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 = 0.03). The mean changes in HbA1c were not statistically significant in either the resistance training (-0.16%; 95% CI -0.46% to 0.15%; p = 0.32) or the aerobic (-0.24%; 95% CI -0.55% to 0.07%; p = 0.14) 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 to 1.5, p < 0.05) 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 < 0.05) and combination training group lost a mean of -1.7 (-2.3 to -1.1 kg; p < 0.05) 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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