Changes in physical fitness predict improvements in modifiable cardiovascular risk factors independently of body weight loss in subjects with type 2 diabetes participating in the Italian Diabetes and Exercise Study (IDES)

Diabetes Care. 2012 Jun;35(6):1347-54. doi: 10.2337/dc11-1859. Epub 2012 Mar 7.

Abstract

Objective: Physical fitness is inversely related to mortality in the general population and in subjects with type 2 diabetes. Here, we present data concerning the relationship between changes in physical fitness and modifiable cardiovascular risk factors in subjects with type 2 diabetes from the Italian Diabetes and Exercise Study.

Research design and methods: Sedentary patients with type 2 diabetes (n = 606) were enrolled in 22 outpatient diabetes clinics and randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling versus counseling alone for 12 months. Baseline to end-of-study changes in cardiorespiratory fitness, strength, and flexibility, as assessed by Vo(2max) estimation, a 5-8 maximal repetition test, and a hip/trunk flexibility test, respectively, were calculated in the whole cohort, and multiple regression analyses were applied to assess the relationship with cardiovascular risk factors.

Results: Changes in Vo(2max), upper and lower body strength, and flexibility were significantly associated with the variation in the volume of physical activity, HbA(1c), BMI, waist circumference, high-sensitivity C-reactive protein (hs-CRP), coronary heart disease (CHD) risk score, and inversely, HDL cholesterol. Changes in fitness predicted improvements in HbA(1c), waist circumference, HDL cholesterol, hs-CRP, and CHD risk score, independent of study arm, BMI, and in case of strength, also waist circumference.

Conclusions: Physical activity/exercise-induced increases in fitness, particularly muscular, predict improvements in cardiovascular risk factors in subjects with type 2 diabetes independently of weight loss, thus indicating the need for targeting fitness in these individuals, particularly in subjects who struggle to lose weight.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • C-Reactive Protein / metabolism
  • Calorimetry, Indirect
  • Cohort Studies
  • Coronary Disease / blood
  • Coronary Disease / etiology
  • Coronary Disease / physiopathology
  • Coronary Disease / prevention & control*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / prevention & control*
  • Directive Counseling
  • Exercise*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Obesity / blood
  • Obesity / complications*
  • Obesity / physiopathology
  • Physical Fitness*
  • Resistance Training*
  • Risk Factors
  • Sedentary Behavior*
  • Waist Circumference
  • Weight Loss*

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • C-Reactive Protein

Associated data

  • ISRCTN/ISRCTN04252749