Background to the STRONG study
Active lifestyle - a key weapon in the fight against the diabetes epidemic
Regular physical activity, together with diet is the cornerstone of diabetes management. Traditionally, aerobic (endurance) exercise training has been promoted as the most suitable type of exercise for people with type 2 diabetes. This is most likely due to the majority of research trials using aerobic training programs to see weight loss, improved glycaemic control and improved cardiovascular fitness among participants.
However, we have recently demonstrated that resistance exercise (strength training) may also be highly beneficial for improving glycaemic control in people with type 2 diabetes. In a study among older adults with type 2 diabetes, the decline in HbA1c after 6 months was significantly greater among people who had been performing strength training compared to the control group. This result is similar, and in some cases greater than the changes that have been seen among people with type 2 diabetes following an aerobic training program.
The American Diabetes Association and the American College of Sports Medicine recommend that patients with type 2 diabetes perform both aerobic and resistance exercise. This is because both may influence insulin sensitivity through different mechanisms in the skeletal muscle. Aerobic training increases cardiovascular fitness, while resistance training increases muscle mass and muscle strength.
Muscle is an important regulator of glucose metabolism. Therefore the more muscle you have, the greater the amount of glucose needed to keep them running, which may lead to greater uptake of glucose from the blood.
Since advancing age is associated with declines in muscle mass and muscle strength, and that these may be further intensified by having type 2 diabetes, the uptake of resistance exercise may hold significant health benefits for the older person with type 2 diabetes.
Strength training program adherence and maintenance
The two biggest challenges encountered when trying to promote physical activity is to support and encourage people to adopt and maintain such a lifestyle. Long-term adherence will bring the best health outcomes, particularly glycaemic control.
Previous research has shown that in a supervised setting, adherence to a 6 month strength training program was excellent. However when the participants were no longer supervised and were performing the strength training at home, there was a significant reduction in adherence. Participants who showed poor adherence also showed poor improvements in glycemic control.
This clearly shows the need to assist people with type 2 diabetes begin and maintain their strength training program so they can reap the benefits.
REFERENCES
- Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH: Physical activity/exercise and diabetes. Diabetes Care 27 Suppl 1:S58-62, 2004
- Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycaemic control and body mass in type 2 diabetes mellitus. A meta-analysis of controlled clinical trials. Journal of The American Medical Association 286:1218-1227, 2001
- Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P: High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 25:1729-1736, 2002
- Dunstan DW, Daly RM, Owen N, Jolley D, Vulikh E, Shaw J, Zimmet P: Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care 28:3-9, 2005
- Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS: American College of Sports Medicine position stand. Exercise and type 2 diabetes. Medicine and Science in Sports and Exercise 32:1345-1360, 2000
- Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 27:2518-2539, 2004
- Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD: Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 29:1433-1438, 2006
- De Rekeneire N, Resnick HE, Schwartz AV, Shorr RI, Kuller LH, Simonsick EM, Vellas B, Harris TB: Diabetes is associated with subclinical functional limitation in nondisabled older individuals: the Health, Aging, and Body Composition study. Diabetes Care 26:3257-3263, 2003
- Dunstan DW, Vulikh E, Owen N, Jolley D, Shaw J, Zimmet P: Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes. Diabetes Care 29:2586-2591, 2006
