title: Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian Diabetes and Exercise Study (IDES).
abstract: BACKGROUND
  While current recommendations on exercise type and volume have strong experimental bases, there is no clear evidence from large-sized studies indicating whether increasing training intensity provides additional benefits to subjects with type 2 diabetes.
  
  
  OBJECTIVE
  To compare the effects of moderate-to-high intensity (HI) versus low-to-moderate intensity (LI) training of equal energy cost, i.e. exercise volume, on modifiable cardiovascular risk factors.
  
  
  METHODS
  Pre-specified sub-analysis of the Italian Diabetes and Exercise Study (IDES), a randomized multicenter prospective trial comparing a supervised exercise intervention with standard care for 12 months (2005-2006).
  
  
  METHODS
  Twenty-two outpatient diabetes clinics across Italy.
  
  
  METHODS
  Sedentary patients with type 2 diabetes assigned to twice-a-week supervised progressive aerobic and resistance training plus exercise counseling (n = 303).
  
  
  METHODS
  Subjects were randomized by center to LI (n = 142, 136 completed) or HI (n = 161, 152 completed) progressive aerobic and resistance training, i.e. at 55% or 70% of predicted maximal oxygen consumption and at 60% or 80% of predicted 1-Repetition Maximum, respectively, of equal volume.
  
  
  METHODS
  Hemoglobin (Hb) A(1c) and other cardiovascular risk factors; 10-year coronary heart disease (CHD) risk scores.
  
  
  RESULTS
  Volume of physical activity, both supervised and non-supervised, was similar in LI and HI participants. Compared with LI training, HI training produced only clinically marginal, though statistically significant, improvements in HbA(1c) (mean difference -0.17% [95% confidence interval -0.44,0.10], P = 0.03), triglycerides (-0.12 mmol/l [-0.34,0.10], P = 0.02) and total cholesterol (-0.24 mmol/l [-0.46, -0.01], P = 0.04), but not in other risk factors and CHD risk scores. However, intensity was not an independent predictor of reduction of any of these parameters. Adverse event rate was similar in HI and LI subjects.
  
  
  CONCLUSIONS
  Data from the large IDES cohort indicate that, in low-fitness individuals such as sedentary subjects with type 2 diabetes, increasing exercise intensity is not harmful, but does not provide additional benefits on cardiovascular risk factors.
  
  
  BACKGROUND
  www.ISRCTN.org ISRCTN-04252749.
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: Alessandra
authors.initials: A
authors.lastname: Bazuro
authors.forename: Luca
authors.initials: L
authors.lastname: Pugliese
authors.forename: Carla
authors.initials: C
authors.lastname: Maccora
authors.forename: Carla
authors.initials: C
authors.lastname: Iacobini
authors.forename: Francesco G
authors.initials: FG
authors.lastname: Conti
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D055070:Resistance Training / Q000009:adverse effects; D012307:Risk Factors