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Resistance Training for Everyone

Sheri_Colberg
 
 
 
By Sheri Colberg, PhD
 
 

The goal of resistance training is increased muscular fitness, both muscular strength and endurance.

Muscle strength is the ability of the muscle to exert force, while muscle endurance is the ability of the muscle to continue to perform without fatigue. Resistance training is recommended for persons with diabetes and follows apparently healthy guidelines, with age and experience as prime considerations in program development. Such training has been shown to improve musculoskeletal health, maintain independence in performing daily activities, and reduce the possibility of injury1,2.

Resistance Exercise Prescription for Type 1 and Type 2 Diabetes

Mode: Muscular fitness can be improved by including free weights (dumbbells and barbells), weight or resistance machines, resistance bands, isometric exercises, and calisthenics using body weight as resistance (e.g., push-ups). Resistance machines and free weights result in fairly equivalent gains in strength and mass of targeted muscles3,4, although no research has specifically evaluated the use of resistance bands or body-weight resistance only. Typically, heavier weights or resistance are needed for optimization of insulin action and blood glucose control4,5.

Individuals should select strengthening exercises that involve the major muscle groups in the upper body, lower body, and core, including the back, legs, hips, chest, shoulders, arms, and abdomen2,6,7. Exercise selection should be based on individual goals, preferences, and skill. Specific muscle groups may also be targeted to enhance other components of the activity program, such as biking, swimming, or golfing.

As far as exercise sequencing goes, individuals should exercise their large muscle groups before small ones, such as doing chest and back exercises before specific arm exercises. In addition, they should do exercises involving multiple joints before those that focus on single joints, e.g., leg presses before leg extensions (quadriceps muscle only) or leg curls (hamstrings)1. Doing them in this sequence helps ensure that adequate energy is available to effectively perform all exercises within a training session and injury risk lower. Abdominal and core muscle exercises should be performed at the end of the training session to avoid premature fatigue.

Intensity: The actual resistance used is determined by a person’s 1-RM that can only be successfully lifted one time. Training should be either moderate (50% 1-RM) or vigorous (75–80% 1-RM) in intensity allows for optimal gains in strength and insulin action3,4,5. No specific amount of time is recommended for muscle strengthening, but exercises should be performed to the point at which it would be difficult to do another repetition without assistance, at least on the final set. Home-based resistance training is adequate for maintaining muscle mass and strength, but less effective than supervised, gym-based training for sustaining blood glucose control as heavier weights or resistance may be needed to optimize insulin action4,5.

Frequency: Resistance exercise should be undertaken at least twice weekly on nonconsecutive days (with a minimum of 48 hours of rest between sessions)2,6,7,8, but more ideally three times a week3, as part of a physical activity program for both T1DM and T2DM, along with regular aerobic activities. Adequate rest periods between sets during a workout session are needed to successfully complete all sets on each exercise. Typically, lower intensity training requires 15 seconds to one minute of rest, while higher intensity training may necessitate up to 2–3 minutes of rest between sets.

Duration: Each training session should minimally include five to 10 exercises involving the major muscle groups in the upper body, lower body, and core, with completion of 10–15 repetitions to near fatigue per set early in training2, progressing over time to heavier weights or resistance that can be lifted only 8–10 times. A minimum of one set of repetitions to near fatigue, but as many as 3–4 sets per exercise, is recommended for optimal strength gains. As far as diabetes management is concerned, single set protocols are generally less effective than multiple set protocols in lowering fasting blood glucose and raising insulin action as there is likely a dose-response relationship between volume and intensity on insulin sensitivity and fasting blood glucose9.

Progression: To avoid injury, progression of intensity, frequency, and duration of training sessions should occur slowly. In most progressive resistance training, increases in weight or resistance are undertaken first—only once the target number of repetitions per set can consistently be exceeded—followed by a greater number of sets and lastly by increased training frequency1,2. Progression over 6 months to thrice weekly sessions of three sets of 8–10 repetitions done at 75–80% of 1-RM on 8–10 exercises may be an optimal goal for most individuals with diabetes3,6. However, individuals with joint limitations or other health complications should complete of one set of exercises for all major muscle groups, starting with 10–15 repetitions and progressing to 15–20 repetitions before additional sets are added8.

