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Comparison of effects of aerobic and resistance trainingin subjects with type 2 diabetes
No full textProgetto 1. Confronto degli effetti del training aerobico e di quello di resistenza muscolare nei soggetti con diabete tipo 2.
Numero di registro ClinicalTrials.gov: NCT01182948
Background. L’esercizio è considerato un importante strumento nel management del diabete tipo 2. Le più recenti linee guida raccomandano a questi pazienti, come strategia per migliorare il controllo glicemico, attività combinata aerobica e di forza. Tuttavia, rimane da definire quali differenze ci siano nei meccanismi con cui queste tipologie di esercizio contribuiscono al miglioramento metabolico nei soggetti diabetici. Questo ha un grande interesse speculativo e può essere di ausilio nel definire le combinazioni più appropriate fra tali tipologie di esercizio. Il nostro studio è stato disegnato per analizzare tali aspetti.
Soggetti e metodi. 40 soggetti con diabete tipo 2, 12 femmine e 28 maschi (età 56±7 anni, BMI 29.4±4.6 kg/m2, HbA1c 7.3±0.7%) sono stati randomizzati ad un gruppo di esercizio aerobico (AER, n=20) e ad uno di forza muscolare (RES, n=20). Entrambi i gruppi si sono allenati 3 volte/settimana per 4 mesi. Il gruppo AER si è allenato per 60 minuti per sessione con una intensità del 60-65% della frequenza cardiaca di riserva. Il gruppo RES ha svolto 3 serie di 8-10 ripetizioni, eseguendo 8 differenti esercizi mediante macchine isotoniche per sessione. Prima e dopo intervento sono stati valutati: HbA1c e altri parametri metabolici, peso, circonferenza addominale, introito calorico e dispendio energetico (questionari), consumo di ossigeno al picco durante esercizio incrementale (VO2picco), test 1RM arti inferiori e superiori (leg extension e chest press), massa grassa e magra (DEXA Total Body), sensibilità insulinica (clamp euglicemico iperinsulinemico), funzione β-cellulare (OGTT con modello matematico), flessibilità metabolica (calorimetria indiretta), grasso addominale sottocutaneo (SAT) e viscerale (VAT) e contenuto di grasso epatico e muscolare (Risonanza Magnetica). Inoltre, è stata valutata la glicemia durante 48 ore di monitoraggio continuo mediante Holter glicemico. Sono stati anche registrati i cambiamenti della terapia antidiabetica e gli eventi avversi. Nel corso dello studio sono state effettuate altre indagini (espressione genica e misura del DNA mitocondriale in agoaspirati del muscolo vasto laterale, estrazione tissutale di ossigeno durante test da sforzo, funzione barorecettoriale, risposta venoarteriolare, analisi spettrale della funzione autonomica, misura dello stress ossidativo). Tuttavia i risultati di queste valutazioni non sono ancora disponibili e pertanto non saranno oggetto di trattazione.
Risultati. I due gruppi avevano simili caratteristiche basali. Dopo 4 mesi di intervento le variazioni di VO2picco e forza muscolare mostravano differenze significative fra i due gruppi (VO2picco 15±10 vs 8±10%, p=0.04; performance alla leg extension 4±11 vs 19±10%, p<0.0001, rispettivamente). I livelli di HbA1c erano ridotti in misura simile nei due gruppi (da 7.23±0.64 a 6.83±0.38; e da 7.34±0.69 a 6.99±0.64%, rispettivamente nel gruppo AER e nel gruppo RES). BMI, circonferenza vita, massa grassa totale e tronculare, massa magra degli arti, SAT e VAT erano ridotti in entrambi i gruppi, senza differenze significative tra le due tipologie di training. La sensibilità insulinica era aumentata in entrambi i gruppi (30% e 15%, rispettivamente), mentre la funzione β-cellulare e la flessibilità metabolica non erano modificate. Sia il gruppo AER che quello RES mostravano una riduzione simile nel grasso epatico e muscolare. Durante la sessione di training la concentrazione di glucosio, misurata mediante Holter glicemico, mostrava una riduzione in entrambi i gruppi. Tuttavia, la riduzione era maggiore in AER rispetto a RES (p<0.001). Differenze tra i due gruppi si osservavano inoltre nelle concentrazioni di glucosio durante la notte successiva alla sessione di training. Dopo i 4 mesi di intervento non vi erano significative modificazioni nella terapia antidiabetica. Non sono stati registrati rilevanti eventi avversi. La riduzione di HbA1c era significativamente associata a cambiamento di massa grassa totale e tronculare, VO2picco, potenza al picco e performance alla leg extension. L’aumento della sensibilità insulinica era significativamente associato a cambiamento di VAT, rapporto VAT/SAT e VO2picco. All’analisi multivariata il cambiamento di HbA1c era predetto in modo indipendente dai livelli basali di HbA1c e dalle variazioni di VO2picco, performance alla leg extension e massa grassa tronculare (varianza spiegata 65%). L’aumento della sensibilità insulinica era predetto dal cambiamento di VAT e VO2picco mentre i cambiamenti della performance alla leg extension e della massa muscolare degli arti mostravano un’associazione con significatività borderline (varianza spiegata 66%).
