Normal weight individuals with type 2 diabetes (NWD) have higher risk of mortality than overweight or obese individuals. NWD may have less lean muscle mass in proportion to adipose tissue, which may contribute to this higher risk of mortality. Strength training increases muscle mass rather than reducing body weight and can combat the age-related shift in body composition that results in higher fat mass and decreased muscle mass (i.e., sarcopenia). Thus, strength training may therefore be helpful for NWD rather than weight loss, as is recommended for overweight/obese individuals with type 2 diabetes (T2DM). Additionally, strength training in NWD could eliminate known differences in visceral adiposity across racial/ethnic groups. This may have significant implications for management of NWD. Currently, there is a lack of data on effective lifestyle recommendations for NWD, who can represent up to 1 in 5 individuals with T2DM. Physical activity recommendations emphasize aerobic exercise, which may not be appropriate for NWD. Body fat assessment, rather than body mass index, may be a better diagnostic tool in NWD, and better inform therapeutic lifestyle change interventions to control glucose and ultimately alleviate the significantly higher mortality discovered for this group. Strength training, rather than aerobic-focused regimens, may be a more appropriate treatment recommendation. In order to determine the best exercise regimen for NWD, we propose to implement a three- arm randomized control trial comparing the clinical effectiveness of strength training vs. aerobic training vs. combined (strength + aerobic) training for T2DM management among NWD at the Palo Alto Medical Foundation (PAMF), a large, community-based, multi-specialty ambulatory care setting. The primary outcome for measurement will be improvement in T2DM control (e.g., % hemoglobin A1c reduction). Process measures will include changes in physical fitness (e.g., VO2 max), and change in body composition (DEXA scans).While the benefits of combined (strength + aerobic) activity have been well demonstrated in overweight/obese diabetics, there currently exists little evidence to recommend this regimen in NWD. The goal of the Strength Training Regimen for Normal weiGht Diabetics (STRONG-D) Study is to determine the best exercise regimen for NWD, who experience greater mortality than overweight/obese diabetics.

Public Health Relevance

Normal weight individuals with type 2 diabetes experience higher mortality than overweight or obese individuals with type 2 diabetes, but there is little evidence on treatment for this high risk population. The proposed study will inform which exercise recommendation - strength training, aerobic training, or combination strength and aerobic training - is most effective in treating type 2 diabetes among individuals at normal weight, who can represent up to 1 in 5 individuals with type 2 diabetes.

National Institute of Health (NIH)
Research Project (R01)
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Kidney, Nutrition, Obesity and Diabetes Study Section (KNOD)
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Bremer, Andrew
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Palo Alto Medical Foundation Research Institute
Palo Alto
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