Physical activity has been proven to ameliorate the glycemic control, insulin resistance and dyslipidemia (abnormal amount of lipids in the blood) in patients with type 2 diabetes (T2D) (Yang, 2014). A type of training usually associated with benefiting patients with T2D is endurance training. However, it can be difficult to rely on this one as the main activity form of treatment and management of the condition. Many patients are not physically active and may have other health complications that make it challenging or even painful for them to just walk for 30 minutes. Therefore on this page, we focus on how resistance training can improve condition of patients with T2D.
Resistance training (RT), also known as weight training, refers to all exercises that involve lifting or pulling against resistance. It can be done using your own body weight or external resistance, for example, equipment such as dumbells, a barbell, machines, kettlebells or power bands. Regular resistance training can have a wide impact on our body. It can decrease the risk of heart disease by lowering body fat, decreasing blood pressure, improving cholesterol, and lowering the stress placed on the heart while lifting a particular load. (Goulding, 2018)
Management of Type 2 Diabetes
T2D is the most common type of diabetes which is characterised by hyperglycemia in the context of insulin resistance and impaired insulin secretion (Yubo Liu et al, 2019). As T2D is caused by a combination of genetics and bad lifestyle choices, it is often detected in overweight people who live a sedentary life and do not follow a healthy diet. The goal of treatment in T2D is to achieve and maintain optimal blood glucose (BG), lipid, and blood pressure levels to prevent or delay chronic complications of diabetes. Many people with T2D can achieve blood glucose control by improving their lifestyle. This can be achieved by following a nutritious meal plan and exercise program that results in losing excess weight, implementing necessary self-care behaviours, and taking oral medications, although others may need supplemental insulin (Colberg et al, 2010).
A nutritious plan combined with RT has many effects that especially benefit patients with diabetes. They range from improvements in the way patient’s body uses blood sugar and responds to insulin (WebMD, 2019), to improvements in muscular fitness which is important for enhancing the quality of life (Goulding, 2018). The benefits of resistance training have been analysed by many researchers and seem to be a useful therapeutic tool in management and preventing T2D.
People affected by T2D are often 45 years old or older and that is when your muscle mass starts to decrease (Huizen, 2019) and those affected by diabetes tend to lose muscle mass faster than non-diabetic individuals of the same age (Diabetes Self-management, 2017). That is why RT is considered a valid treatment in their case. Colberg (2010) states that there have been performed high-quality studies that prove that regular training improves blood control and it can even prevent or delay T2D.
Insulin-independent and insulin-dependent muscle glucose uptake during exercise.
Colberg et al (2010) describe that there are two pathways that encourage glucose uptake by muscles. At rest and after a meal, glucose uptake by the muscle is insulin-dependent and serves mainly to restore muscle glycogen stores. During exercise, contractions increase blood glucose uptake to supplement intramuscular glycogenolysis. As the two pathways are distinct, blood glucose uptake into working muscle is normal even when insulin-mediated uptake is impaired in type 2 diabetes. Muscular blood glucose uptake remains elevated postexercise, with the contraction-mediated pathway persisting for several hours and insulin-mediated uptake for longer.
Colberg et at (2010) explain the mechanism of glucose transport in skeletal muscle. It is accomplished via GLUT proteins, with GLUT4 being the main isoform in muscle mediated by both insulin and contractions. Insulin through complex of signalling cascade activates GLUT4. Contractions, however, trigger GLUT4 translocation at least in part through activation of 5′-AMP-activated protein kinase. Insulin-stimulated GLUT4, in general, is weakened in T2D. Both aerobic and resistance exercises increase GLUT4 abundance and BG uptake, even in the presence of type 2 diabetes.
For people that want to change their lifestyle to more active, it can be a challenge to know which exercises to perform. The biggest disadvantage of RT is that it requires a relatively high level of knowledge and usually equipment. Awareness of techniques is very important for the safety of patients and for increasing the effectiveness of exercises. That is why a doctor should provide initial instructions and/or assist the patient.
American College of Sports Medicine advises that RT should be performed at least two days a week, with a minimum of 8-10 exercises involving the major muscle groups for 10–15 repetitions to near fatigue. They further highlight that increased intensity or additional volume of training could produce greater benefits and may be appropriate for some individuals (Albright A et al. 2000). Other sources recommend engaging in resistance training that involves all the major muscle groups, three times a week, progressing to 8–10 repetitions. The American Diabetes Association recommends a higher intensity for all individuals. Recent reports suggest that high-intensity resistance training is both feasible and appropriate also for older individuals with type 2 diabetes (Sigal et al. 2004).
Written by: Gabriela Wyszynska (18819907)
Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS: American College of Sports Medicine position stand: exercise and type 2 diabetes. Med Sci Sports Exerc 32:1345–1360, 2000
Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., American Diabetes Association (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147–e167. doi:10.2337/dc10-9990
Diabetes Self-management, 2017. Muscle Mass, s.l.: s.n.
Dominik H. Pesta, R. L. S. G. A. K. M. B. S. &. L. M. S., 2017. Resistance training to improve type 2 diabetes: working toward a prescription for the future. Nutr Metab (Lond).
Goulding, P., 2018. What is resistance training?. Nuffield Health.
Huizen J. (2019). The average age of onset for type 2 diabetes. Medical News Today.
JungHoon Lee, D. K. C. K., 2017. Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis.
Neil D. Eves, R. C. P., 2006. Resistance Training and Type 2 Diabetes. American Diabetes Association.
Pesta, D.H., Goncalves, R.L.S., Madiraju, A.K. et al. Resistance training to improve type 2 diabetes: working toward a prescription for the future. Nutr Metab (Lond) 14, 24 (2017) doi:10.1186/s12986-017-0173-7
Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 27:2518–2539, 2004
WebMD, 2019. Is it OK to Strength Train If I Have Diabetes?.
Xiaodan Yuan, Q. L., 2018. Two Years Supervised Resistance Training Prevented Diabetes Incidence in People with Prediabetes—A Randomized Control Trial. American Diabetes Association.
Yang Z, Scott CA, Mao C, Tang J, Farmer AJ Sports Med. 2014 Apr; 44(4):487-99.
Yubo Liu, 1. W. Y. Q. C. Y. Z. C.-H. K. M. K., 2019. Resistance Exercise Intensity is Correlated with Attenuation of HbA1c and Insulin in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. International Jurnal of Environmental Research and Public Health.