Aerobic vs Resistance Exercise for Type 1 Diabetes

Recruiting at 1 trial location

Overseen By Jane E Yardley, PhD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: University of Alberta

Must be taking: Insulin

Must not be taking: Glucose metabolism drugs

Disqualifiers: Cardiovascular disease, Neuropathy, Smoking, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

20 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different types of exercise affect blood sugar levels in people with Type 1 diabetes. Participants will engage in three sessions: one with no exercise, one with aerobic exercise (such as jogging), and one with resistance exercise (such as weightlifting). Researchers aim to observe changes in blood sugar during and after these activities. The study seeks individuals with Type 1 diabetes who have been diagnosed for at least a year and can perform both types of exercise. Participants should also be post-menopausal or have undergone certain surgeries and be able to visit the lab in Edmonton, Alberta. As an unphased trial, this study offers a unique opportunity to contribute to understanding how exercise impacts diabetes management.

Will I have to stop taking my current medications?

The trial requires that you do not use medications (other than insulin) that affect glucose metabolism. If you are taking such medications, you may need to stop them to participate.

What prior data suggests that these exercise protocols are safe for individuals with Type 1 Diabetes?

Studies have shown that both aerobic and resistance exercises are generally safe for people with type 1 diabetes. Moderate aerobic activity is linked to a lower risk of heart disease and death. However, about 10% of individuals might experience diabetic ketoacidosis, a serious diabetes complication, after exercise. Aerobic exercises typically do not cause severe drops in blood sugar levels.

Research indicates that resistance exercise can help prevent low blood sugar caused by exercise. It is a safe way to improve heart health for everyone, regardless of existing heart conditions. Resistance exercise may also help maintain stable blood sugar levels after working out.

Overall, both types of exercises are well-tolerated by people with type 1 diabetes and can be part of a safe exercise plan. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how different types of exercise—specifically aerobic exercise and resistance exercise—can benefit people with Type 1 Diabetes. Unlike most standard care options that focus on insulin management and diet, this study looks at physical activity as a way to potentially improve blood sugar control and overall health. By comparing aerobic exercise to resistance exercise, researchers hope to find out which type of exercise, if any, offers the most benefits for managing Type 1 Diabetes. This could lead to more personalized and effective exercise recommendations for individuals with this condition.

What evidence suggests that aerobic and resistance exercise could be effective for managing Type 1 Diabetes?

This trial will compare the effects of aerobic exercise and resistance exercise on managing Type 1 Diabetes. Research has shown that aerobic exercise can help manage blood sugar levels in people with Type 1 Diabetes. It lowers HbA1C, a measure of average blood sugar over time, improves heart health, and enhances the body's use of insulin.

Resistance exercise, another focus of this trial, helps control blood sugar after workouts and maintains lower levels for longer. While it doesn't cause a significant drop in blood sugar during the activity, it supports sustained lower levels afterward. Both exercise types benefit diabetes management, so incorporating them into daily routines may be helpful. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

This trial is for post-menopausal women with Type 1 Diabetes who can exercise and visit the lab in Edmonton. They should have stable diabetes management, no severe complications like heart disease or neuropathy, not smoke, drink heavily, or be significantly overweight.

Inclusion Criteria

I have been diagnosed with type 1 diabetes for over a year.

I have been in menopause for at least a year or have had my uterus and ovaries removed.

Able to visit the lab in Edmonton, Alberta (University of Alberta)

Exclusion Criteria

Your blood pressure is higher than 140 over 95.

I am taking medication that affects my blood sugar, not including insulin.

I have a history of heart disease.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-test Measures

Participants undergo pre-test measures including questions related to menopause, PA levels, medication, blood pressure, heart rate, anthropometric characteristics, HbA1c assessment, maximal aerobic capacity test, strength test, and DXA scan.

1-2 weeks

Testing Sessions

Participants complete three testing sessions: a no-exercise resting control session, a moderate aerobic exercise session, and a moderate resistance exercise session. Blood samples are drawn, and continuous glucose monitoring is conducted.

3 sessions over 1-2 weeks

3 visits (in-person)

Follow-up

Participants are monitored for changes in blood glucose and other secondary outcomes using continuous glucose monitoring for up to 24 hours post-exercise.

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Aerobic Exercise
• No exercise
• Resistance Exercise

Trial Overview The study compares how moderate aerobic exercise (like walking), resistance training (like weight-lifting), and no exercise affect blood sugar levels in these women. Blood samples will be taken during and after sessions to monitor glucose changes.

How Is the Trial Designed?

Group I: All participants Experimental Treatment 3 Interventions

All participants will take part in all three testing conditions

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Women and Children's Health Research Institute, Canada

Collaborator

Trials

18

Recruited

24,800+

Published Research Related to This Trial

The READI trial involved 131 physically active adults with type 1 diabetes and aimed to determine if adding a 6-month resistance training program would improve glycemic control compared to aerobic exercise alone.

This study is significant as it is the first to assess the additional health benefits of resistance training in individuals with type 1 diabetes who are already engaged in aerobic exercise, potentially influencing future exercise recommendations for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance Exercise in Already-Active Diabetic Individuals (READI): study rationale, design and methods for a randomized controlled trial of resistance and aerobic exercise in type 1 diabetes. Yardley, JE., Kenny, GP., Perkins, BA., et al.[2022]

In a study involving 131 aerobically active individuals with type 1 diabetes, adding resistance training did not significantly change glycated hemoglobin A1c (HbA1c) levels compared to those who only performed aerobic exercise.

