Effects in Adult Diabetics Participating in Anaerobic Exercise versus Strength Training Exercise - Annotated Bibliography Example

Effects in adult diabetics participating in anaerobic exercise versus strength training exercise? Carol Biddington CALU Heather Snyder November 11, 2012 Introduction Adults with diabetes are able to improve their blood glucose levels in numerous ways with behavioral and lifestyle changes. Treatment plans will follow a protocol of weight control, exercise, diet and insulin as needed to control blood glucose levels. Exercise recommendations are often not specific though research compares the effects of anaerobic exercise results on blood glucose levels to results of strength training exercise. Anaerobic exercise is high intensity and brief and involves the exchange of energy within tissues independent of and without oxygen. Anaerobic exercise can use glucose in the absence of air, and this type of exercise results in muscles that develop differently than other exercise. Some examples of anaerobic exercise are spinning, jumping or sprinting (Train with me, 2012). Strength training can also be considered anaerobic when done in high intensity though most strength training programs are of low to moderate intensity and remain aerobic. Strength training exercise is thought to promote strength while developing flexibility (Spaulding, 2012). Strength training is known to help protect the health of bones and decrease and reverse muscle loss. Strength training involves contracting of muscles against a resistant force. Exercises that are considered strength training are push-ups, stair climbing and weight lifting. The importance of exercise is recognized in diabetic blood glucose control. Each type of exercise burns energy differently, affecting the body’s blood glucose levels. Research will help decide which type of exercise is most beneficial in controlling their glucose levels. Problem Statement The purpose of this review is to evaluate and review research completed within the last ten years comparing the effects of anaerobic exercise to those of strength training exercise. Annotated Bibliography Dijk, J. V., Manders, R., Tummers, K., & Bonomi, A. (2012). Both resistance- and endurance-type exercise reduce the prevalence of hyperglycemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type-2 diabetic patients. Diabetologia, 55(5), 1273-1282. doi: 10.1007/s00125-011-2380-5 Methodology used in this research study was statistics and data analysis. There were 45 participants. 15 were men with IGT and 30 men who were diagnosed with type 2 diabetes. None of the participants had renal failure, liver disease, morbid obesity, hypertension or a history of serious cardiovascular problems. Written consent was obtained from each participant. Instruments used to measure and collect date were venous blood sample analysis, implementation of an endurance-type exercise session consisting of 45 min of continuous cycling, performed on a cycle ergo-meter, and participants were asked to refrain from exhaustive physical labor and exercise training for 2 days prior to and during the intervention period during which time participants were provided with a healthy standardized diet, composed according to the ADA dietary recommendations for type-2 diabetes. Treatment with OGLM and/or insulin was continued as normal throughout the entire experimental period. Data from the continuous glucose monitor were downloaded to a personal computer with GlucoDay software. Intervention effects were analyzed using SPSS data analysis software and Bonferroni correction software to locate differences between interventions. Findings and conclusions indicated fasting plasma glucose concentrations were similar in the OGLM and INS groups but lower in the IGT group. Endurance-type exercise induced strong glucose regulating effects over the first 6 hours following exercise, as both average glucose levels and the prevalence of hyperglycemia were lower during this time period when compared with the control experiment. Hypoglycemia during or directly after exercise, endurance-type exercise induced a slight increase in the prevalence of hypoglycemia. In contrast and comparison to other articles, this article does not compare or contrast regular anaerobic exercise versus strength training exercise effects and outcomes. This research did relate to my problem statement as incidences of hyperglycemia were measured under specified conditions along with the analysis of the outcome. Dijk, J. V., Tummers, K., Stehouwer, C., & Hartgens, F. (2012). Exercise therapy in type-2 diabetes, Is daily exercise required to optimize glycemic control? Diabetes Care, 35(5), 948-954. doi: 10.2337/dc11-2112 This study sought to determine the difference daily exercise had in blood glucose control versus exercise every other day. 30 type 2 diabetics, each 60+, were recruited for this study which was a randomized crossover experiment where participants were in the experimental sessions on three separate occasions for a period of three days. Blood glucose was monitored and the control group performed no exercise while the non-control group exercised for a period of 60 minutes cycling. Physical activity