Sports Medicine

, Volume 40, Issue 11, pp 921–940 | Cite as

The Impact of Training Modalities on the Clinical Benefits of Exercise Intervention in Patients with Cardiovascular Disease Risk or Type 2 Diabetes Mellitus

  • Dominique Hansen
  • Paul Dendale
  • Luc J. C. van Loon
  • Romain Meeusen
Review Article

Abstract

Exercise training intervention represents an effective means to reduce adipose tissue mass, improve glycaemic control and increase whole-body oxygen uptake capacity (V̇O2peak) in obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM) and heart disease patients. In this manuscript, we review the impact of different exercise training modalities on clinical benefits of prolonged exercise intervention in these patient (sub)populations. By changing training modalities, significantly greater clinical benefits can be obtained Greater training frequency and longer programme duration is associated with greater reduction in adipose tissue mass in obesity patients. A greater training frequency (up to 2 days/week) and a longer programme duration (up to 38 weeks) seems to be associated with greater improvements in V̇O2peak in heart disease patients. Longer programme duration and addition of resistancetype exercise further improve glycaemic control in T2DM patients. The first line of evidence seems to indicate that high-intensity interval exercise training has a greater impact on V̇O2peak in heart disease patients and insulin sensitivity in subjects with metabolic syndrome, but not on adipose tissue mass in obese subjects. However, it remains unclear whether addition of resistancetype exercise and continuous higher-intensity endurance-type exercise training are accompanied by greater improvements in V̇O2peak in heart disease patients. Furthermore, the impact of training session duration/volume on adipose tissue mass loss and glycaemic control in obesity and T2DM patients, respectively, is currently unknown. The impact of training frequency on glycaemic control remains to be investigated in T2DM patients.

References

  1. 1.
    Chopra M, Galbraith S, Darnton-Hill I. A global response to a global problem: the epidemic of overnutrition. Bull World Health Organ 2002; 80 (12): 952–8PubMedGoogle Scholar
  2. 2.
    Chakravarthy MV, Booth FW. Eating, exercise, and ‘thrifty’ genotypes: connecting the dots towards an evolutionaryunderstanding of modern diseases. J Appl Physiol 2004 Jan; 96 (1): 3–10PubMedCrossRefGoogle Scholar
  3. 3.
    Booth FW, Chakravarthy MV, Gordon SE, et al. Waging war on physical inactivity: using modern molecular ammunitionagainst an ancient enemy. J Appl Physiol 2000 Jul; 93 (1): 3–30Google Scholar
  4. 4.
    Andersen RE. Obesity; etiology, assessment, treatment, and prevention. Champaign (IL): Human Kinetics, 2003Google Scholar
  5. 5.
    Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for2030. Diabetes Care 2004 May; 27 (5): 1047–53PubMedCrossRefGoogle Scholar
  6. 6.
    Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcareprofessionals from the American Heart Association. Circulation 2001 Oct; 104 (14): 1694–740PubMedCrossRefGoogle Scholar
  7. 7.
    Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/ exercise and type 2 diabetes. Diabetes Care 2006 Jun; 29 (6): 1433–8PubMedCrossRefGoogle Scholar
  8. 8.
    Tjønna AE, Lund Nilsen TI, Slørdahl SA, et al. The association of metabolic clustering and physical activity withcardiovascular mortality: the HUNT study in Norway. J Epidemiol Community Health 2010 Aug; 64 (8): 690–5PubMedCrossRefGoogle Scholar
  9. 9.
    Erbs S, Linke A, Hambrecht R. Effects of exercise training on mortality in patients with coronary heart disease. Coron Artery Dis 2006 May; 17 (3): 219–25PubMedCrossRefGoogle Scholar
  10. 10.
    Church ST, Lavie CJ, Milani RV, et al. Improvements in blood rheology after cardiac rehabilitation and exercisetraining in patients with coronary heart disease. Am Heart J 2002 Feb; 143 (2): 349–55PubMedCrossRefGoogle Scholar
  11. 11.
    Gielen S, Schuler G, Hambrecht R. Exercise training in coronary artery disease and coronary vasomotion. Circulation 2001 Jan; 103 (1): E1–6PubMedCrossRefGoogle Scholar
  12. 12.
    Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronaryartery disease. N Engl J Med 2000 Feb 17; 342 (7): 454–60PubMedCrossRefGoogle Scholar
  13. 13.
    Nicklas JN, You T, Pahor M. Behavioural treatments for chronic systemic inflammation: effects of dietary weightloss and exercise training. CMAJ 2005 Apr 26; 172 (9): 1199–209PubMedCrossRefGoogle Scholar
  14. 14.
    Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exerciseor diet plus exercise intervention. Int J Obes Relat Metab Disord 1997 Oct; 21 (10): 941–7PubMedCrossRefGoogle Scholar
  15. 15.
    Kempen KP, Saris WH, Westerterp KR. Energy balance during an 8-wk energy-restricted diet with and withoutexercise in obese women. Am J Clin Nutr 1995 Oct; 62 (4): 722–9PubMedGoogle Scholar
  16. 16.
    Dengel DR, Hagberg JM, Coon PJ, et al. Effects of weight loss by diet alone or combined with aerobic exercise onbody composition in older obese men. Metabolism 1994 Jul; 43 (7): 867–71PubMedCrossRefGoogle Scholar
  17. 17.
