Slide 1Strength Training and DiabetesStrength Training and DiabetesStrength Training and DiabetesStrength Training and DiabetesStrength Training and DiabetesHIT and DiabetesHIT and DiabetesHIT and DiabetesStrength Training and DiabetesSlide 11Finnish DPP Tuomilehto et al. (2001) Study DesignGroup DetailsDid the intervention group meet its goals?Did the intervention lower T2D development?Study ResultsSlide 17Diabetes prevention program (DPP)Slide 19Slide 20Slide 21Lifestyle vs. medicationLifestyle vs. medicationImportant PointsDiabetes & Exercise SummaryReview of Evidence:Experimental Studies (continued)Prospective StudiesStrength Training2 MAJOR Diabetes StudiesLecture 3 Fall 2017Strength Training and Diabetes•Men with abnormal glucose tolerance•20 weeks of AT, ST or no exercise (3d/wk)– 2 sets, multiple exercise, 90 sec rest max– 12-15 RM –75-85 % VO2 max •OGTT to determine glucose metabolism changesSmutok, et al 1994Glucose AUC15000BL Final*Insulin AUC900000BL Final*OGTT results:ST lowered plasma glucose levels at 60, 90, 120 min after glucose ingestionST lowered plasma insulin levels at rest (0), 90, 120 minStrength Training and Diabetes•ST improved glucose metabolism•8 subjects with impaired glucose tolerance•All normalized their glucose tolerance with strength training•Results were the same for ST and ATSmutok, et al 1994Strength Training and Diabetes•All patients were 50-70 years old•22 (11 men, 11 women) type II diabetes patients for strength training•17 (9 men, 8 women) type II diabetes patients for endurance training•4 months of training–ET: 3x/wk, 60% VO2max, 15 min to 30 min (increased 5’/wk every 4 wk) cycle–ST: 3x/wk, 1 set 10-15 reps (to fatigue) up to 2 sets 10-15 reps (3rd week) (6 sets/week/muscle group)Cauza, et al 2005Strength Training and DiabetesStrength Training and Diabetesfasting not OGTT!AIC Criteria:Prediabetes = 5.7-6.4%Diabetes > 6.5%Cauza, et al, 2005Diabetes meds were reduced by 12% in ST groupHIT and Diabetes•Gillen, et al 2012–T2DM patients (n=7; sedentary, n=6; on meds, n=6 )•62yrs, BMI 30.5kg/m^2–Exercise – Low Volume HIT•10x60s cycle effort – 1 time•60S rest•constant cadence 80-100rpm•85% max HR•3min warm up (50W) •2 min cool down (50W)HIT and DiabetesTime in hyperglycemia 3h postprandialTime spent above 10 mmol/ l was lower after hitHIT and DiabetesStrength Training and DiabetesMost studies show a benefit in those with impaired glucose metabolism and diabetes. In some cases (IGT), exercise can normalize glucose toleranceST can reduce medications1 sessions of HIT can reduce time in hyperglycemiaTwo Major Diabetes StudiesFinnish Diabetes Prevention StudyDiabetes Prevention ProgramFinnish DPPTuomilehto et al. (2001) Study Design•Subjects–40-65 years of age (N=522)–BMI > 25 kg/m2–With impaired glucose tolerance•Random assignment to control and intervention groupsGroup Details•Control Group–Given oral and written information about diet and exercise at baseline and yearly visits•Intervention Group–Given detailed goals, individual and group sessions•Reduce body weight by > 5%•Reduce fat intake to < 30% of calories•Reduce saturated fat intake to < 10% of calories•Increase fiber intake•Moderate exercise > 30 minutes per day•Hypothesis–Lifestyle changes will prevent the development of T2D in subjects with impaired glucose tolerance•Outcome assessed by baseline and annual OGTTsDid the intervention group meet its goals?Did the intervention lower T2D development?Study Results1) incidence of T2DM was half in the intervention group compared with controls2) no cases of T2DM in people who had 4 of the positive lifestyle goals3) those that did not lose 5% weight but exercised 4hr/wk had 80% lower incidence of T2DM compared with sedentary peopleLifestyle vs. MedicationDiabetes prevention program (DPP) N Engl J Med, Vol. 346, No. 6, 2002Outcome: Incidence of diabetes –Three randomized groups (3200 participants)•Control group–Placebo and standard recommendations»Written information and one meeting explaining benefits of a healthy lifestyle•Medication group: Metformin and standard recommendations»Increase uptake of glucose in liver from blood »Suppress liver glucose production•Lifestyle modification group–Diet and physical activityDiabetes prevention program (DPP) •Lifestyle modification group–Goal: Maintain a 7% weight loss from baseline weight•16- lesson curriculum taught in the first 24 weeks–One on one sessions•Monthly sessions thereafter–Diet•Low calorie, low fat diet–Physical activity •Moderate intensity activity for at least 150 min/week–4 yr follow upLifestyle vs. medicationYearsLifestyle vs. medicationYearsLifestyle vs. medicationLifestyle vs. medication•Similar results:–Gender–Race•Lifestyle modification: similar effect as in Finland study (Tuomilehto et al.)•Both lifestyle and medication reduce incidence of diabetes–Lifestyle has a greater beneficial effect than medicationsImportant Points•Impaired Glucose Tolerance (IGT)–a state indicative of prediabetes–diagnosed with an OGTT–rises between 140-199mg/dl•Impaired fasting glucose (IFG)–a state indicative of prediabetes–diagnosed with a fasting plasma glucose test–between 100-126mg/dl•Insulin Resistance (IR)–a state where muscle, fat and liver do not respond appropriately to insulin–healthcare providers do not usually test for IR–if lab tests show prediabetes then IR is likely present–euglycemic clampDiabetes & Exercise Summary 1) Physical activity can decrease the risk of developing NIDDM (Helmrich, NHS, Tumolehto)–adding other lifestyle changes can help–lifestyle changes may be better than medications (DPP)2) BMI appears to be more predictive of NIDDM risk than EE–but PA can influence BMI and therefore NIDDM risk3) Mortality from NIDDM can be reduced with PA, regardless of BMI4) Exercise (and inactivity) modulate the OGTT response–changes happen rapidly–can be improved in patients with NIDDM–includes strength training!!–In combination with weight reduction, may be MORE beneficial than