title: Changes in physical fitness predict improvements in modifiable cardiovascular risk factors independently of body weight loss in subjects with type 2 diabetes participating in the Italian Diabetes and Exercise Study (IDES).
abstract: OBJECTIVE
  Physical fitness is inversely related to mortality in the general population and in subjects with type 2 diabetes. Here, we present data concerning the relationship between changes in physical fitness and modifiable cardiovascular risk factors in subjects with type 2 diabetes from the Italian Diabetes and Exercise Study.
  
  
  METHODS
  Sedentary patients with type 2 diabetes (n = 606) were enrolled in 22 outpatient diabetes clinics and randomized to twice-a-week supervised aerobic and resistance training plus exercise counseling versus counseling alone for 12 months. Baseline to end-of-study changes in cardiorespiratory fitness, strength, and flexibility, as assessed by Vo(2max) estimation, a 5-8 maximal repetition test, and a hip/trunk flexibility test, respectively, were calculated in the whole cohort, and multiple regression analyses were applied to assess the relationship with cardiovascular risk factors.
  
  
  RESULTS
  Changes in Vo(2max), upper and lower body strength, and flexibility were significantly associated with the variation in the volume of physical activity, HbA(1c), BMI, waist circumference, high-sensitivity C-reactive protein (hs-CRP), coronary heart disease (CHD) risk score, and inversely, HDL cholesterol. Changes in fitness predicted improvements in HbA(1c), waist circumference, HDL cholesterol, hs-CRP, and CHD risk score, independent of study arm, BMI, and in case of strength, also waist circumference.
  
  
  CONCLUSIONS
  Physical activity/exercise-induced increases in fitness, particularly muscular, predict improvements in cardiovascular risk factors in subjects with type 2 diabetes independently of weight loss, thus indicating the need for targeting fitness in these individuals, particularly in subjects who struggle to lose weight.
authors.affiliation: Department of Clinical and Molecular Medicine, “La Sapienza” University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Balducci
authors.forename: Silvano
authors.initials: S
authors.lastname: Zanuso
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cardelli
authors.forename: Laura
authors.initials: L
authors.lastname: Salvi
authors.forename: Giulia
authors.initials: G
authors.lastname: Mazzitelli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bazuro
authors.forename: Carla
authors.initials: C
authors.lastname: Iacobini
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002153:Calorimetry, Indirect; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D037001:Directive Counseling; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D010809:Physical Fitness; D055070:Resistance Training; D012307:Risk Factors; D057185:Sedentary Behavior; D055105:Waist Circumference; D015431:Weight Loss
chemical_list: D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human