Influence of resistance training intensity on glycosylated hemoglobin in elderly patients with type 2 diabetes: a meta-analysis_West China Medical Journal

Authors：

HUANG Liyuan ¹ ,  LI Ran ¹ , LI Yufeng ² , DONG Tianqi ¹ , QIN Jingming ¹ , TIAN Shumeng ¹ , YAN Runsheng ¹

1. Sport Science School, Beijing Sport University, Beijing 100084, P. R. China;
2. Department of Endocrinology, Beijing Pinggu Hospital, Beijing 101200, P. R. China;

Corresponding author：

LI Ran, Email: liranemail@bsu.edu.cn

Keywords：

Elderly; type 2 diabetes; resistance training; intensity; glycosylated hemoglobin

DOI：

10.7507/1002-0179.202009208

Video：

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Objectives To systematically analyze the effect of high-intensity and low-intensity resistance training on glycosylated hemoglobin (HbA1c) in elderly patients with type 2 diabetes. Methods PubMed, EBSCO, Cochrane Library, Web of science, Wanfang, Chinese National Knowledge Infrastructure and Chongqing VIP were searched to collect randomized controlled trials of resistance training intervention in elderly patients with type 2 diabetes. The search time limit was from the establishment of the database to August 28, 2021, and the RevMan 5.3 and Stata 15.0 software were used for meta-analysis. Results A total of 415 patients in 8 articles were included in this study. A subgroup analysis based on control measures showed that compared with the resistance training group, the HbA1c level effect value of the non- training group was weighted mean difference (WMD) = −0.54% [95% confidence interval (CI) (−1.06%, −0.03%), P=0.04)], the HbA1c level effect value of the flexibility training group was WMD=−0.47% [95%CI (−1.05%, 0.12%), P=0.12], the HbA1c level effect value of the aerobic training group was WMD=−0.10% [95%CI (−0.71%, 0.51%), P=0.75]. Subgroup analysis of resistance strength showed that compared with the flexibility or non-resistance training group, both high-intensity [WMD=−0.99%, 95%CI (−1.16%, −0.81%), P<0.00001] and low- and medium-intensity resistance training [WMD=−0.29%, 95%CI (−0.58%, −0.01%), P=0.05] can reduce HbA1c. Compared with the high-intensity resistance training, the HbA1c level effect value of the low- and medium-intensity resistance training was WMD=0.03% [95%CI (−0.33%, 0.39%), P=0.88]. Compared with the low- and medium-intensity resistance training, the HbA1c level effect value of the low- and medium-intensity aerobic training was WMD=−0.10% [95%CI (−0.71%, 0.51%), P=0.75]. Among all the included studies, only the high-intensity resistance training group reported multiple adverse events.Conclusions Current evidence suggests that elderly patients with type 2 diabetes are more suitable to choose low-to-medium-intensity resistance training to control HbA1c. It is recommended that elderly patients with type 2 diabetes take 60% to 75% of the maximum muscle strength of medium-intensity resistance training.

Citation： HUANG Liyuan, LI Ran, LI Yufeng, DONG Tianqi, QIN Jingming, TIAN Shumeng, YAN Runsheng. Influence of resistance training intensity on glycosylated hemoglobin in elderly patients with type 2 diabetes: a meta-analysis. West China Medical Journal, 2022, 37(1): 66-73. doi: 10.7507/1002-0179.202009208 Copy

