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Original Contribution
November 24, 2010

Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes : A Randomized Controlled Trial

Author Affiliations

Author Affiliations: Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (Drs Church, Johannsen, Johnson, Myers, and Earnest; Mss Cocreham, Kramer, Nauta, and Thompson; and Mr Rodarte); Arnold School of Public Health, University of South Carolina, Columbia (Dr Blair); Department of Nutrition and Exercise Physiology, University of Missouri, Columbia (Ms Mikus); and Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands (Dr Sparks).

JAMA. 2010;304(20):2253-2262. doi:10.1001/jama.2010.1710
Abstract

Context Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination.

Objective  To examine the benefits of aerobic training alone, resistance training alone, and a combination of both on hemoglobin A1c (HbA1c) in individuals with type 2 diabetes.

Design, Setting, and Participants  A randomized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA1c levels of 6.5% or higher were enrolled in the 9-month exercise program between April 2007 and August 2009.

Intervention Forty-one participants were assigned to the nonexercise control group, 73 to resistance training 3 days a week, 72 to aerobic exercise in which they expended 12 kcal/kg per week; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week.

Main Outcome  Change in HbA1c level. Secondary outcomes included measures of anthropometry and fitness.

Results  The study included 63.0% women and 47.3% nonwhite participants who were a mean (SD) age of 55.8 years (8.7 years) with a baseline HbA1c level of 7.7% (1.0%). Compared with the control group, the absolute mean change in HbA1c in the combination training exercise group was −0.34% (95% confidence interval [CI], −0.64% to −0.03%; P = .03). The mean changes in HbA1c were not statistically significant in either the resistance training (−0.16%; 95% CI, −0.46% to 0.15%; P = .32) or the aerobic (−0.24%; 95% CI, −0.55% to 0.07%; P = .14) groups compared with the control group. Only the combination exercise group improved maximum oxygen consumption (mean, 1.0 mL/kg per min; 95% CI, 0.5-1.5, P < .05) compared with the control group. All exercise groups reduced waist circumference from −1.9 to −2.8 cm compared with the control group. The resistance training group lost a mean of −1.4 kg fat mass (95% CI, −2.0 to −0.7 kg; P < .05) and combination training group lost a mean of −1.7 (−2.3 to −1.1 kg; P < .05) compared with the control group.

Conclusions  Among patients with type 2 diabetes mellitus, a combination of aerobic and resistance training compared with the nonexercise control group improved HbA1c levels. This was not achieved by aerobic or resistance training alone.

Trial Registration  clinicaltrials.gov Identifier: NCT00458133

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