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Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes
Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C
International Journal of Medical Sciences 2006;4(1):19-27
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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) versus CON (-4 +/- 2, p < 0.001) and increased type I (860 +/- 252 microm2) and type II fiber cross-sectional area (720 +/- 285 microm2) compared to CON (type I -164 +/- 290 micro-m2, p = 0.04; and type II -130 +/- 336 micro-m2, p = 0.04). This was accompanied by reduced insulin resistance (ST median (interquartile range) -0.7 (3.6) versus CON 0.8 (3.8), p = 0.05); FFA (ST -84 +/- 30 micro-mol/L versus CON 149 +/- 48 micro-mol/L, p = 0.02); and CRP (ST -1.3 (2.9) mg/L versus CON 0.4 (2.3) mg/L, p = 0.05). Serum adiponectin increased with ST (1.0 (1.8) micro-g/mL) compared to CON (-1.2 (2.2) micro-g/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.

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