Aerobic exercise has consistently been shown to improve glucose control 1 — 3enhance insulin sensitivity 245and improve cardiovascular risk factors such as visceral adiposity 2lipid profile 6arterial stiffness 7and endothelial function 8. Although a lifestyle modification of this nature could have substantial impact on the metabolic and cardiovascular health of this population, it is often difficult for those who have been habitually sedentary to adhere to these guidelines, diabetes databases and research.
Unfortunately, it is frequently those who would benefit the most from aerobic exercise that have the greatest difficulty performing it. With the continued increase in the prevalence of type 2 diabetes 11it is evident that alternate forms of physical activity that produce similar metabolic improvements to aerobic exercise may be beneficial in the management of this disease. Resistance training has recently been recognized as a useful therapeutic tool for the treatment of a number of chronic diseases 12 — 19 and has been demonstrated to be safe and efficacious for the elderly 2021 and obese 22 individuals.
Similar to aerobic exercise, resistance training has been reported to enhance insulin sensitivity 23 — 25daily energy expenditure 2627and quality of life 20 Furthermore, resistance training has the potential for increasing muscle strength 132930lean muscle mass 31and bone mineral density 3233which could enhance functional status and glycemic control and assist in the prevention of sarcopenia and osteoporosis.
However, unlike aerobic exercise, such as walking, resistance training is dependent on equipment, knowledge of exercise technique, diabetes databases and research, and often requires some initial instruction. Subsequently, if resistance training is going to be a realistic form of exercise for individuals with type 2 diabetes, diabetes databases and research, research is needed to discover practical, sustainable, and economically viable ways to safely implement resistance training at a population level.
Therefore, the primary aim of this review was to examine the available literature to investigate whether resistance training is an effective form of exercise for managing glucose homeostasis in individuals with type 2 diabetes. Furthermore, a secondary aim was to also consider strategies and areas for future research to assist with the implementation of resistance training at the population level.
Early studies offered preliminary evidence for the beneficial effects of resistance training 45465052 ; however, these studies often had significant methodological limitations. Similarly, Honkola et al. Even though no significant reduction in A1C was observed, the difference in A1C between the exercise and comparison groups pre- to postintervention was significant, primarily due to a 0.
In the first randomized controlled trial RCTDunstan et al. Complementary to these findings, Ishii et al. However, no statistical change in A1C was observed 9. The nonsignificant change in A1C reported in these two studies can likely be explained by the short duration of training used, which may not have allowed the full effect of the intervention diabetes databases and research A1C to occur These earlier studies were supported by two larger RCTs 4043 that investigated the effects of a longer, higher-intensity resistance training intervention.
This finding was observed without any difference between groups for waist circumference or total fat mass. However, the WL-only group tended to lose lean body mass 0. Similar findings were also reported by Castenada et al.
In the resistance training group, A1C was reduced from 8. Systolic blood pressure was also reduced in the resistance training group, but there were no differences in other cardiovascular risk factors such as HDL, LDL, and total cholesterol levels. Body weight remained stable in both groups, diabetes databases and research, but there was a mean increase in lean tissue mass of 1.
Although these findings clearly support the benefits of resistance training for lowering A1C, it should be noted that the mean physical activity levels of those in the resistance training group significantly increased during the study and may have contributed to the promising improvements observed. In another more recent RCT, Baldi et al. There was also a significant 6.
The common finding that increases in skeletal muscle mass are related to decreases in A1C 384046 supports the hypothesis that resistance training improves glycemic control by augmenting the skeletal muscle storage of glucose. Interestingly, insulin sensitivity has been reported to occur without a change in lean body mass 52which suggests that qualitative improvements in skeletal muscle function play a role in the resistance training—induced improvements in insulin sensitivity.
In support of this postulate, Holten et al. In concert, these findings demonstrate improvement in the insulin signaling pathway and in the regulation of insulin-mediated GLUT4 translocation, which would at least partially explain the improved insulin sensitivity with resistance training. As abdominal adiposity has also been linked to diabetes databases and research resistance 5758it is possible that resistance training reduces visceral adiposity and improves insulin sensitivity.
Interestingly, no significant relationship between the improvements in insulin sensitivity and the losses in either visceral or subcutaneous fat were found, diabetes databases and research.
