Resistance Exercise for Type 1 Diabetes

Overseen By Jane Yardley, PhD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: University of Alberta

Must not be taking: Atypical antipsychotics, Corticosteroids

Disqualifiers: Cardiovascular disease, Severe neuropathy, others

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

Compensation: Varies

Number of Visits: 5

16 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that participants do not take medications other than insulin that affect glucose metabolism, such as atypical antipsychotics or corticosteroids.

What data supports the effectiveness of this treatment for type 1 diabetes?

Research shows that resistance training, like weight lifting, can help people with type 1 diabetes manage their blood sugar levels better. Studies found that it can lower HbA1c (a measure of long-term blood sugar control) and improve overall health, making it a useful addition to treatment plans. ^{1 2 3 4 5}

Is resistance exercise safe for people with type 1 diabetes?

Resistance exercise, like weight lifting, is generally considered safe for people with type 1 diabetes. Studies suggest it may reduce the risk of low blood sugar (hypoglycemia) during and after exercise compared to aerobic exercise. ^{2 3 4 6 7}

How does resistance exercise differ from other treatments for type 1 diabetes?

Resistance exercise, like weight lifting, is unique for type 1 diabetes as it can improve muscle strength, body composition, and glycemic control (blood sugar levels) without the need for medication. Unlike aerobic exercise, it may offer additional benefits in reducing HbA1c (a measure of long-term blood sugar control) and enhancing insulin sensitivity. ^{2 3 4 8 9}

What is the purpose of this trial?

Regular physical activity has substantial health benefits in people with type 1 diabetes. The fear of hypoglycemia, both during and after exercise, is a major barrier to exercise in this population. A major obstacle to providing specific physical activity and exercise advice is that there are still significant gaps in the fundamental understanding of the impact of physical activity and exercise on blood glucose levels in type 1 diabetes. Women with type 1 diabetes have a substantial increase in cardiovascular risk once they have passed menopause. They may lose both bone quality and muscle mass at a faster rate with aging than those without diabetes. Overall, these changes greatly increase the risk of both cardiovascular and frailty related complications. Despite the many potential benefits of resistance exercise for post-menopausal women with type 1 diabetes, there are currently no published studies examining the effects of resistance exercise in this population. Before being able to design a clinical trial of resistance exercise, an examination of the acute effects of resistance exercise on blood glucose levels in post-menopausal women with type 1 diabetes is required. The present study will compare the glycemic effects of a low resistance, high repetition (3 sets of 15 to 20 repetitions) weight lifting program to the effects of a moderate resistance, moderate repetition (3 sets of 8 to 10 repetitions). The investigators hypothesize that the high repetition program will be associated with a bigger decline in blood glucose during exercise, but that the moderate resistance program will be associated with a higher risk of post-exercise hypoglycemia.

Eligibility Criteria

This trial is for post-menopausal women with Type 1 Diabetes living near Edmonton, Alberta. They should have been diagnosed at least a year ago and not had a menstrual period in the last 12 months. Participants must be able to do resistance exercise but can't join if they have high blood pressure, cardiovascular disease history, are on certain medications, or have conditions affecting exercise ability.

Inclusion Criteria

Your HbA1c level is less than 10%.

Residing near Edmonton, Alberta or able to attend laboratory based sessions at the University of Alberta

I am a woman diagnosed with type 1 diabetes for over a year.

Exclusion Criteria

You have a body mass index higher than 30, which means you are very overweight.

I have a history of heart disease.

You are a smoker.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Pre-test Measures

Participants undergo pre-test measures including questions related to menopause, physical activity levels, medication, blood pressure, heart rate, anthropometric characteristics, and blood sample for HbA1c.

1 week

1 visit (in-person)

Testing Sessions

Participants perform resistance exercises in two sessions with different protocols, and blood samples are drawn at various times.

2 weeks

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after exercise sessions, including CGM data collection and focus group participation.

1-2 weeks

1 visit (in-person or virtual)

Treatment Details

Interventions

• High repetition (HI)
• Moderate repetition (MOD)

Trial Overview The study tests how different resistance exercises affect blood sugar levels in participants. One group will do low resistance but high repetition weight lifting (3 sets of 15-20 reps), while another does moderate resistance and repetitions (3 sets of 8-10 reps). The goal is to see which method impacts blood glucose during and after exercise.

Participant Groups

Group I: All participants Experimental Treatment 2 Interventions

All participants will be in a single arm that undergoes two separate interventions. These interventions will include a high repetition, low resistance protocol, and a moderate repetition, moderate intensity protocol.

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Findings from Research

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]

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]

In a study involving 12 individuals with type 1 diabetes, resistance exercise led to a smaller initial drop in blood glucose during the activity compared to aerobic exercise, but resulted in more sustained reductions in blood glucose levels afterward.

The findings suggest that resistance exercise may be more effective than aerobic exercise for managing post-exercise glycemia, which could help explain the observed reductions in HbA(1c) levels associated with resistance training in type 1 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Yardley, JE., Kenny, GP., Perkins, BA., et al.[2022]

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]

Resistance training significantly reduces glycated hemoglobin (HbA1c) levels in individuals with Type 1 Diabetes (T1D), indicating improved glycemic control, based on a review of five studies.

Longer resistance training interventions, particularly in children and adolescents, not only lowered HbA1c but also increased strength and improved lipid profiles, suggesting additional health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of resistance training on the glycemic control of people with type 1 diabetes: a systematic review and meta-analysis. de Abreu de Lima, V., de Menezes, FJ., da Rocha Celli, L., et al.[2023]

Intermittent high-intensity exercise (IHE) resulted in a smaller decline in blood glucose levels compared to moderate-intensity exercise (MOD) in individuals with type 1 diabetes, with a decrease of -2.9 mmol/l for IHE versus -4.4 mmol/l for MOD.

During recovery, blood glucose levels remained more stable after IHE, likely due to elevated lactate and hormone levels, indicating that IHE may help in better managing blood glucose levels post-exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Guelfi, KJ., Jones, TW., Fournier, PA.[2022]

Exercise training, particularly a combination of strength exercises and high-intensity interval training, may help reduce the risk of hypoglycemia in individuals with Type 1 diabetes mellitus (T1DM) compared to continuous aerobic exercise.

This proposed training regimen, performed three times a week, aims to improve long-term health markers and reduce the risk of complications associated with T1DM by enhancing glycemic control and overall physical fitness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise for type 1 diabetes mellitus management: General considerations and new directions. Farinha, JB., Krause, M., Rodrigues-Krause, J., 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]

A 3-month resistance training program significantly increased maximal muscle strength in 11 male patients with long-term type 1 diabetes, indicating that they can adapt well to physical training.

Despite the improvement in muscle strength, there were no significant changes in serum irisin levels or metabolic control parameters like HbA1c, suggesting that while strength can improve, other metabolic factors may remain unchanged.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients. Wróbel, M., Gołaś, A., Rokicka, D., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Insulin-sensitivity response to a single bout of resistive exercise in type 1 diabetes mellitus. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. [2022]

4. United States 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. [2022]

5. Brazil pubmed.ncbi.nlm.nih.gov

Effects of resistance training on the glycemic control of people with type 1 diabetes: a systematic review and meta-analysis. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Exercise for type 1 diabetes mellitus management: General considerations and new directions. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomized Clinical Trial. [2023]

9. Poland pubmed.ncbi.nlm.nih.gov

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients. [2022]