For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years. The last American Diabetes Association (ADA) technical review of exercise and type 2 diabetes (formerly known as non–insulin dependent diabetes) was published in 1990. The present work emphasizes the advances that have occurred since the last technical review was published.

Major developments since the 1990 technical review include: 

Based on this new evidence, we have refined the recommendations on the desired types, amounts, and intensities of aerobic physical activity for people with diabetes. Resistance training will now be recommended in a broader group of patients and at a broader range of intensity than done previously. There are other areas in which new evidence is lacking, but we feel that previous recommendations may have been more conservative than necessary. These areas include indications for exercise stress test before beginning an exercise program and precautions regarding …

https://care.diabetesjournals.org/content/diacare/27/10/2518.full.pdf

Physical activity/exercise and type 2 diabetes.

Current recommendations on resistance training (RT) frequency for gains in muscular strength are based on extrapolations from limited evidence on the topic, and thus their practical applicability remains questionable. To elucidate this issue, we conducted a systematic review and meta-analysis of the studies that compared muscular strength outcomes with different RT frequencies. To carry out this review, English-language literature searches of the PubMed/MEDLINE, Scopus, and SPORTDiscus databases were conducted. The meta-analysis was performed using a random-effects model. The meta-analysis models were generated with RT frequencies classified as a categorical variable as either 1, 2, 3, or 4+ times/week, or, if there were insufficient data in subgroup analyses, the training frequencies were categorized as 1, 2, or 3 times/week. Subgroup analyses were performed for potential moderators, including (1) training volume; (2) exercise selection for the 1 repetition maximum (RM) test (for both multi-joint and single-joint exercises); (3) upper and lower body strength gains; (4) training to muscular failure (for studies involving and not involving training to muscular failure); (5) age (for both middle-aged/older adults and young adults); and (6) sex (for men and for women). The methodological quality of studies was appraised using the modified Downs and Black checklist. A total of 22 studies were found to meet the inclusion criteria. The average score on the Downs and Black checklist was 18 (range 13–22 points). Four studies were classified as being of good methodological quality, while the rest were classified as being of moderate methodological quality. Results of the meta-analysis showed a significant effect (p = 0.003) of RT frequency on muscular strength gains. Effect sizes increased in magnitude from 0.74, 0.82, 0.93, and 1.08 for training 1, 2, 3, and 4+ times per week, respectively. A subgroup analysis of volume-equated studies showed no significant effect (p = 0.421) of RT frequency on muscular strength gains. The subgroup analysis for exercise selection for the 1RM test suggested a significant effect of RT frequency on multi-joint (p < 0.001), but not single-joint, 1RM test results (p = 0.324). The subgroup analysis for upper and lower body showed a significant effect of frequency (p = 0.004) for upper body, but not lower body, strength gains (p = 0.070). In the subgroup analysis for studies in which the training was and was not carried out to muscular failure, no significant effect of RT frequency was found. The subgroup analysis for the age groups suggested a significant effect of training frequency among young adults (p = 0.024), but not among middle-aged and older adults (p = 0.093). Finally, the subgroup analysis for sex indicated a significant effect of RT frequency on strength gains in women (p = 0.030), but not men (p = 0.190). The results of the present systematic review and meta-analysis suggest a significant effect of RT frequency as higher training frequencies are translated into greater muscular strength gains. However, these effects seem to be primarily driven by training volume because when the volume is equated, there was no significant effect of RT frequency on muscular strength gains. Thus, from a practical standpoint, greater training frequencies can be used for additional RT volume, which is then likely to result in greater muscular strength gains. However, it remains unclear whether RT frequency on its own has significant effects on strength gain. It seems that higher RT frequencies result in greater gains in muscular strength on multi-joint exercises in the upper body and in women, and, finally, in contrast to older adults, young individuals seem to respond more positively to greater RT frequencies. More evidence among resistance-trained individuals is needed as most of the current studies were performed in untrained participants.

