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

Journal article


Mavros, Yorgi, Kay, Shelley, Anderberg, Kylie, Baker, Michael K., Wang, Yi, Zhao, Renru, Meiklejohn, Jacinda, Climstein, Mike, O'Sullivan, Anthony and De Vos, Nathan. (2013). 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. 36(8), pp. 2372 - 2379. https://doi.org/10.2337/dc12-2196
AuthorsMavros, Yorgi, Kay, Shelley, Anderberg, Kylie, Baker, Michael K., Wang, Yi, Zhao, Renru, Meiklejohn, Jacinda, Climstein, Mike, O'Sullivan, Anthony and De Vos, Nathan
Abstract

OBJECTIVE To investigate changes in body composition after 12 months of high-intensity progressive resistance training (PRT) in relation to changes in insulin resistance (IR) or glucose homeostasis in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS One-hundred three participants were randomized to receive either PRT or sham exercise 3 days per week for 12 months. Homeostasis model assessment 2 of insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c) were used as indices of IR and glucose homeostasis. Skeletal muscle mass (SkMM) and total fat mass were assessed using bioelectrical impedance. Visceral adipose tissue, mid-thigh cross-sectional area, and mid-thigh muscle attenuation were quantified using computed tomography. RESULTS Within the PRT group, changes in HOMA2-IR were associated with changes in SkMM (r = −0.38; P = 0.04) and fat mass (r = 0.42; P = 0.02). Changes in visceral adipose tissue tended to be related to changes in HOMA2-IR (r = 0.35; P = 0.07). Changes in HbA1c were related to changes in mid-thigh muscle attenuation (r = 0.52; P = 0.001). None of these relationships were present in the sham group (P > 0.05). Using ANCOVA models, participants in the PRT group who had increased SkMM had decreased HOMA2-IR (P = 0.05) and HbA1c (P = 0.09) compared with those in the PRT group who lost SkMM. Increases in SkMM in the PRT group decreased HOMA2-IR (P = 0.07) and HbA1c (P < 0.05) compared with those who had increased SkMM in the sham group. CONCLUSIONS Improvements in metabolic health in older adults with type 2 diabetes were mediated through improvements in body composition only if they were achieved through high-intensity PRT. Body composition is central to insulin resistance (IR) and type 2 diabetes, projected to affect 435 million adults by 2030 (<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-1" id="x-x-x-x-xref-ref-1-1">1). Lifestyle interventions are recommended to improve body composition (reduce adiposity, increase lean tissue) and, ultimately, to improve metabolic health. One lifestyle component is progressive resistance training (PRT), an anabolic exercise shown to improve body composition, as well as IR and glucose homeostasis in type 2 diabetes (<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-2" id="x-x-x-x-xref-ref-2-1">2–<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-4" id="x-x-x-x-xref-ref-4-1">4). Skeletal muscle hypertrophy is thought to mediate metabolic benefits of PRT by increasing the quality and quantity of skeletal muscle available for glucose storage. Increases in lean tissue have been associated with improvements in IR and glucose homeostasis (<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-5" id="x-x-x-x-xref-ref-5-1">5,<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-6" id="x-x-x-x-xref-ref-6-1">6). In the Graded Resistance Exercise And Type 2 Diabetes in Older adults (GREAT2DO) study, we have shown strong relationships between body composition and homeostasis model assessment 2 of insulin resistance (HOMA2-IR) at baseline, before randomization to experimental (power training) or control (sham exercise) groups (<a href="http://care.diabetesjournals.org/content/36/8/2372#ref-7" id="x-x-x-x-xref-ref-7-1">7). The purpose of this interim report was to investigate changes in body composition after the first 12 months of training in relation to changes in IR or glucose homeostasis. We hypothesized that the experimental group would improve body composition (increased skeletal muscle mass [SkMM] and reduced visceral adipose tissue [VAT], reduced total fat mass [FM], and reduced intramyocellular lipid [IMCL]) compared with the control group. Furthermore, we hypothesized that across the entire cohort, beneficial shifts in body composition would lead to improvements in IR and glucose homeostasis.

