EXSC-510: Advanced Exercise Physiology Article Review
I chose the article “Exercise Training and Quality of Life in Individuals with Type 2
Diabetes”. This article was chosen so that exercise does not only improve untrained
individuals, but also improves those with chronic diseases, in this case type 2 diabetes. It
is important that those affected with chronic diseases realize that medicine is not always a
cure all. Though exercise and physical activity is a preventative measure for type 2
diabetes it can also improve the body’s tremendously. Regular physical activity can lead
to an improvement in blood glucose control, blood pressure, and improvements on insulin
action.
Introduction: The quality of life (QOL) is a construct developed that includes the
physical, emotional, and social aspects of an individuals well being. This includes the
physical functions and limitations that an individual may experience dealing with
physical and emotional problems. Prior exercise studies in most healthy individuals and
those with chronic diseases such as chronic obstructive pulmonary disease (COPD),
cardiovascular disease (CVD), hypertension, and many others have found improvements
in their QOL after exercise training. Previous exercise studies were small , but recent data
has provided more detailed evidence that exercise has beneficial effects on the QOL.
Krysten Crudup
Many adults with diabetes have a decreased QOL than those without diabetes. Physical
activities have proven to improve glycemic control. Poor glycemic control is the main
problem with individuals with Type 2 diabetes and the reason for a decreased QOL.
Changes in hemoglobin (HbA) can also be a result of physical activity and exercise
which leads to an improvement of QOL. Most studies showing beneficial effects on QOL
of diabetics used smaller sample sizes, but recently there have been two trials with larger
sample sizes and etc. An analysis of QOL was performed by the Diabetes Aerobic
Resistance Exercise trial. This was a 22 week exercise intervention that consisted of
strictly aerobic exercise and resistance training only. This study consisted of 218
individuals. The results of this study found that physical QOL improved in the resistance
training and combined training groups than the control group. The second study
examined QOL from the Italian Diabetes and Exercise study. This consisted of 606
individuals where they were given 150 minutes of exercise per week. This too proved
that exercise improves QOL of those with type 2 diabetes.
Research Design and Methods: This study, HART-D was a 9 month study that
compared the effects of aerobic, resistance and a combination of both on the hemoglobin
(HBA) measures in those who are sedentary and have type 2 diabetes. There was a total
of 262 sedentary adults with Hba levels of 6.5-11%. They were determined sedentary if
they did not involve themselves in exercise for 20 mins and at least 3 days a week. There
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many exclusions to the criteria, all of the exclusions included any medical condition, age
ranges, BMI and etc that would not prevent the individual from exercising. Each
participant gave written consent.
The four groups were randomized. These groups were aerobic training only, resistance
training only, combination and then a control group who do none of the exercise. Weight
and height of these individuals were recorded and the BMI was calculated. The QOL was
evaluated using a questionnaire. This is a valid, self administered questionnaire.
The exercise training given to these individuals was 150 minutes of moderate intensity exercise
every week. The intensity for aerobic exercise was 50-80% of maximal oxygen consumption.
The participants were weighed every week and each session had a warm up and cool down. In
the resistance training group, they exercise 3 days a week. Each session consisted of two sets of
four upper body exercises, and two sets of abdominal crunches and back extensions. With the
combination group they had two resistance sessions per week. All of these groups were
monitored and instructed on a one on one basis. The control group was given stretching and
relaxing type of conditioning. This included 45 minute weekly sessions that focused on
increasing flexibility and reducing stress.
Results: The total number of participants that were screened for the study was 2.421 and 262v
of them participated in the study. They were chosen randomly. The total number of participants
by the end of the trial was 243. There was a delay in getting the copyright permissions of the
Quality of Life (QOL) assessments, which resulted in only 173 participants data of QOL. The
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characteristics of the sample was that there was a mean age of 57.1 years. The majority of the
participants in this trial were either white (58.4)), female (59.5)or married (64.7). There were a
few smokers that participated and some participants had a history of antidepressant use. The
mean BMI was 34.7 and the mean hemoglobin or HBA was 7.6.
Individuals with type 2 diabetes and the baseline characteristic means were matched by
age,gender, and age by gender. These comparisons used z scores. Those with a BMI >40kg/m
had lower physical component scores than those with a BMI between 25 and 35kg/m. Those who
were not married had lower mental component summary scores on the HART-D. Those with
lower HBA were reported functioning worse on the mental component. With the QOL
component scores, all three exercise groups experienced great improvements than the control
group. The improvement was in the physical component scores and the general health scale.
With the physical functioning scale the aerobic training and combination training group had
greater improvements than the control group. The resistance training group experiences an
increase in body pain compared with the control group.
QOL component scores in mental health there was not much of a difference between the control
group and the three exercise groups. There were differences between the combined training
group and the aerobic group, the combined training group experienced a greater improvement on
mental components.
Conclusion: The main findings in this study was that exercise improves physical health QOL in
those with type 2 diabetes regardless of the type of training. Mental QOL improvements favored
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the combined training group. The overall health of all the exercise groups improved. The lack of
improvement in the mental component of QOL compared to the controlled group is one thing
that is noted in this study. It does not compare to the other studies of nondiabetic populations that
shows an increase in mental QOL. The mental health QOL was also higher than average in the
study and is possible that those with a lower baseline of their mental QOL will benefit more from
exercise. It is also possible that longer exercise programs are needed to see an improvement in
mental QOL.The body pain mentioned regarding the physical health QOL could be related to
muscle soreness in the participants. It was the aerobic and combined groups that saw the most
improvement.
There were also concerns that the control group could have biased outcomes. This group just
participated in stretching and relaxing, which could have therapeutic effects on QOL, as opposed
to somebody completely sedentary. Some of the strengths of the study was that it had a large
sample that had a large amount of african american representation. The randomized study design
was carefully controlled, also the exercise intervention and exercise does. Overall those with
type 2 diabetes will benefit from an exercise training regime.
Krysten Crudup
