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Aerobic and Strength Training in Concomitant Metabolic Syndrome and Type 2 Diabetes

EARNEST, CONRAD P.1; JOHANNSEN, NEIL M.2; SWIFT, DAMON L.3; GILLISON, FIONA B.1; MIKUS, CATHERINE R.4; LUCIA, ALEJANDRO5; KRAMER, KIMBERLY6; LAVIE, CARL J.6,7; CHURCH, TIMOTHY S.6

Medicine & Science in Sports & Exercise: July 2014 - Volume 46 - Issue 7 - p 1293–1301
doi: 10.1249/MSS.0000000000000242
Clinical Sciences

Purpose: Concomitant type 2 diabetes (T2D) and metabolic syndrome exacerbates mortality risk; yet, few studies have examined the effect of combining (AER + RES) aerobic (AER) and resistance (RES) training for individuals with T2D and metabolic syndrome.

Methods: We examined AER, RES, and AER + RES training (9 months) commensurate with physical activity guidelines in individuals with T2D (n = 262; 63% female, 44% black). Primary outcomes were change in, and prevalence of, metabolic syndrome score at follow-up (mean and 95% confidence interval [CI]). Secondary outcomes included maximal cardiorespiratory fitness (V˙O2peak) and estimated METs from time-to-exhaustion (TTE) and exercise efficiency calculated as the slope of the line between ventilatory threshold, respiratory compensation, and maximal fitness. General linear models and bootstrapped Spearman correlations were used to examine changes in metabolic syndrome associated with training primary and secondary outcome variables.

Results: We observed a significant decrease in metabolic syndrome scores (P for trend = 0.003) for AER (−0.59, 95% CI = −1.00 to −0.21) and AER + RES (−0.79, 95% CI = −1.40 to −0.35), both being significant (P ≤ 0.02) versus control (0.26, 95% CI = −0.58 to 0.40) and RES (−0.13, 95% CI = −1.00 to 0.24). This led to a reduction in metabolic syndrome prevalence for the AER (56% vs 43%) and AER + RES (55% vs 46%) groups between baseline and follow-up. The observed decrease in metabolic syndrome was mediated by significant improvements in exercise efficiency for the AER and AER + RES training groups (P < 0.05), which was more strongly related to TTE (25%–30%; r = −0.38, 95% CI = −0.55 to −0.19) than V˙O2peak (5%–6%; r = −0.24, 95% CI = −0.45 to −0.01).

Conclusions: AER and AER + RES training significantly improved metabolic syndrome scores and prevalence in patients with T2D. These improvements appear to be associated with improved exercise efficiency and are more strongly related to improved TTE versus V˙O2peak.

1Department for Health, University of Bath, Bath, UNITED KINGDOM; 2School of Kinesiology, Louisiana State University, Baton Rouge, LA; 3Department of Kinesiology, East Carolina University, Greenville, NC; 4Division of Cardiology, Duke University Medical Center, Durham, NC; 5Universidad Europea and Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, SPAIN; 6Division of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, LA; and 7Cardiac Rehabilitation and Prevention, Ochsner Clinical School, University of Queensland School of Medicine, John Ochsner Heart and Vascular Institute, New Orleans, LA

Address for correspondence: Conrad P. Earnest, Ph.D., Department for Health, University of Bath, Bath, United Kingdom; E-mail: cpe03@icloud.com.

Submitted for publication October 2013.

Accepted for publication December 2013.

© 2014 American College of Sports Medicine