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Dietary weight loss and exercise effects on insulin resistance in postmenopausal women
Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, Campbell KL, Wang CY, Duggan CR, Ulrich CM, Alfano CM, Blackburn GL, McTiernan A
American Journal of Preventive Medicine 2011 Oct;41(4):366-375
clinical trial
7/10 [Eligibility criteria: Yes; 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*

BACKGROUND: Comprehensive lifestyle interventions are effective in preventing diabetes and restoring glucose regulation; however, the key stimulus for change has not been identified and effects in older individuals are not established. The aim of the study was to investigate the independent and combined effects of dietary weight loss and exercise on insulin sensitivity and restoration of normal fasting glucose in middle-aged and older women. DESIGN: Four-arm RCT, conducted between 2005 and 2009 and data analyzed in 2010. SETTING/PARTICIPANTS: 439 inactive, overweight/obese postmenopausal women. INTERVENTIONS: Women were assigned to: dietary weight loss (n = 118); exercise (n = 117); exercise+diet (n = 117); or control (n = 87). The diet intervention was a group-based reduced-calorie program with a 10% weight-loss goal. The exercise intervention was 45 min/day, 5 days/week of moderate-to-vigorous intensity aerobic activity. MAIN OUTCOME MEASURES: 12-month change in serum insulin, C-peptide, fasting glucose, and whole body insulin resistance (HOMA-IR). RESULTS: A significant improvement in HOMA-IR was detected in the diet (-24%, p < 0.001) and exercise+ diet (-26%, p < 0.001) groups but not in the exercise (-9%, p = 0.22) group compared with controls (-2%); these effects were similar in middle-aged (50 to 60 years) and older women (aged 60 to 75 years). Among those with impaired fasting glucose (5.6 to 6.9 mmol/L) at baseline (n = 143; 33%), the odds (95% CI) of regressing to normal fasting glucose after adjusting for weight loss and baseline levels were 2.5 (0.8 to 8.4); 2.76 (0.8 to 10.0); and 3.1 (1.0 to 9.9) in the diet, exercise+diet, and exercise group, respectively, compared with controls. CONCLUSIONS: Dietary weight loss, with or without exercise, significantly improved insulin resistance. Older women derived as much benefit as did the younger postmenopausal women. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov NCT00470119.

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