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26-07-2023 | Sarcopenia | Article

Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial

Authors: Yukari Kobayashi, Jin Long, Shozen Dan, Neil M. Johannsen, Ruth Talamoa, Sonia Raghuram, Sukyung Chung, Kyla Kent, Marina Basina, Cynthia Lamendola, Francois Haddad, Mary B. Leonard, Timothy S. Church, Latha Palaniappan

Published in: Diabetologia | Issue 10/2023

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Abstract

Aims/hypothesis

Type 2 diabetes in people in the healthy weight BMI category (<25 kg/m2), herein defined as ‘normal-weight type 2 diabetes’, is associated with sarcopenia (low muscle mass). Given this unique body composition, the optimal exercise regimen for this population is unknown.

Methods

We conducted a parallel-group RCT in individuals with type 2 diabetes (age 18–80 years, HbA1c 47.5–118.56 mmol/mol [6.5–13.0%]) and BMI <25 kg/m2). Participants were recruited in outpatient clinics or through advertisements and randomly assigned to a 9 month exercise programme of strength training alone (ST), aerobic training alone (AER) or both interventions combined (COMB). We used stratified block randomisation with a randomly selected block size. Researchers and caregivers were blinded to participants’ treatment group; however, participants themselves were not. Exercise interventions were conducted at community-based fitness centres. The primary outcome was absolute change in HbA1c level within and across the three groups at 3, 6 and 9 months. Secondary outcomes included changes in body composition at 9 months. Per adherence to recommended exercise protocol (PP) analysis included participants who completed at least 50% of the sessions.

Results

Among 186 individuals (ST, n=63; AER, n=58; COMB, n=65) analysed, the median (IQR) age was 59 (53–66) years, 60% were men and 83% were Asian. The mean (SD) HbA1c level at baseline was 59.6 (13.1) mmol/mol (7.6% [1.2%]). In intention-to-treat analysis, the ST group showed a significant decrease in HbA1c levels (mean [95% CI] −0.44 percentage points [−0.78, −0.12], p=0.02), while no significant change was observed in either the COMB group (−0.35 percentage points, p=0.13) or the AER group (−0.24 percentage points, p=0.10). The ST group had a greater improvement in HbA1c levels than the AER group (p=0.01). Appendicular lean mass relative to fat mass increased only in the ST group (p=0.0008), which was an independent predictor of HbA1c change (beta coefficient −7.16, p=0.01). Similar results were observed in PP analysis. Only one adverse event, in the COMB group, was considered to be possibly associated with the exercise intervention.

Conclusions/interpretation

In normal-weight type 2 diabetes, strength training was superior to aerobic training alone, while no significant difference was observed between strength training and combination training for HbA1c reduction. Increased lean mass relative to decreased fat mass was an independent predictor of reduction in HbA1c level.

Trial registration

ClinicalTrials.gov NCT02448498.

Funding

This study was funded by the National Institutes of Health (NIH; R01DK081371).

Graphical Abstract

Appendix
Available only for authorised users
Literature
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Metadata
Title
Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial
Authors
Yukari Kobayashi
Jin Long
Shozen Dan
Neil M. Johannsen
Ruth Talamoa
Sonia Raghuram
Sukyung Chung
Kyla Kent
Marina Basina
Cynthia Lamendola
Francois Haddad
Mary B. Leonard
Timothy S. Church
Latha Palaniappan
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia / Issue 10/2023
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-023-05958-9

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