OBJECTIVE -To determine the efficacy of high-intensity progressive resistance training (PRT) on glycemic control in older adults with type 2 diabetes.RESEARCH DESIGN AND METHODS -We performed a 16-week randomized controlled trial in 62 Latino older adults (40 women and 22 men; mean Ϯ SE age 66 Ϯ 8 years) with type 2 diabetes randomly assigned to supervised PRT or a control group. Glycemic control, metabolic syndrome abnormalities, body composition, and muscle glycogen stores were determined before and after the intervention.RESULTS -Sixteen weeks of PRT (three times per week) resulted in reduced plasma glycosylated hemoglobin levels (from 8.7 Ϯ 0.3 to 7.6 Ϯ 0.2%), increased muscle glycogen stores (from 60.3 Ϯ 3.9 to 79.1 Ϯ 5.0 mmol glucose/kg muscle), and reduced the dose of prescribed diabetes medication in 72% of exercisers compared with the control group, P ϭ 0.004 -0.05. Control subjects showed no change in glycosylated hemoglobin, a reduction in muscle glycogen (from 61.4 Ϯ 7.7 to 47.2 Ϯ 6.7 mmol glucose/kg muscle), and a 42% increase in diabetes medications. PRT subjects versus control subjects also increased lean mass (ϩ1.2 Ϯ 0.2 vs. Ϫ0.1 Ϯ 0.1 kg), reduced systolic blood pressure (-9.7 Ϯ 1.6 vs. ϩ7.7 Ϯ 1.9 mmHg), and decreased trunk fat mass (Ϫ0.7 Ϯ 0.1 vs. ϩ0.8 Ϯ 0.1 kg; P ϭ 0.01-0.05).CONCLUSIONS -PRT as an adjunct to standard of care is feasible and effective in improving glycemic control and some of the abnormalities associated with the metabolic syndrome among high-risk older adults with type 2 diabetes.

Hispanics are at increased risk of morbidity and mortality due to their high prevalence of diabetes and poor glycemic control. Strength training is the most effective lifestyle intervention to increase muscle mass but limited data is available in older adults with diabetes. We determined the influence of strength training on muscle quality (strength per unit of muscle mass), skeletal muscle fiber hypertrophy, and metabolic control including insulin resistance (Homeostasis Model Assessment –HOMA-IR), C-Reactive Protein (CRP), adiponectin and Free Fatty Acid (FFA) levels in Hispanic older adults. Sixty-two community-dwelling Hispanics (>55 y) with type 2 diabetes were randomized to 16 weeks of strength training plus standard care (ST group) or standard care alone (CON group). Skeletal muscle biopsies and biochemical measures were taken at baseline and 16 weeks. The ST group show improved muscle quality (mean±SE: 28±3) vs CON (-4±2, p<0.001) and increased type I (860±252µm2) and type II fiber cross-sectional area (720±285µm2) compared to CON (type I: -164±290µm2, p=0.04; and type II: -130±336µm2, p=0.04). This was accompanied by reduced insulin resistance [ST: median (interquartile range) -0.7(3.6) vs CON: 0.8(3.8), p=0.05]; FFA (ST: -84±30µmol/L vs CON: 149±48µmol/L, p=0.02); and CRP [ST: -1.3(2.9)mg/L vs CON: 0.4(2.3)mg/L, p=0.05]. Serum adiponectin increased with ST [1.0(1.8)µg/mL] compared to CON [-1.2(2.2)µg/mL, p<0.001]. Strength training improved muscle quality and whole-body insulin sensitivity. Decreased inflammation and increased adiponectin levels were related with improved metabolic control. Further studies are needed to understand the mechanisms associated with these findings. However, these data show that strength training is an exercise modality to consider as an adjunct of standard of care in high risk populations with type 2 diabetes.

Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.

Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older. Physical activity, particularly weight-bearing exercise, is thought to provide the mechanical stimuli or "loading" important for the maintenance and improvement of bone health, whereas physical inactivity has been implicated in bone loss and its associated health costs. Both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, yet research indicates that resistance training may have a more profound site specific effect than aerobic exercise. Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass.