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Strength Training or Aerobic Exercise,

Which Is Best for Preventing Diabetes and Cognitive Decline?

Not too many years ago strength training was considered superficial and cosmetic, while aerobic exercise was the ticket to fitness and health. Dr. Kenneth Cooper, in his blockbuster book Aerobics (published in 1968), wrote that lifting weights was akin to putting a beautiful coat of paint on an automobile badly in need of an engine overhaul. Dr. Cooper has since moderated his views, but that was mainstream thinking among coaches and medical professionals for many years. A quick scan of the “Strength Training” category on this website will show how things have changed; weight training is now recommended for everything from arthritis to aging and heart disease. Athletes in every sport now lift weights to assist their performance.

We now have studies comparing the relative benefits of resistance training and aerobic exercise. Two of the latest deal with diabetes and mental function.

Researchers from the Harvard School of Public Health and the University of Southern Denmark followed 32,002 health professionals for 18 years; 2,278 developed type 2 diabetes during the study. Weekly time spent weight training or doing aerobic exercise was obtained from questionnaires at the beginning of the study and every other year thereafter. The findings were reported online August 6, 2012, in the Archives of Internal Medicine.  

The results were ground breaking. “Whereas the evidence that regular aerobic exercise can prevent type 2 diabetes (T2DM) is compelling, no studies have examined the role of weight training in the primary prevention of T2DM,” the researchers wrote in introducing the study. They were particularly interested in finding out whether weight training alone can prevent diabetes. They also wanted to know the combined benefits of the two forms of exercise.

Primary prevention means preventing subjects from developing diabetes. An earlier study of people who already had type 2 diabetes found that a combination of aerobic exercise and resistance training was associated with reductions in long-term blood sugar concentrations; see article 287 in our Strength Training category. The new study looked at which form of exercise does the best job of warding off diabetes.

What they found is good news for health-conscious people and their doctors. We have options.

Lead researcher Anders Grontved, senior researcher Frank Hu and their colleagues found that engaging in weight training or aerobic exercise for at least 150 minutes a week was independently associated with a lower risk of T2DM. Weight training reduced the risk by 34%, while aerobic exercise reduced risk by 54%.

Significantly, men who did both aerobic exercise and weight training for at least 150 minutes per week—30 minutes a day, five times a week would do it—had the greatest reduction in T2DM risk. Splitting at least 150 minutes a week between the two forms of exercise reduced risk by a whopping 59%.

“Weight training was associated with significantly lower risk of type 2 diabetes, independently of aerobic exercise,” the researchers concluded. “Combining weight training and aerobic exercise conferred a greater benefit.”

The strengths of the Grontved study are the large sample size and the long follow-up period. The weakness is that no information was collected on the importance of the type and intensity of weight training. We are making progress in the war against diabetes, but more research is needed on the form or forms of weight training that do the best job of preventing diabetes—a disease on the rise everywhere.   

Let’s move on to the second study. It’s more good news for strength training.

Teresa Liu-Ambrose, PT, PhD, and her colleagues at the University of British Columbia are in the forefront of investigating the effect of resistance training on brain function (see articles 260 and 318 in our “Strength Training” category). Their latest study was published April 23, 2012, in the Archives of Internal Medicine. “Exercise is a promising strategy for combating cognitive decline,” said Liu-Ambrose. Previous studies have found that both aerobic exercise and resistance training improve cognitive function in people with mild cognitive impairment. But no study has compared the effectiveness of the two forms of training, according to Liu-Ambrose and her colleagues.

Cognitive decline is a pressing problem worldwide, Liu-Ambrose et al tell us in introducing their study. A new case of dementia is detected every 7 seconds. Importantly, mild cognitive decline frequently leads to full-blown dementia. Successful intervention to alter the trajectory of decline would be a major achievement.

Liu-Ambrose and her team divided 86 women (ages 70 to 80) with mild cognitive decline into three groups. One group trained twice a week with machines and free weights; the second group did aerobic exercise consisting of an outdoor walking program. The third group served as a control, doing only balancing and stretching.

Mental function was measured at the beginning of the study using standard tests of decision making ability and executive function. Secondarily, they examined the effects of both types of exercise on associative memory, everyday problem solving ability, patterns of brain plasticity (change), and physical fitness.

After six months of exercise, the aerobic exercise group became more fit and improved balance, but saw no cognitive benefits (see explanation below). The resistance training group, however, significantly improved on tests of selective attention/conflict resolution, and associative memory. (Impaired associative memory is a hallmark of early stages of Alzheimer’s disease.)

(Noting that previous studies have demonstrated that six months of aerobic training (AT) improves cognitive function in older women, the Liu-Ambrose team suggested that differences in frequency and intensity may account for the opposite result in their study. They also observed that their study participants were older and had lower mental state scores. The benefits of resistance training may simply be more potent than AT for those at greater risk for dementia.)

What’s more, the researchers were able to actually see functional changes taking place in the brains of the women.

In MRI scans of 22 participants (7 or 8 from each group), those in the lifting group showed significant changes in “regional patterns of functional brain plasticity.” Significantly, the areas of the brain that showed functional change are associated with cognition and memory.

“We provide novel evidence that resistance training (RT) can benefit multiple domains in those at risk for dementia,” Liu-Ambrose and colleagues concluded. “Our study suggests that twice-weekly RT is a promising strategy to alter the trajectory of cognitive decline in seniors with mild cognitive impairment.”  

Cosmetic? I don’t think so.

Chalk up another win for strength training!

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