was assessed using a validated triaxial accelerometer that kept track of the total physical activity. Both diet and insulin requirements and usage remained the same. Blood was sampled using venous collection and data was analyzed for patterns with software known as Glucoday, similar to Dijk, Manders, Tummers, & Bonomi 2012 study which compared resistance and endurance types of exercise in the control of blood glucose. Once all data was analyzed non exercise physical activity was the same between both groups. Study findings indicated only 30 minutes of moderate intensity exercise reduced the prevalence of hyperglycemia the following day. Despite the small sample size results, culture, ethnicity, lifestyle factors or other contributory factors to blood glucose levels were not considered. This study did not compare types of training though cycling is aerobic, requiring oxygen. Hansen, D., Dendale, P., Jonkers, R. M., Beelen, M., Manders, R. F., Corluy, L., & Loon, L. C. (2009). Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA1c in obese type-2 diabetes patients. Diabetologia, 52(9), 1789-1797. doi: 10.1007/s00125-009-1354-3 50 male patients meeting criteria for clinical obesity took part in a 6-month research study involving endurance exercise. Sessions were supervised 3 times weekly and who had admitted to being sedentary with no exercise program within the last five years, each having had type 2 Diabetes for the previous year and on oral medication to lower blood glucose. Methodology of the study included measurements performed prior to intervention and eight days after the end of the study. Each participant retained their normal style 3 days prior to each experimental exercise day; recording their dietary intake 2 days prior and each having the same standard meal the second night. Venous was blood was collected after a 20 minute rest; whole body oxygen uptake and workload capacity was measured continuously, immunohistochemistry chemistry was obtained from muscle tissue samples and results were analyzed statistically. Participants were assigned to training regimens randomly with an 89% compliance with the program. The study noted a significant reduction in blood HbA blood levels after 2 and 6 month interventions. 6 participants lowered their medication. This study also noted that high intensity exercise was more associated with dropout rates though otherwise each exercise regimen way equally beneficial. Houmard, J. A., Tanner, C., Slentz, C., & Duscha, B. (2003). Effect of the volume and intensity of exercise training on insulin sensitivity. Journal of Applied Physiology, 96(1), 101-106. doi: 10.1152/japplphysiol.00707.2003 Three exercise training programs were used to evaluate changes in insulin sensitivity. This study wanted to determine if exercise of vigorous intensity affected insulin sensitivity more so than moderate intensity exercise. 154 sedentary participants considered obese were placed randomly in an exercise group or a control group for 6 months. Body mass was measured initially and the participants sensitivity to insulin using the 3 hour intravenous glucose tolerance test. Study conclusions were effected by a drop rate of 30% and the main findings of the study presented that exercise of any intensity improved insulin sensitivity. Physical activity is known to prevent insulin resistance that these participants lifestyle or characteristics made them more prone to insulin resistance, overweight, inactive, high BMI. Implementation of this study in certain populations may reduce the need for increasing doses of insulin. Limitations of this study are the high dropout rate though all three exercise groups experience increased sensitivity to insulin at the end of 6 months. Juel, C., Holten, M., & Dela, F. (2004). Effects of strength training on muscle lactate release and MCT1 and MCT4 content in healthy and type-2 diabetic humans. The Journal of Physiology, 556, 297-304. doi: 10.1113 The control group in this study was 7 Caucasian males with no family history of type 2 diabetes while the experimental group included 12 males, Caucasian, with type 2 Diabetes. All participants took part in a 6-month strength-training program. Study conclusions were that protein content within muscles is lower initially in the experimental group, substantially so. The training program was moderate intensity in endurance using low weights and more repetitions. Strength training normalized the reduced amount of protein MCT1 when compared with the control group though there is no change in the level of MCT4, which increases in those patients who are healthy but does not increase in the experimental group. Lactate concentration in skeletal muscle biopsies was lower in the control group though after training the groups were similar. Lactate levels are attributed to the enhanced lactate release from trained muscle is most likely a consequence of increased glucose uptake rates in trained muscle and subsequent enhancement of glycolysis, in agreement with earlier reports. This study relates directly to the problem statement as lactic acid formation is a product of anaerobic exercise though the study did not compare the two types of exercise it described the