Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes

Hispanics are at increased risk of morbidity and mortality due to their high prevalence of diabetes and poor glycemic control. Strength training is the most effective lifestyle intervention to increase muscle mass but limited data is available in older adults with diabetes. We determined the influence of strength training on muscle quality (strength per unit of muscle mass), skeletal muscle fiber hypertrophy, and metabolic control including insulin resistance (Homeostasis Model Assessment –HOMA-IR), C-Reactive Protein (CRP), adiponectin and Free Fatty Acid (FFA) levels in Hispanic older adults. Sixty-two community-dwelling Hispanics (>55 y) with type 2 diabetes were randomized to 16 weeks of strength training plus standard care (ST group) or standard care alone (CON group). Skeletal muscle biopsies and biochemical measures were taken at baseline and 16 weeks. The ST group show improved muscle quality (mean±SE: 28±3) vs CON (-4±2, p<0.001) and increased type I (860±252µm2) and type II fiber cross-sectional area (720±285µm2) compared to CON (type I: -164±290µm2, p=0.04; and type II: -130±336µm2, p=0.04). This was accompanied by reduced insulin resistance [ST: median (interquartile range) -0.7(3.6) vs CON: 0.8(3.8), p=0.05]; FFA (ST: -84±30µmol/L vs CON: 149±48µmol/L, p=0.02); and CRP [ST: -1.3(2.9)mg/L vs CON: 0.4(2.3)mg/L, p=0.05]. Serum adiponectin increased with ST [1.0(1.8)µg/mL] compared to CON [-1.2(2.2)µg/mL, p<0.001]. Strength training improved muscle quality and whole-body insulin sensitivity. Decreased inflammation and increased adiponectin levels were related with improved metabolic control. Further studies are needed to understand the mechanisms associated with these findings. However, these data show that strength training is an exercise modality to consider as an adjunct of standard of care in high risk populations with type 2 diabetes.

[1]  C. Roberts,et al.  Effect of a diet and exercise intervention on oxidative stress, inflammation and monocyte adhesion in diabetic men. , 2006, Diabetes research and clinical practice.

[2]  C. Mantzoros,et al.  Circulating adiponectin and expression of adiponectin receptors in human skeletal muscle: associations with metabolic parameters and insulin resistance and regulation by physical training. , 2006, The Journal of clinical endocrinology and metabolism.

[3]  J. Whitehead,et al.  Adiponectin – a key adipokine in the metabolic syndrome , 2006, Diabetes, obesity & metabolism.

[4]  J. E. Cunnick,et al.  Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of β-blockers, BMI, and psychosocial factors in older adults , 2006, Brain, Behavior, and Immunity.

[5]  A. Jamurtas,et al.  Leptin and adiponectin responses in overweight inactive elderly following resistance training and detraining are intensity related. , 2005, The Journal of clinical endocrinology and metabolism.

[6]  G. Pacini,et al.  The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. , 2005, Archives of physical medicine and rehabilitation.

[7]  P. Reaven,et al.  Exercise training is not associated with improved levels of C-reactive protein or adiponectin. , 2005, Metabolism: clinical and experimental.

[8]  P. Froguel,et al.  Insulin/Foxo1 Pathway Regulates Expression Levels of Adiponectin Receptors and Adiponectin Sensitivity* , 2004, Journal of Biological Chemistry.

[9]  S. Tokmakidis,et al.  The effects of a combined strength and aerobic exercise program on glucose control and insulin action in women with type 2 diabetes , 2004, European Journal of Applied Physiology.

[10]  A. Levey,et al.  Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[11]  F. Dela,et al.  Strength Training Increases Insulin-Mediated Glucose Uptake, GLUT4 Content, and Insulin Signaling in Skeletal Muscle in Patients With Type 2 Diabetes , 2004 .

[12]  Adrienne Y. Stith,et al.  Unequal treatment: confronting racial and ethnic disparities in health care. , 2003 .

[13]  R. Henry,et al.  Adiponectin: more than just another fat cell hormone? , 2003, Diabetes care.

[14]  S. Kritchevsky,et al.  Strength and Muscle Quality in a Well‐Functioning Cohort of Older Adults: The Health, Aging and Body Composition Study , 2003, Journal of the American Geriatrics Society.

