The Health Benefits of Resistance

Exercise in Type 1 Diabetes

Miss Olivia McCarthyZienkiewicz Scholar at the Applied Sports, Technology, Exercise and

Medicine Centre (A-STEM) and Diabetes Research Group

Content

1) What is Resistance Exercise?

2) The Health Benefits of Resistance Exercise

3) Muscle Matters: Benefits Beyond Size

4) Muscle Matters: Metabolic Control

Exercise that requires

the skeletal muscle

to move against an

opposing/resisting

force.

What is Resistance Exercise?

The Health Benefits of Resistance Exercise

Morphological Responses• Increased Muscle Size

• Increased Muscle Strength

• Decreased Body Fat %

• Increased Lean Body Mass

• Increased Bone Mineral Density

Health Benefits

• Improved Metabolic Control

• Increased Insulin Sensitivity

• Lower Cardiovascular Disease Risk

• Extended Life Span

• Healthier Bones

• Lowered Frailty & Falls

• Psychological & Neurological BenefitsPerformance Benefits • Improve Athletic Performance

• Reduced Risk of Injury

Muscle Matters: Benefits Beyond Size

LOCOMOTION/MOVEMENT

LONGEVITY/HEALTH SPAN

GLUOSE/METABOLIC CONTROL

BRAIN FACTORS

Age-related muscle wasting ‘Sarcopenia’

Age (Years)

Mu

scle

are

a (m

m3/4

8)

From 30 years onwards there is a 3-8% loss in muscle mass per decade of life

(Signorile, 2011)

Muscle Mass and Longevity

40-year old triathlete 74-year old sedentary man 70-year old triathlete

Use it or lose it….A visual Representation

(Wroblewski, Amati, Smiley, Goodpaster, & Wright, 2011)

Muscular Strength and Longevity

<60 years >60 years (Ruiz et al., 2008)

All

cau

se m

ort

alit

y ra

te p

er

10

,00

0 p

erso

n y

ears

Muscle Strength and Endurance capacity in Type 1 diabetes and diabetes polyneuropathy (DPN) Vs controls

*Significantly lower than control (p < 0.05), †significantly lower compared with T1D group.

(Orlando, Balducci, Bazzucchi, Pugliese, & Sacchetti, 2017)

Early Onset of Muscle Fatigue in Well Controlled Type 1 Diabetes

(Crowther et al., 2003)

Higher proportion of fatigable TypeⅡ skeletal muscle

fibres in T1D contributing to early fatigue?

Measurements Muscle Fibre Type T1D Group Control Group

Fibre Type Proportion

(%)

Type Ⅰ 55.4 (40.4-83.2) 62.3 (45.6-88.4)*

Type Ⅱ 44.6 (16.8-59.6) 37.7 (11.6-54.4)*

Characteristics of Type Ⅰ and Type Ⅱ fibres in Skeletal Muscle

Type Ⅰ fibres Type Ⅱ fibres

Energy Utilisation Low High

Mitochondria Abundant Few

Colour Red White

Contraction rate Slow Fast

Fatigue status Low High

(Andreassen, Jensen, Jakobsen, Ulhøj, & Andersen, 2014)

What Determines Muscle Mass?

Protein SynthesisProtein Breakdown

Resistance Exercise

Growth Hormones

Dietary Protein Intake

Insulin

Caloric Deficit

Resistance Exercise and Protein Synthesis

A bout of high intensity resistance exercise increases muscle protein synthesis by 50% after 4hours and 115% by 24 hours

(Chesley, MacDougall, Tarnopolsky, Atkinson, & Smith, 1992)

Resistance Exercise and Growth Signalling

Sample (Minutes Post Exercise)

Rest 0 15 30 60

(Turner et al., 2015)

Glucose Responses to Resistance Exercise…What Happens Acutely?

Blood Glucose Responses to Exercise Modality

(Yardley, Jane E, Kenny, Glen P, Perkins, Bruce A, MD, MPH; Riddell, Michael C, Balaa, Nadia, 2013)

Combining Resistance with Aerobic exercise prevents blood glucose decline

Plasma glucose levels during 45 minutes of aerobic exercise (AE) on its own (dashed line with open symbols ○) or after resistance exercise (RA) (solid line with closed symbols ●).

(Yardley, 2011)

Effects to Exercise Order

Aerobic exercise performed before resistance exercise (AR, dashed line with ○) and resistance exercise performed before aerobic exercise (RA, solid line with ●)

(Jane E. Yardley, Sigal, Riddell, Perkins, & Kenny, 2014)

Blood Glucose Effects to Resistance Exercise Volume

(Turner et al., 2015)

Why?...

Resistance Exercise Causes Physiological Stress

(Turner et al., 2015)

Glucose Responses to Resistance Exercise Training …

What Happens Chronically?

Glucose Metabolism responses to Resistance Exercise Training in T1D

Study Exercise Design Strength Outcomes Metabolic Outcomes

Durak et at., (1990)

10 whole body Resistance exercises3 – 7 sets. 12 reps. 3 x per week. 10 weeks

↑ 50-94% depending on exercise

↓ HbA1c

Mosher et al (1998)

Circuit Resistance Exercises. Whole body Resistance Exercises

↑ 13.7 – 44.4% depending on exercise

↓ HbA1c

Ramalho et al (2006)

Whole body Resistance exercises. 3 sets. 8-12 reps. 60-80% 1RM. 3 x per week. 12 weeks

Not reported ↓ HBA1c ↓ Insulin dose

Salem et al (2010)

30min cycle/run for 1-2 min intervals Resistance Exercise: lower body exercises 3 sets of 10 repetitions at 50 to 75% to 100% 10RM

↑ Muscular Strength ↓HbA1c ↓ insulin dose

D’Hooge et al,. (2011)

Combined aerobic and Resistance Exercise Vs No training

↑ Muscle strength and Fatigue resistance

↔HbA1c↓ insulin dose in exercise group

Insulin

Insulin Receptor

P13K

mTORC2

PIP3

PDK1

AKT

GLUT-4

GLUCOSE

GLUCOSE

GLYCOLYSIS

AS160

Bloodstream

Cell

Insulin Independent Glucose Uptake

AMPK

Ca 2+

Ca2+

2+Ca

ATPAMP

IGF-1

P13K

Muscle Contraction

More Muscle = More opportunity to uptake

Blood Glucose

Hypertrophy Hyperplasia

1. Muscle strengthening activities

involving the major muscle groups

of the body

2. 2+ days (preferably 3) per week in

addition to 150 min.wk-1 moderate-

intensity activity.

