Einfluss von Widerstandstraining auf Parameter des Glukosestoffwechsels bei Gesunden, Typ-2-Diabetikern und Individuen mit Anzeichen einer Insulinresistenz

Zusammenfassung

Ausdauertraining gilt als wichtiger Bestandteil von Therapie und Prävention des Typ-2-Diabetes. Bezüglich des Widerstandstrainings ist die Datenlage dagegen unzureichend. Für eine aktuelle Übersicht wurden relevante Publikationen zu Mechanismen und Auswirkungen von Widerstandstraining im Zusammenhang mit dem Kohlenhydratstoffwechsel identifiziert und ausgewertet. Obwohl z. T. Studien mit einem limitierten Design berücksichtigt werden mussten, spricht die deutliche Mehrheit der Resultate dafür, dass Widerstandstraining Parameter des Glukosestoffwechsels bei Gesunden, Insulinresistenten und Typ-2-Diabetikern positiv beeinflusst. Aspekte des Trainingsaufbaus sind dabei vielfach noch unzureichend untersucht. Clampstudien liefern jedoch deutliche Hinweise, dass im Bereich einer Trainingsintensität von 40 - 60 % der 1RM (Maximalkraft, 1 repetition maximum) und einer Trainingshäufigkeit von 3 - 5 Einheiten pro Woche Verbesserungen der Insulinwirkung in Größenordnungen von 23 - 48 % möglich sind. Weitere Resultate weisen darauf hin, dass entgegen früherer Ansichten die Glukoseaufnahme pro Einheit fettfreier Masse durch Widerstandstraining erhöht werden kann. Die vermittelnden Mechanismen sind den bei Ausdauerinterventionen beobachteten ähnlich und betreffen Veränderungen der Glukosetransportkapazität, -speicherung, Insulinrezeptordichte sowie eventuell Auswirkungen auf der Postrezeptorebene. Weiterhin gibt es Hinweise auf die Beeinflussung von Sekretionsprodukten der Skelettmuskulatur und des weißen Fettgewebes durch physische Aktivität, wobei vor allem für Leptin Evidenz besteht. Widerstandstraining vermag über verschiedene Mechanismen den Glukosestoffwechsel relevant zu verändern und stellt eine wichtige Alternative bzw. Ergänzung zu Ausdaueraktivitäten dar.

Abstract

Regular endurance exercise is recommended as an important factor for the prevention and care of type 2 diabetes. In contrast, the lack of available data on the beneficial effects of resistance training exercise on parameters of glucose metabolism in the scientific literature must be noted. In spite of some limited study designs, the majority of results emphasizes the beneficial effects of regular resistance exercise in healthy, glucose impaired and type 2 diabetic individuals. The factor of exercise routine modulations are poorly understood, but early study results indicate that exercising on three to five days a week with an intensity of 40 - 60 % of the 1RM (1 repetition maximum) may improve insulin sensitivity within a range of 23 - 48 %. Also most of the present data indicates that resistance exercise induced increases in insulin sensitivity, even when corrected for lean body mass. The responsible mechanisms for this improvement appear similar to those found in endurance training studies, i.e, increased capacity for glucose transport and glucose storage, enhanced insulin receptor number and probably some effects on the postreceptor levels. Additionally, resistance training may influence circulating mediators that are secreted by white adipose tissue and skeletal muscle and these mediators are interfering with insulin action. Especially the adipocytokine leptin represents such a candidate. In conclusion, the present research indicates that regular resistance exercise contributed to improvements in certain parameters of glucose metabolism and might represent an adjunct or even alternative to endurance exercise.

Schlüsselwörter

Typ-2-Diabetes - Widerstandstraining - Glukosestoffwechsel - Insulinwirkung - Leptin

Key words

Diabetes type 2 - resistance exercise - glucose metabolism - insulin action - leptin

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