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The Relative Benefits of Endurance and Strength Training on the Metabolic Factors and Muscle Function of People With Type 2 Diabetes Mellitus

      Abstract

      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.

      Objective

      To compare the effects of a 4-month strength training (ST) versus aerobic endurance training (ET) program on metabolic control, muscle strength, and cardiovascular endurance in subjects with type 2 diabetes mellitus (T2D).

      Design

      Randomized controlled trial.

      Setting

      Large public tertiary hospital.

      Participants

      Twenty-two T2D participants (11 men, 11 women; mean age ± standard error, 56.2±1.1y; diabetes duration, 8.8±3.5y) were randomized into a 4-month ST program and 17 T2D participants (9 men, 8 women; mean age, 57.9±1.4y; diabetes duration, 9.2±1.7y) into a 4-month ET program.

      Interventions

      ST (up to 6 sets per muscle group per week) and ET (with an intensity of maximal oxygen consumption of 60% and a volume beginning at 15min and advancing to a maximum of 30min 3×/wk) for 4 months.

      Main Outcome Measures

      Laboratory tests included determinations of blood glucose, glycosylated hemoglobin (Hb A1c), insulin, and lipid assays.

      Results

      A significant decline in Hb A1c was only observed in the ST group (8.3%±1.7% to 7.1%±0.2%, P=.001). Blood glucose (204±16mg/dL to 147±8mg/dL, P<.001) and insulin resistance (9.11±1.51 to 7.15±1.15, P=.04) improved significantly in the ST group, whereas no significant changes were observed in the ET group. Baseline levels of total cholesterol (207±8mg/dL to 184±7mg/dL, P<.001), low-density lipoprotein cholesterol (120±8mg/dL to 106±8mg/dL, P=.001), and triglyceride levels (229±25mg/dL to 150±15mg/dL, P=.001) were significantly reduced and high-density lipoprotein cholesterol (43±3mg/dL to 48±2mg/dL, P=.004) was significantly increased in the ST group; in contrast, no such changes were seen in the ET group.

      Conclusions

      ST was more effective than ET in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that ST may play an important role in the treatment of T2D.

      Key Words

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      Linked Article

      • Exercise Interventions for Diabetes Control: Do We Really Know That Strength Training Is Better Than Endurance Training?
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          Recently Cauza et al1 compared the influence of strength training to endurance training on glycemic control, atherogenic markers, cardiovascular risk factors, body composition, strength, and cardiorespiratory endurance in people with diabetes. At first glance, results seemed clearly definitive that strength training was superior to endurance training. However, on closer inspection, the analysis strategy proposed in the methods section did not appear to be the analysis on which reported results were based.
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        Archives of Physical Medicine and RehabilitationVol. 88Issue 12
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          In his letter criticizing the study by Cauza et al,1 Weeks2 makes 2 points. The first is that Cauza and colleagues state that they conducted a 2-factor repeated-measures analysis of variance (ANOVA) to analyze their outcomes from their randomized controlled trial, yet they do not actually report such. The second point concerns the lack of equivalence at baseline for the 2 groups.
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      • The author responds
        Archives of Physical Medicine and RehabilitationVol. 88Issue 12
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          Several authors over the years have informed us that the value of the F ratio for the interaction effect between a treatment factor (eg treatment vs control) and a pre-post repeated-measures factor is equal in value to the F ratio when change scores (posttest score minus pretest) are analyzed in a 1-way analysis of variance (ANOVA) comparing treatment groups.1-3 This equality has led some authors to suggest that using the treatment main effect (the primary effect of interest) from the repeated-measures ANOVA to judge the influence of an intervention would be a mistake because the pretest scores are not influenced by the treatment.
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