Abstract
The aim was to investigate whether the addition of supervised high intensity progressive resistance training to a moderate weight loss program (RT+WLoss) could maintain bone mineral density (BMD) and lean mass compared to moderate weight loss (WLoss) alone in older overweight adults with type 2 diabetes. We also investigated whether any benefits derived from a supervised RT program could be sustained through an additional home-based program. This was a 12-month trial in which 36 sedentary, overweight adults aged 60 to 80 years with type 2 diabetes were randomized to either a supervised gymnasium-based RT+WLoss or WLoss program for 6 months (phase 1). Thereafter, all participants completed an additional 6-month home-based training without further dietary modification (phase 2). Total body and regional BMD and bone mineral content (BMC), fat mass (FM) and lean mass (LM) were assessed by DXA every 6 months. Diet, muscle strength (1-RM) and serum total testosterone, estradiol, SHBG, insulin and IGF-1 were measured every 3 months. No between group differences were detected for changes in any of the hormonal parameters at any measurement point. In phase 1, after 6 months of gymnasium-based training, weight and FM decreased similarly in both groups (P<0.01), but LM tended to increase in the RT+WLoss (n=16) relative to the WLoss (n=13) group [net difference (95% CI), 1.8% (0.2, 3.5), P<0.05]. Total body BMD and BMC remained unchanged in the RT+WLoss group, but decreased by 0.9 and 1.5%, respectively, in the WLoss group (interaction, P<0.05). Similar, though non-significant, changes were detected at the femoral neck and lumbar spine (L2-L4). In phase 2, after a further 6 months of home-based training, weight and FM increased significantly in both the RT+WLoss (n=14) and WLoss (n=12) group, but there were no significant changes in LM or total body or regional BMD or BMC in either group from 6 to 12 months. These results indicate that in older, overweight adults with type 2 diabetes, dietary modification should be combined with progressive resistance training to optimize the effects on body composition without having a negative effect on bone health.
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References
Barrett-Connor E, Holbrook TL (1992) Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 268:3333–3337
Gregorio F, Cristallini S, Santeusanio F, Filipponi P, Fumelli P (1994) Osteopenia associated with non-insulin-dependent diabetes mellitus: what are the causes? Diabetes Res Clin Pract 23:43–54
Tuominen JT, Impivaara O, Puukka P, Ronnemaa T (1999) Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 22:1196–1200
Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Zmuda JM, Bauer DC, Tylavsky FA, de Rekeneire N, Harris TB, Newman AB (2004) Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: The Health, Aging, and Body Composition Study. J Bone Miner Res 19:1084–1091
Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, Schreiner PJ, Margolis KL, Cauley JA, Nevitt MC, Black DM, Cummings SR (2002) Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 25:1749–1754
Chao D, Espeland MA, Farmer D, Register TC, Lenchik L, Applegate WB, Ettinger WH Jr (2000) Effect of voluntary weight loss on bone mineral density in older overweight women. J Am Geriatr Soc 48:753–759
Jensen LB, Quaade F, Sorensen OH (1994) Bone loss accompanying voluntary weight loss in obese humans. J Bone Miner Res 9:459–463
Ensrud KE, Cauley J, Lipschutz R, Cummings SR (1997) Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:857–863
Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR (2003) Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc 51:1740–1747
Ramsdale SJ, Bassey EJ (1994) Changes in bone mineral density associated with dietary-induced loss of body mass in young women. Clin Sci (London) 87:343–348
Langlois JA, Harris T, Looker AC, Madans J (1996) Weight change between age 50 years and old age is associated with risk of hip fracture in white women aged 67 years and older. Arch Intern Med 156:989–994
O’Dea JP, Wieland RG, Hallberg MC, Llerena LA, Zorn EM, Genuth SM (1979) Effect of dietary weight loss on sex steroid binding sex steroids, and gonadotropins in obese postmenopausal women. J Lab Clin Med 93:1004–1008
Ricci TA, Heymsfield SB, Pierson RN, Jr., Stahl T, Chowdhury HA, Shapses SA (2001) Moderate energy restriction increases bone resorption in obese postmenopausal women. Am J Clin Nutr 73:347–352
