aerobic and resistance training effects compared to aerobic training alone in obese type 2 diabetic...

8/11/2019 Aerobic and Resistance Training Effects Compared to Aerobic Training Alone in Obese Type 2 Diabetic Patients on

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1.

Introduction

Aerobic exercise has shown many positive effects on insulin

sensitivity and glucose homeostasis [1]. A chronic aerobic

training (AT), even without changes in body composition,

improves

insulin

sensitivity

up

to

30%

both

in

impaired

glucose tolerant (IGT) and type 2 diabetic patients [1]. Exerciseintervention in adultswith type 2 diabetes induces amean fall

in HbA1c percentage of 0.74 compared with control group,

independently

to

body

weight

change

[2]. In

addition

it

promotes

mobilization

of

visceral

adipose

tissue

so

reducing

insulin resistance [3]. AT improves as well some cardiovascu-

lar risk factors such as hypertension, dyslipidemia and

fibrinolytic

activity

[4]. According

to

these

benefits

daily

AT

was listed in guidelines for exercise in type 2 diabetes [5].

Resistance

training

(RT)

shows

potential

benefits

in

rehabilitation,

thanks

to

its

ability

in

avoiding

disease-related

muscle wasting. Further, muscle contraction increases glu-

cose uptake and improves insulin sensitivity in skeletal

muscle thereby providing a rationale for its use in diseaselike

type

2

diabetes

[6,7].

RT

enhances

muscular

strength

and

changes in body composition by increasing lean body mass

and decreasing visceral and total body fat [8]. In particular,

light

to

moderate

loads

(4060%

of

1

RM)

are

recommended

for

local

muscular

endurance

training

performed

at

high

repeti-

tion

using

short

resting

period

(


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that

performed

by

aerobic

training

group

followed

by

a

resistance training session consisting in 9 resistance exercise

for 15 min: 5 exercises for the upper part of the body (arm

curls, military press, push-ups, upright rowing, back exten-

sion) and 4 exercises for the lower part of the body (squats,

knee extensions,heel raisesandbent knee sit-ups).Resistance

loads

were

4050%

of

one

repetition

maximum

testing

(1RM)

performedat baselineand at the end of the study.The subjectsperformed 10 repetitions per set for all upper body exercises

and 20 repetitions per set for lower body exercises. One set for

each

exercise

was

performed,

at

a

moderate

contraction

velocity

(2

s

concentric,

2

s

eccentric).

The

resting

interval

between sets was


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performance in terms of meters walked at final walking test,comparedwithAT,ART group showed a concomitant increase

inmean basalbloodpressure, knownas the resultofheart rate

and peripheral resistance interaction. This finding is of

particular interest in order to better investigate the hemody-

namic

effects

that

follow

the

association

of

resistance

to

aerobic

exercise.

In the present study leptin to adiponectin ratio, a novelpro-

atherosclerotic index, was halved after 21 days of AT as a

consequence

of

the

marked

increase

in

adiponectin

levels

while

in

ART

group

L/A

ratio

significantly

increased

mainly

since, in this group, adiponectin levels did not change.

Accordingly, in a recent study, Fernandez-Real et al. did not

found significant changes in adiponectin levels in obese

women after diet plus resistance training [35]. A possibleexplanation of the differences between AT and ART trainings

on adiponectin levels could be related to the fact that TNF-a

were higher in ART than in AT and it was demonstrated that

TNF-a down-regulates adiponectin levels in vivo [36].

AT

determined

also

a

significant

improvement

in

pro-

inflammatory

markers

consisting

in

about

20%

reduction

in

TNF-a, and MMP-2 and 10% reduction in MCP-1 levels in

agreement with previous studies. In particular, recently

Balducci

et

al.

showed

that

an

intensive

physical

intervention

comprehensive

of

aerobic

and

resistance

training

was

able

to

improve inflammatorymarkers irrespective ofweight loss in a

population of type 2 diabetic patients with metabolic

syndrome [37]. In line with our data, Reed et al. demonstrated

Fig.

2

Leptin

(A),

adiponectin

(B),

resistin

(C),

TNF-a (D), MCP-1 (E) and MMP-2 (F)before and after 21 days of AT (left) or ART

(right)

in

obese

type

2

diabetic

patients.

