Developing a new treatment paradigm for disease prevention and healthy aging

Abstract

An increasingly prevalent pattern of risk factors has emerged in middle-aged and older adults that includes the presence of type 2 diabetes or prediabetes, overweight or obese weight status with central obesity and very high body fat, low cardiorespiratory fitness (CRF), low strength, and a low lean-body-mass-to-body-fat ratio. Traditionally, these problems have been approached with a low-fat and low-calorie diet and with lower to moderate intensity activity such as walking. While the treatment has some clear benefits, this approach may no longer be optimal because it does not reflect more recent findings from nutrition and exercise sciences. Specifically, these fields have gained a greater understanding of the metabolic and functional importance of focusing on reducing body fat and central obesity while maintaining or even increasing lean body mass, a quality weight loss, and how to efficiently and effectively increase CRF and strength. Evidence is presented for shifting the treatment paradigm for disease prevention and healthy aging to include the DASH nutrition pattern but with additional protein, higher intensity, brief aerobic training, effortbased, brief resistance training, and structured physical activity. Recent interventions based on social cognitive theory for initiating and then maintaining health behavior changes show the feasibility and efficacy of the approach we are advocating especially within a multiple health behavior change format and the potential for translating the new treatment paradigm into practice. KEYWORDSDiabetes, Quality weight loss, Treatment paradigm, Multiple health behaviors IMPORTANCE OF THE PROBLEM, USUAL TREATMENT, CHANGING THE TREATMENT PARADIGM A pressing public health problem is the high prevalence of engagement in multiple, poor health behaviors, creating patterns of high risk for morbidity and mortality and contributing to considerable individual and societal financial burden [1,2]. One pattern that is becoming increasingly prevalent is the combination of prediabetes, overweight or obese weight status, central obesity (increased visceral adipose tissue), and low cardiorespiratory fitness (CRF) with gradual loss of lean body mass and strength [3], which further increases the risks for type 2 diabetes (T2D), cardiovascular diseases, and some cancers, disabilities, and premature death [4]. The prevalence of T2D, based on fasting glucose or hemoglobin A1c levels in adults, aged 45-64 years old, is~14 %, and the prevalence of prediabetes for adults >20 years old is~35 % [5]. For adults over 65 years old, the prevalence of T2D is 27 % and the prevalence of prediabetes is~50 % [5]. Overweight, not just obesity weight status, is often comorbid for central obesity (waist circumference (WC) ≥102 cm for men and ≥88 cm for women) [3], which is associated with increased risk of T2D, especially for women [6]. Overweight individuals with large WC's, though at high risk, are often not identified for interventions [6,7]. The normal agerelated loss of lean body mass beginning in m...

Low‐load resistance exercise during inactivity is associated with greater fibre area and satellite cell expression in older skeletal muscle

“…This model resulted in a within‐participant comparison to determine how exercise during step reduction (SR + EX) influences muscle fibre characteristics and SC content compared with a leg that did not perform exercise (SR). The low‐load (30% of maximal strength) and low‐volume (three sets each of leg press and knee extension) exercise was performed to volitional fatigue to minimize the potential for musculoskeletal injuries in this older population yet maximize muscle fibre recruitment, especially of the type II muscle fibres, and muscle protein synthesis . On average, participants completed ~30 repetitions per set for knee extension and ~35 repetitions per set for leg press.…”

“…The low-load (30% of maximal strength) and low-volume (three sets each of leg press and knee extension) exercise was performed to volitional fatigue to minimize the potential for musculoskeletal injuries in this older population yet maximize muscle fibre recruitment, especially of the type II muscle fibres, and muscle protein synthesis. 11,25 On average, participants completed~30 repetitions per set for knee extension and~35 repetitions per set for leg press. Muscle biopsies were taken from the vastus lateralis of both legs immediately after the 14-day step-reduction, which occurred 72 h after the final exercise, bout to determine muscle fibre characteristics and changes in muscle protein synthesis, as described previously.…”

Using response variation to develop more effective, personalized behavioral medicine?: evidence from the Resist Diabetes study

“…The pressing need for lifestyle changes to reduce the costs and burdens of disease risk and premature death [24] amplifies the need for effective, theory-based [15] behavioral intervention and maintenance approaches [25]. While perhaps underappreciated, the alteration of interventions based on individual responsiveness, a critical aspect of these endeavors, is part of our traditions, for example, in behavior therapy and applied behavior analysis [26].…”

“…This approach involves empirically supported multiple behavioral interventions. Given the multiple stimuli appropriate for different conditions and diseases, these interventions may lead to more favorable distributions across key clinical outcome measures [25]. This hypothesis, however, remains one that needs to be tested.…”

Timing and intensity of exercise for glucose control. Reply to Chacko E. [letter]

“…Furthermore, walking exercise alone may not maximally increase, or maintain, cardiovascular fitness and lean muscle mass, the latter of which must be maintained in order to continue walking and physical activity throughout the ageing process. Our point here is simple: although our first goal should be to increase physical activity, we must also provide type 2 diabetic patients with the crucial ammunition needed for battling further disease development and living a healthy, long life [3]. Thus, using exercise to improve glycaemic control in addition to maintaining aerobic fitness and lean body mass (strength) should all be a part of the ‘exercise formula’ prescribed to patients with, or at risk of developing, type 2 diabetes.…”