Conclusioni. Questi dati mostrano che l’allenamento aerobico e quello di forza possono esercitare effetti benefici simili sul controllo metabolico nei soggetti con diabete tipo 2, malgrado effetti differenti sulle capacità funzionali. La riduzione acuta post-esercizio della glicemia è maggiore dopo attività aerobica che dopo attività di forza, suggerendo che l’aumentato rischio di ipoglicemia dopo esercizio va considerato soprattutto dopo attività aerobica. Gli effetti positivi dell’esercizio sull’insulinoresistenza appaiono associati in modo indipendente all’aumento nella fitness cardiorespiratoria e alla riduzione del grasso viscerale.
Progetto 2. Il modello dei gruppi di cammino supervisionati per implementare la pratica dell’attività fisica nei soggetti con diabete tipo 2.
Numero di registro ClinicalTrials.gov: NCT01115205
Background e scopo. L’esercizio fisico ha documentato un potenziale ruolo di primo piano nel management del diabete tipo 2, ma resta da chiarire come questa evidenza possa essere trasferita nella pratica clinica. Numerosi studi hanno documentato l’inefficacia, nell’ottenere cambiamenti metabolici in questi soggetti, di programmi di esercizio non supervisionato. Scopo di questo studio è stato quello di valutare l’impatto che l’attività di gruppi di cammino supervisionati può avere in questi pazienti.
Soggetti e Metodi. 59 soggetti con diabete tipo 2 sono stati randomizzati, con rapporto 1:2, ad un gruppo di controllo o ad un gruppo di intervento. Il gruppo di controllo ha ricevuto raccomandazioni standard, nell’ambito della routine ambulatoriale, per aumentare l’attività fisica spontanea, mentre il gruppo di intervento è stato organizzato in gruppi di cammino e sottoposto a sedute di counseling. L’intervento ha avuto una durata di 4 mesi per una frequenza di 3 volte/settimana. All’inizio e al termine dell’intervento sono stati misurati HbA1c (outcome primario), glicemia, profilo lipidico, peso e pressione arteriosa. Inoltre, all’inizio e al termine dell’intervento, è stata misurata la distanza percorsa in 6 minuti di cammino veloce (6 minute walk test) e sono stati quantificati l’attività fisica complessiva svolta e i farmaci antidiabetici prescritti.
Risultati. I due gruppi presentavano simili caratteristiche basali. Al termine dello studio le variazioni nella distanza percorsa nel test dei 6 minuti e nel volume di attività fisica complessiva erano maggiori nel gruppo di intervento, mentre i cambiamenti nei parametri metabolici non erano significativamente diversi. Tuttavia, nei soggetti del gruppo di intervento che avevano frequentato almeno il 50% delle sessioni di cammino guidato la riduzione di HbA1c e glicemia era significativamente maggiore del gruppo di controllo. Al termine dei 4 mesi, una riduzione o sospensione dei farmaci antidiabetici era stata prescritta nel 33% dei soggetti del gruppo di intervento e nel 5% dei controlli (p<0.05).
Conclusioni. Praticare attività fisica mediante gruppi di cammino guidato può determinare significativi benefici metabolici nei soggetti con diabete tipo 2, purché vi sia una adeguata compliance.Project 1. Effects of Aerobic training and Resistance training in type 2 Diabetes.
ClinicalTrials.gov Identifier Number: NCT01182948
Background. Exercise is considered a fundamental issue in the management of subjects with type 2 diabetes (T2DM). The most recent guidelines recommend both aerobic and strength exercise in these subjects, as this strategy may have greater beneficial effects on glucose control. However, it still remains unclear which differences and similarities exist between the effects of these two training protocols on the different factors contributing to metabolic control in subjects with T2DM. This is of great speculative interest and could help in programming a more appropriate combination of different exercise modalities. Our study aimed at exploring this crucial issue.
