, c).
2) The thigh/height ratio would have less error and would bestatistically a more useful factor than the thigh/waist ratio( Fig. 5c, d ). 3) The thigh/waist ratio would be a useful factor,

indicating the aging decrease of muscle volume ( Fig. 5e).
4) There was no significant correlation between HbA1c(pre-, post- or changed values) and other factors ( Fig. 5f ),suggesting that exercise therapy for 6 months would not be
sufficient for a remarkable reduction of weight, or decreased
HbA1c, as compared to diet therapy for months with a marked
weight loss.
As to BMI and thigh circumference, we would be careful
for evaluating the following viewpoints; 1) BMI is calculatedby the values of height and body weight without the ratio ofmuscle and fat, resulting in limitation to some extent forevaluation of BMI, 2) the evaluation of thigh circumference
after starting squat exercise would include variable condition,such as thinner changes by decrease of subcutaneous fat inearly stages, and stable – thicker changes by increase of
muscle volume in later stages, 3) from our current research,the measurement of waist and thigh circumference would
be useful for evaluating the effect of exercise, with someattention for influencing variables of BMI and thighcircumference.

Effect of squat

From the point of anti-aging and protective medicine,the neurosurgeon, Brett Osborn 27) stated that there are five
exercises to protect against ‘Disease of Aging’, including:1) squatting, 2) overhead press, 3) deadlift, 4) bench press,5) pull-up / chin-up. Squatting is a full-body exercise: it is
the basic movement around which all training should becentered. He cited a large, long-term study of 8762 men aged
20-80 28), in which after 18.9 years of follow-up, the men still
living were those with the most muscular strength.
Hagen, an educator of fitness exercise, summarized“stronger for long – a functional training elixir”, and presented
six primal movement patterns with variations/progression 29).
Those are 1 squat, 2 lunge, 3 pull/dead lift/row, 4 push/plank/
hover, 5 twist (torso rotation), 6 gait (walk/run), in which thesquat is the most fundamental and valuable. Two types ofsquatting activities in 24 healthy older adults (70-85 years)
were tried 30). One is a typical self-selected depth (normal
squat; SQ) and another is a squat onto a chair (chair squat;
CSQ, 43.8cm), and descending and ascending phase joint
kinematics and kinetics were investigated. CSQ generated
greater hip flexion angles, whereas SQ generated greaterknee and ankle flexion angles, suggesting possible
application of either SQ or CSQ for each elder in the future.
The dose-response relationship of training intensity to
training effect was investigated by searching in PubMed for
publications of five years 31). Thirty-three studies from morethan 1500 papers were used for the recommendation ofstrength training in the elderly ( > 60 years of age ), andpresented the following results: 1) For increasing muscle mass,
recommended training dosage would be 8 –12 repetitions per
muscle group in 70 – 85% of the one-repetition-maximum,
3 sets; 2 – 3 training units per week; at least 8 – 12 weeks, 2)
For training of intramuscular coordination, recommended
training dosage would be up to 8 repetitions per muscle
group with intensities of more than 80% of the one-repetitionmaximum; 3 – 5 sets; 3 training units per week; several
weeks 31). As stated above, when the middle-aged to elderly
aged person tries to exercise for the purpose of anti-aging or
exercise therapy, squatting as well as other resistance training
and stretching would be recommended for promoting physicalhealth 32).