Year2013
JournalDiabetes Care
Journal citation36 (8), pp. 2372 - 2379
ISSN1935-5548
Digital Object Identifier (DOI)https://doi.org/10.2337/dc12-2196
Scopus EID2-s2.0-84883291926
Open accessOpen access
Page range2372 - 2379
Research GroupSports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre
Publisher's version
Grant IDnhmrc/512381
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Turner, Sarah, Torode, Margaret Ellen, Climstein, Michael, Naughton, Geraldine, Greene, David, Baker, Michael and Fiatarone Singh, Maria. (2011). A randomized controlled trial of whole body vibration exposure on markers of bone turnover in postmenopausal women. Journal of Osteoporosis. 2011(1), pp. 1 - 10. https://doi.org/10.4061/2011/710387
A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union
Higgins, Trevor R., Heazlewood, Ian Timothy and Climstein, Mike. (2011). A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union. Journal of Strength and Conditioning Research. 25(4), pp. 1046 - 1051. https://doi.org/10.1519/JSC.0b013e3181cc269f
Core self-evaluation as a predictor of strength training adoption in older adults
Baker, Michael, Kennedy, David, Bohle, Philip, Campbell, Deena, Wiltshire, James and Fiatarone Singh, Maria Antoinette. (2011). Core self-evaluation as a predictor of strength training adoption in older adults. Maturitas. 68(1), pp. 88 - 93. https://doi.org/10.1016/j.maturitas.2010.10.001
Efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases: a randomized controlled trial
Galvao, Daniel, Taaffe, D R, Cormie, P, Spry, Nigel, Chambers, Suzanne, Peddle-McIntyre, C, Baker, Michael, Denham, James, Joseph, David and Groom, Geoff. (2011). Efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases: a randomized controlled trial. BMC Cancer. 11(13), pp. 517 - 523. https://doi.org/10.1186/1471-2407-11-517
A systematic review and meta-analysis on the effect of aerobic vs. resistance exercise training on visceral fat
Ismail, I, Keating, S, Baker, Michael and Johnson, Nathan. (2011). A systematic review and meta-analysis on the effect of aerobic vs. resistance exercise training on visceral fat. Obesity Reviews. 13(1), pp. 68 - 91. https://doi.org/10.1111/j.1467-789X.2011.00931.x
Incidence of chronic disease and lipid profile in veteran rugby athletes
Climstein, Mike, Walsh, Joe, Heazlewood, Tim, Burke, Stephen, Kettunen, Jyrki, Adams, Kent and DeBeliso, Mark. (2011). Incidence of chronic disease and lipid profile in veteran rugby athletes. International Journal of Biological and Medical Sciences. 1(1), pp. 41 - 45.
Sydney 2009 World Masters Games: Paricipants medicaland health history survey
Climstein, Mike, Burke, Stephen, Walsh, Joe, Heazlewood, Tim and Brock, Kim. (2010). Sydney 2009 World Masters Games: Paricipants medicaland health history survey. Be Active 2012 : Australian Conference of Science and Medicine in Sport. Sydney Convention and Exhibition Centre, Sydney, New South Wales, Australia 31 Oct - 03 Nov 2012 Australia: Elsevier. pp. 79 - 79
The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis
Vanwanseele, Benedicte, Eckstein, Felix, Smith, Richard, Lange, Angela, Foroughi, Nasim, Baker, Michael, Shnier, Ron and Fiatarone Singh, Maria Antoinette. (2010). The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis. Osteoarthritis and Cartilage. 18(7), pp. 894 - 901. https://doi.org/10.1016/j.joca.2010.04.006
Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis
Foroughi, Nasim, Smith, Richard, Lange, Angela, Baker, Michael, Fiatarone Singh, Maria and Vanwanseele, Benedicte. (2010). Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis. The Knee. 17(3), pp. 210 - 216. https://doi.org/10.1016/j.knee.2009.09.006