Although care should be taken in interpreting these findings due to the small sample size and uncontrolled study design, it would appear that reductions in visceral and subcutaneous adiposity with resistance training might not be the mechanism responsible for the improved insulin sensitivity with this type of training. Considering the available evidence, it appears that resistance training could be an effective intervention to help improve glycemic control.
Furthermore, the effect of resistance training on A1C reported in the three RCTs 384043 is comparable with that reported with aerobic exercise 1, diabetes databases and research. Indeed, a recent RCT 42 that randomized 43 individuals with type 2 diabetes to either resistance training or aerobic training AT group for 4 months, reported that A1C diabetes databases and research significantly reduced with resistance training 8. Furthermore, fasting blood glucose and insulin resistance were reduced and lipid profile improved with resistance training but not aerobic training.
These findings highlight the potential benefits of resistance training for this population. However, with the substantial evidence that now diabetes databases and research both resistance training and aerobic training for managing glucose homeostasis, it is possible that a combination of the two exercise modalities may be the optimal intervention.
Whether combined resistance and aerobic training would have a synergistic effect on glycemic control in individuals with type 2 diabetes has been addressed by a number of studies 223953 — Data from the same sample in a later publication 54 also showed that combined training enhanced conduit and resistance vessel endothelial function, as demonstrated by improvements in brachial artery flow-mediated dilation and an improvement in the forearm blood flow ratio to acetylcholine.
Although these data 5354 supplied evidence for the beneficial use of combined training, the cross-over design only allowed comparison between combined training and a nonexercising control. In a more recent RCT, Cuff et al. These findings are in contrast to the aforementioned study by Ibanez et al, diabetes databases and research. However, whether this is an effect of the resistance or aerobic training or a combination of the two still needs to be elucidated. More specifically, compared with a nonexercising comparison group, A1C was significantly reduced from 8.
Additionally, fasting blood glucose, LDL cholesterol, and total cholesterol were significantly reduced, while HDL cholesterol was increased.
The findings of this study 39 demonstrate more global improvements in cardiovascular risk factors than has currently been reported in resistance training alone and, in combination with the marked improvement in A1C, highlights the potential benefits of combined training for individuals with type 2 diabetes.
Furthermore, these findings also identify that longer-duration, more moderate resistance training may be as beneficial as short-term high-intensity programs for maintaining glucose homeostasis and reducing cardiovascular risk factors. However, some caution is warranted in interpreting these results, as study participants were allowed to self-select whether they wanted to be in the exercise or nonexercise groups, and Balducci et al.
Although previous studies 2239 have provided evidence for the benefit of combined training versus aerobic training diabetes databases and research a nonexercising control group, it is still unknown whether combined training offers any additional benefits over resistance training alone. The need still exists for a large RCT that examines each training regime separately, and in combination, to provide more definitive evidence in this area, diabetes databases and research.
Recent recommendations in the ADA technical review 9 support the American College of Sports Medicine guidelines 59 that resistance training be included as an essential component of a well-balanced physical activity program for those with type 2 diabetes who do not have contraindications to exercise.
Specifically, the American College of Sports Medicine advocates that resistance training should be performed on at least 2 days per week, with a minimum of 8—10 exercises involving the major muscle groups for 10—15 repetitions to near fatigue, diabetes databases and research.
The American College of Sports Medicine further highlights that increased intensity or additional volume of training could produce greater benefits and may be appropriate for some individuals Similarly, Sigal et al. The primary difference between these two prescriptions is the higher intensity recommended for all individuals by the ADA, which is in light of recent reports suggesting that high-intensity resistance training is both feasible and appropriate for older individuals with type 2 diabetes 9.
The recommendation from the ADA is predominantly based on two RCTs 4043 demonstrating that high-intensity resistance training improves A1C, whereas studies using lower intensities have not found consistent improvements in this parameter 50 As mentioned above, this may be more an issue of study length than exercise intensity.
However, the aforementioned study by Balducci et al. Therefore, there is a need for research that can identify the optimal prescription of diabetes databases and research training to induce benefits in skeletal muscle adaptation and control of glucose homeostasis.
However, current data advocate diabetes databases and research if individuals can be encouraged to make a lifestyle change that incorporates long-term resistance training into their daily routine, then resistance training is likely to be beneficial for improving glycemic control even at more moderate intensities.
It is evident that research is now required that not only documents the benefits of resistance training but also identifies practical and economical ways to implement resistance training at the individual and population levels.
