Strength Training Might Be More Effective Than Aerobics for Blood Sugar Control in Type 2 Diabetes

A recent study published in the Diabetologia journal suggests strength training is more effective than aerobics for people with normal-weight type 2 diabetes. The study found that strength training led to a greater reduction in HbA1c, a marker of blood sugar control. Strength training also increases muscle mass, which burns more calories at rest and can improve blood sugar management. People with normal-weight type 2 diabetes often have different physiological issues than overweight individuals, and this study suggests strength training may be a more targeted approach for managing their condition. Doctors should consider recommending strength training to patients with normal-weight type 2 diabetes.

Key Points

1. The focus of the Study: The STRONG-D trial compared the effects of strength training, aerobic exercise, and a combination of both on HbA1c (blood sugar control marker) and body composition in people with normal-weight type 2 diabetes.

2. Strength Training vs Aerobics: The study found that strength training led to a significantly greater reduction in HbA1c compared to aerobics. This suggests strength training might be more effective for blood sugar control in this population.

3. Muscle Mass Matters: Strength training resulted in an increase in lean muscle mass and a decrease in fat mass. Muscles burn more calories at rest, potentially contributing to better blood sugar management.

4. Strength Training Advantages: The study suggests that strength training might be a more targeted approach for managing normal-weight type 2 diabetes compared to aerobics.

5. Exercise Recommendations: Doctors should consider prioritizing strength training when creating exercise plans for patients with normal-weight type 2 diabetes.

6. Benefits Beyond Blood Sugar: Strength training offers additional benefits like improved bone density, better balance, and weight management, all contributing to a healthier lifestyle for people with diabetes.

7. Consult Your Doctor: Before starting any new exercise program, consult a doctor to ensure it's safe and appropriate for your individual needs.

Living with type 2 diabetes can be challenging, requiring constant vigilance over blood sugar levels and lifestyle choices. Exercise is a cornerstone of managing the condition, but the debate around the "best" type of exercise often arises. This blog post delves into the science behind strength training for type 2 diabetes, specifically focusing on its potential benefits for individuals with normal weight.

We'll explore a recent study that investigated the impact of different exercise regimens on HbA1c levels, a key marker of blood sugar control. We'll dissect the findings, analyze their implications, and address any limitations. Additionally, we'll cover the broader benefits of strength training for type 2 diabetes management, explore practical workout routines, and answer frequently asked questions.

Understanding HbA1c and Glycemic Control

Before diving into the study, let's establish a foundation by understanding HbA1c. Hemoglobin A1c (HbA1c), often referred to as A1C, is a form of hemoglobin, a protein in red blood cells that carries oxygen throughout the body. When glucose (sugar) enters the bloodstream, it attaches to hemoglobin. Over time, this glycation process creates HbA1c. The higher the HbA1c level, the more glucose has been circulating in the bloodstream for extended periods.

Glycemic control refers to maintaining healthy blood sugar levels. In type 2 diabetes, the body either doesn't produce enough insulin (a hormone that helps cells absorb glucose) or becomes resistant to its effects. This leads to elevated blood sugar levels, which, if not controlled, can damage nerves, eyes, kidneys, and other organs. HbA1c measurement provides a long-term picture (roughly 2-3 months) of average blood sugar control, making it a valuable tool for managing type 2 diabetes.

Understanding Normal-Weight Type 2 Diabetes

Normal-weight type 2 diabetes (NWT2D) presents a unique set of challenges compared to T2D in overweight or obese individuals. People with NWT2D typically have a BMI below 25 kg/m² and often experience different physiological issues such as sarcopenia (loss of muscle mass) and altered fat distribution. This necessitates a tailored approach to exercise to manage the condition effectively.

Research Insights

A recent randomized controlled trial (RCT) aimed to evaluate the impact of different exercise regimens on individuals with NWT2D. The study, known as the STRONG-D trial, involved 289 participants who were randomly assigned to one of three groups: strength training (ST), aerobic exercise (AER), and a combination of both (COMB). The trial lasted nine months, and 186 participants (median BMI 23.7 kg/m²) completed the intervention.

The researchers divided participants into three groups:

• Strength Training (ST): This group engaged in resistance training exercises targeting major muscle groups, focusing on 8-12 repetitions per set, 2-3 sets per exercise, and 2-3 sessions per week.

• Aerobic Training (AER): This group participated in moderate-intensity cardio exercises like brisk walking, cycling, or swimming for 30 minutes per session, 3-4 times per week.

• Combined Training (COMB): This group incorporated elements of both strength training and aerobic training into their routines.

Key Findings

1. Glycaemic Control:

   • Participants in the ST group experienced a significantly greater reduction in HbA1c levels compared to those in the AER group.

   • The ST group saw a mean reduction in HbA1c of 0.44 percentage points, while the AER group did not achieve a statistically significant reduction.

   • This suggests that strength training is more effective at improving glycaemic control in individuals with NWT2D.

2. Body Composition:

   • Strength training led to significant improvements in body composition, particularly in increasing lean muscle mass and reducing fat mass.

   • The ST group showed a significant increase in appendicular lean mass index (ALMI) relative to fat mass index (FMI), which was associated with better glycaemic control.