Resistive exercise for arthritic cartilage health (REACH): A randomized double-blind, sham-exercise controlled trial
Lange, Angela K., Vanwanseele, Benedicte, Foroughi, Nasim, Baker, Michael Kevin, Shnier, Ronald C., Smith, Richard M. and Singh, Maria Fiatarone. (2009). Resistive exercise for arthritic cartilage health (REACH): A randomized double-blind, sham-exercise controlled trial. BMC Geriatrics. 9(1), pp. 1 - 10. https://doi.org/10.1186/1471-2318-9-1
Obesity effects on depression: Systematic review of epidemiological studies
Atlantis, Evan and Baker, Michael Kevin. (2008). Obesity effects on depression: Systematic review of epidemiological studies. International Journal of Obesity. 32(6), pp. 881 - 891. https://doi.org/10.1038/ijo.2008.54
Multi-modal exercise programs for older adults
Baker, Michael, Atlantis, Evan and Fiatarone Singh, Maria. (2007). Multi-modal exercise programs for older adults. Age and Ageing. 36, pp. 375 - 381. https://doi.org/10.1093/ageing/afm054
Metabolic demands of "junkyard" training: Pushing and pulling a motor vehicle
Berning, Joseph, Ada, Kent, Climstein, Mike and Stamford, Bryant. (2007). Metabolic demands of "junkyard" training: Pushing and pulling a motor vehicle. Journal of Strength and Conditioning Research. 21(3), pp. 853 - 856. https://doi.org/10.1519/R-18335.1
Efficacy and feasibility of a novel tri-modal robust exercise prescription in a retirement community : A randomized, controlled trial
Baker, Michael, Kennedy, David, Bohle, Philip, Campbell, Deena, Knapman, Leona, Grady, Jodie, Wiltshire, James, McNamara, Maria, Evans, William and Fiatarone Singh, Maria. (2007). Efficacy and feasibility of a novel tri-modal robust exercise prescription in a retirement community : A randomized, controlled trial. Journal of the American Geriatrics Society. 55, pp. 1 - 10. https://doi.org/10.1111/j.1532-5415.2006.01031.x
Degenerative meniscus tears and mobility impairment in women with knee osteoarthritis
Lange, Angela, Fiatarone Singh, Maria, Smith, Richard, Foroughi, Nasim, Baker, Michael, Shnier, Ron and Vanwanseele, Benedicte. (2007). Degenerative meniscus tears and mobility impairment in women with knee osteoarthritis. Osteoarthritis and Cartilage. 15(6), pp. 701 - 708. https://doi.org/10.1016/j.joca.2006.11.004
Effect of high-fat meals and fatty acid saturation on postprandial levels of the hormones ghrelin and leptin in healthy men
Poppitt, S. D., Leahy, F. E., Keogh, G. F., Wang, Y, Mulvey, T B., Stojkovic, M, Chan, Kai, Choong, Y S., McArdle, B H. and Cooper, G. J. S.. (2006). Effect of high-fat meals and fatty acid saturation on postprandial levels of the hormones ghrelin and leptin in healthy men. European Journal of Clinical Nutrition. 60(1), pp. 77 - 84. https://doi.org/10.1038/sj.ejcn.1602270
Effectiveness of a 10 week 'heart moves' exercise program in Australian Vietnam veterans
Climstein, Mike, Currie, Janet, Otter, Leanne, De Beliso, M. and Ada, Kent. (2005). Effectiveness of a 10 week 'heart moves' exercise program in Australian Vietnam veterans. Sports Health (print version). 22(4), pp. 25 - 28.
The effects of anabolic-androgenic steroids upon resting and peak exercise left ventricular heart wall motion kinetics in male strength and power athletes
Climstein, Mike, O'Shea, Pat, Ada, Kent and DeBeliso, Mark. (2003). The effects of anabolic-androgenic steroids upon resting and peak exercise left ventricular heart wall motion kinetics in male strength and power athletes. Journal of Science and Medicine in Sport. 6(4), pp. 387 - 397. https://doi.org/10.1016/S1440-2440(03)80265-7