Subjects and Methods. 40 T2DM subjects, 12 females and 28 males (mean±SD: age 56±7 years, BMI 29.4±4.6 kg/m2, HbA1c 7.3±0.7%) were randomized to aerobic (AER, n=20) or resistance (RES, n=20) training. In both groups exercise was performed 3 times weekly, for 4 months. The AER group exercised for 60 minutes at 60-65% heart rate reserve. The RES group performed 3 series of 8-10 repetitions of 8 different exercises on weight machines each session, at 70-80% 1RM. Before and after the intervention the following were assessed: HbA1c and other metabolic features, weight, waist circumference, caloric intake and overall physical activity (through questionnaires), peak oxygen uptake (VO2peak), leg and arm muscle 1RM tests (leg extension and chest press), fat mass and fat free mass (DEXA Total Body), insulin sensitivity (euglycemic hyperinsulinemic clamp), β-cell function (OGTT and mathematical models), metabolic flexibility (calorimetry), subcutaneous (SAT) and visceral abdominal adipose tissue (VAT), and hepatic and skeletal muscle fat content (Magnetic Resonance Imaging). In addition, continuous plasma glucose monitoring for 48 h was carried out and changes in antidiabetic therapy and adverse events were recorded. Some additional investigations were also carried out (expression of relevant genes and measurement of mitochondrial DNA in fine needle aspirates of vastus lateralis muscle; tissue oxygen extraction during exercise test; baroreceptor function; venoarteriolar response; spectral analysis of autonomic system function; oxidative stress measurement). However, these data are not yet available and therefore these aspects have not been included in the thesis.
Results. The two groups had similar baseline characteristics. After 4 months of training, changes in VO2peak and strength showed significant differences between the AER and RES groups (VO2peak 15±10 vs 8±10%, p=0.04; Leg extension performance 4±11 vs 19±10%, p<0.0001, respectively). HbA1c was similarly reduced in the two groups (from 7.23±0.64 to 6.83±0.38; and from 7.34±0.69 to 6.99±0.64%, respectively in the AER and RES groups). BMI, waist, fat mass, truncal fat, limbs lean mass, SAT and VAT were also significantly reduced in both groups, with no statistically significant differences between the two groups. Insulin sensitivity was significantly increased in both groups (by 30% and 15%, respectively), while β-cell function and metabolic flexibility did not change in the two groups. AER and RES groups showed similar reductions in hepatic and skeletal muscle fat. During the 60 min of supervised training, blood glucose, measured by a continuous glucose monitoring system, showed a reduction in both groups. However, reduction was significantly greater in the AER than in the RES group (p<0.001). Differences between groups were also found in the comparison of blood glucose values recorded during the night following the training session. After 4 months of training there was no significant change in antidiabetic medications and no relevant adverse events were reported. In the entire cohort of subjects, reduction after training of HbA1c was significantly associated with changes in total body fat, truncal fat, VO2peak, maximal workload and leg extension performance. Changes in insulin sensitivity, as measured by the glucose clamp, were significantly associated with changes in VAT and VAT/SAT ratio, as well as with changes in VO2peak. In multiple regression analyses, change after intervention in HbA1c was independently predicted by HbA1c at baseline and changes in VO2peak, leg extension performance and truncal fat (overall variance explained 65%). Change after intervention in insulin sensitivity was independently predicted by changes in VAT and VO2peak, whereas changes of leg extension performance and limb lean mass were of borderline significance (variance explained 66%).
Conclusions. These data show that aerobic and resistance training can exert similar beneficial effects on glucose control in type 2 diabetes subjects, despite their different effects on functional capacity. Post-exercise acute blood glucose reduction is greater after aerobic training than after resistance training, suggesting an increased risk of post-exercise hypoglycemia after an aerobic exercise session. Exercise-induced improvement of insulin sensitivity is independently predicted by the increase in cardiorespiratory fitness and reduction in visceral fat.
Project 2. Supervised walking groups to increase physical activity in type 2 diabetes patients.
