title: Changes in body fat distribution and fitness are associated with changes in hemoglobin A1c after 9 months of exercise training: results from the HART-D study.
abstract: OBJECTIVE
  To investigate the associations between changes in body composition and fitness after exercise training and changes in hemoglobin A1c (HbA1c) in individuals with type 2 diabetes.
  
  
  METHODS
  Participants (n = 201) were randomized to aerobic, resistance, or combined training for 9 months. HbA1c, waist circumference, total and trunk fat mass, appendicular fat mass, lean body mass, isokinetic leg muscle strength, peak O2 uptake, and estimated METs were assessed at baseline and follow-up. Change in HbA1c was evaluated across quartiles of change in body composition and fitness.
  
  
  RESULTS
  Change in HbA1c was associated with changes in body weight (r = 0.13, P = 0.052), waist circumference (r = 0.17, P = 0.013), trunk fat mass (r = 0.19, P = 0.005), and estimated METs (r = -0.16, P = 0.023). There was a trend in change in HbA1c across quartiles of waist circumference (P = 0.011), trunk fat mass (P = 0.020), and estimated METs (P = 0.011). Participants with increased estimated METs and reduced trunk fat mass had greater odds of having reduced HbA1c after training (3.48, 1.46-8.31). Finally, participants with increased estimated METs and reduced waist circumference were 2.81 (1.13-6.98) times more likely to have reduced HbA1c and type 2 diabetes medication use than those without improved fitness and central adiposity.
  
  
  CONCLUSIONS
  In patients with type 2 diabetes, a reduction in central adiposity and increase in fitness were the most prominent predictors of the change in HbA1c in response to exercise training.
authors.affiliation: Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Sénéchal
authors.forename: Damon L
authors.initials: DL
authors.lastname: Swift
authors.forename: Neil M
authors.initials: NM
authors.lastname: Johannsen
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.forename: Conrad P
authors.initials: CP
authors.lastname: Earnest
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
mesh_terms: D050218:Body Fat Distribution; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055105:Waist Circumference / Q000502:physiology
chemical_list: D006442:Glycated Hemoglobin