Skip to main content
SpringerLink
Log in

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

  • Published:
AGE Aims and scope Submit manuscript

Abstract

In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abdelhafiz AH, Sinclair AJ (2011) Management of type 2 diabetes in older people. Diabetes Therapy: Re, Treat Educ Diabetes Relat Disord 2013; 4: 13-26.

  • ADA (2011) Standards of medical care in diabetes. Diabetes Care 34:11–61

    Google Scholar 

  • Asa C, Maria S, Katharina SS, Bert A (2012) Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evid Based Complement Alternat Med 2012:349209. doi:10.1155/2012/349209.

    Article  PubMed Central  PubMed  Google Scholar 

  • Asano RY, Sales MM, Browne RA, Moraes JF, Coelho Júnior HJ, Moraes MR, Simões HG (2014) Acute effects of physical exercise in type 2 diabetes: A review. World J Diabetes 5(5):659–665. doi:10.4239/wjd.v5.i5.659

  • Balducci S, Zanuso S, Cardelli P, Salvi L, Bazuro A, Pugliese L, Maccora C, Iacobini C, Conti FG, Nicolucci A, Pugliese G; Italian Diabetes Exercise Study (IDES) Investigators (2012) Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES). PLoS One 7: e49297. doi:10.1371/journal.pone.0049297

  • Balducci S, Leonetti F, Di Mario U, Fallucca F (2004) Is a long-term aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients? Diabetes Care 27:841–842

    Article  PubMed  Google Scholar 

  • Blaum CS, West NA, Haan MN (2007) Is the metabolic syndrome with or without diabetes, associated with progressive disability in older Mexican Americans? J Gerontol Ser A. Biol Sci Med Sci 62:766–773

    Google Scholar 

  • Borghouts LB, Keizer HA (2000) Exercise and insulin sensitivity: a review. Int J Sports Med 21:1–12

    Article  CAS  PubMed  Google Scholar 

  • Brandon LJ, Gaasch DA, Boyette LW, Lloyd AM (2003) Effects of long-term resistive training on mobility and strength in older adults with diabetes. J Gerontol A Biol Sci Med Sci 58:740–745

    Article  PubMed  Google Scholar 

  • Brooks N, Layne E, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceps C (2007) Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci 4:19–27

    Article  CAS  PubMed Central  Google Scholar 

  • Cadore EL, Izquierdo M (2013) How to simultaneously optimize muscle strength, power, functional capacity, and cardiovascular gains in elderly: an update. Age (Dordr) 35:2329–2344

    Article  CAS  Google Scholar 

  • Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, Rodriguez-Mañas L, Izquierdo M (2013a) Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr) 36:773–785

    Article  Google Scholar 

  • Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M (2013b) Effects of different exercise interventions on risk of falls, gait ability and balance in physically frail older adults. A systematic review. Rejuvenation Res 16:105–114

    Article  PubMed Central  PubMed  Google Scholar 

  • Cadore EL, Moneo ABB, Mensat MM, Muñoz AR, Casas-Herrero A, Rodriguez-Mañas L, Izquierdo M (2014) Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age (Dordr) 36:801–811

    Article  Google Scholar 

  • Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, Idoate F, Millor N, Martínez-Ramírez A, Gómez M, Rodríguez-Mañas L, Marcellan T, Ruiz de Gordoa A, Marques MC, Izquierdo M (2013) Functional capacity, muscle fat infiltration, power output and cognitive impairment in institutionalized frail oldest-old. Rejuvenation Res 16:396–403

    Article  PubMed Central  PubMed  Google Scholar 

  • Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME (2002) A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 25:2335–2341

    Article  PubMed  Google Scholar 

  • Cheung NW, Cinnadaio N, Russo M, Marek S (2009) A pilot randomised controlled trial of resistance exercise bands in the management of sedentary subjects with type 2 diabetes. Diabetes Res Clin Pract 83:e68–e71

    Article  CAS  PubMed  Google Scholar 

  • Correa CS, LaRoche DP, Cadore EL, Reischak-Oliveira A, Bottaro M, Kruel LF, Tartaruga MP, Radaelli R, Wilhelm EN, Lacerda FC, Gaya AR, Pinto RS (2012) 3 Different types of strength training in older women. Int J Sports Med 33:962–969

    Article  CAS  PubMed  Google Scholar 

  • Dustan DW, Daly RM, Owen N, Jolley D (2002) High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 25:1729–1736