ClinicalTrials.gov Identifier Number: NCT01115205
Background. Previous studies reported that self-paced walking is inadequate to obtain metabolic improvement in patients with type 2 diabetes (T2DM). The aims of this study were to evaluate the compliance of T2DM patients with an exercise programme organized into supervised walking groups; and to assess the impact of this model on metabolic control and overall physical activity.
Subjects and Methods. 59 T2DM subjects were randomized, with a 1:2 ratio, to a control group or an intervention group. The control group received standard recommendations to increase physical activity. Intervention was based on supervised walking groups and counselling. Progressive training sessions were scheduled 3 times weekly for 4 months. Before and at the end of the study, haemoglobin (Hb)A1c (primary outcome), fasting glucose, serum lipids, weight, and blood pressure were measured. Functional capacity was assessed by a 6 minute walk test. Changes in prescription of antidiabetic medications and overall physical activity were also recorded.
Results. At baseline, the two groups were similar. At the end of the study, functional capacity and overall physical activity were higher in the intervention group, whereas changes in metabolic parameters did not show significant differences between the groups. However, in subjects of the intervention group who attended at least 50% of scheduled walking, changes in HbA1c and fasting glucose were greater than in controls. Discontinuation or reduction of antidiabetic drugs occurred in 33% of these patients vs 5 % in the control group (p<0.05).
Conclusions. Supervised walking may be beneficial in diabetic subjects, but metabolic improvement requires adequate compliance
Is cardiorespiratory fitness impaired in PCOS women? A review of the literature
No full textPolycystic ovary syndrome (PCOS) is a common and heterogeneous endocrine disorder, affecting 8-12% of reproductive-aged women. Insulin resistance and body fat excess are common features in these subjects. Increased physical activity and diet modifications are the first recommended approach in the management of these women, at least in overweight/obese subjects. Evaluation of cardiorespiratory fitness (CRF) is important in assessing exercise performance and in monitoring the effects of physical exercise interventions. Several studies have shown that CRF may be impaired in metabolic and endocrine disorders. However, there are little data on this issue in PCOS women. The aim of this narrative review is to critically evaluate whether aerobic capacity is altered in PCOS women, focusing on maximal oxygen uptake
Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers
No full textBackground. Several studies have reported that low body weight and menstrual alterations are very frequent findings in elite dancers, suggesting they could be at risk for associated medical problems. However, it is still largely unknown whether these alterations are also common in the very large number of young amateur dancers.Aim. The aim of this study was to assess whether there is an increased prevalence of menstrual dysfunction also in amateur dancers.Material/Subjects and Methods. 92 professional ballet dancers, 93 non-professional ballet dancers, and 293 (160 sedentary, 133 physically active) control women, ranging in age 14-23 yr were included in the study. In these subjects a detailed questionnaire that included questions on weight, height, age at menarche, training profile and menstrual alterations was administered.Results. BMI was lower in both professional and non-professional dancers than in controls. Frequency of menstrual dysfunction was 51%, 34% and 21% in professional dancers, non-professional dancers and controls, respectively (p<0.0001). Amenorrhea was reported by 23% of professional dancers, vs 1-7% in the other groups (p<0.0001). Age at menarche occurred later in professional dancers than in the other groups. Logistic regression analyses showed that menstrual dysfunction was associated with the training profile in professional dancers, and with BMI in non-professional dancers. Age at menarche was associated with menstrual dysfunction in both groups.Conclusions. This study shows that low body weight and menstrual dysfunction are frequent findings also in amateur ballet dancers
VO2/PO Relationship In Type 2 Diabetic Subjects.: 2149 Board #301 June 2, 3: 30 PM - 5: 00 PM
No full text[no abstract available
Lo stile di vita come terapia. Manuale per medici di famiglia e specialisti per la prescizione di corretti stili di vita nella cura delle patologie cardiocerebrovascolari.