Data

are

presented

as

MeanW SD. *p


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that weight loss after 4-month moderate to vigorous aerobicexercise training (4 times perweek) and caloric restriction (20

35%

of

the

estimated

baseline

energy

needs)

was

effective

in

reducing inflammatory markers [38]. Surprisingly, the addi-

tion of resistance to aerobic exercise did not further improve

inflammation and on the contrary, induced a significant

increment in inflammation. Contradictory results were found

comparing resistance exercise and inflammatory mediators.

In

fact,

although

previous

studies,

investigating

of

inflamma-

tory

mediators

changes

after

resistance

exercise,

found

a

slight increase in these indices [39], Kohut et al. showed that

only cardiovascular but not flexibility/strength exercise

showed

positive

effects

over

serum

IL-6,

IL-18

and

CRP

levels

[40]. In our study, several factors like exercise intensity,different duration of ART than AT time of exercise and

frequency or adaptation to exercise may have influenced the

extent to which serum inflammatory markers was altered in

the two groups. In particular, short recovery periods between

resistance

exercises

may impair

specific

anabolic

processes

for

up

to

48

h

after

exercise

and

generate

an

acute

inflamma-

tory response [41].

A possible limitation of the present study is the short

duration

of

treatment

(3

weeks)

since

previous

studies

evaluating

the

effect

of

resistance

training

alone

over

metabolic parameters for longer period showed a positive

effect in terms of glucose, insulin sensitivity, blood pressure

control and free fat mass preservation in type 2 diabetic

patients [42,43]. This might have influenced the lack ofadditional beneficial effects of ART than AT alone in our

group

of

obese,

type

2

diabetic

patients.

Further,

training

modality may have influenced our results and more studies

with longer follow-up are needed to better investigate clinical

benefits of training modalities (inclusive of frequency, dura-

tion and volume) in the same class of patients [44].

Due to our short (3 weeks) study design in hospitalized

patients, we

are not able to

rule

out

the

specific contribution

of

diet

alone on

amelioration

of

insulin

sensitivity

and

inflammatory markers and the lack of a personalized dietary

restrictionmighthaveinfluenced thefinalresults,as negative

energy

balance

could

have been

higher

for certain

patients

withhighBMI compared to otherswith lowerBMI. However, itis known that hypocaloric diet alone resulted in specific

reduction of inflammatory markers and improvement in

metabolic measurements [45]. In addition, recently it has

been published data suggesting that caloric restriction can

influence

protein

metabolism and FFM

maintenance

irre-

spective of

obesity

level [46]. Conversely, in

our opinion,

the

strength of the present study was that all patients were

hospitalized and study was conducted in highly controlled

condition

both for the

diet

treatment

and for exercise

training.

In conclusion, 3 weeks of high frequency AT alone have

beneficial effects on insulin sensitivity, endothelial function,

and adipokine releasewhile 3weeks ofhigh frequency ART on

Fig.

3

Mean

blood

pressure

at

the

end

of

the

walking

test

(A),

ET-1

incremental

area

(B),

TNF-alpha

incremental

area

(C),

NOx

incremetal

area

(D),

during

walking

test

before

and

after

21

days

of

AT

(left)

or

ART

(right)

in

obese

type

2

diabetic

patients.

Data

are

presented

as

Mean W SD. *p


8/9

sequential

day,

even

if

similarly

improved

body

weight

loss

as

high frequency AT alone, exerted less positive effects on

insulin sensitivity, additionally having an adverse effect on

endothelial function, hemodynamic balance with a greater

pro-inflammatory response in obese type 2 diabetic patients.

In clinical perspective, even if ART remains an important

tool

in

the

therapy

of

obese

type

2

diabetic

patients,

duration

and mostly frequency of ART may adversely impact itsbeneficial effects inducing a more pro-inflammatory pathway,

especially in a population of sedentary, severely obese,

diabetic

patient

at

the

beginning

of

a

physical

activity

program.

The

negative

results

of

combined

ART

exercise

on

sequentialdaysachieved in the present study strongly support

ACSM/ADA Guidelines suggesting that such patients should

exercise

on

alternate

days.

Acknowledgment

The excellent technical support of Ms. Sabrina Costa and

Barbara Fontana is gratefully acknowledged.

Conflict

of

interest

There

are

no

conflicts

of

interest.

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aerobic and resistance training effects compared to aerobic training alone in obese type 2 diabetic...

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