[15]  Hitoshi Nishizawa,et al.  Reciprocal Association of C-Reactive Protein With Adiponectin in Blood Stream and Adipose Tissue , 2003, Circulation.

[16]  C. Castaneda,et al.  A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. , 2002, Diabetes care.

[17]  J. Shaw,et al.  High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. , 2002, Diabetes care.

[18]  C. Bogardus,et al.  Plasma adiponectin concentration is associated with skeletal muscle insulin receptor tyrosine phosphorylation, and low plasma concentration precedes a decrease in whole-body insulin sensitivity in humans. , 2002, Diabetes.

[19]  D. Green,et al.  Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. , 2002, Diabetes research and clinical practice.

[20]  Y. Terauchi,et al.  The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity , 2001, Nature Medicine.

[21]  A. Saltiel.  New Perspectives into the Molecular Pathogenesis and Treatment of Type 2 Diabetes , 2001, Cell.

[22]  C. Castaneda,et al.  Protein nutritional status and function are associated with type 2 diabetes in Hispanic elders. , 2000, The American journal of clinical nutrition.

[23]  J. Zierath,et al.  Insulin action and insulin resistance in human skeletal muscle , 2000, Diabetologia.

[24]  C. Dutta.  Commentary on “Effects of Strength Training and Detraining on Muscle Quality Age and Gender Comparisons” , 2000 .

[25]  M NessAiver,et al.  Effects of strength training and detraining on muscle quality: age and gender comparisons. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[26]  R Conwit,et al.  Muscle quality and age: cross-sectional and longitudinal comparisons. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[27]  T. Shoji,et al.  Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. , 1999, Diabetes care.

[28]  K. Tucker,et al.  Adaptation of a food frequency questionnaire to assess diets of Puerto Rican and non-Hispanic adults. , 1998, American journal of epidemiology.

[29]  I. Stratton,et al.  Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23) , 1998, BMJ.

[30]  Standards of Medical Care for Patients With Diabetes Mellitus , 1998, Diabetes Care.

[31]  S. Haffner,et al.  The Homeostasis Model in the San Antonio Heart Study , 1997, Diabetes Care.

[32]  J. Eriksson,et al.  Resistance training in the treatment of non-insulin-dependent diabetes mellitus. , 1997, International journal of sports medicine.

[33]  C. Dutta.  Significance of sarcopenia in the elderly. , 1997, The Journal of nutrition.

[34]  C. Bouchard,et al.  Body composition by DEXA in older adults: accuracy and influence of scan mode. , 1997, Medicine and science in sports and exercise.

[35]  S. Heymsfield,et al.  Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. , 1996, Journal of applied physiology.

[36]  A. Jette,et al.  The Physical Activity Scale for the Elderly (PASE): development and evaluation. , 1993, Journal of clinical epidemiology.

[37]  R. Turner,et al.  Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man , 1985, Diabetologia.

[38]  D. James,et al.  Heterogeneity of insulin action in individual muscles in vivo: euglycemic clamp studies in rats. , 1985, The American journal of physiology.

[39]  R. DeFronzo,et al.  Synergistic interaction between exercise and insulin on peripheral glucose uptake. , 1981, The Journal of clinical investigation.

[40]  L. Kennedy.  Decreased Muscle Strength and Quality in Older Adults With Type 2 Diabetes: The Health, Aging, and Body Composition Study , 2007 .

[41]  Tamara B Harris,et al.  Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[42]  H. Florez,et al.  C-reactive protein is elevated in obese patients with the metabolic syndrome. , 2006, Diabetes research and clinical practice.

[43]  F. Dela,et al.  Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. , 2004, Diabetes.

[44]  B. Goodpaster,et al.  Muscle triglyceride and insulin resistance. , 2002, Annual review of nutrition.

[45]  M. C. Crim,et al.  Marginal protein intake results in reduced plasma IGF-I levels and skeletal muscle fiber atrophy in elderly women. , 2000, The journal of nutrition, health & aging.

[46]  J. Fleg,et al.  Muscle quality. I. Age-associated differences between arm and leg muscle groups. , 1999, Journal of applied physiology.

[47]  J. Zierath,et al.  Exercise in the Management of Non—Insulin-Dependent Diabetes Mellitus , 1998, Sports medicine.

[48]  W. Evans,et al.  Suction applied to a muscle biopsy maximizes sample size. , 1982, Medicine and science in sports and exercise.