Home-Based Resistance Training Is Not Sufficient to Maintain Improved Glycemic Control Following Supervised Training in Older Individuals With Type 2 Diabetes

Abstract

OBJECTIVE -To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training.RESEARCH DESIGN AND METHODS -We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60 -80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA 1c ), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months.RESULTS -Compared with the WL group, HbA 1c decreased significantly more in the RT&WL group (Ϫ0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P Ͻ 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P ϭ 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P Ͻ 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months.CONCLUSIONS -In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control. Diabetes Care 28:3-9, 2005P hysical activity recommendations for older patients with type 2 diabetes have traditionally focused on aerobic-based activities such as walking programs. However, resistance or strength training has been considered a viable alternative to aerobic exercise because of its effectiveness in improving muscular strength and its role in the prevention of age-related sarcopenia (1). Recently, we have reported improved HbA 1c in sedentary, overweight, older men and women (60 -80 years of age) with type 2 diabetes after 6 months of supervised progressive resistance training (2). Other controlled trials have also demonstrated improved glycemic control in patients with type 2 diabetes after supervised resistance training for 2-4 months (3,4).Although these findings support the use of resistance training for the management of glycemic control in older adults with type 2 diabetes, it is unclear whether improved glycemic control can be maintained after supervised exercise is withdrawn. Most trials have used supervised exercise sessions in laborator...

Multicomponent, home-based resistance training for obese adults with type 2 diabetes: a randomized controlled trial

“…Of the two previous studies 10,11 that have investigated the benefits of home-based RT in patients with type 2 diabetes, both used dumbbells and/or ankle weights to provide the training stimulus. This type of equipment makes it difficult to perform moderate-to highintensity RT using multijoint, large muscle exercises and may explain why these studies reported that home-based training was insufficient to further increase strength or maintain improvements in A1C following a period of supervised laboratory-based RT.…”

“…To the best of our knowledge, only two studies have examined the effectiveness of performing RT with the type 2 diabetes population in a home-based setting, 10,11 and both used home-/community-based RT to try and maintain improvements in glycemic control after an initial laboratory-supervised RT program. In both studies, home-based training was ineffective for maintaining the improvements in glycemic control and insulin sensitivity observed with the more rigorous laboratory-based program.…”

Physical Activity/Exercise and Type 2 Diabetes

“…In both studies, the average age of participants was 66 years, and the resistance-training regimen involved multiple exercises at high intensity (three sets, three times per week), and absolute A1C declined 1.1-1.2% in resistance-training subjects versus no significant change in control subjects. One of these trials had a second phase (months 7-12), where training was home based rather than facility based (34). Body composition changes were maintained, but exercise intensity and adherence were lower than in the first 6 months and the A1C difference between groups became statistically nonsignificant.…”

The effect of high-intensity progressive resistance training on adiposity in children: a randomized controlled trial

“…11 High intensity resistance training may provide equal or greater metabolic benefit than other forms of exercises. 14 Virtually no study of isolated low intensity PRT shows change in adiposity or improved insulin sensitivity, 15 whereas high-intensity PRT has been shown to reduce visceral fat, 5 glucose control and insulin resistance 6,7 in obese and diabetic adults. 16 Position statements from numerous national organizations now advocate the use of supervised resistance training with children and adolescents.…”