No full textExercise for Hepatic Fat Accumulation in Type 2 Diabetic Subjects
Full text linkType 2 diabetes is characterized by frequent ectopic fat accumulation in several tissues and organs. In particular, a number of studies showed that these subjects frequently have hepatic fat accumulation, which may play a role in the metabolic abnormalities typical of diabetes and has been also linked to increased risk for cardiovascular disease. In the last decade, the effect of exercise on ectopic fat content of type 2 diabetic patients has raised growing interest. However, there are only a few small randomized controlled trials on this topic. Results from these intervention studies indicate that exercise training, independent of dietary modifications, may reduce hepatic fat content and serum transaminases in these patients, suggesting that exercise per se may be an effective strategy to be combined with the traditional dietary interventions. As regards the different training modalities, there is recent evidence that both aerobic and resistance exercise may equally reduce hepatic fat accumulation in type 2 diabetic subjects. However, information regarding the effect of exercise on liver histology and fat accumulation in other ectopic sites is still very limited
Influence of Acute Bouts of Exercise on Blood Glucose in Type 2 Diabetic patients, as Measured by Continuous Glucose Monitoring Systems
Full text linkLiterature data indicate that the effect on blood glucose levels of a single bout of exercise may persist up to 48-h after cessation of exercise. Regular exercise improves insulin sensitivity and blood glucose control in subjects with type 2 diabetes and is considered a key element in the management of this condition. However, adaptive responses to exercise are altered in diabetic subjects and medications used in these patients may cause inappropriate insulin levels for the concurrent blood glucose concentrations, with a possible increase in risk for hypoglycaemia. Recently, the development and clinical availability of systems for the continuous monitoring of glucose (continuous glucose monitoring system, CGMS), have made it possible to continuously record blood glucose levels for several days in real life conditions, showing that possible differences in blood glucose levels of these individuals may occur during and after a single bout of exercise, depending on the characteristics of the physical activity. In particular, differences between aerobic vs resistance exercise and between low-intensity vs high-intensity exercise have been reported. However, there are only a few, small heterogeneous studies on this topic, and results are to some extent discordant, limiting any conclusions.
Further research on this issue is needed before we can reach clear conclusions. In particular, the role of differences in frequency, duration, intensity, type and timing of exercise needs to be carefully investigated. Hopefully, this information will assist clinicians and exercise specialists in designing personalized exercise programmes and strategies aimed at optimally improving glucose control of type 2 diabetic patients, also limiting the risk for hypoglycaemia. In this article, we review the literature regarding the acute effect of different types of exercise on glucose levels, as measured by CGMS, in subjects with type 2 diabetes
Metabolic Effects of Exercise
No full textExercise has a powerful action on metabolism, and adaptation of the body to changes induced by exercise is fundamental to be able to provide the energy required for muscle contraction and physiological functions of vital tissues. Depending on the intensity and duration of exercise, different mechanisms are called on to make energy available, and under homeostatic control, this is guaranteed by rapid and coordinated changes in the secretion of several hormones. Molecular mechanisms controlling muscle function and fiber phenotype are related to the specific mode of muscle activation. We can distinguish between two fundamental types of physical activity, endurance exercise and strength exercise, although there is a continuum between these exercise modalities. Besides the acute changes induced by a single exercise session, regular exercise may induce chronic adaptations, improving exercise capacity and affecting energy metabolism. Notably, although acute metabolic effects of exercise are mostly due to insulin-independent effects, exercise training may improve muscle insulin sensitivity and is considered a key tool in the prevention and treatment of metabolic disorders. This chapter focuses on the biochemistry of energy supply to the exercising muscle, on molecular mechanisms involved and on the physiology of energy metabolism during exercise in healthy subjects and patients with insulin resistance and/or diabetes
Comparison between dual-energy X-ray absorptiometry and skinfold thickness in assessing body fat in overweigh/obese adult patients with type-2 diabetes
Full text linkPercentage of body fat (%BF) is estimated in clinical practice using anthropometric equations, but little is known about their reliability in overweight/obese patients with type-2 diabetes. The aim of this study was to compare, in overweight/obese adults with type-2 diabetes, %BF estimated with several commonly used anthropometric equations and %BF measured with dual-energy X-ray absorptiometry (DXA, Hologic). The %BF was measured with DXA in 40 patients aged 40-68 years with type-2 diabetes (mean HbA1c, 7.3 ± 0.9%). Body density was estimated in the same patients by means of four anthropometric equations and converted to %BF using the Siri and Brozek equations. Paired-sample t-test and the mean signed difference procedure were used to compare anthropometric equation-derived %BF and DXA measurements. The coefficient of determination was computed. Bland-Altman analysis was used to test the agreement between methods. Among the four anthropometric equations, the Durnin-Womersley equation only showed close agreement with DXA in both female and male patients; the other equations significantly underestimated or overestimated %BF. Two new predictive equations were developed using DXA as the reference to predict total body and trunk %BF. Further comparative studies are required to confirm and refine the accuracy of practical, non-invasive methods for monitoring %BF in this population
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