    Wadden TA, Vogt RA, Andersen RE, et al. Exercise in the treatment of obesity: effects of four interventions on bodycomposition, resting energy expenditure, appetite, andmood. J Consult Clin Psychol 1997 Apr; 65 (2): 269–77PubMedCrossRefGoogle Scholar
  18. 18.
    Ballor DL, Keesey RE. A meta-analysis of the factors affecting changes in bodymass, fat mass and fat-free mass inmales and females. Int J Obes 1991 Nov; 15 (11): 717–26PubMedGoogle Scholar
  19. 19.
    Ballor DL, Poehlman ET. Exercise-training enhances fatfree mass preservation during diet-induced weight loss: ameta-analytical finding. Int J Obes 1994 Jan; 18 (1): 35–40Google Scholar
  20. 20.
    Ross R, Rissanen J, Pedwell H, et al. Influence of diet and exercise on skeletal muscle and visceral adipose tissue inmen. J Appl Physiol 1996 Dec; 81 (6): 2445–55PubMedGoogle Scholar
  21. 21.
    Ohlsen LO, Larsson B, Larsson B, et al. The influence of body fat distribution on the incidence of diabetes mellitus:13.5 years of follow-up of the participants in the study ofmen born in 1913. Diabetes 1985 Oct; 34 (10): 1055–8CrossRefGoogle Scholar
  22. 22.
    Peiris AN, Sothmann MS, Hoffmann RG, et al. Adiposity, fat distribution, and cardiovascular risk. Ann Intern Med 1989 Jun; 110 (11): 867–72PubMedGoogle Scholar
  23. 23.
    Tjønna AE, Lee SJ, Rognmo ø, et al. Aerobic interval training versus continuous moderate exercise as a treatmentfor the metabolic syndrome. Circulation 2008 Jul 22; 118 (4): 346–54PubMedCrossRefGoogle Scholar
  24. 24.
    Dumortier M, Brandou F, Perez-Martin A, et al. Low intensity endurance exercise targeted for lipid oxidationimproves body composition and insulin sensitivity inpatients with the metabolic syndrome. Diabetes Metab 2003 Nov; 29 (5): 509–18PubMedCrossRefGoogle Scholar
  25. 25.
    Watkins LL, Sherwood A, Feinglos M, et al. Effects of exercise and weight loss on cardiac risk factors associatedwith syndrome x. Arch Intern Med 2003 Sep 8; 163 (16): 1889–95PubMedCrossRefGoogle Scholar
  26. 26.
    Johnson JL, Slentz CA, Houmard JA, et al. Exercise training amount and intensity effects on metabolic syndrome(from studies of a targeted risk reduction interventionthrough defined exercise). Am J Cardiol 2007 Dec 15; 100 (12): 1759–66PubMedCrossRefGoogle Scholar
  27. 27.
    Anderssen SA, Carroll S, Urdal P, et al. Combined diet and exercise intervention reverses the metabolic syndrome inmiddle-aged males: results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports 2007 Dec; 17 (6): 687–95PubMedCrossRefGoogle Scholar
  28. 28.
    Aloulou I, Varlet-Marie E, Mercier J, et al. Hemorheologic effects of low intensity endurance training in sedentarypatients suffering from the metabolic syndrome. Clin Hemorheol Microcirc 2006; 35 (1-2): 333–9PubMedGoogle Scholar
  29. 29.
    Green JS, Stanforth PR, Rankinen T, et al. The effects of exercise training on abdominal visceral fat, body composition,and indicators of the metabolic syndrome in postmenopausalwomen with and without estrogen replacementtherapy: the HERITAGE Family Study. Metabolism 2004 Jul; 53 (9): 1192–6PubMedCrossRefGoogle Scholar
  30. 30.
    Katzmarzyk PT, Leon AS, Wilmore JH, et al. Targeting the metabolic syndrome with exercise: evidence from theHERITAGE Family Study. Med Sci Sports Exerc 2003 Oct; 35 (10): 1703–9PubMedCrossRefGoogle Scholar
  31. 31.
    Irving BA, Davis CK, Brock DW, et al. Effect of exercise training intensity on abdominal visceral fat and body composition. Med Sci Sports Exerc 2008 Nov; 40 (11): 1863–72PubMedCrossRefGoogle Scholar
  32. 32.
    Roussel M, Garnier S, Lemoine S, et al. Influence of a walking program on the metabolic risk profile of obesepostmenopausal women. Menopause 2009 May-Jun; 16 (3): 56–75CrossRefGoogle Scholar
  33. 33.
    Yassine HN, Marchetti CM, Krishnan RK, et al. Effects of exercise and caloric restriction on insulin resistance andcardiometabolic risk factors in older obese adults: a randomizedclinical trial. J Geront A Biol Sci Med Sci 2009 Jan; 64 (1): 90–5CrossRefGoogle Scholar
  34. 34.
    Praet SF, Jonkers RA, Schep G, et al. Long-standing, insulintreated type 2 diabetes patients with complications respondwell to short-term resistance and interval exercisetraining. Eur J Endocrinol 2008 Feb; 158 (2): 163–72PubMedCrossRefGoogle Scholar
  35. 35.
