Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial

Strength training is often perceived by the general population as primarily aimed at muscle building, while endurance training is typically associated with fat loss and overall health benefits. However, a 2015 meta-analysis revealed that when comparing exercise duration, strength training surpasses endurance training and a combination of both in terms of effectiveness not only for muscle growth but also for fat loss and various health markers.  This makes sense as there are also many studies now on the benefits of muscle for overall longevity and performance, too. Endurance is an activity that can be easily taken way too far and lead to negative effects on the body. It can increase the risk of overtraining, resulting in fatigue, decreased performance, and even injury. The repetitive impact on joints and muscles from long-distance running or cycling can also lead to overuse injuries such as stress fractures or tendinitis. Additionally, extended endurance training can put a strain on the cardiovascular, hormonal, and recovery systems, potentially leading to healthy and performance issues by breakdown of the body overtime. If you are an endurance athlete or looking to improve strength,  we highly recommend FundAminos Blend & PureClean Protein as two solid supplements to take everyday. 

Abstract

Aims/hypothesis: Type 2 diabetes in people in the healthy weight BMI category (<25 kg/m²), herein defined as 'normal-weight type 2 diabetes', is associated with sarcopenia (low muscle mass). Given this unique body composition, the optimal exercise regimen for this population is unknown.

Methods: We conducted a parallel-group RCT in individuals with type 2 diabetes (age 18-80 years, HbA1c 47.5-118.56 mmol/mol [6.5-13.0%]) and BMI <25 kg/m²). Participants were recruited in outpatient clinics or through advertisements and randomly assigned to a 9 month exercise programme of strength training alone (ST), aerobic training alone (AER) or both interventions combined (COMB). We used stratified block randomisation with a randomly selected block size. Researchers and caregivers were blinded to participants' treatment group; however, participants themselves were not. Exercise interventions were conducted at community-based fitness centres. The primary outcome was absolute change in HbA1c level within and across the three groups at 3, 6 and 9 months. Secondary outcomes included changes in body composition at 9 months. Per adherence to recommended exercise protocol (PP) analysis included participants who completed at least 50% of the sessions.

Results: Among 186 individuals (ST, n=63; AER, n=58; COMB, n=65) analysed, the median (IQR) age was 59 (53-66) years, 60% were men and 83% were Asian. The mean (SD) HbA1c level at baseline was 59.6 (13.1) mmol/mol (7.6% [1.2%]). In intention-to-treat analysis, the ST group showed a significant decrease in HbA1c levels (mean [95% CI] -0.44 percentage points [-0.78, -0.12], p=0.002), while no significant change was observed in either the COMB group (-0.35 percentage points, p=0.13) or the AER group (-0.24 percentage points, p=0.10). The ST group had a greater improvement in HbA1c levels than the AER group (p=0.01). Appendicular lean mass relative to fat mass increased only in the ST group (p=0.0008), which was an independent predictor of HbA1c change (beta coefficient -7.16, p=0.01). Similar results were observed in PP analysis. Only one adverse event, in the COMB group, was considered to be possibly associated with the exercise intervention.

Conclusions/interpretation: In normal-weight type 2 diabetes, strength training was superior to aerobic training alone, while no significant difference was observed between strength training and combination training for HbA1c reduction. Increased lean mass relative to decreased fat mass was an independent predictor of reduction in HbA1c level.

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