1.	Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care, 2002, 25(12): 2335-2341.
2.	Honkola A, Forsén T, Eriksson J. Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol, 1997, 34(4): 245-248.
3.	Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care, 2010, 33(12): e147-e167.
4.	Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med, 2000, 21(1): 1-12.
5.	Cuff DJ, Meneilly GS, Martin A, et al. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care, 2003, 26(11): 2977-2982.
6.	Holten MK, Zacho M, Gaster M, et al. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes, 2004, 53(2): 294-305.
7.	Dreyer HC, Fujita S, Cadenas JG, et al. Resistance exercise increases AMPK activity and reduces 4E-BP1 phosphorylation and protein synthesis in human skeletal muscle. J Physiol, 2006, 576(Pt 2): 613-624.
8.	于秀娟, 欧超伟. 糖化血红蛋白检测的影响因素及临床意义. 中国老年学杂志, 2013, 33(19): 4930-4933.
9.	Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care, 2013, 36(8): 2372-2379.
10.	Dunstan DW, Vulikh E, Owen N, et al. Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes. Diabetes Care, 2006, 29(12): 2586-2591.
11.	Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care, 2002, 25(10): 1729-1736.
12.	Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
13.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.2. (2009-1-1)[2020-9-17]. https:// training.cochrane.org/handbook/archive/v5.0.2/.
14.	Ratamess NA. ACSM’s foundations of strength training and conditioning. Philadelphia:Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011: 201.
15.	Botton CE, Umpierre D, Rech A, et al. Effects of resistance training on neuromuscular parameters in elderly with type 2 diabetes mellitus: a randomized clinical trial. Exp Gerontol, 2018, 113: 141-149.
16.	Simpson KA, Mavros Y, Kay S, et al. Graded resistance exercise and type 2 diabetes in older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial. Trials, 2015, 16: 512.
17.	Kadoglou NP, Fotiadis G, Athanasiadou Z, et al. The effects of resistance training on ApoB/ApoA-I ratio, Lp(a) and inflammatory markers in patients with type 2 diabetes. Endocrine, 2012, 42(3): 561-569.
18.	Brooks N, Layne JE, Gordon PL, et al. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci, 2006, 4(1): 19-27.
19.	Gordon PL, Vannier E, Hamada K, et al. Resistance training alters cytokine gene expression in skeletal muscle of adults with type 2 diabetes. Int J Immunopathol Pharmacol, 2006, 19(4): 739-749.
20.	Dunstan DW, Daly RM, Owen N, et al. Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care, 2005, 28(1): 3-9.
21.	Hangping Z, Xiaona Q, Qi Z, et al. The impact on glycemic control through progressive resistance training with bioDensityTM in Chinese elderly patients with type 2 diabetes: The PReTTy2 (Progressive Resistance Training in Type 2 Diabetes) Trial. Diabetes Res Clin Pract, 2019, 150: 64-71.
22.	Baum K, Votteler T, Schiab J. Efficiency of vibration exercise for glycemic control in type 2 diabetes patients. Int J Med Sci, 2007, 4(3): 159-163.
23.	Rech A, Botton CE, Lopez P, et al. Effects of short-term resistance training on endothelial function and inflammation markers in elderly patients with type 2 diabetes: a randomized controlled trial. Exp Gerontol, 2019, 118: 19-25.
24.	Kadoglou NP, Fotiadis G, Kapelouzou A, et al. The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with type 2 diabetes. Diabet Med, 2013, 30(2): e41-e50.
25.	Ng CL, Goh SY, Malhotra R, et al. Minimal difference between aerobic and progressive resistance exercise on metabolic profile and fitness in older adults with diabetes mellitus: a randomised trial. J Physiother, 2010, 56(3): 163-170.
26.	Umpierre D, Ribeiro PA, Schaan BD, et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia, 2013, 56(2): 242-251.
27.	Houmard JA, Tanner CJ, Slentz CA, et al. Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol (1985), 2004, 96(1): 101-106.
28.	Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Ther, 2017, 8(3): 459-473.
29.	Nery C, Moraes SRA, Novaes KA, et al. Effectiveness of resistance exercise compared to aerobic exercise without insulin therapy in patients with type 2 diabetes mellitus: a meta-analysis. Braz J Phys Ther, 2017, 21(6): 400-415.
30.	Yang Z, Scott CA, Mao C, et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med, 2014, 44(4): 487-499.
31.	Poehlman ET, Dvorak RV, DeNino WF, et al. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab, 2000, 85(7): 2463-2468.
32.	Dela F, Kjaer M. Resistance training, insulin sensitivity and muscle function in the elderly. Essays Biochem, 2006, 42: 75-88.
33.	Lindle RS, Metter EJ, Lynch NA, et al. Age and gender comparisons of muscle strength in 654 women and men aged 20-93 yr. J Appl Physiol (1985), 1997, 83(5): 1581-1587.
34.	Liu Y, Ye W, Chen Q, et al. Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. Int J Environ Res Public Health, 2019, 16(1): 140.
35.	Brown AB, McCartney N, Sale DG. Positive adaptations to weight-lifting training in the elderly. J Appl Physiol (1985), 1990, 69(5): 1725-1733.
36.	Frontera WR, Meredith CN, O’Reilly KP, et al. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol (1985), 1988, 64(3): 1038-1044.
37.	Pyka G, Lindenberger E, Charette S, et al. Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women. J Gerontol, 1994, 49(1): M22-M27.
38.	Nicolaï SP, Kruidenier LM, Leffers P, et al. Supervised exercise versus non-supervised exercise for reducing weight in obese adults. J Sports Med Phys Fitness, 2009, 49(1): 85-90.
39.	Olney SJ, Nymark J, Brouwer B, et al. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke, 2006, 37(2): 476-481.

1. Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care, 2002, 25(12): 2335-2341.
2. Honkola A, Forsén T, Eriksson J. Resistance training improves the metabolic profile in individuals with type 2 diabetes. Acta Diabetol, 1997, 34(4): 245-248.
3. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care, 2010, 33(12): e147-e167.
4. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med, 2000, 21(1): 1-12.
5. Cuff DJ, Meneilly GS, Martin A, et al. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care, 2003, 26(11): 2977-2982.
6. Holten MK, Zacho M, Gaster M, et al. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes, 2004, 53(2): 294-305.
7. Dreyer HC, Fujita S, Cadenas JG, et al. Resistance exercise increases AMPK activity and reduces 4E-BP1 phosphorylation and protein synthesis in human skeletal muscle. J Physiol, 2006, 576(Pt 2): 613-624.
8. 于秀娟, 欧超伟. 糖化血红蛋白检测的影响因素及临床意义. 中国老年学杂志, 2013, 33(19): 4930-4933.
9. Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care, 2013, 36(8): 2372-2379.
10. Dunstan DW, Vulikh E, Owen N, et al. Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes. Diabetes Care, 2006, 29(12): 2586-2591.
11. Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care, 2002, 25(10): 1729-1736.
12. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.2. (2009-1-1)[2020-9-17]. https:// training.cochrane.org/handbook/archive/v5.0.2/.
14. Ratamess NA. ACSM’s foundations of strength training and conditioning. Philadelphia:Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011: 201.
15. Botton CE, Umpierre D, Rech A, et al. Effects of resistance training on neuromuscular parameters in elderly with type 2 diabetes mellitus: a randomized clinical trial. Exp Gerontol, 2018, 113: 141-149.
16. Simpson KA, Mavros Y, Kay S, et al. Graded resistance exercise and type 2 diabetes in older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial. Trials, 2015, 16: 512.
17. Kadoglou NP, Fotiadis G, Athanasiadou Z, et al. The effects of resistance training on ApoB/ApoA-I ratio, Lp(a) and inflammatory markers in patients with type 2 diabetes. Endocrine, 2012, 42(3): 561-569.
18. Brooks N, Layne JE, Gordon PL, et al. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci, 2006, 4(1): 19-27.
19. Gordon PL, Vannier E, Hamada K, et al. Resistance training alters cytokine gene expression in skeletal muscle of adults with type 2 diabetes. Int J Immunopathol Pharmacol, 2006, 19(4): 739-749.
20. Dunstan DW, Daly RM, Owen N, et al. Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care, 2005, 28(1): 3-9.
21. Hangping Z, Xiaona Q, Qi Z, et al. The impact on glycemic control through progressive resistance training with bioDensityTM in Chinese elderly patients with type 2 diabetes: The PReTTy2 (Progressive Resistance Training in Type 2 Diabetes) Trial. Diabetes Res Clin Pract, 2019, 150: 64-71.
22. Baum K, Votteler T, Schiab J. Efficiency of vibration exercise for glycemic control in type 2 diabetes patients. Int J Med Sci, 2007, 4(3): 159-163.
23. Rech A, Botton CE, Lopez P, et al. Effects of short-term resistance training on endothelial function and inflammation markers in elderly patients with type 2 diabetes: a randomized controlled trial. Exp Gerontol, 2019, 118: 19-25.
24. Kadoglou NP, Fotiadis G, Kapelouzou A, et al. The differential anti-inflammatory effects of exercise modalities and their association with early carotid atherosclerosis progression in patients with type 2 diabetes. Diabet Med, 2013, 30(2): e41-e50.
25. Ng CL, Goh SY, Malhotra R, et al. Minimal difference between aerobic and progressive resistance exercise on metabolic profile and fitness in older adults with diabetes mellitus: a randomised trial. J Physiother, 2010, 56(3): 163-170.
26. Umpierre D, Ribeiro PA, Schaan BD, et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia, 2013, 56(2): 242-251.
27. Houmard JA, Tanner CJ, Slentz CA, et al. Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol (1985), 2004, 96(1): 101-106.
28. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Ther, 2017, 8(3): 459-473.
29. Nery C, Moraes SRA, Novaes KA, et al. Effectiveness of resistance exercise compared to aerobic exercise without insulin therapy in patients with type 2 diabetes mellitus: a meta-analysis. Braz J Phys Ther, 2017, 21(6): 400-415.
30. Yang Z, Scott CA, Mao C, et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med, 2014, 44(4): 487-499.
31. Poehlman ET, Dvorak RV, DeNino WF, et al. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab, 2000, 85(7): 2463-2468.
32. Dela F, Kjaer M. Resistance training, insulin sensitivity and muscle function in the elderly. Essays Biochem, 2006, 42: 75-88.
33. Lindle RS, Metter EJ, Lynch NA, et al. Age and gender comparisons of muscle strength in 654 women and men aged 20-93 yr. J Appl Physiol (1985), 1997, 83(5): 1581-1587.
34. Liu Y, Ye W, Chen Q, et al. Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. Int J Environ Res Public Health, 2019, 16(1): 140.
35. Brown AB, McCartney N, Sale DG. Positive adaptations to weight-lifting training in the elderly. J Appl Physiol (1985), 1990, 69(5): 1725-1733.
36. Frontera WR, Meredith CN, O’Reilly KP, et al. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol (1985), 1988, 64(3): 1038-1044.
37. Pyka G, Lindenberger E, Charette S, et al. Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women. J Gerontol, 1994, 49(1): M22-M27.
38. Nicolaï SP, Kruidenier LM, Leffers P, et al. Supervised exercise versus non-supervised exercise for reducing weight in obese adults. J Sports Med Phys Fitness, 2009, 49(1): 85-90.
39. Olney SJ, Nymark J, Brouwer B, et al. A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Stroke, 2006, 37(2): 476-481.

West China Medical Journal

Influence of resistance training intensity on glycosylated hemoglobin in elderly patients with type 2 diabetes: a meta-analysis

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