    Praet SF, van Loon LJ. Exercise: the brittle cornerstone of type 2 diabetes treatment. Diabetologia 2008 Mar; 51 (3): 398–401PubMedCrossRefGoogle Scholar
  36. 36.
    Praet SF, van Loon LJ. Optimizing the therapeutic benefits of exercise in type 2 diabetes. J Appl Physiol 2007 Oct; 103 (4): 1113–20PubMedCrossRefGoogle Scholar
  37. 37.
    De Feyter HM, Praet SF, van den Broek NM, et al. Exercise training improves glycemic control in long-standinginsulin-treated type 2 diabetic patients. Diabetes Care 2007 Oct; 30 (10): 2511–3PubMedCrossRefGoogle Scholar
  38. 38.
    Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors forcomplications in type 2 diabetic patients. Diabetes Care 2006 Nov; 29 (11): 2518–27PubMedCrossRefGoogle Scholar
  39. 39.
    UK Prospective Diabetes Study Group. Intensive bloodglucose control with sulphonylureas or insulin comparedwith conventional treatment and risks of complications inpatients with type 2 diabetes (UKPDS 33). Lancet 1998 Sep; 352 (9131): 837–53CrossRefGoogle Scholar
  40. 40.
    Khaw K, Wareham N, Luben R, et al. Glycated haemoglobin, diabetes and mortality in men in Norfolk cohort ofEuropean Prospective Investigation of Cancer and Nutrition(EPIC-Norfolk). BMJ 2001 Jan; 322 (7277): 15–8PubMedCrossRefGoogle Scholar
  41. 41.
    Boulé NG, Kenny GP, Haddad E, et al. Meta-analysis of the effect of structured exercise training on cardiorespiratoryfitness in type 2 diabetes mellitus. Diabetologia 2007 Sep; 46 (8): 1071–81Google Scholar
  42. 42.
    Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic controlin type 2 diabetes. Ann Intern Med 2007 Sep; 147 (6): 357–69PubMedGoogle Scholar
  43. 43.
    Dunstan DW, Mori TA, Puddey IB, et al. The independent and combined effects of aerobic exercise and dietary fishintake on serum lipids and glycaemic control in NIDDM. Diabetes Care 1997 Jun; 20 (6): 913–21PubMedCrossRefGoogle Scholar
  44. 44.
    Praet SF, van Rooij ESJ, Wijtvliet A, et al. Brisk walking compared with an individual medical fitness programmefor patients with type 2 diabetes: a randomised controlledtrial. Diabetologia 2008 May; 51 (5): 736–46PubMedCrossRefGoogle Scholar
  45. 45.
    Dela F, von Linstow ME, Mikines KJ, et al. Physical training may enhance b-cell function in type 2 diabetes. AmJ Physiol Endocrinol Metab 2004 Nov; 287 (5): E1024–31CrossRefGoogle Scholar
  46. 46.
    Tessier D, Ménard J, Fülöp T, et al. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Arch Geron Geriatr 2000 Oct; 31 (2): 121–32CrossRefGoogle Scholar
  47. 47.
    Poirier P, Tremblay A, Broderick T, et al. Impact of moderate aerobic exercise training on insulin sensitivity in type2 diabetic men treated with oral hypoglycemic agents: isinsulin sensitivity enhanced only in nonobese subjects? Med Sci Monit 2002 Feb; 8 (2): CR59–65Google Scholar
  48. 48.
    Mourier A, Gautier JF, De Kerviler E, et al. Mobilization of visceral adipose tissue related to the improvement in insulinsensitivity in response to physical training in NIDDM:effects of branched-chain amino acid supplements. Diabetes Care 1997 Mar; 20 (3): 385–91PubMedCrossRefGoogle Scholar
  49. 49.
    Boudou P, Sobngwi E, Mauvais-Jarvis F, et al. Absence of exercise-induced variations in adiponectin levels despitedecreased abdominal adiposity and improved insulinsensitivity in type 2 diabetic men. Eur J Endocrinol 2003 Nov; 149 (5): 421–4PubMedCrossRefGoogle Scholar
  50. 50.
    Cuff DJ, Meneilly GS, Martin A, et al. Effective exercise modality to reduce insulin resistance in women with type 2diabetes. Diabetes Care 2003 Nov; 26 (11): 2977–82PubMedCrossRefGoogle Scholar
  51. 51.
    Giannopoulou I, Fernhall B, Carhart R, et al. Effects of diet and/or exercise on the adipocytokines and inflammatorycytokine levels of postmenopausal women with type 2diabetes. Metabolism 2005 Jul; 54 (7): 866–75PubMedCrossRefGoogle Scholar
  52. 52.
    Giannopoulou I, Ploutz-Snyder LL, Carhart R, et al. Exercise is required for visceral fat loss in postmenopausalwomen with type 2 diabetes. J Clin Endocrinol Metab 2005 Mar; 90 (3): 1511–8PubMedCrossRefGoogle Scholar
  53. 53.
    Toledo GS, Menshikova EV, Ritov VB, et al. Effects of physical activity and weight loss on skeletal muscle mitochondriaand relationship with glucose control in type 2diabetes. Diabetes 2007 Aug; 56 (8): 2142–7PubMedCrossRefGoogle Scholar
  54. 54.
