title: Metabolic Effects of Exercise Training Among Fitness-Nonresponsive Patients With Type 2 Diabetes: The HART-D Study.
abstract: OBJECTIVE
  To evaluate the impact of exercise training (ET) on metabolic parameters among participants with type 2 diabetes mellitus (T2DM) who do not improve their cardiorespiratory fitness (CRF) with training.
  
  
  METHODS
  We studied participants with T2DM participating in the Health Benefits of Aerobic and Resistance Training in Individuals With Type 2 Diabetes (HART-D) trial who were randomized to a control group or one of three supervised ET groups for 9 months. Fitness response to ET was defined as a change in measured peak absolute oxygen uptake (ΔVO(2peak), in liters per minute) from baseline to follow-up. ET participants were classified based on ΔVO(2peak) into fitness responders (ΔVO(2peak) ≥5%) and nonresponders (ΔVO(2peak) <5%), and changes in metabolic profiles were compared across control, fitness responder, and fitness nonresponder groups.
  
  
  RESULTS
  A total of 202 participants (mean age 57.1 ± 7.9 years, 63% women) were included. Among the exercise groups (n = 161), there was substantial heterogeneity in ΔVO(2peak); 57% had some improvement in CRF (ΔVO(2peak) >0), with only 36.6% having a ≥5% increase in VO(2peak). Both fitness responders and nonresponders (respectively) had significant improvements in hemoglobin A1c and measures of adiposity (ΔHbA(1c): -0.26% [95% CI -0.5 to -0.01] and -0.26% [-0.45 to -0.08]; Δwaist circumference: -2.6 cm [-3.7 to -1.5] and -1.8 cm [-2.6 to -1.0]; Δbody fat: -1.07% [-1.5 to -0.62] and -0.75% [-1.09 to -0.41]). No significant differences were observed in the degree of change of these metabolic parameters between fitness responders and nonresponders. Control group participants had no significant changes in any of these metabolic parameters.
  
  
  CONCLUSIONS
  ET is associated with significant improvements in metabolic parameters irrespective of improvement in cardiorespiratory fitness.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Department of Kinesiology, East Carolina University, Greenville, NC.
authors.forename: Damon L
authors.initials: DL
authors.lastname: Swift
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Neeland
authors.affiliation: Department of Exercise Science, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.affiliation: School of Kinesiology, College of Human Sciences & Education, Louisiana State University, Baton Rouge, LA.
authors.forename: Neil
authors.initials: N
authors.lastname: Johannsen
authors.affiliation: Department for Health & Kinesiology, Texas A&M University, College Station, TX.
authors.forename: Conrad P
authors.initials: CP
authors.lastname: Earnest
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX jarett.berry@utsouthwestern.edu.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.affiliation: Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Church
mesh_terms: D050154:Adiposity / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000628:therapy; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology; D055070:Resistance Training / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin