Non-weight-bearing lower-limb simple resistance activities, soleus push-ups, and muscle stretching: Impact on glycemic control and metabolic-circulatory outcomes

Abstract

Objective: To review the role of lower-body skeletal muscle non-weight-bearing simple resistance activities (SRAs), soleus push-ups (SPUs), and stretching exercises (SEs) in improving glycemic control and metabolic/circulatory outcomes in those individuals who cannot do weight-bearing aerobic exercises due to musculoskeletal, cardiorespiratory and other reasons.

Research design and methods: We conducted a narrative review of randomized controlled trials, prospective cohorts, and pilot interventions identified through searches of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, EBSCO, and ScienceDirect. We examined non-weight-bearing SRAs, SPUs, and SEs, focusing on pathophysiological mechanisms and clinical outcomes.

Results: Moderate lower-body strength is associated with 32-35% lower type 2 diabetes (T2D) risk (HR: 0.68, 95% CI: 0.49-0.94). Interrupting prolonged sitting with 3-min SRAs every 30 min reduces insulin response by 26%. SPUs-sustained, seated plantarflexion contractions-reduce postprandial glucose by 39-52% and insulin response by 60% during oral glucose tolerance tests. Passive SE for 40 min acutely lowered blood glucose by 24-28 mg/dL, chronically improves femoral blood flow by 30% and flow-mediated dilation by 25%. Benefits are likely mediated through AMPK-dependent GLUT4 translocation, myokine secretion, and improved endothelial function.

Conclusions: Lower-body SRAs, SPUs, and SEs are simple interventions that can be performed while seated and have the potential to significantly improve glucose regulation, insulin sensitivity, and vascular function in populations unable to engage in traditional weight-bearing aerobic exercise. Integration into clinical practice could provide cost-effective tools for the prevention and management of T2D. Finally, the effects of these exercises should be evaluated in long-term studies to determine their impact on glycaemic control and cardiovascular protection.

Keywords: Circulation; Exercise; Insulin response; Postprandial glucose; Resistance training; Soleus push‐ups; Stretching exercises; Type 2 diabetes.