title: Graded Resistance Exercise And Type 2 Diabetes in Older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial.
abstract: BACKGROUND
  Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes. Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control group for 12 months. Intervention group participants performed whole body machine-based power training at 80%1RM, 3 days per week. The control group undertook the same volume of non-progressive, low-intensity training. Participants were assessed at baseline, 6 months and 12 months and followed for a further 5 years, during which time participants were advised to exercise at moderate-high intensity. Glycemic control (HbA1c) and insulin resistance as measured by the homeostatic model assessment 2 (HOMA2-IR) were the primary outcomes of the trial. Outcome assessors were blinded to group assignment and participants were blinded to the investigators' hypothesis regarding the most effective intervention.
  
  
  RESULTS
  We recruited 103 participants (48.5 % women, 71.6 ± 5.6 years). Participants had 5.1 ± 1.8 chronic diseases, had been diagnosed with T2D for 8 ± 6 years and had a body mass index (BMI) of 31.6 ± 4.0 kg/m(2). Fasting glucose and insulin were 7.3 ± 2.4 mmol/L and 10.6 ± 6.3 mU/L, respectively. HbA1c was 54 ± 12 mmol/mol. Eighty-six participants completed the 12-month assessment and follow-up is ongoing. This cohort had a lower-than-expected dropout (n = 14, 14 %) over the 12-month intervention period.
  
  
  CONCLUSIONS
  Power training may be a feasible adjunctive therapy for improving glycemic control for the growing epidemic of T2D in older adults.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12606000436572 (24 September 2006).
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. kylie.simpson@sydney.edu.au.
authors.forename: Kylie A
authors.initials: KA
authors.lastname: Simpson
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. yorgi.mavros@sydney.edu.au.
authors.forename: Yorgi
authors.initials: Y
authors.lastname: Mavros
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. shelley.jo.kay@gmail.com.
authors.forename: Shelley
authors.initials: S
authors.lastname: Kay
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. jacinda.meiklejohn@sydney.edu.au.
authors.forename: Jacinda
authors.initials: J
authors.lastname: Meiklejohn
authors.affiliation: The Center for STRONG Medicine, Balmain Hospital, 29 Booth St, Balmain, NSW, 2041, Australia. nath.devos@hotmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: de Vos
authors.affiliation: San Francisco, Diabetes Center, University of California, Box 0540, 513 Parnassus Ave 1119, San Francisco, CA, 94143-0540, USA. YWang@diabetes.ucsf.edu.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. qguo5002@uni.sydney.edu.au.
authors.forename: Qianyu
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. rzha6475@uni.sydney.edu.au.
authors.forename: Renru
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. mike.climstein@sydney.edu.au.
authors.forename: Mike
authors.initials: M
authors.lastname: Climstein
authors.affiliation: Discipline of Psychiatry, The University of Adelaide, Level 4, Eleanor Harrold Building, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia. bernhard.baune@adelaide.edu.au.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Baune
authors.affiliation: Department of Exercise Science, Public Health Research Building, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA. sblair@mailbox.sc.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Blair
authors.affiliation: Department of Medicine, University of New South Wales, St George and Sutherland Clinical School, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia. a.osullivan@unsw.edu.au.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: O'Sullivan
authors.affiliation: Faculty of Medicine, Metabolic Disorders Research Group, University of New South Wales, Sydney, NSW, 2052, Australia. D.Simar@unsw.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Simar
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. singhnah@gmail.com.
authors.forename: Nalin
authors.initials: N
authors.lastname: Singh
authors.affiliation: Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. maria.fiataronesingh@sydney.edu.au.|Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia. maria.fiataronesingh@sydney.edu.au.|Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA, USA. maria.fiataronesingh@sydney.edu.au.
authors.forename: Maria A Fiatarone
authors.initials: MA
authors.lastname: Singh
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010352:Patient Dropouts; D012107:Research Design; D055070:Resistance Training / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human