The need for a population-based approach is most apparent when considering the risk to this population if resistance training is not performed. Population attributable risk is the incidence of a disease that is attributable to being exposed to a risk factor i.
Although we currently cannot calculate a true population attributable risk for the risk of not performing resistance training in the diabetic population, we can extrapolate the population attributable risk concept with existing published results to demonstrate the impact of this behavior on reducing diabetes-related complications at the population level. Based on the estimated criterion that a 0. Despite the importance of increasing activity levels in the type 2 diabetic population, there are numerous challenges regarding the feasibility of implementing this form of exercise.
Existing studies use resource-intensive, supervised, diabetes databases and research, one-to-one individual and clinically based approaches, and to date, we are unaware of any that offer practical, sustainable, economically viable strategies to implement diabetes databases and research training as a viable physical activity option.
The following addresses the lack of literature in this area and identifies needed research in this domain. No known research has been conducted on the long-term efficacy, retention, and adherence of resistance training programs in this population, and there is a need for research to examine these questions in both clinical and nonclinical settings. It may be that longer duration, low- to moderate-intensity resistance training programs that utilize diabetes databases and research progression may be more beneficial than shorter, diabetes databases and research, more intensive programs.
There may be inherent difficulties in implementing resistance training programs that normally require diabetes databases and research to unsupervised settings. Future research is also required to guide the success of such programs to ensure the feasibility, safety, and ultimate attitudinal, behavioral, and clinical efficacy of such strategies.
To date, diabetes databases and research is known about the effectiveness or feasibility of home-based training, speciality gymnasiums, diabetes databases and research, community-based education classes and programs, or the combinations of the above, with and without clinical supervision. The only known study in this area 44 diabetes databases and research that after a 6-month supervised gymnasium-based resistance training program, home-based resistance training was effective for maintaining muscle strength but was inadequate for maintaining improvements seen in glycemic control during supervised training Further research is required to understand the types, combinations, temporal sequencing, diabetes databases and research, and feasibility dimensions of such potential approaches.
Furthermore, it would appear that a number of community gymnasiums and public fitness centers may have a significant role to play in providing education and supervision to individuals with type 2 diabetes, diabetes databases and research.
Typically, these centers have focused on young athletic individuals; however, with an aging population and a growing prevalence of type 2 diabetes 11it may be appropriate for these facilities to readdress their target market. There would appear to be a need for specialized trainers and centers that can assist people with type 2 diabetes to incorporate resistance training safely and effectively into their daily routine.
Research examining diabetes databases and research of cialis and kamagra taken together e.
Such approaches are feasible for population-based approaches, as they have the potential to reach a large number of individuals in a relatively cost-effective manner and have shown some success for the general and diabetic populations in the promotion of aerobic physical activity 6264 Further, tailored messages appear to be more efficacious than generic mass education approaches for producing change across various health behaviors, including physical activity, in population studies 66 However, research to date has focused on aerobic exercise, and it cannot be assumed that the results of such approaches are applicable to resistance training, given the technical nature of this behavior.
Research is needed to examine the feasibility and efficacy of such modes of delivery specifically for resistance training in this population. Costs of resistance training programs for both efficacy and effectiveness studies on this population have yet to be determined.
Therefore, there is an imperative need to conduct cost-effectiveness analyses on intervention strategies, comparing the incremental direct costs of the interventions relative to the incremental gain in physical activity achieved within the program period.
Costs must also be examined at the individual e. There is a need for theoretically driven approaches. Indeed, approaches that incorporate social-cognitive theories are shown to be more efficacious than atheoretical-based interventions in the general population Theoretical models need to be tested in populations with type 2 diabetes to identify factors that can be operationalized to achieve behavior change 69 Identifying constructs and theories that can be used to increase the degree of behavior change in diabetic populations will enable interventions to be tailored more effectively and ultimately increase treatment efficacy for lifestyle behavioral change 66 Although recent studies provide some initial support for the application of social-cognitive theories among this population i.
However, diabetes databases and research, diabetes databases and research is worth noting that social-cognitive theories have only been applied for the promotion of aerobic-type activities; no study to date has assessed the determinants of resistance training in this population. Indeed, there appears to be only one published study 73 that has explored resistance training correlates in a sample of healthy older individuals.
It is crucial that the predictors of this behavior are understood so that they may be appropriately tailored in subsequent interventions For example, perceived barriers, attitudes, and confidence toward an aerobic activity, such as walking, may be very different for resistance cancer and types.