    Article  Google Scholar 

  • Ebeling P, Bourey R, Koranyi L, Tuominen JA, Groo LC, Henrikson J, Mueckler M, Sovijarvi A, Koivisto VA (1993) Mechanism of enhanced insulin sensitivity in athletes, increased blood flow, muscle glucose transport protein (GLUT−4) concentration, and glycogen synthase activity. J Clin Invest 92:1623–1631

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Eckert K (2012) Impact of physical activity and bodyweight on health-related quality of life in people with type 2 diabetes. Diabetes, Metab Syndr Obesity: Targets Therapy 5:303–311

    Article  Google Scholar 

  • Egger A, Niederseer D, Diem G, Finkenzeller T, Ledl-Kurkowski E, Forstner R, Pirich C, Patsch W, Weitgasser R, Niebauer J (2013) Different types of resistance training in type 2 diabetes mellitus: effects on glycaemic control, muscle mass and strength. Eur J Prev Cardiol 20:1051–1060

    Article  PubMed  Google Scholar 

  • Figueira FR, Umpierre D, Cureau FV, Zucatti AT, Dalzochio MB, Leitão CB, Schaan BD (2014) Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med 44:1557–1572

    Article  PubMed  Google Scholar 

  • Garg PK, Liu K, Tian L, Guralnik JM, Ferrucci L, Criqui MH, Tan J, McDermott MM (2009) Physical activity during daily life and functional decline in peripheral arterial disease. Circulation 119:251–260

    Article  PubMed Central  PubMed  Google Scholar 

  • Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I (2012) Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci 67:1259–1265

    Article  CAS  PubMed  Google Scholar 

  • Heden TD, Winn NC, Mari A, Booth FW, Rector RS, Thyfault JP, Kanaley JA (2014) Post-dinner resistance exercise improves postprandial risk factors more effectively than pre-dinner resistance exercise in patients with type 2 diabetes. J Appl Physiol 118:624–634

    Article  PubMed  Google Scholar 

  • Henwood TR, Riek S, Taaffe DR (2008) Strength versus muscle power-specific resistance training in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 63:83–91

    Article  PubMed  Google Scholar 

  • Honkola A, Forsén T, Eriksson J (1997) Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol 34:245–248

    Article  CAS  PubMed  Google Scholar 

  • Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO (2008) The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med 149:11–19

    Article  PubMed Central  PubMed  Google Scholar 

  • Hwang MH, Kim S (2014) Type 2 Diabetes: Endothelial dysfunction and Exercise. J Exerc Nutrition Biochem (3):239–247. doi:10.5717/jenb.2014.18.3.239

  • Ibañez J, Izquierdo M, Argüelles I, Forga L (2005) Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care 28:662–667

    Article  PubMed  Google Scholar 

  • Ibañez J, Gorostiaga EM, Alonso AM, Forga L, Arguelles I, Larrion JL, Izquierdo M (2008) Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complicat 22:112–118

    Article  PubMed  Google Scholar 

  • Ijzerman TH, Schaper NC, Melai T, Meijer K, Willems PJB, Savelberg HHCM (2012) Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes Res Clin Pract 95:345–351

    Article  PubMed  Google Scholar 

  • Kahn AJ (2007) Central and peripheral mechanisms of aging and frailty: a report on the 8th Longevity Consortium Symposium, Santa Fe, New Mexico, May 16–18. J Gerontol A Biol Sci Med Sci 62:1357–1360

    Article  PubMed  Google Scholar 

  • Kim HJ, Kang CK, Park H, Lee MG (2014) Effects of vitamin D supplementation and circuit training on indices of obesity and insulin resistance in T2D and vitamin D deficient elderly women. J Exerc Nutrition Biochem 18(3):249–257. doi:10.5717/jenb.2014.18.3.249

  • Kirwan JP, Kohrt WM, Wojta DM, Bourey RE, Holloszy JO (1993) Endurance exercise training reduces glucose-stimulated insulin levels in 60- to 70-year-old men and women. J Gerontol Med Sci 48:M84–M90

    Article  CAS  Google Scholar 

  • Ko S, Stenholm S, Chia CW, Simonsick EM, Ferrucci L (2011) Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy—results from the Baltimore longitudinal study of aging. Gait Posture 34:548–552

    Article  PubMed Central  PubMed  Google Scholar 

  • Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, van Loon LJ (2013) Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc 14:585–592

    Article  PubMed  Google Scholar 

  • Levinger I, Selig S, Jerums G, Stewart A, Gaskin CJ, Hare DL (2012) Depressed mood, glycaemic control and functional capacity in overweight/obese men with and without type 2 diabetes. Diabetol Metab Syndr 4:46–53

    Article  PubMed Central  PubMed  Google Scholar 

  • Maiorana A, Driscoll GO, Goodman C, Taylor R, Gree D (2002) Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 56:115–123

    Article  CAS  PubMed  Google Scholar 

  • Mavros Y, Kay S, Anderber KA, Baker MK, Wang Y, Zhao R, Meiklejohn J, Climstein M, O’Sullivan A, Vos N, Baune BT, Blair SN, Simar D, Rooney K, Singh N, Fiatarone Singh MA (2013) Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes. Diabetes Care 33:2372–2379

    Article  Google Scholar 

  • Mitranun W, Deerochanawong C, Tanaka H, Suksom D (2014) Continuous vs interval training on glycemic control and macro- and microvascular reactivity in type 2 diabetic patients. Scand J Med Sci Sports 24: e69-e76

  • Morley JE (2008) Diabetes, sarcopenia, and frailty. Clin Geriatr Med 24:455–469

    Article  PubMed  Google Scholar 

  • Morley JE (2011) Frailty: diagnosis and management. J Nutr Health Aging 15:667–670

    Article  CAS  PubMed  Google Scholar 

  • Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ (2014) Frailty, sarcopenia and diabetes. J Am Med Dir Assoc 15:853–859

    Article  PubMed  Google Scholar 

  • Nuttamonwarakul A, Amatyakul S, Suksom D (2012) Twelve weeks of agua-aerobic exercise improve physiological adaptations and glycemic control in elderly patients with type 2 diabetes. J Exerc Physiol 15:64–70

    Google Scholar 

  • Oliveira PP, Fachin SM, Tozatti J, Ferreira MC, Marinheiro LPF (2012) Comparative analysis of falls risk between patients with and without type 2 diabetes mellitus. Rev Assoc Med Bras 58: 234–239 Portuguese

  • Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Cho YW, Newman AB (2007) Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 30:1507–1512

    Article  PubMed  Google Scholar 

  • Pereira A, Izquierdo M, Silva AJ, Costa AM, Bastos E, Gonzalez-Badillo JJ, Marques MC (2012) Effects of high-speed power training on functional capacity and muscle performance in older women. Exp Gerontol 47:250–255

    Article  PubMed  Google Scholar 

  • Powell MW, Carnegie DH, Burke TJ (2006) Reversal of diabetic peripheral neuropathy with phototherapy (MIRE) decreases falls and the fear of falling and improves activities of daily living in seniors. Age Ageing 35:11–16

    Article  PubMed  Google Scholar 

  • Radaelli R, Botton CE, Wilhelm EN, Bottaro M, Brown LE, Lacerda F, Gaya A, Moraes K, Peruzzolo A, Pinto RS (2014) Time course of low- and high-volume strength training on neuromuscular adaptations and muscle quality in elderly women. Age 36:881–892

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Ramirez-Campillo R, Castillo A, de la Fuente CI, Campos-Jara C, Andrade DC, Álvarez C, Martínez C, Castro-Sepúlveda M, Pereira A, Marques MC, Izquierdo M (2014) High-speed resistance training is more effective than low-speed resistance training to increase functional capacity and muscle performance in older women. Exp Gerontol 58:51–57

    Article  PubMed  Google Scholar 

  • Reeves MJ, Vaidya RS, Fonarow GC, Liang L, Smith EE, Matulonis R, Olson DM, Schwamm LH (2010) Quality of care and outcomes in patients with diabetes hospitalized with ischemic stroke: findings from Get With the Guidelines-Stroke. Stroke 41:e409–e417

    Article  PubMed  Google Scholar 

  • Reid KF, Fielding RA (2012) Skeletal muscle power: a critical determination of physical functioning in older adults. Exerc Sport Sci Rev 40:1–12

    Article  CAS  Google Scholar 

  • Rodriguez-Mañas L, Fried LP (2015) Frailty in the clinical scenario. Lancet 385(9968):e7-9. doi: 10.1016/S0140-6736(14)61595-6.

