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Exercise Column

Choosing Between Aerobic and Resistance Exercise for Type 2 Diabetes

     Over the past several decades, type 2 diabetes has become a chronic disease of epidemic proportion. In fact, the American Diabetes Association reports that 19 million people have been diagnosed as diabetic, with over four times as many people estimated to be pre-diabetic (having a fasting plasma glucose between 100 and 125mg/dL). The impact of the elevated blood glucose level and the disease—which includes a host of complications not limited to stroke, blindness, and kidney disease—has prompted researchers to conduct studies centered around how to most effectively curb the development of type 2 diabetes. Exercise is a method consistently shown to be successful in the treatment and prevention of diabetes. Indeed, one topic of critical interest and importance to both researchers and diabetics alike is the ongoing argument over whether resistance training, aerobic training, or both used in combination, is most effective for treating type 2 diabetes.

     A 2010 study published by Church et al. sought to shed some light on the question of which form of exercise is best for preventing & treating diabetes. Their group evaluated the influence of different exercise regimens on disease parameters specific for type 2 diabetes.In this nine month intervention, 262 sedentary type 2 diabetics were divided into 4 groups, consisting of either: 1) resistance training; 2) aerobic training; 3) combined aerobic and resistance training; or 4) no exercise training. Researchers controlled for both exercise duration and caloric expenditure to ensure that any changes in blood glucose levels were due solely to training type. The patient blood glucose response to exercise training was measured using patient hemoglobin A1c (HbA1c) levels, a blood marker that enables physicians to monitor blood sugar control over a two to three month period.A HbA1c value of less than 6.00% is considered normal, while individuals with an HbA1c of 6.50% or greater is diagnosed as diabetic.

     A look at the results, finds that aerobic or resistance training alone were associated with drops in HbA1c, by 0.24% and 0.16%, respectively. However, only the combination exercise group experienced a significant reduction in HbA1c, equal to 0.34%. Their data provides enormous implications for type 2 diabetics, as an improvement in HbA1c by 0.34% can conservatively be expected to reduce the risk of cardiovascular disease events by 7% and microvascular complications by 12%. These achievements are made even more impressive when you look at the fact that by the end of the study, the combination group decreased their use of diabetes medications, while subjects engaging in no exercise actually increased their use of diabetes medications. These results do not stand alone, as a similar 2010 study published in the Journal of the American Medical Association also found combined aerobic and resistance training to be more beneficial to type 2 diabetics than either alone—and given the long-term adverse effects of type 2 diabetes, a person is better off performing both than either alone.

     With diabetes projected by the Center for Disease Control and Prevention to affect one in three Americans by 2050, it is important that national exercise guidelines are rooted in scientific research that is clear and consistent. In conjunction, these findings meet those requirements in support of the 2008 Federal Physical Activity Guidelines, which recommend a combination of weekly aerobic and resistance training. Based on the aforementioned studies, patients can most effectively treat their diabetes by employing a mix of weekly aerobic and resistance training.

Written by Michael Fox and Eric Sternlicht, Ph.D. - Department of Kinesiology,
Occidental College, Los Angeles, CA.