 

Table 8.2. Recommended Resistance Exercise Rx for Type 1 and Type 2 Diabetes

 
Type 1 Diabetes
Type 2 Diabetes
Mode of Training

All major muscle groups, using resistance bands, free weights, resistance training machines, isometric exercises, and/or calisthenics (using body weight)

Upper body: 4–5 exercises

Lower body/core: 4–5 exercises

All major muscle groups, using resistance bands, free weights, resistance training machines, isometric exercises, and/or calisthenics (using body weight)

Upper body: 4–5 exercises

Lower body/core: 4–5 exercises

Intensity

60–80% 1-RM

7–8 (10-point scale)

50/60–80% 1-RM

(50% 1-RM initially if untrained)

5–8 (10-point scale)

Frequency

2–3 days per week (nonconsecutive)

Allow 48 hours of rest between training sessions

A minimum of 2, but preferably 3, nonconsecutive days per week

Allow 48 hours of rest between training sessions

Duration/
Number of Repetitions

8–12 repetitions per exercise

1–3 sets per exercise

8–12 repetitions per exercise as a goal, but 10–15 repetitions initially

1–3 sets per exercise

Progression

Start with 1–2 sets of 8–12 repetitions, progressing to 8–10 harder repetitions, and finally to 2–3 sets of 8–10 repetitions to near fatigue

Start with 1–2 sets of 8–15 repetitions: 1 set of 10–15 repetitions to fatigue initially, progressing to 8–10 harder repetitions, and finally to 2–3 sets of 8–10 repetitions

Note: Certain individuals may need to lower their intensity (more repetitions with less resistance) when diabetic retinopathy, hypertension, or orthopedic limitations are present.

 

In conclusion, people with any type of diabetes will benefit from engaging in resistance exercise training a minimum of two, or more ideally three, days per week. Resistance training has been shown to be the best exercise to maintain muscle mass and to prevent losses of muscle mass and strength, but also to potentially increase muscle mass and enhance insulin action. A greater muscle mass generally results in increased resting blood glucose uptake and better glycemic control in individuals with any type of diabetes. Whole body resistance training may actually be more beneficial than aerobic training in this regard due to the increased utilization of all muscle fibers during resistance exercises.  

References:

  1. American College of Sports, Medicine. 2009. "American College of Sports Medicine position stand. Progression models in resistance training for healthy adults." Med Sci Sports Exerc no. 41 (3):687-708.
  2. Garber, C. E., B. Blissmer, M. R. Deschenes, B. A. Franklin, M. J. Lamonte, I. M. Lee, D. C. Nieman, D. P. Swain, and Medicine American College of Sports. 2011. "American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise." Med Sci Sports Exerc no. 43 (7):1334-59.
  3. Dunstan, D. W., R. M. Daly, N. Owen, D. Jolley, M. De Courten, J. Shaw, and P. Zimmet. 2002. "High-intensity resistance training improves glycemic control in older patients with type 2 diabetes." Diabetes Care no. 25 (10):1729-36.
  4. Dunstan, D. W., R. M. Daly, N. Owen, D. Jolley, E. Vulikh, J. Shaw, and P. Zimmet. 2005. "Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes." Diabetes Care no. 28 (1):3-9.
  5. Willey, K. A., and M. A. Singh. 2003. "Battling insulin resistance in elderly obese people with type 2 diabetes: bring on the heavy weights." Diabetes Care no. 26 (5):1580-8.
  6. Colberg, S. R., R. J. Sigal, B. Fernhall, J. G. Regensteiner, B. J. Blissmer, R. R. Rubin, L. Chasan-Taber, A. L. Albright, B. Braun, Medicine American College of Sports, and Association American Diabetes. 2010. "Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement." Diabetes Care no. 33 (12):e147-67.
  7. Haskell, W. L., I. M. Lee, R. R. Pate, K. E. Powell, S. N. Blair, B. A. Franklin, C. A. Macera, G. W. Heath, P. D. Thompson, and A. Bauman. 2007. "Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association." Med Sci Sports Exerc no. 39 (8):1423-34.
  8. Nelson, M. E., W. J. Rejeski, S. N. Blair, P. W. Duncan, J. O. Judge, A. C. King, C. A. Macera, and C. Castaneda-Sceppa. 2007. "Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association." Med Sci Sports Exerc no. 39 (8):1435-45.
  9. Black, L. E., P. D. Swan, and B. A. Alvar. 2010. "Effects of intensity and volume on insulin sensitivity during acute bouts of resistance training." J Strength Cond Res no. 24 (4):1109-16.

 

This article is excerpted from Chapter 8 of Exercise and Diabetes: A Clinician’s Guide to Prescribing Physical Activity, a case-study based book available through the American Diabetes Association in June 2013 and written by Dr. Sheri Colberg (find more information about the book online at www.shericolberg.com/exercise-diabetes.asp).

In addition, anyone wishing to earn free CME credits through the ADA for completing a new self-assessment program on exercise and diabetes may do so now through the ADA’s web site at http://professional.diabetes.org/ce.

Copyright © 2013 Diabetes In Control, Inc.