  • Rodriguez-Mañas L, Bayer AJ, Kelly M, Zeyfang A, Izquierdo M, Laosa O, Hardman TC, Sinclair AJ, on behalf of the MID-Frail Consortium (2014) An evaluation of the effectiveness of a multi-modal intervention in frail and pre-frail older people with type 2 diabetes—the MID-Frail study: study protocol for a randomised controlled trial. Trials 15:34

    Article  PubMed Central  PubMed  Google Scholar 

  • Seals D, Hagberg JM, Hurley BF, Ehsani AA, Holloszy JO (1984) Effects of endurance training on glucose tolerance and plasma lipids levels in older men and women. JAMA 252:645–649

    Article  CAS  PubMed  Google Scholar 

  • Simmonds MJ, Minahan CL, Serre KR, Gass GC, Marshall Gradisnik SM, Haseler LJ, Sabapayhy S (2012) Preliminary findings in the heart rate variability and haemorheology response to varied frequency and duration of walking in women 65–74 yr with type 2 diabetes. Clin Hemorheol Microcirc 51:87–99

    PubMed  Google Scholar 

  • Sinclair A, Morley JE, Rodriguez-Manas L, Paolisso G, Bayer T, Zeyfang A, Bourdel-Marchasson I, Vischer U, Woo J, Chapman I, Dunning T, Meneilly G, Rodriguez-Saldana J, Gutierrez Robledo LM, Cukierman-Yaffe T, Gadsby R, Schernthaner G, Lorig K (2012) Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc 13:497–502

    Article  PubMed  Google Scholar 

  • Snowling NJ, Hopkins WG (2006) Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 29(11):2518–2527

  • Sung K, Bae S (2012) Effect of a regular walking exercise program on behavior and biochemical aspects in elderly people with type II diabetes. Nurs Health Sci 11:438–495

    Article  Google Scholar 

  • Tan S, Li W, Wang J (2012) Effects of six months of combined aerobic and resistance training for elderly patients with a long history of type 2 diabetes. J Sports Sci Med 11:495–501

    PubMed Central  PubMed  Google Scholar 

  • Terada T, Fresen A, Chahal BS, Bell GJ, McCargar LJ, Boulé NG (2013) Feasibility and preliminary efficacy of high intensity interval training in type 2 diabetes. Diabetes Res Clin Pract 99:120–129

    Article  PubMed  Google Scholar 

  • Tessier D, Ménard J, Fulop T, Ardilouze JL, Roy MA, Dubuc N, Dubois MF, Gauthier P (2000) Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Arch Gerontol Geriatr 31:121–132

    Article  PubMed  Google Scholar 

  • Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD (2011) Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305:1790–1799

    Article  CAS  PubMed  Google Scholar 

  • Vinik AI, Vinik EJ, Colberg SR, Morrison S (2015) Falls risk in older adults with type 2 diabetes. Clin Geriatr Med 31:89–99

    Article  PubMed  Google Scholar 

  • Volpato S, Bianchi L, Lauretani F, Bandinelli S, Guralnik JM, Zuliani G, Ferrucci L (2012) Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care 35:1672–1679

    Article  PubMed Central  PubMed  Google Scholar 

  • Wray LA, Ofstedal MB, Langa KM, Blaum CS (2005) The effect of diabetes on disability in middle-aged and older adults. J Gerontol A Biol Sci Med Sci 60:1206–1211

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported in part by the Spanish Department of Health and Institute Carlos III of the Government of Spain [Spanish Net on Aging and frailty; (RETICEF)(RD12/043/0002], the European Commission Seventh Framework Program (Midfrail study), as well as by the Erasmus + European Commission program [556988-EPP-1–2014–1-ES-SPO-SCP (www.vivifrail.com)].

Author information

Authors and Affiliations

  1. Exercise Research Laboratory, Physical Education School, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

    Eduardo Lusa Cadore

  2. Department of Health Sciences, Public University of Navarre, Av. de Tarazona s/n., 31500, Tudela, Navarra, Spain

    Mikel Izquierdo

Authors
  1. Eduardo Lusa Cadore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikel Izquierdo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mikel Izquierdo.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cadore, E.L., Izquierdo, M. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life. AGE 37, 64 (2015). https://doi.org/10.1007/s11357-015-9800-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11357-015-9800-2

Keywords

Search

Navigation