3. Glucose declines are likely to be

smaller than during aerobic

exercise

4. Consider Exercise Order. RE then

AE Vs AE then RE

5. Consider adding volume if high

glucose is a concern

Resistance Exercise Prescription

Specific Training Outcome

Endurance Hypertrophy Strength Power

1-3 sets x 15-20RM

Single and Multi joint movements

Varied Order30-60sec recovery between sets and

exercises1:0: 1 temp

2-3 d/w

4-6 sets x 8-15 RMSingle and Multi joint movements Large-small order1-2min recovery

between sets and exercises

2: 1: 2 temp3-5 d/w

3-5 sets x 3-8RMSingle and Multi joint movements Large-small order3-5min recovery

between sets and exercise

1: 0: 1 temp3-5 d/w

1-3 sets x 15-20RM

Multi joint movements

Large-small order5-8min recovery

between sets and exercise

Explosive temp4-6 d/w

Practical Guidelines

(Bird, Tarpenning, & Marino, 2005)

Thank you

Acknowledgements

Co-Investigators; Dr. O. Moser, Ms. R. Deere, Mr. M. L Eckstein, Prof. S. Bain, Mr.

Dr. R.M. Bracken

Andreassen, C. S., Jensen, J. M., Jakobsen, J., Ulhøj, B. P., & Andersen, H. (2014). Striated muscle fiber size, composition, and capillary density in

diabetes in relation to neuropathy and muscle strength. Journal of Diabetes, 6(5), 462–71. https://doi.org/10.1111/1753-0407.12124

Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2005). Designing Resistance Training Programmes to Enhance Muscular Fitness. Sports Medicine, 35(10),

841–851. https://doi.org/10.2165/00007256-200535100-00002

Chesley, A., MacDougall, J. D., Tarnopolsky, M. A., Atkinson, S. A., & Smith, K. (1992). Changes in human muscle protein synthesis after resistance

exercise. Journal of Applied Physiology, 73(4), 1383–1388. https://doi.org/10.1152/jappl.1992.73.4.1383

Crowther, G. J., Milstein, J. M., Jubrias, S. A., Kushmerick, M. J., Gronka, R. K., & Conley, K. E. (2003). Altered energetic properties in skeletal muscle of

men with well-controlled insulin-dependent (type 1) diabetes. American Journal of Physiology-Endocrinology and Metabolism, 284(4), E655–E662.

https://doi.org/10.1152/ajpendo.00343.2002

Orlando, G., Balducci, S., Bazzucchi, I., Pugliese, G., & Sacchetti, M. (2017). The impact of type 1 diabetes and diabetic polyneuropathy on muscle

strength and fatigability. Acta Diabetologica, 54(6), 543–550. https://doi.org/10.1007/s00592-017-0979-9

Ruiz, J. R., Sui, X., Lobelo, F., Morrow, J. R., Jackson, A. W., Sjöström, M., … Blair, S. N. (2008). Association between muscular strength and mortality in

men: prospective cohort study. BMJ (Clinical Research Ed.), 337(7661), a439. https://doi.org/10.1136/BMJ.A439

Signorile, J. F. (2011). Bending the aging curve : the complete exercise guide for older adults. Human Kinetics. Retrieved from

https://books.google.co.uk/books?hl=en&lr=&id=FqhrkRw_HsoC&oi=fnd&pg=PR1&dq=bent+curve+of+aging+muscle+area&ots=kokm8umPnp&sig=I-

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Turner, D., Luzio, S., Gray, B. J., Dunseath, G., Rees, E. D., Kilduff, L. P., … Bracken, R. M. (2015). Impact of single and multiple sets of resistance

exercise in type 1 diabetes. Scandinavian Journal of Medicine & Science in Sports, 25(1), e99–e109. https://doi.org/10.1111/sms.12202

Wroblewski, A. P., Amati, F., Smiley, M. A., Goodpaster, B., & Wright, V. (2011). Chronic Exercise Preserves Lean Muscle Mass in Masters Athletes, 39(3),

91–3847. https://doi.org/10.3810/psm.2011.09.1933

Yardley, Jane E, Kenny, Glen P, Perkins, Bruce A, MD, MPH; Riddell, Michael C, Balaa, Nadia, B. et al. (2013). Resistance Versus Aerobic Exercise: Acute

effects on glycemia in type 1 diabetes - ProQuest. Diabetes Care, 36(3). https://doi.org/10.2337/dc12-0963.

Yardley, J. E. (2011). The Acute Effects of Aerobic and Resistance Exercise on Blood Glucose Levels in Type 1 Diabetes. Retrieved from

https://ruor.uottawa.ca/bitstream/10393/20031/5/Yardley_Jane_Elizabeth_2011_thesis.pdf

Yardley, J. E., Sigal, R. J., Riddell, M. C., Perkins, B. A., & Kenny, G. P. (2014). Performing resistance exercise before versus after aerobic exercise

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