The Effects of Supervised Aerobic and Resistance Exercise Training on Sri Lankan Adults with Type 2 Diabetes Mellitus - Sri Lanka Diabetes Aerobic and Resistance Training (SL-DART) Study

Abstract

Type 2 diabetes mellitus (T2DM) and the associated cardiovascular diseases (CVD) are contributing to rising global mortality [1]. South Asia is the home to almost one-fifth of the world's population [2]. South Asians are more prone to T2DM compared to other ethnicities [3].There is a high prevalence of diabetes (10-15%) in South Asian Sri Lankans [4] who are at a greater risk of CVD [5].Exercise is known to improve blood glucose, lipid profiles, blood pressure [6] and visceral adiposity [7] which are goals of diabetes management. Aerobic exercise training (AT) interventions have been studied widely; resistance exercises training (RT) interventions are becoming more prevalent. Some recommendations involve combining AT and RT interventions for the management and prevention of T2DM [9,10]. Currently there are no documented studies in Sri Lanka and limited studies conducted in South Asia, comparing the effects of AT with RT on people with T2DM on glycemic control, visceral adiposity (anthropometric), liver enzymes and, blood lipid profiles (biochemical).This thesis is novel because, to the best of my knowledge, there is no comparison of the effects of RT and AT on physiological and behavioural parameters in Sri Lankans. Studies tend to be conducted in White Caucasians who have a different body composition to South Asians. Secondly, the addition of a qualitative study to assess the barriers and facilitators for compliance and adherence to exercise has not been documented to date.The Randomized Controlled Trial (RCT) of the SL-DARTS recruited sedentary Sri Lankans (age 35-65 years) with T2DM (HbA1c 6.5-11.0%) from medical and diabetic clinics of the National Hospital of Sri Lanka (NHSL) and selected private sector clinics in the capital city, Colombo. They were randomized into aerobic training (AT), resistance training (RT) and control (CN) groups. Supervised progressive exercises were conducted 2 days/week for 3 months.Mean absolute changes in glycemic control (HbA1c) and percentage body fat were the primary outcomes. The change in glycaemia and insulin resistance (fasting blood sugar/FBS and fasting insulin/FI) lipid profile, liver enzymes, chronic inflammatory state, anthropometric measures (height, weight, body mass index/BMI, and waist / hip / mid-thigh / mid-arm circumferences), muscular strength, cardiovascular endurance, blood pressure, food preference, Quality of life, were secondary measures. All outcomes were measured within iii one week before the start date of the intervention (pre) and within one week after the intervention (post).A qualitative study using in-depth interviews was conducted to assess the experiences of the participants who completed the program. The themes discussed in the in-depth interviews were selected based on a critical literature review that was conducted on evidence-based cognitive behavioural approaches on exercise adoption and adherence. Percentage body fatChange in mean absolute body weight and BMI was minimal among groups. The absolute change in %BF in RT, AT and CN...

Impact of Physical Activity on Working Memory of 10-11 year old Children from Colombo Educational zone

“…Levels of physical activity have been shown to decrease during adolescence [5] and in Sri Lanka only 38% adolescent school children were reported to be getting sufficiently physically active [6]. However, the benefits of physical activity go beyond physical health and extend to psychosocial benefits [7] and increased cognitive function and academic performance [8].…”