Jacqueline Shahar, MEd, RCEP, CDE Manager, Exercise Physiology Joslin Diabetes Center, Boston MA Resistance Training:Exercise You Should Not Resist
Objectives Definition and history of resistance training Facts about muscles Research data on resistance training Benefits, guidelines, principles and types of resistance training Diabetes management Exercise physiology services
Comprehensive Exercise Program Aerobic Flexibility Strength
Resistance/Strength Training Training designed to increase strength, power, and muscular endurance through resistance to the force of muscular contraction.
Origins of Resistance/Strength Training • “That which if used develops, and that which if not used wastes away” • Hippocrates (460 BC) • Resistance Training dates back to Ancient Greece and China • Weight training became part of the Olympic games • Chinese emperors used strength training for their soldiers( 1122-249 BC) • In the 6th century: resistance training developed into a popular form of exercise called “The age of Strength”
Muscle Fiber Overtime Sarcopenia: Loss of skeletal muscle mass associated with aging Laxell J. et al. Journal of the Neurological Sciences, 1988, 84: 275-294
Sarcopenia Effect Glucose Intolerance Sarcopenia Muscle Dysfunction Sedentary Lifestyle Slow Metabolic Rate Weight Gain Hills et al., Resistance Training for obese, Obesity Reviews, 2009
Muscle Mass and Diabetes • Muscle is the body’s biggest user of glucose • Differences in muscle’s usage of glucose: healthy vs. diabetes • a. Effect of type 1 diabetes on muscle mass • Insulin deprivation causes profound increase in catabolism, especially in skeletal muscle • b. Effect of type 2 diabetes on muscle mass: • People with diabetes were found to have excessive loss of • skeletal muscle compared to healthy individuals • Women with diabetes showed about twofold greater loss of • quads muscle mass compared to healthy individuals a. Charlton et al., Journal of Nutrition 1998; Karakelides H. et al., Diabetes 2007. b. Park SW, et al. Diabetes Care 2009;32:1993-1997.
Medical Exercise Therapy is a Key Component in Diabetes and Obesity Management
Benefits of Resistance Training Negative Energy Balance Subcutaneous & visceral fat CVD Metabolic Syndrome T2DM Insulin Sensitivity Glucose Tolerance Muscle Mass & Function Resistance Training Hills et al., Resistance Training for obese, Obesity Reviews, 2009
Additional Benefits Resistance training improves: • Glucose uptake by the muscles • Muscular strength and endurance • Body composition and metabolism • Blood pressure, lipids, LV wall contractility • Bone density • Posture • Sports performance • State of mind • And reduces the likelihood of injury Soukup JT et al., The Diabetes Educator, 1993, Vol 19, No 4. Balady GJ et al., J Cardiopulmonary Rehab & Prev. 2009; 29: 67-75.
Terminology Repetition one complete movement of an exercise Set group of repetitions performed without stopping Repetition maximal (RM) the maximum amount of weight that can be lifted for a predetermined number of repetitions
Research on Resistance Training Relative Muscle Mass is Inversely Associated with Insulin Resistance and Pre Diabetes. The Third National Health and Nutrition Examination Survey Srikanthan P. and Karlamangia S. J Clin Endocrinol Metab, 2011, 96 (9): 2898-2903. N= 14,000, average age: 41yr, bioelectrical impedance analysis 10% increase in ratio of muscle mass to total body weight was associated with 11% reduction in insulin resistance Resistance Exercise and Glycemic Control in Women with Gestational Diabetes de Barros et al., American J Ob & Gyn, 2010 N=64 with GDM , EG: average of 2.36 d/wk, 30-40 minutes Required insulin: CG 18 (56.3%) EG 7(21.9%) P< 0.005
Additional Research Randomized Crossover Study of Effect of Resistance Training on Glycemic Control, Muscular Strength, and Cholesterol in Type I Diabetic Men Durak et al., Diabetes Care, 1990, 13 (10): 1039-43 N=8 males with type 1 DM, age 31 ± 3.5 yr, RT 3 d/wk 60min HbA1c 6.9 ± 1.4 vs. 5.8 ± 0.9%* Muscle strength increased: Squat 93.6% & bench press 58%* (*P< 0.005) Resistance Training in the Treatment of Diabetes & Obesity Mark A. Tresiera, MA and Gary J. Balady, MD 2009 Increase insulin sensitivity & glucose tolerance Decrease in visceral adipose tissue. 90 days detraining decreased whole body glucose uptake by 11%
Resistance Training Guidelines • Perform resistance training: • 2-3 days a week • 8 exercises • 8-12 repetitions, 1-3 sets • Moderate velocity through the full range of motion • Exhale during exertion- avoid breathe holding • Perform exercises within a pain-free range of motion • Stop exercise if feels unusual discomfort American College of Sports Medicine (ACSM), 2006, ACSM’s guidelines for exercise testing and prescription, 7th ed.
Modes of Resistance Training Weight machines Free weights Physio & medicine balls Body weight exercises Resistance bands Yoga Pilates
Training Goal Power 1-2 reps, 3-5 Strength < 6 reps, 2-6 sets Hypertrophy 6-12 reps, 3-6 sets Muscular Endurance > 12 reps, 2-3 sets
Fundamental Principles of Training Individuality Progressive Overload Disuse Specificity
Periodization • aFor major muscle group exercises performed each phase; each phase lasts 6 to 8 wk.
Types of Resistance Training Muscle failure Superset Pyramid Circuit
Resistance Training & Diabetes
Fuel Metabolism and Exercise • Check BG, adjust insulin, and replenish muscles with food & water Chu et al., The Physician and Sportsmedicine, Volume 39, 2011
Diabetes Complications High blood pressure Nephropathy Autonomic/neuropathy Cardiovascular disease Retinopathy Peripheral vascular disease Musculoskeletal
Exercise Physiology Services Individualized plan Exercise programs Measurements and waist and hip and body composition Referral to nutrition educator for a proper meal plan
Summary • Resistance training could benefit most patients with diabetes • Educate on the benefits of RT as part of a complete program • Provide instructions with precise demonstration & attentive supervision • Address diabetes complications and BG control • Allow gradual progression with small increments in intensity • Provide positive reinforcement and specific feedback • Re-evaluate plan as ability improves and health status
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