    Allenberg K, Johansen K, Saltin B. Skeletal muscle adaptations to physical training in type II (non-insulin-dependent)diabetes mellitus. Acta Med Scand 1988; 223 (4): 365–73PubMedCrossRefGoogle Scholar
  55. 55.
    Bruce CR, Kriketos AD, Cooney GJ, et al. Dissociation of muscle triglyceride content and insulin sensitivity afterexercise training in patients with type 2 diabetes. Diabetologia 2004 Jan; 47 (1): 23–30PubMedCrossRefGoogle Scholar
  56. 56.
    Fritz T, Kramer DK, Karlsson HKR, et al. Low-intensity exercise increases skeletal muscle protein expression of PPARd and UCP3 in type 2 diabetic patients. Diab Metab Res Rev 2006 Nov-Dec; 22 (6): 492–8CrossRefGoogle Scholar
  57. 57.
    Lim S, Choi SH, Choi EK, et al. Comprehensive evaluation of coronary arteries by multidetector-row cardiaccomputed tomography according to the glucose level ofasymptomatic individuals. Atherosclerosis 2009 Jul; 205 (1): 156–62PubMedCrossRefGoogle Scholar
  58. 58.
    Vanhees L, Fagard R, Thijs L, et al. Prognostic value of training-induced change in peak exercise capacity in patientswith myocardial infarcts and patients with coronarybypass surgery. Am J Cardiol 1995 Nov; 76 (14): 1014–9PubMedCrossRefGoogle Scholar
  59. 59.
    Kavanagh T, Mertens DJ, Hamm LF, et al. Prediction of long-term prognosis in 12169 men referred for cardiacrehabilitation. Circulation 2002 Aug; 106 (6): 666–71PubMedCrossRefGoogle Scholar
  60. 60.
    Suaya JA, Stason WB, Ades PA, et al. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol 2009 Jun; 54 (1): 25–33PubMedCrossRefGoogle Scholar
  61. 61.
    Hansen D, Dendale P, Berger J, et al. Rehabilitation in cardiac patients: what do we know about training modalities? Sports Med 2005; 35 (12): 1063–84PubMedCrossRefGoogle Scholar
  62. 62.
    Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function inpatients with prior myocardial infarction? Eur Heart J 1996 Oct; 17 (10): 1511–21PubMedCrossRefGoogle Scholar
  63. 63.
    Sakuragi S, Takagi S, Suzuki S, et al. Patients with large myocardial infarction gain a greater improvement in exercisecapacity after exercise training than those withsmall to medium infarction. Clin Cardiol 2003 Jun; 26 (6): 280–6PubMedCrossRefGoogle Scholar
  64. 64.
    Uchida I, Takaki H, Kobayashi Y, et al. O2 extraction during exercise determines training effect after cardiacrehabilitation in myocardial infarction. Circ J 2002 Oct; 66 (10): 891–6PubMedCrossRefGoogle Scholar
  65. 65.
    Belardinelli R, Georgiou D, Purcaro A. Low dose dobutamine echocardiography predicts improvement in functionalcapacity after exercise training in patients withischemic cardiomyopathy: prognostic implication. J Am Coll Cardiol 1998 Apr; 31 (5): 1027–34PubMedCrossRefGoogle Scholar
  66. 66.
    Willenheimer R, Ernhardt L, Cline C, et al. Exercise training in heart failure improves quality of life and exercisecapacity. Eur Heart J 1998 May; 19 (5): 774–81PubMedCrossRefGoogle Scholar
  67. 67.
    Balady GJ, Jette D, Scheer J, et al. Changes in exercise capacity following cardiac rehabilitation in patients stratified according to age and gender: results of the Massachusetts Association of Cardiovascular and Pulmonary Rehabilitation Multicenter Database. J Cardiopulm Rehabil 1996 Jan-Feb; 16 (1): 38–46PubMedCrossRefGoogle Scholar
  68. 68.
    Cannistra LB, O’Malley CJ, Balady GJ. Comparison of outcome of cardiac rehabilitation in black women andwhite women. Am J Cardiol 1995 May; 75 (14): 890–3PubMedCrossRefGoogle Scholar
  69. 69.
    Pavia L, Orlando G, Myers J, et al. The effect of betablockade therapy on the response to exercise training inpostmyocardial infarction patients. Clin Cardiol 1995 Dec; 18 (12): 716–20PubMedCrossRefGoogle Scholar
  70. 70.
    Hambrecht R, Niebauer J, Fiehn E, et al. Physical training in patients with chronic heart failure: effects on cardiorespiratoryfitness and ultrastructural abnormalities of legmuscles. J Am Coll Cardiol 1995 May; 25 (6): 1239–49PubMedCrossRefGoogle Scholar
  71. 71.
    Belardinelli R, Georgiou D, Scocco V, et al. Low intensity exercise training in patients with chronic heart failure. J Am Coll Cardiol 1995 Oct; 26 (4): 975–82PubMedCrossRefGoogle Scholar
  72. 72.
    Dziekan G, Myers J, Goebbels U, et al. Effects of exercise training on limb blood flow in patients with reduced ventricularfunction. Am Heart J 1998 Jul; 136 (1): 22–30PubMedCrossRefGoogle Scholar
  73. 73.