_ 70 _Glycative Stress Research

The exercise equipment ‘HiSquat’ can be used in different
ways according to the different types of subjects. First, whenathletes exercise for heavy muscle training with a low hiplevel, the way of squatting would be full-bottom, full orparallel.
Second, when middle-aged or elderly people use HiSquatfor slight to moderate resistance training with a shallow hiplevel, the way of squatting would be half or quarter. In thiscase, the squatting movements are continued with position
support by grasping the back of a chair or a table. This
complemental movement with a chair would be useful forcontinuing daily exercise therapy, because a series of exercise
movements such as warm up, stretch, muscle training can be
performed 32). We can stretch the neck, shoulders, upper back,quadriceps and hamstring/calf, and also strengthen the 5minute walk, squat, toe stand, knee curl, and knee extension.
Therefore, the combination of HiSquat and a chair would
be useful for the daily continuation of stretch and muscle
training with each different program.
Recently, the development of an air- squat training
support system using Microsoft Kinect has been reported 33).
The exercise method is that subjects assume the half-squatting
position and sustain the position for one second, which
would be effective and can be evaluated for the amountof exercise effect by computer analysis. Such a trial will
facilitate development of a new era in the combined fieldof information, communication and technology (ICT),
medicine and fitness.
The combined activity of sitting, walking and stepping
are reportedly favorable for diabetic patients. The differencein the effects among sitting, standing and stepping wasinvestigated and is clarified as follows 34) : 1) sitting - tostanding reallocations 2 hours/day showed significant 2%lower fasting plasma glucose, 11% lower triglycerides, 6%
lower total/HDL-cholesterol ratio, 2) sitting-to-stepping
similarly showed significant 11% lower BMI, 7.5 cm lower
waist circumference, 11% lower 2-h plasma glucose, 14%
lower triglycerides, and 0.10 mmol/L higher HDL-cholesterolper 2 h /day, and 3) standing-to-stepping similarly showedsignificant 10% lower BMI, and 11% lower 2-h plasma
glucose.
Thus, a daily stepping habit would be beneficial for the
glucose profile, and we suggest that HiSquat exercise would
be clinically useful due to moderately strong stimuli to large
muscles including quadriceps and hamstrings.
In our investigation and speculation, we could estimate
the limitation of this study as follows: 1) The research design
is short of control group, which enables only comparison
between pre- and post- investigation, 2) There are possibly
other confounding factors that made the subjects lead
regular and healthy life in the current intervention, 3) If theintervention should be discontinued, their lifestyle would bepossibly returned back to the original settings, 4) we could
not clarified that only squatting might have decreased thevalue of HbA1c, in this current research design.

Significance of diabetes prevention(from among10 items), 4) end-stage CKD, and 5) COPD.
Category (3) items consist of age, DM, hypertension,
hypercholesterolemia and smoking, indicating that DM is an
important risk factor.
On the other hand, prevention of DM is also importantin anti-aging medicine. In the centenarian study of Keio
University, the past history included hypertension in thelargest portion, and then followed by cataract, bone fracture
and CVD in 302 centenarians living in Tokyo 37). Severe
obesity and severely thin were a few among them. Of course,
the centenarians suffered from a variety of diseases, however,the fewest had DM in their past history. Their DM prevalence
was only 6% which is markedly lower than the average value(about 20%) in those aged 70s and 80s. These findings
indicate that it is very meaningful to prevent DM or control
it strictly in order to achieve healthy longevity which is the
purpose of the anti-aging medicine.
As to preventing glycative degeneration changes in antiaging medicine, exercise therapy in older age people could
be carried out with easy accessibility, low cost, short training
time and feeling for efficacy. From this point, HiSquat would
be an effective useful tool for exercise therapy. Many aged
people tend to have a difficulty to go outside or to use various
equipment due to the aging process. Furthermore, some aged
would lose motivation or activation from incompletion of his
activity, or by comparison of his performance with others.
On the contrary, the aged people would gain a successful
positive emotion from the preparation of attending some
opportunities, the refreshing experience on attendance andthe network with new friends. In the context of primary care,
we should take these merits and weak points into consideration,and then correspond in accordance with each person.

Conclusions

Here, we studied the effect of exercise therapy in thepatients with diabetes mellitus using the exercise equipment(HiSquat). As a result, HbA1c value was significantly
decreased 0.4% in 61 subjects. Our results would provide
fundamental data of exercise therapy for diabetes, and canserve as a reference for the applicable exercise for eachsubject and patient in anti-aging medicine.

Acknowledgement

A summary version of this article was presented at the58th Scientific Meeting of Japan Diabetes Society (Yamaguchi)
in 2015.

Statement of conflict of interest

American College of Sports Medicine (ACSM) has
reported “ACSM’s Guidelines for Exercise Testing and
Prescription, 9th ed” 35, 36), which shows the pre-exercise
checklist for subjects with high risks. The risks are classified
into 5 categories: 1) diagnosed CVD (cardiovascular disease),2) possible CVD. 3) DM and at least one additional item
_ 71 _

Non contributory.

Squat Exercise for Diabetes Using HiSquat

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