Preventing Diabetes with Resistance Training or Aerobic Exercise

Is preventing diabetes with resistance training possible? Study examines whether it can improve beta-cell function in patients with prediabetes,

Prediabetes is characterized by impaired glucose regulation and reduced β-cell function. Focusing on prevention measures can help curb the diabetes epidemic. This can be achieved by focusing on measures to improve insulin resistance and preserving β-cell mass and function. Incident type 2 diabetes can be reduced by 58% with lifestyle modifications, according to the Diabetes Prevention Program.

Although aerobic exercise has been accepted by the Diabetes Prevention Program to slow the progression from prediabetes to diabetes, resistance training has not. In the rodent models resistance training has been shown to improve insulin sensitivity. Other studies have attempted to compare these exercise regimens but failed to differentiate between β-cell function and insulin sensitivity. This recent study analyzed glycemic control and β-cell function over six months in prediabetes patients performing either aerobic exercise or resistance training.

This randomized controlled trial included 248 Chinese participants with prediabetes that were recruited from three different medical centers. These patients were randomized into 3 groups as follows: aerobic exercise n=83, resistance training n=82, and control n=83. Both exercise groups performed three times per week for six months under the supervision of a research nurse or research assistant. The mean age of participants was 60 years old and there were no significant differences in demographic traits. Mean HbA1c values were 5.98% in the aerobics group, 5.92% in the resistance training group, and 5.95% in the control group. The resistance patients performed 13 exercises while the aerobics group exercised to achieve 60-70% of maximum heart rate. The primary outcome of this trial was evidence of improved metabolic control.

Before and after the 6-month exercise trial, an oral glucose tolerance test was given to measure metabolic control.  Fasting blood lipid assays were also used to determine the effects of an exercise intervention on cholesterol levels. Body mass index was calculated pre and post-treatment. In addition to the assigned exercise regimen, all participants were ordered to follow a healthy diet individualized by a dietician and recorded their food intake throughout the trial.

The completion rate of the study was 87.5%, no exercise-related adverse events were documented, and there were no significant differences in baseline characteristics. Both the aerobic exercise and resistance training groups had improved HbA1c levels with no significant differences noted. This significant improvement was not seen in the control group. The aerobics and resistance groups showed significant improvement in HOMA2-β compared to the control group. The exercise groups showed greater improvements in body weight, body mass index, glucose tolerance test, and systolic blood pressure compared to the control group. Results indicated a significant decrease in fasting blood glucose for the exercise treatment groups at the end of the 6 months.

This trial demonstrated that resistance training has comparable efficacy to aerobic training for improving β-cell function and metabolic regulation. Both exercise groups showed significant improvements in HbA1c compared to the control group, but when comparing the resistance group to baseline, results were not significant, although this study suggests that resistance training can improve HbA1c in patients with prediabetes. Limitations to this trial include: no follow up measures of VO2max or strength, and this study consisted of a much greater number of female participants.

Practice Pearls:

• Six months of resistance training is comparable to aerobic exercise at improving β-cell function and may prevent the progression of prediabetes to type 2 diabetes.
• Both resistance training and aerobic exercise improve glucose regulation compared to the control group.
• Due to the limitations of this trial a larger more diverse study is required to confirm results.

Reference for “Preventing Diabetes with Resistance Training or Aerobic Exercise”:

Yuan, Xiaodan, et al. “Comparing the Effects of 6 Months Aerobic Exercise and Resistance Training on Metabolic Control and β‐Cell Function in Chinese Patients with Prediabetes: A Multicenter Randomized Controlled Trial.” Journal of Diabetes, 2019, doi:10.1111/1753-0407.12955. 

Kassey James, Pharm.D.Candidate, LECOM School of Pharmacy