    Demopoulos L, Bijou R, Fergus I, et al. Exercise training in patients with severe congestive heart failure: enhancingpeak aerobic capacity while minimizing the increase in ventricularwall stress. J Am Coll Cardiol 1997 Mar; 29 (3): 597–603PubMedCrossRefGoogle Scholar
  74. 74.
    Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 1998 Sep; 78 (3): 506–15CrossRefGoogle Scholar
  75. 75.
    Lan C, Chen SY, Chiu SF, et al. Poor functional recovery may indicate restenosis in patients after coronary angioplasty. Arch Phys Med Rehabil 2003 Jul; 84 (7): 1023–7PubMedCrossRefGoogle Scholar
  76. 76.
    Van Loan MD, Keim NL, Barbeiri TF, et al. The effects of endurance exercise with and without a reduction of energyintake on fat-free mass and the composition of fat-freemass in obese women. Eur J Clin Nutr 1994 Jun; 48 (6): 408–15PubMedGoogle Scholar
  77. 77.
    van Dale D, Saris WHM. Repetitive weight loss and weight regain: effects on weight reduction, resting metabolic rate,and lipolytic activity before and after exercise and/or diettreatment. Am J Clin Nutr 1989 Mar; 49 (3): 409–16PubMedGoogle Scholar
  78. 78.
    Kukkonen K, Rauramaa R, Siitonen O, et al. Physical training of obese middle-aged parsons. Ann Clin Res 1982; 14 Suppl.34: 80–5Google Scholar
  79. 79.
    Jeffery RW, Wing RR, Sherwood NE, et al. Physical activity and weight loss: does prescribing higher physical activitygoals improve outcome? Am J Clin Nutr 2003 Oct; 78 (4): 684–9PubMedGoogle Scholar
  80. 80.
    Hays NP, Starling RD, Kiu X, et al. Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition,and fat distribution in older men and women. Arch Intern Med 2004 Jan; 164 (2): 210–7PubMedCrossRefGoogle Scholar
  81. 81.
    Fox AA, Thompson JL, Butterfield GE, et al. Effects of diet and exercise on common cardiovascular disease riskfactors in moderately obese older women. Am J Clin Nutr 1996 Feb; 63 (2): 225–33PubMedGoogle Scholar
  82. 82.
    Donnelly JE, Pronk NP, Jacobsen DJ, et al. Effects of a very-low-calorie diet and physical-training regimens onbody composition and resting metabolic rate in obese females. Am J Clin Nutr 1991 Jul; 54 (1): 56–61PubMedGoogle Scholar
  83. 83.
    Sweeney ME, Hill JO, Heller PA, et al. Severe vs moderate energy restriction with and without exercise in the treatmentof obesity: efficiency of weight loss. Am J Clin Nutr 1993 Feb; 57 (2): 127–34PubMedGoogle Scholar
  84. 84.
    Perri MG, Martin D, Leermakers EA, et al. Effects of group- versus home-based exercise in the treatment ofobesity. J Cons Clin Psychol 1997 Apr; 65 (2): 278–85CrossRefGoogle Scholar
  85. 85.
    Pasman WJ, Westerterp-Platenga MS, Saris WHM. The effect of body weight changes and endurance training on24h substrate oxidation. Int J Obes 1999 Dec; 23 (12): 1223–32CrossRefGoogle Scholar
  86. 86.
    Hammer RL, Barrier CA, Roundy ES, et al. Calorierestricted low-fat diet and exercise in obese women. AmJ Clin Nutr 1989 Jan; 49 (1): 77–85Google Scholar
  87. 87.
    Ozcelik O, Dogan H, Kelestimur H. Effects of eight weeks of exercise training and orlistat therapy on body compositionand maximal exercise capacity in obese females. Publ Health 2006 Jan; 120 (1): 76–82CrossRefGoogle Scholar
  88. 88.
    Lehmann R, Vokac A, Niedermann K, et al. Loss of abdominal fat and improvement of the cardiovascular riskprofile by regular moderate exercise training in patientswith NIDDM. Diabetologia 1995 Nov; 38 (11): 1313–9PubMedCrossRefGoogle Scholar
  89. 89.
    Saltin B, Lindgarde F, Houston M, et al. Physical training and glucose tolerance in middle-aged men with chemicaldiabetes. Diabetes 1979; 28 Suppl.1: 30–2Google Scholar
  90. 90.
    Bourn DM, Mann JI, McSkimming BJ, et al. Impaired glucose tolerance and NIDDM: does a lifestyle interventionprogram have an effect? Diabetes Care 1994 Nov; 17 (11): 1311–9PubMedCrossRefGoogle Scholar
  91. 91.
    Uusitupa MI. Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impairedglucose tolerance. Ann Med 1996 Oct; 28 (5): 445–59PubMedCrossRefGoogle Scholar
  92. 92.
    Tokmakidis SP, Zois CE, Volaklis KA, et al. The effects of a combined strength and aerobic exercise program onglucose control and insulin action in women with type 2diabetes. Eur J Appl Physiol 2004 Aug; 92 (4-5): 437–42PubMedCrossRefGoogle Scholar
  93. 93.
    Brubaker PH, Warner Jr JG, Rejeski WJ, et al. Comparison of standard- and extended-length participation incardiac rehabilitation on body composition, functionalcapacity, and blood lipids. Am J Cardiol 1996 Oct; 78 (7): 769–73PubMedCrossRefGoogle Scholar
  94. 94.