/pdf/effect-of-resistance-training-frequency-on-gains-in-muscular-c76208ai92.pdf

Effect of Resistance Training Frequency on Gains in Muscular Strength: A Systematic Review and Meta-Analysis

Previous meta-analyses have compared the effects of single to multiple sets on strength, but analyses on muscle hypertrophy are lacking. The purpose of this study was to use multilevel meta-regression to compare the effects of single and multiple sets per exercise on muscle hypertrophy. The analysis comprised 55 effect sizes (ESs), nested within 19 treatment groups and 8 studies. Multiple sets were associated with a larger ES than a single set (difference = 0.10 +/- 0.04; confidence interval [CI]: 0.02, 0.19; p = 0.016). In a dose-response model, there was a trend for 2-3 sets per exercise to be associated with a greater ES than 1 set (difference = 0.09 +/- 0.05; CI: -0.02, 0.20; p = 0.09), and a trend for 4-6 sets per exercise to be associated with a greater ES than 1 set (difference = 0.20 +/- 0.11; CI: -0.04, 0.43; p = 0.096). Both of these trends were significant when considering permutation test p values (p < 0.01). There was no significant difference between 2-3 sets per exercise and 4-6 sets per exercise (difference = 0.10 +/- 0.10; CI: -0.09, 0.30; p = 0.29). There was a tendency for increasing ESs for an increasing number of sets (0.24 for 1 set, 0.34 for 2-3 sets, and 0.44 for 4-6 sets). Sensitivity analysis revealed no highly influential studies that affected the magnitude of the observed differences, but one study did slightly influence the level of significance and CI width. No evidence of publication bias was observed. In conclusion, multiple sets are associated with 40% greater hypertrophy-related ESs than 1 set, in both trained and untrained subjects.

Single vs. Multiple Sets of Resistance Exercise for Muscle Hypertrophy: A Meta-Analysis

The health benefits and quality-of-life outcomes of a fit musculoskeletal system (musculoskeletal fitness) are reviewed in this article. The World Health Organization suggests health is a state of complete physical, mental or social well-being and not merely the absence of disease or infirmity. Physical health includes such characteristics as body size and shape, sensory acuity, susceptibility to disease and disorders, body functioning, recuperative ability and the ability to perform certain tasks.

https://powcs.med.unsw.edu.au/sites/default/files/powcs/page/Exercise%2B%2BHealth%2BOutcomes%2BHlth%2BM.pdf

Musculoskeletal fitness, health outcomes and quality of life.

During the aging process, physical capabilities (e.g., muscular strength) and cognitive functions (e.g., memory) gradually decrease. Regarding cognitive functions, substantial functional (e.g., compensatory brain activity) and structural changes (e.g., shrinking of the hippocampus) in the brain cause this decline. Notably, growing evidence points towards a relationship between cognition and measures of muscular strength and muscle mass. Based on this emerging evidence, resistance exercises and/or resistance training, which contributes to the preservation and augmentation of muscular strength and muscle mass, may trigger beneficial neurobiological processes and could be crucial for healthy aging that includes preservation of the brain and cognition. Compared with the multitude of studies that have investigated the influence of endurance exercises and/or endurance training on cognitive performance and brain structure, considerably less work has focused on the effects of resistance exercises and/or resistance training. While the available evidence regarding resistance exercise-induced changes in cognitive functions is pooled, the underlying neurobiological processes, such as functional and structural brain changes, have yet to be summarized. Hence, the purpose of this systematic review is to provide an overview of resistance exercise-induced functional and/or structural brain changes that are related to cognitive functions. A systematic literature search was conducted by two independent researchers across six electronic databases; 5957 records were returned, of which 18 were considered relevant and were analyzed. Based on our analyses, resistance exercises and resistance training evoked substantial functional brain changes, especially in the frontal lobe, which were accompanied by improvements in executive functions. Furthermore, resistance training led to lower white matter atrophy and smaller white matter lesion volumes. However, based on the relatively small number of studies available, the findings should be interpreted cautiously. Hence, future studies are required to investigate the underlying neurobiological mechanisms and to verify whether the positive findings can be confirmed and transferred to other needy cohorts, such as older adults with dementia, sarcopenia and/or dynapenia.

/pdf/functional-and-or-structural-brain-changes-in-response-to-29kyzmjcix.pdf

Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements – a systematic review

Strength training: single versus multiple sets.

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Strength training: single versus multiple sets.