Ronald J. Sigal, MD, MPH; Glen P. Kenny, PhD; Normand G. Boulé, PhD; George A. Wells, PhD; Denis Prud'homme, MD, MSc; Michelle Fortier, PhD; Robert D. Reid, PhD, MBA; Heather Tulloch, MSc; Douglas Coyle, PhD; Penny Phillips, MA; Alison Jennings, MA; James Jaffey, MSc
The benefits of exercise in improving glycemic control in patients with type 2 diabetes are well documented. Previous studies have examined aerobic or resistance exercise alone but not in combination.
This randomized, controlled trial showed better reduction in hemoglobin A1c values in patients who followed a combined aerobic exercise and resistance training program 3 times weekly than in patients who followed a program of either exercise type alone.
Patients in the combined exercise group had a longer duration of exercise than those in the other exercise groups; the study thus does not permit definitive conclusions about whether the benefits were due to longer exercise duration or to the combined exercise training.
Appendix Table 1.
Appendix Table 2.
Appendix Table 3.
Appendix Table 4.
Appendix Table 5.
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Video News Release - Study Finds Combining Aerobic and Resistance Training Greatly Improved Diabetes Numbers
Milo A Puhan
Horten Centre for patient-oriented research, University of Zurich, Switzerlan
October 1, 2007
No patient-important outcomes?
Dr Sigal and colleagues showed in their randomized trial impressive reductions in HbA1c in patients with type 2 diabetes after supervised exercise sessions over a period of 22 weeks.(1) It is, however, a limitation that only surrogate parameters were presented as outcomes. HbA1c is associated with clinically relevant events in the future (microvascular complications and cardiovascular events) but it does not reflect treatment effects that are of immediate importance to the patient. A great advantage of physical exercise in the treatment of chronic diseases is that it often combines benefits on the patients' current health status and on prognosis. Without the use of patient-important endpoints, clinically relevant effects of physical exercise on the patients' symptoms, limitations and health-related quality of life may have been missed. To know about these effects is also important to inform patients about potential benefits of physical exercise. Just informing patients about potential preventative effects might not convince them to start an exercise program. It would be important to learn whether the investigators used any patient- important outcomes that are going to be reported elsewhere. If such outcomes were not included, it would be important to know the reason for not investigating this important aspect.
(1) Sigal RJ et al: Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007 Sep 18;147(6):357-69.
Young Kwang Chae
Johns Hopkins University
October 10, 2007
Effect of Aerobic Exercise versus Resistance Exercise
In their well-designed clinical trial, Signal and colleagues  reported the favorable effect of both aerobic and resistance exercise in the type 2 diabetes patients. I agree with their discussion in the article that the effect of aerobic training and resistance training was about equal. Indeed, the fact that the effect of combined exercise training was twice that of either type of exercise alone alludes to the notion that both types of excise are of similar benefit to type 2 diabetes patients, regardless of their difference in physiological effects. However, it seems that aerobic exercise actually helped to achieve a significantly lower level of hemoglobin A1c much faster than resistance excise, comparing 3 month results versus 6 month (Table 2). Moreover, the effect of aerobic exercise seems much greater among patients whose baseline hemoglobin A1c levels were above 7.5 percentage point (Appendix Table 1). In the same group of patients, only the added effect of aerobic exercise, not resistance exercise, was shown to be statistically significant (combined excise vs. aerobic, and resistance exercise alone, Appendix Table 1). These additional observations may suggest that aerobic exercise may provide greater benefit to type 2 diabetes patients, at least to those with worse glycemic control.
Reference: 1. Sigal RJ, Kenny GP, Boule NG, Wells GA, Prud'homme D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jennings A, Jaffey J. Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes: A Randomized Trial. Ann Intern Med. 2007; 147: 357-69.
Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud'homme D, Fortier M, et al. Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes: A Randomized Trial. Ann Intern Med. 2007;147:357-369. doi: 10.7326/0003-4819-147-6-200709180-00005
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Published: Ann Intern Med. 2007;147(6):357-369.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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