Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial.

Autor: Kobayashi Y; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. yukariko@stanford.edu.; Stanford Cardiovascular Institute, Stanford, CA, USA. yukariko@stanford.edu., Long J; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA., Dan S; Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA., Johannsen NM; Pennington Biomedical Research Center, Baton Rouge, LA, USA.; Louisiana State University, Baton Rouge, LA, USA., Talamoa R; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA., Raghuram S; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA., Chung S; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA., Kent K; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA., Basina M; Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, USA., Lamendola C; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA., Haddad F; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.; Stanford Cardiovascular Institute, Stanford, CA, USA., Leonard MB; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA., Church TS; Pennington Biomedical Research Center, Baton Rouge, LA, USA.; Louisiana State University, Baton Rouge, LA, USA.; Wondr Health, Dallas, TX, USA., Palaniappan L; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Jazyk: angličtina
Zdroj: Diabetologia [Diabetologia] 2023 Oct; Vol. 66 (10), pp. 1897-1907. Date of Electronic Publication: 2023 Jul 26.
DOI: 10.1007/s00125-023-05958-9
Abstrakt: Aims/hypothesis: Type 2 diabetes in people in the healthy weight BMI category (<25 kg/m 2 ), herein defined as 'normal-weight type 2 diabetes', is associated with sarcopenia (low muscle mass). Given this unique body composition, the optimal exercise regimen for this population is unknown.
Methods: We conducted a parallel-group RCT in individuals with type 2 diabetes (age 18-80 years, HbA 1c 47.5-118.56 mmol/mol [6.5-13.0%]) and BMI <25 kg/m 2 ). Participants were recruited in outpatient clinics or through advertisements and randomly assigned to a 9 month exercise programme of strength training alone (ST), aerobic training alone (AER) or both interventions combined (COMB). We used stratified block randomisation with a randomly selected block size. Researchers and caregivers were blinded to participants' treatment group; however, participants themselves were not. Exercise interventions were conducted at community-based fitness centres. The primary outcome was absolute change in HbA 1c level within and across the three groups at 3, 6 and 9 months. Secondary outcomes included changes in body composition at 9 months. Per adherence to recommended exercise protocol (PP) analysis included participants who completed at least 50% of the sessions.
Results: Among 186 individuals (ST, n=63; AER, n=58; COMB, n=65) analysed, the median (IQR) age was 59 (53-66) years, 60% were men and 83% were Asian. The mean (SD) HbA 1c level at baseline was 59.6 (13.1) mmol/mol (7.6% [1.2%]). In intention-to-treat analysis, the ST group showed a significant decrease in HbA 1c levels (mean [95% CI] -0.44 percentage points [-0.78, -0.12], p=0.002), while no significant change was observed in either the COMB group (-0.35 percentage points, p=0.13) or the AER group (-0.24 percentage points, p=0.10). The ST group had a greater improvement in HbA 1c levels than the AER group (p=0.01). Appendicular lean mass relative to fat mass increased only in the ST group (p=0.0008), which was an independent predictor of HbA 1c change (beta coefficient -7.16, p=0.01). Similar results were observed in PP analysis. Only one adverse event, in the COMB group, was considered to be possibly associated with the exercise intervention.
Conclusions/interpretation: In normal-weight type 2 diabetes, strength training was superior to aerobic training alone, while no significant difference was observed between strength training and combination training for HbA 1c reduction. Increased lean mass relative to decreased fat mass was an independent predictor of reduction in HbA 1c level.
Trial Registration: ClinicalTrials.gov NCT02448498.
Funding: This study was funded by the National Institutes of Health (NIH; R01DK081371).
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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