    Dubach P, Myers J, Dziekan G, et al. Effect of high intensity exercise training on central hemodynamics responseto exercise in men with reduced left ventricular function. J Am Coll Cardiol 1997 Jun; 29 (7): 1591–8PubMedCrossRefGoogle Scholar
  95. 95.
    DeBusk RF, Haskell WL, Miller NH, et al. Medically directed at-home rehabilitation soon after clinically uncomplicatedacute myocardial infarction: a new model forpatient care. Am J Cardiol 1985 Feb; 55 (4): 251–7CrossRefGoogle Scholar
  96. 96.
    Belardinelli R, Georgiou D, Cianci G, et al. Randomised, controlled trial of long-term moderate exercise training inchronic heart failure: effects on functional capacity, qualityof life, and clinical outcome. Circulation 1999 Mar; 99 (9): 1173–82PubMedCrossRefGoogle Scholar
  97. 97.
    Foster C, Pollock ML, Anholm JD, et al. Work capacity and left ventricular function during rehabilitation aftermyocardial revascularization surgery. Circulation 1984 Apr; 69 (4): 748–55PubMedCrossRefGoogle Scholar
  98. 98.
    Kiilavuori K, Sovijarvi A, Naveri H, et al. Effect of physical training on exercise capacity and gas exchange in patientswith chronic heart failure. Chest 1996 Oct; 110 (4): 985–91PubMedCrossRefGoogle Scholar
  99. 99.
    Keteyian SJ, Levine AB, Brawner CA, et al. Exercise training in patients with heart failure: a randomised controlledtrial. Ann Intern Med 1996 Jun; 124 (12): 1051–7PubMedGoogle Scholar
  100. 100.
    Ades PA, Waldmann ML, Poehlman ET, et al. Exercise conditioning in older coronary patients: submaximal lactateresponse and endurance capacity. Circulation 1993 g; 88 (2): 572–7PubMedCrossRefGoogle Scholar
  101. 101.
    Dugmore LD, Tipson RJ, Philips MH, et al. Changes in cardiorespiratory fitness, psychological wellbeing, qualityof life, and vocational status following a 12 month cardiacexercise rehabilitation programme. Heart 1999 Apr; 81 (4): 359–66PubMedGoogle Scholar
  102. 102.
    Kavanagh T, Myers MG, Baigrie RS, et al. Quality of life and cardiorespiratory function in chronic heart failure:effects of 12months’ aerobic training. Heart 1996 Jul; 76 (1): 42–9PubMedCrossRefGoogle Scholar
  103. 103.
    Hamm LF, Kavanagh T, Campbell RB. Timeline for peak improvements during 52 weeks of outpatient cardiac rehabilitation. J Cardiopulm Rehabil 2004 Nov-Dec; 24 (4): 374–82PubMedCrossRefGoogle Scholar
  104. 104.
    Ashutosh K, Methrotra K, Fragale-Jackson J. Effects of sustained weight loss and exercise on aerobic fitness inobese women. J Sports Med Phys Fitness 1997 Dec; 37 (4): 252–7PubMedGoogle Scholar
  105. 105.
    Donnelly JE, Jacobsen DJ, Jakicic JM, et al. Very low calorie diet with concurrent versus delayed and sequentialexercise. Int J Obes 1994 Jul; 18 (7): 469–75Google Scholar
  106. 106.
    Marks BL, Ward A, Morris DH, et al. Fat-free mass is maintained in women following a moderate diet and exerciseprogram. Med Sci Sports Exerc 1995 Sep; 27 (9): 1243–51PubMedGoogle Scholar
  107. 107.
    Stewart KJ, McFarland LD, Weinhofer JJ, et al. Safety and efficacy of weight training soon after acute myocardialinfarction. J Cardiopulm Rehabil 1998 Jan-Feb; 18 (1): 37–44PubMedCrossRefGoogle Scholar
  108. 108.
    Delagardelle C, Feiereisen P, Autier P, et al. Strength/ endurance training versus endurance training in congestiveheart failure. Med Sci Sports Exerc 2002 Dec; 34 (12): 1868–72PubMedCrossRefGoogle Scholar
  109. 109.
    Gayda M, Choquet D, Ahmaida S. Effects of exercise training modality on skeletal muscle fatigue in men withcoronary heart disease. J Electromyogr Kinesiol 2009 Apr; 19 (2): e32–9PubMedCrossRefGoogle Scholar
  110. 110.
    Marzolini S, Oh PI, Thomas SG, et al. Aerobic and resistance training in coronary disease: single versus multiplesets. Med Sci Sports Exerc 2008 Sep; 40 (9): 1557–64PubMedCrossRefGoogle Scholar
  111. 111.
    Pierson LM, Herbert WG, Norton HJ, et al. Effects of combined aerobic and resistance training versus aerobictraining alone in cardiac rehabilitation. J Cardiopulm Rehabil 2001 Mar-Apr; 21 (2): 101–10PubMedCrossRefGoogle Scholar
  112. 112.
    Daub WD, Knapik GP, Black WR. Strength training early after myocardial infarction. J Cardiopulm Rehabil 1996 Mar-Apr; 16 (2): 100–8PubMedCrossRefGoogle Scholar
  113. 113.
