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“We can now look individuals with diabetes right in the face and tell them, ‘This is the best exercise prescription for you.’” Timothy S. Church, MD, MPH, PhD (NY Times, November 24, 2010)
Combination—Weights and Aerobics—Best for Diabetics
I’ve been doing both weights and aerobics practically forever. I began lifting at about 13, and Carol and I were running and biking before we were married. So I’m always interested in studies that show the benefits of the dual approach, especially for management of a disease such as adult-onset diabetes, which has become so widespread it is now being seen in an alarming number of children.
My father developed diabetes late in life, and Dr. Arnie Jensen told me on my first visit to the Cooper Clinic (1988) that I am probably predisposed to follow in his footsteps. “With your family history,” Jensen told me, “it would be my guess that you’d probably develop adult-onset diabetes if you weren’t lean, fit and on an excellent diet." All things considered, he said I shouldn’t have any problems. (He was right. My blood sugar (glucose) has been tested many times since then and has always been normal.)
Arnie said at the time, “I believe you’ve got to have balance in your training regimen, but it’s pretty hard to get people to believe that…What we need to do is get the word out that weight or resistance training, done properly, along with aerobic exercise, can give you tremendous fitness [and health].”
Surprisingly, it’s only now being established that a balanced approach works best for diabetics. Exercise is commonly recommended for people with diabetes, but the best type of exercise has not been well studied.
The new study, reported in the November 24, 2010 issue of the Journal of the American Medical Association, clarifies the issue.
Landmark Study
A team of researchers led by Dr. Timothy S. Church, director of preventive medicine research at the Pennington Biomedical Center at Louisiana State University in Baton Rouge, recruited 262 sedentary men and women with type 2 diabetes for a nine month trial. Average age of the participants was 56 years and duration of diabetes was 7.1 years.
They assigned 73 volunteers to resistance training, 72 to aerobic exercise, and 76 to a combination of the two forms of exercise. The remaining 41 participants served as controls, doing no exercise.
The resistance-training group lifted three times a week; each session consisted of two sets of four upper-body exercises, three sets of three leg exercises, and two sets of abdominal crunches and back extensions. Weight machines were used where appropriate.
The aerobics group did about 150 minutes a week of moderately paced walking on a treadmill.
The combination group did two resistance-training sessions a week consisting of one set each of the above exercises, and walked proportionately less than the aerobic only group.
The exercise regiments were planned so that all three groups spent about the same amount of time exercising each week.
The primary end point of the study was change in HbA1C level, a marker of long-term blood sugar concentration. Unlike a fasting blood glucose test, HbA1C level indicates how well blood sugar has been controlled over the past eight to 12 weeks.
HbA1C is a component of hemoglobin (a substance in red blood cells that carries oxygen and carbon dioxide), which binds to glucose (blood sugar). HbA1C builds up when blood sugar stays elevated.
HbA1C level is expressed as a percentage. At the start of the study participants averaged 7.7 percent. Levels under 6% are considered normal. Small reductions in HbA1C can make a big difference in risk level.
At the end of the nine-month trial, the combination group had lowered their HbA1C levels by 0.34 percent compared to the control group. The aerobics group and the resistance group also went down, by 0.24 percent and 0.16 percent, respectively. Only the change in the combination group was considered statistically significant.
The combination group also saw a lowering in the amount of diabetes medication needed on average. Importantly, the follow-up difference in HbA1C occurred even though the control group had increased its use of diabetes medication, while the combination training group decreased its usage. The combination group was also the only group to lose both fat and weight.
“The primary finding from this randomized, controlled exercise trial involving individuals with type 2 diabetes is that although both resistance and aerobic training provide benefits, only the combination of the two was associated with reductions in HbA1C levels,” the researchers wrote.
Commentary/Explanation
The researchers believe this is the first randomized trail involving people with type 2 diabetes to directly test the benefits of aerobic exercise combined with two days of resistance training (as prescribed by the 2008 Physical Activity Guidelines).
“From the health perspective, the combination exercise program really outshined the others,” Dr. Church told reporters. “We really thought that the walking and the combination group would be similar, but the combination group was the only group that had significant improvement.”
“For individuals with diabetes, the optimal program involves aerobic and resistance training,” Church continued. “The biggest consumer of blood sugar is skeletal muscle, and anything you do to improve the health of your muscles will help control your use of blood sugar,” Church explained.
It’s telling—but not surprising—that only the combination group lost weight. (The resistance group apparently offset fat loss with muscle gain. The aerobic group likely compensated by eating more.)
The resistance-only group did lose some fat mass (3 lbs.), but the combination group lost the most fat—about 4 pounds. Walking burns fat and sugar, but resistance training maximizes the metabolic effect around the clock.
What’s more, only the combination group improved maximum oxygen consumption.
At least for type 2 diabetics, it takes both weights and aerobics to maximize fat loss and fitness.
Dr. Church believes that those with type 1 diabetes would also benefit from combination exercise. People without diabetes would benefit as well, he adds.
Advocates of resistance-only or aerobic-only training take note.
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