However, participants who engaged in resistance training experienced greater increases in muscular strength and a more significant reduction in waist circumference over 22 weeks, indicating benefits in body composition and fitness without affecting glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomized Clinical Trial. Sigal, RJ., Yardley, JE., Perkins, BA., et al.[2023]

In a study of 21 non-physically active men with long-lasting type 1 diabetes, both aerobic and resistance training were found to be safe and did not significantly affect glycemic control or cardiovascular risk factors over three months.

While neither exercise type led to significant changes in HbA1c levels, there was a slight downward trend in the aerobic group, suggesting potential benefits that may require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic as well as resistance exercises are good for patients with type 1 diabetes. Wróbel, M., Rokicka, D., Czuba, M., et al.[2022]

In a study involving 497 adults with type 1 diabetes, aerobic exercise led to the largest decrease in glucose levels during exercise, followed by interval and resistance exercises, indicating that exercise type significantly affects glycemic control.

Structured exercise sessions improved the time participants spent within the target glucose range (70-180 mg/dL) in the 24 hours following exercise, suggesting that regular physical activity can enhance glycemic management in individuals with type 1 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining the Acute Glycemic Effects of Different Types of Structured Exercise Sessions in Type 1 Diabetes in a Real-World Setting: The Type 1 Diabetes and Exercise Initiative (T1DEXI). Riddell, MC., Li, Z., Gal, RL., et al.[2023]

In a study involving diabetic rats, combined aerobic and resistance exercise (DARE) led to improved lipid metabolism and insulin sensitivity compared to aerobic exercise alone (DAE), suggesting a beneficial approach for managing type 1 diabetes.

DARE rats exhibited increased skeletal muscle lipid storage and oxidation capabilities, indicating a potential 'athlete's paradox' effect, which may help mitigate insulin resistance associated with type 1 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Combined Exercise Versus Aerobic-Only Training on Skeletal Muscle Lipid Metabolism in a Rodent Model of Type 1 Diabetes. Dotzert, MS., McDonald, MW., Murray, MR., et al.[2018]

In a study involving 14 physically active individuals with type 1 diabetes, a single session of strenuous resistance exercise did not significantly change insulin sensitivity compared to a non-exercise control group.

Insulin sensitivity was measured using a precise technique before exercise and at 12 and 36 hours after, showing no significant differences over time or between the groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Insulin-sensitivity response to a single bout of resistive exercise in type 1 diabetes mellitus. Jimenez, C., Santiago, M., Sitler, M., et al.[2019]

Resistance training is an important addition to exercise programs for individuals with diabetes, as it enhances muscular conditioning and overall health.

The article provides guidelines for safely prescribing resistance training for people with diabetes, considering both those with and without vascular complications, ensuring effective and safe exercise regimens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance training guidelines for individuals with diabetes mellitus. Soukup, JT., Maynard, TS., Kovaleski, JE.[2017]

In a study involving 12 individuals with type 1 diabetes, performing resistance exercise before aerobic exercise led to better glycemic stability during the workout, with lower blood glucose levels compared to doing aerobic exercise first.

The order of exercise also influenced post-exercise hypoglycemia, with resistance-aerobic (RA) resulting in a shorter duration and less severe hypoglycemia compared to aerobic-resistance (AR), although these differences were not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Yardley, JE., Kenny, GP., Perkins, BA., et al.[2021]

Moderate-intensity aerobic exercise can increase the risk of hypoglycemia in individuals with type 1 diabetes, while brief high-intensity activities can lead to post-exercise hyperglycemia.

Incorporating short bursts of anaerobic exercise, like sprints or resistance training, during aerobic sessions may help mitigate the drop in blood glucose levels associated with moderate-intensity aerobic exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance exercise in type 1 diabetes. Yardley, JE., Sigal, RJ., Perkins, BA., et al.[2013]

A 12-week structured exercise program combining aerobic and resistance training significantly improved body mass index (BMI), maximum muscular strength, and exercise intensity in adolescents with type 1 diabetes mellitus (T1DM).

Participants in the exercise group also showed positive trends in psychological well-being, including improved attention and quality of life, while experiencing reduced stress and behavioral problems, without significant changes in insulin dosage or HbA1c levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Once-weekly supervised combined training improves neurocognitive and psychobehavioral outcomes in young patients with type 1 diabetes mellitus. Suh, J., Choi, HS., Kwon, A., et al.[2020]

Citations

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Physical Activity/Exercise and Diabetes: A Position ... Aerobic training increases mitochondrial density, insulin sensitivity, oxidative enzymes, compliance and reactivity of blood vessels, lung function, immune ...

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Are Regular Aerobic Exercisers With Type 1 Diabetes ... Ten percent of participants experienced diabetic ketoacidosis after exercise, and only 27% restricted exercise in the 24 hours after having a ...

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Clinical outcomes to exercise training in type 1 diabetes Exercise training improves some markers of type 1 diabetes severity; particularly body mass, BMI, Peak VO2 and LDL in adults and insulin dose, waist ...

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Clinical outcomes and glycaemic responses to different ... Our pooled analysis of aerobic exercise studies showed a significant improvement in both HbA1C% and peak VO2. Moreover our data support existing ...

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Epidemiology and Cardiovascular Benefits of Physical ... In this review, we focus on the beneficial effects of routine physical activity (PA) on the cardiovascular system, the different ways we can achieve and ...

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Physical activity, exercise, and chronic diseases: A brief review The implementation of daily PA and exercise prevention interventions support an 80% reduction in CVD risk, 90% reduction in type 2 diabetes risk, 33% reduction ...