The goal of the proposed study, Health benefits of Aerobic and Resistance Training in individuals with type 2 Diabetes (HART-D), is to compare the effect of resistance training alone, and resistance in combination with aerobic training to aerobic training alone on hemoglobin A1c (HbA1c), in initially sedentary women and men with type 2 diabetes (T2D). While it is generally accepted that regular exercise provides substantial health benefits to individuals with T2D, the exact exercise prescription in terms of type (aerobic versus resistance versus both) still remains largely unexplored, particularly in regard to week-to-week glucose control as assessed by HbA1c. For example, there has been very little research performed that examines the benefit of resistance training alone in individuals with diabetes, and there exists no adequately powered or controlled trials that have examined the benefits of combining resistance training with aerobic training. This is particularly problematic given that most recommendations/guidelines from national organizations for exercise prescription in individuals with T2D suggest a combination of aerobic and resistance training for maximal health benefits. There is a need for more research to help better formulate exercise recommendations for patients with T2D as well as potentially provide more exercise options, which is very important given the small percentage of individuals with T2D who regularly participate in exercise. The study group will be sedentary women and men with T2D, aged 30 to 75 years. We will randomly assign 300 individuals equally to an aerobic exercise training-only group (AT), a resistance training-only group (RT), or a combination of aerobic plus resistance training (AT+RT). The AT individuals will participate in 3 or 4 training sessions each week for 9 months, progressing to a total energy expenditure of 12 kcal/kg/week (KKW), which is an exercise dose consistent with the current public health recommendations for physical activity for individuals with T2D. The RT group will participate in 3 sessions per week (30-45 minutes each), which focus on large muscle groups. Individuals in the AT+RT group will receive both the 12 KKW of aerobic training and a reduced resistance-training regimen of 2 sessions per week at 20 minutes per session. This combination regimen represents the exact exercise recommendations of the American College of Sports Medicine and the American Diabetes Association. Simply stated, we wish to examine if a RT has comparable benefits in lowering HbA1c to a standard AT program, and if a hybrid program of AT +RT is superior to AT alone (&RT alone) in reducing HbA1c. The primary outcome measure is HbA1c, an integrated measure of blood glucose control over the past 8-12 weeks.
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