    Santa-Clara H, Fernhall B, Mendes M, et al. Effect of a 1 year combined aerobic- and weight-training exerciseprogramme on aerobic capacity and ventilatory thresholdin patients suffering from coronary artery disease. EurJ Appl Physiol 2002 Oct; 87 (6): 568–75CrossRefGoogle Scholar
  114. 114.
    Arthur HM, Gunn E, Thorpe KE, et al. Effect of aerobic vs combined aerobic-strength training on 1-year, post-cardiacrehabilitation outcomes in women after a cardiac event. J Rehabil Med 2007 Nov; 39 (9): 730–5PubMedCrossRefGoogle Scholar
  115. 115.
    Beckers PJ, Denollet J, Possemiers NM, et al. Combined endurance-resistance training vs. endurance training inpatients with chronic heart failure: a prospective randomizedstudy. Eur Heart J 2008 Aug; 29 (15): 1858–66PubMedCrossRefGoogle Scholar
  116. 116.
    Bryner RW, Ullrich IH, Sauers J, et al. Effects of resistance vs. aerobic training combined with an 800 calorie liquiddiet on lean body mass and resting metabolic rate. J Am Coll Clin Nutr 1999 Apr; 18 (2): 115–21Google Scholar
  117. 117.
    Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older patientswith type 2 diabetes. Diabetes Care 2002 Oct; 25 (10): 1729–36PubMedCrossRefGoogle Scholar
  118. 118.
    Eriksson J, Taimela S, Eriksson K, et al. Resistance training in the treatment of non-insulin-dependent diabetes. Int J Sports Med 1997 May; 18 (4): 242–6PubMedCrossRefGoogle Scholar
  119. 119.
    Ballor DL, McCarthy JP, Wilterdink EJ. Exercise intensity does not affect the composition of diet- and exercise-inducedbody mass loss. Am J Clin Nutr 1990 Feb; 51 (2): 142–6PubMedGoogle Scholar
  120. 120.
    Leutholtz BC, Keyser RE, Heusner WW, et al. Exercise training and severe caloric restriction: effect on lean bodymass in the obese. Arch Phys Med Rehabil 1995 Jan; 76 (1): 65–70PubMedCrossRefGoogle Scholar
  121. 121.
    van Aggel-Leijssen D, Saris WHM, Wagenmakers AJM, et al. Effect of exercise training at different intensitieson fat metabolism of obese men. J Appl Physiol 2002 Mar; 92 (3): 1300–9PubMedGoogle Scholar
  122. 122.
    Hansen D, Dendale P, Jonkers RA, et al. Continuous low-tomoderate intensity exercise is equally effective as moderateto-high intensity exercise training at lowering blood HbA1c content in obese type 2 diabetes patients. Diabetologia 2009 Sep; 52 (9): 1789–97PubMedCrossRefGoogle Scholar
  123. 123.
    Blumenthal JA, Rejeski WJ, Walsh-Riddle M, et al. Comparison of high- and low-intensity exercise training earlyafter acute myocardial infarction. Am J Cardiol 1988 Jan; 61 (1): 26–30PubMedCrossRefGoogle Scholar
  124. 124.
    Jensen BE, Fletcher BJ, Rupp JC, et al. Training level comparison study: effect of high and low intensity training onventilatory threshold in men with coronary artery disease. J Cardiopulm Rehabil 1996 Jul-Aug; 16 (4): 227–32PubMedCrossRefGoogle Scholar
  125. 125.
    Oberman A, Fletcher GF, Lee J, et al. Efficacy of highintensity exercise training on left ventricular ejection fractionin men with coronary artery disease (the training levelcomparison study). Am J Cardiol 1995 Oct; 76 (10): 643–7PubMedCrossRefGoogle Scholar
  126. 126.
    Friedlander AL, Jacobs KA, Fattor JA, et al. Contributions of working muscle to whole body lipid metabolismare altered by exercise training and intensity. AmJ Physiol 2007 Oct; 292 (4): E107–12Google Scholar
  127. 127.
    Perri MG, Anton SD, Durning PE, et al. Adherence to exercise prescriptions: effects of prescribing moderateversus higher levels of intensity and frequency. Health Psychol 2002 Sep; 21 (5): 452–8PubMedCrossRefGoogle Scholar
  128. 128.
    Kang J, Robertson RJ, Hagberg JM, et al. Effect of exercise intensity on glucose and insulin metabolism in obeseindividuals and obese NIDDM patients. Diabetes Care 1996 Apr; 19 (4): 341–9PubMedCrossRefGoogle Scholar
  129. 129.
    Kang J, Kelley DE, Robertson RJ, et al. Substrate utilization and glucose turnover during exercise of varying intensitiesin individuals with NIDDM. Med Sci Sports Exerc 1999 Jan; 31 (1): 82–9PubMedCrossRefGoogle Scholar
  130. 130.
    Garcia-Roves PM, Han DH, Song Z, et al. Prevention of glycogen supercompensation prolongs the increase in muscle GLUT4 after exercise. Am J Physiol 2003 Oct; 285 (4): E729–36Google Scholar
  131. 131.
    Swain DP, Franklin BA. Is there a threshold intensity for aerobic training in cardiac patients? Med Sci Sports Exerc 2002 Jul; 34 (7): 1071–5PubMedCrossRefGoogle Scholar
  132. 132.
