Is Resistance training to be encouraged in adults?
Preserve your muscles and you will preserve your health: here’s how!
Muscle decline and its consequences
Muscle tissue is the primary site of glucose disposal, as it declines at a rate of 3–8% each decade after the age of 30 [1], aging brings a decline in skeletal muscle, increasing the risk of diabetes and changes in glucose tolerance: total diabetes prevalence (undiagnosed and diagnosed) is currently estimated to be 14% of the U.S adult population and is highest in those aged ≥65 years. By the year 2050, diabetes prevalence could be as high as 33%, recent estimates indicate [2]. The improved occurrence of diabetes amongst older adults, coupled with the growing old of our population, suggests a clear need for powerful diabetes prevention strategies [3, 4].
In addition, a decrease in the muscle twitch time and force is experienced, which can be considered a cause or an effect of muscle mass reduction, also named sarcopenia [4]. Other outcomes of this decline in muscles encompass decreased muscle strength, decreased resting metabolic rate, decreased lipid oxidative capacity, and improved adiposity [3, 4].
Are we all becoming diabetic?
The evidence showing that type 2 diabetes can be prevented or delayed by lifestyle interventions including improved nutrition, improved physical activity, and weight reduction of 5% to 7% is robust [5, 6]
However, most of the evidence from clinical trials enrolled primarily middle-aged participants [7]. The exception is the Diabetes Prevention Program (DPP)—the largest clinical trial to date. In the Diabetes Prevention Program, approximately 20% of the participants were aged 60 years or older at enrolment. These seniors experienced a 71% risk reduction for type 2 diabetes compared with a 58% risk reduction in younger participants [8].
Follow-up of the Diabetes Prevention Program participants for 10 years showed the seniors continued to benefit most. Those aged 60 and older had a 49% risk reduction compared with a 34% reduction for all participants. Additional benefits of the lifestyle intervention that might impact older adults, such as reduction in urinary incontinence, improvement in several quality-of-life domains, and improvements in cardiovascular risk factors, also were observed.
The most robust predictor of glucose tolerance
Increasing lean body mass (primarily muscle mass) parallels the improvements in glucose tolerance seen with resistance training among older adults, as many clinical studies have shown [9, 10]. Although lean mass may not be the most robust predictor of glucose tolerance, the results of numerous clinical trials suggest that increases in lean body mass with resistance training are associated with improvements in glucose tolerance [11, 12]. Therefore, increasing lean mass regardless of baseline levels should improve glucose tolerance and insulin resistance, which may be an important strategy to combat the age-related increases in insulin resistance and glucose intolerance.
Can we stop muscle decline?
The Diabetes Prevention Program demonstrated that lifestyle modification reduces the development of diabetes by focusing on weight loss, increased physical activity, and dietary modification. Lifestyle modification decreased the incidence of type 2 diabetes by 58%, as compared to 31% among individuals taking metformin. The physical activity component of the DPP recommended that individuals accumulate 150 minutes/week of moderate physical activity. The DPP stressed brisk walking as the physical activity of choice but also lists aerobic dance, skating, bicycle riding, and swimming as options. In support of the DPP’s recommendations for aerobic training (AT), regular AT improves glucose control and insulin sensitivity [13]. The American Diabetes Association (ADA) recommends that individuals with diabetes perform at least 150 minutes of moderate-intensity AT per week. However, factors such as obesity, arthritis, low back pain, and physical disabilities affecting many older adults may preclude this population from regularly performing AT [14].
Is resistance training safe?
Resistance training is an activity that can be safe and effective for older adults, including the elderly. The ADA encourages individuals with type 2 diabetes to perform resistance exercise three times a week targeting all major muscle groups, progressing to three sets of 8–10 repetitions at high intensity. By using machines that provide external resistance with controlled movements, even those confined to a wheelchair or a walker can perform some types of RT. Though older adults demonstrate reduced overall muscle protein synthesis (MPS) relative to younger adults after a bout of resistance training, clinical trials investigating RT interventions among older adults have shown improvements in insulin resistance and sarcopenia, by increasing lean body mass [15].
High-intensity RT (defined as training loads above 75% one-repetition maximum (RM)) produces greater improvements than RT performed at a moderate or low intensity (training loads between 50%–74% of one RM and below 50% one RM, respectively) [16, 17].
Resistance training? Why not?
Diabetes in the elderly can be prevented or delayed with lifestyle interventions, including improved nutrition, increased physical activity, and weight loss. Physical activity and in particular resistance training has to be clearly encouraged.
References:
[1] Shur NF, Creedon L, Skirrow S, Atherton PJ, MacDonald IA, Lund J, Greenhaff PL. Age-related changes in muscle architecture and metabolism in humans: The likely contribution of physical inactivity to age-related functional decline. Ageing Res Rev. 2021 Jul;68:101344. doi: 10.1016/j.arr.2021.101344. Epub 2021 Apr 16. PMID: 33872778; PMCID: PMC8140403.
[2] “Prevalence of Diagnosed Diabetes | Diabetes | CDC.” https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-diabetes.html
[3] Nishikawa H, Asai A, Fukunishi S, Nishiguchi S, Higuchi K. Metabolic Syndrome and Sarcopenia. Nutrients. 2021 Oct 7;13(10):3519. doi: 10.3390/nu13103519. PMID: 34684520; PMCID: PMC8541622.