   • The COMB group did not show additional benefits over ST alone, indicating that focusing on strength training might be more advantageous for this population.

3. Exercise Adherence and Safety:

   • Adherence to the exercise protocol was similar across all groups, with participants attending an average of 2.6 to 2.7 sessions per week.

   • Serious adverse events were rare and evenly distributed across the groups, highlighting the safety of strength training in this demographic.

Implications for Exercise Recommendations

The findings from the STRONG-D trial suggest that healthcare providers should consider prioritizing strength training when advising NWT2D patients on exercise regimens. Here are some practical tips for incorporating strength training into a diabetes management plan:

1. Start Slowly: Begin with lighter weights or resistance bands and gradually increase the intensity as strength and confidence build.

2. Target Major Muscle Groups: Exercises such as squats, deadlifts, and bench presses are effective in building muscle mass.

3. Maintain Consistency: Aim for at least two to three strength training sessions per week to see significant benefits.

4. Combine with Proper Nutrition: Ensure a diet rich in protein to support muscle growth and repair.

The study's primary outcome focused on changes in HbA1c levels after the intervention period:

• Strength Training Outperforms Aerobics: The group participating in strength training exhibited the most significant decrease in HbA1c levels compared to the aerobics group.

• Statistically Significant Change: Notably, only the strength training group's HbA1c reduction was considered statistically significant, meaning it was likely due to the exercise program and not random chance.

• Muscle Mass Increase: Interestingly, the strength training group also showed an increase in lean muscle mass relative to fat mass.

These findings suggest that strength training might be a more effective strategy for improving glycemic control (HbA1c reduction) in individuals with normal-weight type 2 diabetes. The observed increase in muscle mass could be a contributing factor. Muscles are more metabolically active than fat tissue, meaning they burn more calories at rest. This increased metabolic activity potentially aids in better blood sugar control.

Beyond Blood Sugar Control: The Broader Benefits of Strength Training

While the study highlights the potential of strength training for HbA1c reduction, its benefits for type 2 diabetes management go beyond just blood sugar control. Here's how strength training can contribute to a healthier lifestyle:

• Improved Bone Density: Strength training helps build and maintain strong bones, reducing the risk of osteoporosis, a common complication of diabetes.

• Enhanced Strength and Balance: Stronger muscles improve balance and coordination, lowering the risk of falls, another concern for people with diabetes.

• Weight Management: Muscle burns more calories at rest, aiding in weight management or preventing weight gain, both of which can improve blood sugar control.

• Reduced Inflammation: Strength training can help reduce chronic inflammation, a contributing factor to diabetes complications.

• Improved Body Composition: Building muscle mass while reducing fat mass creates a healthier body composition, further supporting blood sugar regulation.

• Psychological Benefits: Exercise, including strength training, has been shown to improve mood, reduce stress, and boost overall well-being, all of which are crucial for managing diabetes.

Creating a Strength Training Routine for Type 2 Diabetes

If you have type 2 diabetes and are considering incorporating strength training, here's a guide to get you started:

• Consult your doctor: Before beginning any new exercise program, consult your doctor to ensure it's safe for you. They can advise on appropriate intensity levels and any modifications needed for pre-existing conditions.

• Start slow and progress gradually: Begin with lighter weights and gradually increase the weight or resistance as you get stronger. Aim for 8-12 repetitions per set, 2-3 sets per exercise, and 2-3 sessions per week.

• Focus on major muscle groups: Target major muscle groups like legs, back, chest, shoulders, and core during your workouts.

• Proper form is key: Use proper form for each exercise to maximize benefits and minimize injury risk. Consider working with a certified personal trainer for guidance.

• Listen to your body: Rest when needed, and don't push yourself through pain.

Remember, consistency is key! Aim for regular strength training sessions alongside a healthy diet and other diabetes management strategies for optimal results.

Conclusion

The STRONG-D trial provides compelling evidence that strength training is superior to aerobic exercise for improving glycaemic control and body composition in individuals with normal-weight type 2 diabetes. By focusing on building lean muscle mass, strength training offers a targeted approach that addresses the unique physiological needs of this population, leading to better health outcomes.

As more research continues to emerge, it becomes increasingly clear that exercise recommendations for diabetes management should be personalized based on individual characteristics such as BMI and body composition. For those with NWT2D, incorporating regular strength training could be a crucial component in managing their condition effectively. Please always consult with healthcare professionals before starting any new exercise regimen to make sure it's safe and appropriate for your specific health needs.

Journal Reference

Kobayashi, Y., Long, J., Dan, S., Johannsen, N. M., Talamoa, R., Raghuram, S., Chung, S., Kent, K., Basina, M., Lamendola, C., Haddad, F., Leonard, M. B., Church, T. S., & Palaniappan, L. (2023). Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia, 66(10), 1897–1907. https://doi.org/10.1007/s00125-023-05958-9

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Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.

With a commitment to improving patient outcomes, Dr. Didwal integrates the latest medical advancements with a compassionate approach. He believes in empowering patients to take control of their health and make informed decisions that support long-term wellness.