Training, Detraining, and Retraining Effects on Glycemic Control and Physical Fitness in Women with Type 2 Diabetes

Abstract

Little is known about the detraining and retraining effects of exercise in patients with diabetes. The purpose of the present study was to investigate the effects of training, detraining, and retraining, using a combined strength and aerobic exercise program on glycemic control in women with type 2 diabetes. Thirteen postmenopausal women with type 2 diabetes (n=13, age: 55.8±5.1 years) followed a supervised aerobic and strength training program for 9 months, which was interrupted for 3 months (detraining) and resumed again for a period of 9 months (retraining). Anthropometric characteristics, glycemic control, and physical fitness were determined at baseline and after 9, 12, and 21 months. Training induced a small reduction in body mass index (BMI: −3.3%, 95% CI −5.1 to −1.5%), a moderate decrease in fasting plasma glucose (FPG: −12.0%, 95% CI −20.70 to −3.2%), glycosylated hemoglobin (HbA1c: −4.7%, 95% CI −12.1 to 2.7%), and a large decrease in postprandial glucose (PPG: − 12.1%, 95% CI −20.2 to −4.1%). In addition, there was an increase in power output (20.2%, 95% CI 6.9 to 33.6%) and total muscle strength (33.8%, 95% CI 21.4 to 46.1%). Detraining reversed PPG, HbA1c, and physical fitness. Resumption of training, however, led to a moderate decrease in BMI (−5.4%, 95% CI −8.1 to −2.7%), PPG (−9.5%, 95% CI −19.4 to 0.3%), and HbA1c (−6.8%, 95% CI −14.1 to 0.5%), and to large changes in FPG (−20.9%, 95% CI −31.9 to −9.9%), power output (33.1%, 95% CI 17.9 to 48.4%) and total muscle strength (48.2%, 95% CI 34.0 to 62.4%) compared to baseline. Thus, systematic training improves body composition, glycemic control and physical fitness in patients with type 2 diabetes. The cessation of exercise brings about negative alterations, while retraining restores all beneficial adaptations and improves them even more. Therefore, diabetic patients should follow a regular and an uninterrupted exercise program throughout life in order to control glucose metabolism and improve health.

Key words

glucose metabolism - glycosylated hemoglobin - exercise training - fitness

• References

• 1 Maiorana A, O’Driscoll G, Goodman C, Taylor R, Green D. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 2002; 56: 115-123
• 2 Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, Wagner O, Georg P, Prager R, Kostner K, Dunky A, Haber P. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil 2005; 86: 1527-1533
• 3 Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003; 26: 2977-2982
• 4 Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006; 29: 2518-2527
• 5 Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002; 25: 1729-1736
• 6 Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25: 2335-2341
• 7 Tokmakidis SP, Zois CE, Volaklis KA, Kotsa K, Touvra A-M. The effects of a combined strength and aerobic exercise program on glucose control and insulin action in women with type 2 diabetes. Eur J Appl Physiol 2004; 92: 437-442
• 8 Zois CE, Tokmakidis SP, Volaklis KA, Kotsa K, Touvra AM, Douda E, Yovos IG. Lipoprotein profile, glycemic control and physical fitness after strength and aerobic training in post-menopausal women with type 2 diabetes. Eur J Appl Physiol 2009; 106: 901-907
• 9 Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical Activity/Exercise and Type 2 Diabetes: A consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1433-1438
• 10 Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. American College of Sports Medicine; American Diabetes Association: Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care 2010; 33: 2692-2696
• 11 Kalapotharakos VI, Diamantopoulos K, Tokmakidis SP. Effects of resistance training and detraining on muscle strength and functional performance of older adults aged 80 to 88 years. Aging Clin Exp Res 2010; 22: 134-140
• 12 Tokmakidis SP, Volaklis KA. Training and detraining effects of a combined-strength and aerobic exercise program on blood lipids in patients with coronary artery disease. J Cardiopulm Rehabil 2003; 23: 193-200
• 13 Volaklis KA, Douda HT, Kokkinos PF, Tokmakidis SP. Physiological alterations to detraining following prolonged combined strength and aerobic training in cardiac patients. Eur J Cardiovasc Prev Rehabil 2006; 13: 375-380
• 14 Tokmakidis SP, Spassis AT, Volaklis KA. Training, detraining and retraining effects after a water-based exercise program in patients with coronary artery disease. Cardiology 2008; 111: 257-264
• 15 Vukovich MD, Arciero PJ, Kohrt WM, Racette SB, Hansen PA, Holloszy JO. Changes in insulin action and GLUT-4 with 6 days of inactivity in endurance runners. J Appl Physiol 1996; 80: 240-244
• 16 Harriss DJ, Atkinson G. Update – ethical standards in sports and exercise science research. Int J Sports Med 2011; 32: 819-821
• 17 Cohen J. Statistical power analysis for the behavioral sciences. 2^nd ed Hillside, NJ: L. Erlbaum Associates; 1988
• 18 Balducci S, Leonetti F, Di Mario U, Fallucca F. Is a long-term aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients?. Diabetes Care 2004; 27: 841-842
• 19 Albu JB, Heilbronn LK, Kelley DE, Smith SR, Azuma K, Berk ES, Pi-Sunyer FX, Ravussin E. Look AHEAD Adipose Research Group. Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes. Diabetes 2010; 59: 627-633
• 20 Fatone C, Guescini M, Balducci S, Battistoni S, Settequattrini A, Pippi R, Stocchi L, Mantuano M, Stocchi V, De Feo P. Two weekly sessions of combined aerobic and resistance exercise are sufficient to provide beneficial effects in subjects with type 2 diabetes mellitus and metabolic syndrome. J Endocrinol Invest 2010; 33: 489-495
• 21 Yamagishi SI, Nakamura K, Matsui T, Ueda SI, Imaizumi T. Role of postprandial hyperglycaemia in cardiovascular disease in diabetes. Int J Clin Pract 2007; 61: 83-87
• 22 Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-412
• 23 Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421-431
• 24 Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud’homme D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jennings A, Jaffey J. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007; 147: 357-369
• 25 Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia 2003; 46: 1071-1081
• 26 Kokkinos P, Myers J, Nylen E, Panagiotakos DB, Manolis A, Pittaras A, Blackman MR, Jacob-Issac R, Faselis C, Abella J, Singh S. Exercise capacity and all-cause mortality in African American and Caucasian men with type 2 diabetes. Diabetes Care 2009; 32: 623-628
• 27 Ortega FB, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ 2012; 11: 345-350
• 28 Artero EG, Lee DC, Lavie CJ, Espana-romero V, Sui X, Church TS, Blair SN. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev 2012; 32: 351-358
• 29 Henwood TR, Taaffe DR. Detraining and retraining in older adults following long-term muscle power or muscle strength specific training. J Gerontol A Biol Sci Med Sci 2008; 63: 751-758