    Schjerve IE, Tyldum GA, Tjønna AE, et al. Both aerobic endurance and strength training programmes improvecardiovascular health in obese adults. Clin Sci 2008 Nov; 115 (9): 283–93PubMedCrossRefGoogle Scholar
  133. 133.
    Warburton DE, McKenzie DC, Haykowski MJ, et al. Effectiveness of high-intensity interval training for therehabilitation of patients with coronary artery disease. Am J Cardiol 2005 May; 95 (9): 1080–4PubMedCrossRefGoogle Scholar
  134. 134.
    Rognmo O, Hetland E, Helgerud J, et al. High intensity aerobic interval exercise is superior to moderate intensityexercise for increasing aerobic capacity in patients withcoronary artery disease. Eur J Cardiovasc Prev Rehabil 2004 Jun; 11 (3): 216–22PubMedCrossRefGoogle Scholar
  135. 135.
    Amundsen BH, Rognmo O, Hatlen-Rebhan G, et al. Highintensity aerobic exercise improves diastolic function incoronary artery disease. Scand Cardiovasc J 2008 Apr; 42 (2): 110–7PubMedCrossRefGoogle Scholar
  136. 136.
    Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exerciseafter coronary artery bypass surgery: a randomized studyof cardiovascular effects and quality of life. Am Heart J 2009 Dec; 158 (6): 1031–7PubMedCrossRefGoogle Scholar
  137. 137.
    Gibala MJ, McGee SL. Metabolic adaptations to shortterm high-intensity interval training: a little pain for a lotof gain? Exerc Sport Sci Rev 2008 Apr; 36 (2): 58–63PubMedCrossRefGoogle Scholar
  138. 138.
    Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderatecontinuous training in heart failure patients: a randomizedstudy. Circulation 2007 Jun; 115 (24): 3086–94PubMedCrossRefGoogle Scholar
  139. 139.
    Bond Brill J, Perry AC, Parker L, et al. Dose-response effect of walking exercise on weight loss: how much is enough? Int J Obes 2002 Nov; 26 (11): 1484–93CrossRefGoogle Scholar
  140. 140.
    Hansen D, Dendale P, Berger J, et al. Importance of training session duration in the rehabilitation of coronary arterydisease patients. Eur J Cardiovasc Prev Rehabil 2008 Aug; 15 (4): 453–9PubMedCrossRefGoogle Scholar
  141. 141.
    Sriwijitkamol A, Coletta DK, Wajcberg E, et al. Effect of acute exercise on AMPK signalling in skeletal muscle ofsubjects with type 2 diabetes. Diabetes 2007 Mar; 56 (3): 836–48PubMedCrossRefGoogle Scholar
  142. 142.
    Praet SF, Manders RJ, Lieverse AG, et al. Influence of acute exercise on hyperglycaemia in insulin-treated type 2diabetes. Med Sci Sports Exerc 2006 Dec; 38 (12): 2037–44PubMedCrossRefGoogle Scholar
  143. 143.
    Whatley JE, Gillespie WJ, Honig J, et al. Does the amount of endurance exercise in combination with weight training and avery-low-energy diet affect resting metabolic rate and body composition? Am J Clin Nutr 1994 May; 59 (5): 1088–92PubMedGoogle Scholar
  144. 144.
    Dressendorfer RH, Franklin BA, Cameron JL, et al. Exercise training frequency in early post-infarction cardiacrehabilitation: influence on aerobic conditioning. J Cardiopulm Rehabil 1995 Jul-Aug; 15 (4): 269–76PubMedCrossRefGoogle Scholar
  145. 145.
    Tygesen H, Wettervik C, Wennerblom B. Intensive homebased exercise training in cardiac rehabilitation increasesexercise capacity and heart rate variability. Int J Cardiol 2001 Jul; 79 (2-3): 175–82PubMedCrossRefGoogle Scholar
  146. 146.
    Nieuwland W, Berkhuysen MA, van Veldhuizen DJ, et al. Differential effects of high-frequency versus low-frequency exercise training in rehabilitation of patients with coronaryartery disease. J Am Coll Cardiol 2000 Jul; 36 (1): 202–7PubMedCrossRefGoogle Scholar
  147. 147.
    Henriksen EJ. Exercise effects of muscle insulin signalling and action: effects of acute exercise and exercise trainingon insulin resistance. J Appl Physiol 2002 Aug; 93 (2): 788–96PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Dominique Hansen
    • 1
    • 2
    • 3
  • Paul Dendale
    • 1
    • 2
  • Luc J. C. van Loon
    • 4
  • Romain Meeusen
    • 5
  1. 1.Jessa Hospital/Heart Centre HasseltHasseltBelgium
  2. 2.Faculty of MedicineHasselt UniversityDiepenbeekBelgium
  3. 3.Rehabilitation & Healthcare Research Centre, Department of HealthcarePHL-University CollegeHasseltBelgium
  4. 4.Department of Human Movement Sciences, Nutrition and Toxicology Research Institute (NUTRIM)Maastricht University Medical CentreMaastrichtthe Netherlands
  5. 5.Department of Human Physiology and Sports MedicineVrije Universiteit Brussel (VUB)BrusselsBelgium

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