findings of anaerobic strength training in a narrow and small population; all Caucasian, all male, and the control group having no family history of Diabetes. Mikus, C. R., Fairfax, S. T., Libla, J. L., Boyle, L. J., Vianna, L. C., Oberlin, D. J., ... Thyfault, J. P. (2011). Seven days of aerobic exercise training improves conduit artery blood flow following glucose ingestion in patients with type-2 diabetes. Journal of Applied Physiology, 111(3), 657-664. doi: 10.1152/japplphysiol.00489.2011 This study sought to determine if short-term aerobic exercise training improved blood flow following ingestion of glucose. Participants were sedentary, overweight, and obese, between 30 and 65 and the patient’s metabolic and cardiovascular response was measured using electrocardiogram, blood analysis and continuous glucose monitoring. 6 men and 5 women completed the study and baseline information was recorded for each. Exercise regimen involved 60 minutes of supervised aerobic exercise daily for one week and on experiment day’s participants were given a 75 g glucose drink and venous blood was drawn for analysis every 15 minutes. There were few reductions after 7 days and the primary finding of the study was that the 7-day program increased FBF, (femoral blood flow) following glucose ingestion. FBF was measured using duplex Doppler ultrasound. Numerous studies have suggested a strong correlation between limb blood flow and the uptake of glucose. Blood flow increased up to 50% following 7 days, this finding is more directly related to managing the complications of Diabetes and comorbidity. Praet, S. E., & Van Loon, L. C. (2007). Optimizing the therapeutic benefits of exercise in type-2 diabetes. Journal of Applied Physiology, 103(4), 1113-1120. doi: 10.1152/japplphysiol.00566.2007 This study completes a thorough literature review of Diabetes 2 recommendations along with current and published findings. While the ADA recommends at least 150 minutes weekly of moderate intensity aerobic exercise or 90 minutes of vigorous exercise it is only since 2006 the ADA explicitly mentions that unless it is otherwise contradicted it is encouraged to complete resistance exercise 3 times weekly though the ADA does not specify preferred type of intensity of exercise; only that all muscle groups are worked. It has been recognized for over 20 years that the characteristics of exercise programs need to be much more defined; this review attempts to define regimens for certain subgroup populations. Both endurance and resistance or strength training have been shown to be therapeutic. Lifestyle intervention programs will usually focus on endurance type training; effecting insulin sensitivity. High intensity is most associated with lack of follow through and literature does not provide much information on intensity and duration needed. The review concludes that factors such as disease state, comorbidity, and safety aspects are often ignored in reviews and studies and that these subpopulations need to better defined in order to recommend intervention training that the patient is able to adhere to and benefit from. Ramalho, A., Delourdeslima, M., Nunes, F., Cambui, Z., Barbosa, C., Andrade, A., ... Aragao, C. (2006). The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Research & Clinical Practice, 72(3), 271-276. doi: 10.1016/j.diabres.2005.11.011 16 patients with type 1 Diabetics were recruited in Salvador, Bahia, Brazil, aged 13-30, each admitted to exercising less than twice per week. Measurements recorded height, weight, and BMI. Venous blood samples were drawn and the participant’s monitored pre and post exercise glucose levels and patients were randomly divided into 2 groups. Group a was assigned to an aerobic exercise program while group b were placed in a resistance training program for a period of 12 weeks, 3 times weekly with supervision. Statistical analysis was used for comparison. After the program both groups had a reduction in NPH insulin dose and group A, one participant had a reduction in the rapid insulin dose while in group B, four had reductions in rapid and ultra-rapid insulin doses. Limitations of this study are the small sample size and a lack of guidelines to adapt the dose of insulin. The evidence lacks substance that regular exercise can improve metabolic control as lipid profiles and BMI remained the same in each group. Snowling, N., & Hopkins, W. (2006). Effects of different modes of exercise training on glucose control and risk factors for complications in type-2 diabetic patients. Diabetes Care, 29(11), 2518-2527. doi: 10.2337/dc06-1317 This study is a meta-analysis of 27 different studies involving 1003 Diabetic type 2 patients. Research design used PubMed and SportDiscus databases. Studies were eliminated which did not use a control group, also excluded were studies where the control group was healthy, the program was interrupted or the study did not increase usual physical activity. Effects of exercise were then analyzed assigning values to certain factors and plotted. Small reductions were evident with the use of aerobic exercise, resistance training or a combination of the two. No data was analyzed involving anaerobic exercise. Resistance and aerobic exercise showed too small of a difference in benefit to be considered other than trivial. The study concluded that all 3 types of exercise program had small to moderate effects on glucose control though combination showed small to moderate effects on the related risk factors of complications from Diabetes Type 2. This studies meta-analysis is useful in this research for validating the benefits of resistance training. Yardley, J., Kenny, G., Perkins, B., & Riddle, M. (2012). Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type-1 diabetes. Diabetes Care, 35(4), 669-675. doi: 10.2337/dc11-1844 Twelve active adults with type-1 diabetes participated in a study completed at the University of Ottawa. Experimental sessions included 2 sessions in random order over a period of five days, and IV catheters were placed before each session. The experimental sessions included anaerobic exercise before resistance exercise with the second session being resistance exercise before anaerobic exercise. The exercises themselves were the same, just ordered differently. During the exercise session blood glucose was tested every ten minutes via capillary and glucose given as needed to maintain levels above 5.5. Oxygen consumption was measured and energy expenditure was calculated. Venous blood samples were drawn at specific time periods including baseline and at interval during exercise and certain intervals post exercise. Plasma glucose was determined through the use of the hexokinase timed end point method. Results found no difference in energy expenditure though resistance exercise before aerobic exercise caused declines in glucose concentrations and fewer less episodes of hypoglycemia. Limitations of this study is the relatively small sample size, though its’ conclusions provides data confirming that a combination of resistance and aerobic exercise does reduce blood glucose level if one is performed before the other, unlike Praet & Van Loon, who in 2007 indicated either resistance or endurance training alone contributed to the control of blood glucose levels and stabilization. Clinical Implications Though these findings indicate clearly that strength or resistance training in each case was shown to improve blood glucose levels despite each individual sample size being relatively statistically small when regarded as a whole they provide significant evidence (Hansen, Dendale, Jonkers, Beelen, Manders, Corluy, & Loon, 2009). There is some disappointment in the research availability of strength training versus anaerobic exercise’s effect on blood glucose level as strength training such as weight lifting becomes an anaerobic exercise when done with high intensity (Praet, & Van Loon, 2007). High intensity training programs are the most frequent programs that participants discontinue or drop out of and many times the presence of comorbid factors prevent anaerobic exercise. Not all exercise of high intensity is considered anaerobic; only those strength training exercises such as weight training done in short bursts and increased or fast repetitions become anaerobic. Houmard, Tanner, Slentz & Duscha, in 2003 noted that programs of high intensity and moderate intensity increased sensitivity to insulin though this study had a 30% drop out rate, more likely associated with the vigorous intensity exercise group. This study concluded that programs of all intensity done consistently over a sufficient span of time; in this case 6 months, effected sensitivity to insulin. Conclusion It has been shown that moderate intensity and low intensity resistance training has positive effects on blood glucose levels along with reducing many of the risks associated with blood glucose levels being either too high or too low. Lactic acid is a byproduct of anaerobic exercise and limited data and only small samples sizes are available to determine if this increases sensitivity to insulin uptake, decreasing the need for increases in dosages of insulin or the amount of insulin needed in those with insulin dependent diabetes (Juel, Holten, & Dela, 2004). This research agrees with the findings of ADA which is unable to specify that high intensity or anaerobic exercise should be recommended across the patient continuum due to comorbidity factors. Future Research Research findings involving the impact of anaerobic exercise only and high intensity programs which use resistance or strength training are those programs most likely to be discontinued or have a high dropout rate. Future research should consider more specific sub populations which are able to complete high intensity strength training or anaerobic exercise in order to more narrowly focus on the effects these programs have on blood glucose levels when compared. Because of comorbid conditions that can occur with diabetes and lifestyle factors populations need to be better defined and often narrowly defined in order to compare strength training to anaerobic exercise effects on blood glucose. References Train with me. (2012). Anaerobic Exercise. Anaerobic Exercise. http://www.trainwithmeonline.com/glossary/anaerobic_exercise.asp Spaulding, W. (2012). 20-Minute Strength Training Workout. 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