Kerr D, Morton A, Dick I, Prince R (1996) Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res 11:218–225
Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ (1994) Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 272:1909–1914
Ryan AS, Nicklas BJ, Dennis KE (1998) Aerobic exercise maintains regional bone mineral density during weight loss in postmenopausal women. J Appl Physiol 84:1305–1310
Fogelholm GM, Sievanen HT, Kukkonen-Harjula TK, Pasanen ME (2001) Bone mineral density during reduction, maintenance and regain of body weight in premenopausal, obese women. Osteoporos Int 12:199–206
Pritchard JE, Nowson CA, Wark JD (1996) Bone loss accompanying diet-induced or exercise-induced weight loss: a randomised controlled study. Int J Obes Relat Metab Disord 20:513–520
Svendsen OL, Hassager C, Christiansen C (1993) Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight postmenopausal women. Am J Med 95:131–140
Salamone LM, Cauley JA, Black DM, Simkin-Silverman L, Lang W, Gregg E, Palermo L, Epstein RS, Kuller LH, Wing R (1999) Effect of a lifestyle intervention on bone mineral density in premenopausal women: a randomized trial. Am J Clin Nutr 70:97–103
Andersen RE, Wadden TA, Herzog RJ (1997) Changes in bone mineral content in obese dieting women. Metabolism 46:857–861
Maddalozzo GF, Snow CM (2000) High intensity resistance training: Effects on bone in older men and women. Calcif Tissue Int 66:399–404
Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P (2002) High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 25:1729–1736
American College of Sports Medicine (2000) ACSM guidelines for exercise testing and prescription. Lippincott Williams and Wilkins, Philadelphia
Dunstan DW, Daly RM, Owen N, Jolley D, Vulikh E, Shaw J, Zimmet P (2005) Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes. Diabetes Care 28:3–9
Snow Harter C, Bouxsein ML, Lewis BT, Carter DR, Marcus R (1992) Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. J Bone Miner Res 7:761–769
Van Loan MD, Johnson HL, Barbieri TF (1998) Effect of weight loss on bone mineral content and bone mineral density in obese women. Am J Clin Nutr 67:734–738
Ricci TA, Chowdhury HA, Heymsfield SB, Stahl T, Pierson RN Jr, Shapses SA (1998) Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. J Bone Miner Res 13:1045–1050
Chen Z, Lohman TG, Stini WA, Ritenbaugh C, Aickin M (1997) Fat or lean tissue mass: which one is the major determinant of bone mineral mass in healthy postmenopausal women? J Bone Miner Res 12:144–151
Reid IR, Ames RW, Evans MC, Sharpe SJ, Gamble GD (1994) Determinants of the rate of bone loss in normal postmenopausal women. J Clin Endocrinol Metab 79:950–954
Hui SL, Perkins AJ, Zhou L, Longcope C, Econs MJ, Peacock M, McClintock C, Johnston CC, Jr. (2002) Bone loss at the femoral neck in premenopausal white women: effects of weight change and sex-hormone levels. J Clin Endocrinol Metab 87:1539–1543
Compston JE, Laskey MA, Croucher PI, Coxon A, Kreitzman S (1992) Effect of diet-induced weight loss on total body bone mass. Clin Sci (London) 82:429–432
Tothill P, Pye DW (1992) Errors due to non-uniform distribution of fat in dual X-ray absorptiometry of the lumbar spine. Br J Radiol 65:807–813
Acknowledgements
Dr. Robin Daly and Dr. David Dunstan are both supported by National Health and Medical Research Council (NHMRC) Research Fellowships. Professor Owen is supported by Queensland Health and by the National Health and Medical Research Council. This study was financially supported by a grant from the Victorian Health Promotion Foundation (VicHealth). Funds for the purchase of exercise equipment were kindly provided by the Rotary Club of Kew, Victoria, and the Soroptimist International, Brighton Division. We wish to thank Lucy Robinson and Elena Vulikh for their kind assistance in the clinical management of our volunteers. We are also grateful for the dietary assistance of Kathy McConell and Helen Bauzon. Most importantly, the authors are indebted to the volunteers whose cooperation and dedication made this study possible.
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Daly, R.M., Dunstan, D.W., Owen, N. et al. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?. Osteoporos Int 16, 1703–1712 (2005). https://doi.org/10.1007/s00198-005-1906-4
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DOI: https://doi.org/10.1007/s00198-005-1906-4