[4] Nishikawa H, Fukunishi S, Asai A, Yokohama K, Ohama H, Nishiguchi S, Higuchi K. Sarcopenia, frailty and type 2 diabetes mellitus (Review). Mol Med Rep. 2021 Dec;24(6):854. doi: 10.3892/mmr.2021.12494. Epub 2021 Oct 15. PMID: 34651658.
[5] Ard J, Fitch A, Fruh S, Herman L. Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists. Adv Ther. 2021 Jun;38(6):2821-2839. doi: 10.1007/s12325-021-01710-0. Epub 2021 May 11. PMID: 33977495; PMCID: PMC8189979.
[6] “Diabetes Prevention in Older Adults – Today’s Dietitian Magazine.” https://www.todaysdietitian.com/newarchives/0417p30.shtml.
[7] Grevendonk L, Connell NJ, McCrum C, Fealy CE, Bilet L, Bruls YMH, Mevenkamp J, Schrauwen-Hinderling VB, Jörgensen JA, Moonen-Kornips E, Schaart G, Havekes B, de Vogel-van den Bosch J, Bragt MCE, Meijer K, Schrauwen P, Hoeks J. Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function. Nat Commun. 2021 Aug 6;12(1):4773. doi: 10.1038/s41467-021-24956-2. PMID: 34362885; PMCID: PMC8346468.
[8] Gruss SM, Nhim K, Gregg E, Bell M, Luman E, Albright A. Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Curr Diab Rep. 2019 Aug 5;19(9):78. doi: 10.1007/s11892-019-1200-z. Erratum in: Curr Diab Rep. 2020 Jun 27;20(8):36. PMID: 31385061; PMCID: PMC6682852.
[9] Buchanan A, Villani A. Association of Adherence to a Mediterranean Diet with Excess Body Mass, Muscle Strength and Physical Performance in Overweight or Obese Adults with or without Type 2 Diabetes: Two Cross-Sectional Studies. Healthcare (Basel). 2021 Sep 24;9(10):1255. doi: 10.3390/healthcare9101255. PMID: 34682935; PMCID: PMC8535373.
[10] Barrett M, McClure R, Villani A. Adiposity is inversely associated with strength in older adults with type 2 diabetes mellitus. Eur Geriatr Med. 2020 Jun;11(3):451-458. doi: 10.1007/s41999-020-00309-y. Epub 2020 Mar 19. PMID: 32297268.
[11] Xing Z, Chai X. Changes in fat mass and lean body mass and outcomes in type 2 diabetes mellitus. Intern Emerg Med. 2022 Jun;17(4):1073-1080. doi: 10.1007/s11739-021-02916-4. Epub 2022 Feb 1. PMID: 35106709.
[12] Pan B, Ge L, Xun YQ, Chen YJ, Gao CY, Han X, Zuo LQ, Shan HQ, Yang KH, Ding GW, Tian JH. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act. 2018 Jul 25;15(1):72. doi: 10.1186/s12966-018-0703-3. PMID: 30045740; PMCID: PMC6060544.
[13] Burd C, Gruss S, Albright A, Zina A, Schumacher P, Alley D. Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare Expansion of the National Diabetes Prevention Program Lifestyle Intervention. Milbank Q. 2020 Mar;98(1):172-196. doi: 10.1111/1468-0009.12443. Epub 2020 Jan 28. PMID: 31994260; PMCID: PMC7077780.
[14] “Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers,” Clin. Diabetes, vol. 40, no. 1, pp. 10–38, Jan. 2022, doi: 10.2337/cd22-as01.
[15] Yamada M, Kimura Y, Ishiyama D, Nishio N, Otobe Y, Tanaka T, Ohji S, Koyama S, Sato A, Suzuki M, Ogawa H, Ichikawa T, Ito D, Arai H. Synergistic effect of bodyweight resistance exercise and protein supplementation on skeletal muscle in sarcopenic or dynapenic older adults. Geriatr Gerontol Int. 2019 May;19(5):429-437. doi: 10.1111/ggi.13643. Epub 2019 Mar 13. PMID: 30864254.
[16] Nilsson MI, Mikhail A, Lan L, Di Carlo A, Hamilton B, Barnard K, Hettinga BP, Hatcher E, Tarnopolsky MG, Nederveen JP, Bujak AL, May L, Tarnopolsky MA. A Five-Ingredient Nutritional Supplement and Home-Based Resistance Exercise Improve Lean Mass and Strength in Free-Living Elderly. Nutrients. 2020 Aug 10;12(8):2391. doi: 10.3390/nu12082391. PMID: 32785021; PMCID: PMC7468764.
[17] Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open. 2017 Jul 20;7(7):e014619. doi: 10.1136/bmjopen-2016-014619. PMID: 28729308; PMCID: PMC5541589.
Disclaimer
The information contained herein is not and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Before making any changes to your diet, exercise or treatment, always consult your doctor or a qualified health professional.
The guidance provided may not be appropriate for your specific situation. Never make any decisions about your health based solely on the information provided in this article.
The author and creator of this article are not responsible for any damage or loss resulting from the improper use of the information presented here. Remember that each person is unique and therefore needs a personalized approach to health.
If you have any concerns about your health, please consult a qualified medical professional.