Weight training program for type 2 diabetes

For those already diagnosed, this consequently means that regular strength training and an increase in muscle mass can help combat insulin resistance, body fat, and high blood sugar levels.

More work is needed to determine the proper dose of resistance exercise, which may vary for different health outcomes and populations. The participants, ages 20 to years old, performed chest and leg exercises to measure muscle strength during different points of the study. Factors taken into account included age, gender, and body weight. These variables complicate the study, researchers noted. While researchers say their study is the first to look at diabetes and strength training alone without adding cardiovascular or aerobic exercise to the equation, a great deal of past research has concluded that the benefits of strength training for people with diabetes are significant.

For example, a study published earlier this year on strength training showed it reduced the likelihood of prediabetes progressing to type 2 diabetes.

A study demonstrated the benefits of strength training on diabetes risk and cardiovascular disease. And a study demonstrated the benefits of strength training on insulin resistance. Additionally, to actually build a great deal of bulk muscle requires significant intention, well-structured training programs, and precise nutrition. Oerum recommends three to four days a week of strength training for the best results, but depending on your current history of exercise, two to three days a week may be plenty.

Are they a beginner? How old are they? What injuries or other physical limitations do they have? While the ideal strength-training workout could be 45 minutes to an hour in length, Oerum said a beginner should aim for 10 to 20 minutes a day.

You should also expect to be a little sore during your first week of strength training. That soreness will fade with a cautious approach, including warming up the muscles during exercise, light stretching, and rest days between training days.

Resistance training simply means we are putting our muscles under tension. Oerum also recommends doing modified pushups against a wall or kitchen counter or using a step at the bottom of your staircase to do step-ups.

If you want to add equipment, Oerum says the easiest and most affordable item is a set of resistance bands. When that becomes too easy, you combine the bands and use them at the same time to create a heavier band. She also encourages the use of household items such as gallon jugs or cans of vegetables in place of dumbbells.

Ginger Vieira is an expert patient living with type 1 diabetes, celiac disease, and fibromyalgia. Find her diabetes books on Amazon and her articles on Diabetes Strong. Aerobic activity should be performed in bouts of at least 10 min and be spread throughout the week. The average weekly duration in meta-analyses of exercise interventions in type 2 diabetes 24 , , , including higher-intensity aerobic exercise , has been in a similar range.

The U. Unfortunately, most people with type 2 diabetes do not have sufficient aerobic capacity to jog at 9. In a meta-analysis, the mean maximal aerobic capacity in diabetic individuals was only Therefore, most diabetic individuals will require at least min of moderate to vigorous aerobic exercise per week to achieve optimal CVD risk reduction.

Some CV and BG benefits may be gained from lower exercise volumes a minimum dose has not been established , whereas further benefit likely results from engaging in durations beyond recommended amounts.

Any form of aerobic exercise including brisk walking that uses large muscle groups and causes sustained increases in HR is likely to be beneficial , and undertaking a variety of modes of PA is recommended At present, no study on individuals with type 2 diabetes has compared rates of progression in exercise intensity or volume.

Gradual progression of both is advisable to minimize the risk of injury, particularly if health complications are present, and to enhance compliance.

The most successful weight control programs involve combinations of exercise, diet, and behavior modification. ADA B level recommendation. Resistance exercise should be undertaken at least twice weekly on nonconsecutive days 1 , , , , , , but more ideally three times a week 65 , , as part of a PA program for individuals with type 2 diabetes, along with regular aerobic activities. Home-based resistance training following supervised, gym-based training may be less effective for maintaining BG control but adequate for maintaining muscle mass and strength Each training session should minimally include 5—10 exercises involving the major muscle groups in the upper body, lower body, and core and involve completion of 10—15 repetitions to near fatigue per set early in training 1 , 97 , , , , progressing over time to heavier weights or resistance that can be lifted only 8—10 times.

A minimum of one set of repetitions to near fatigue, but as many as three to four sets, is recommended for optimal strength gains. Resistance machines and free weights e. Heavier weights or resistance may be needed for optimization of insulin action and BG control To avoid injury, progression of intensity, frequency, and duration of training sessions should occur slowly.

In most progressive training, increases in weight or resistance are undertaken first and only once when the target number of repetitions per set can consistently be exceeded, followed by a greater number of sets and lastly by increased training frequency. Initial instruction and periodic supervision by a qualified exercise trainer is recommended for most persons with type 2 diabetes, particularly if they undertake resistance exercise training, to ensure optimal benefits to BG control, BP, lipids, and CV risk and to minimize injury risk Inclusion of both aerobic and resistance exercise training is recommended.

Combined training thrice weekly in individuals with type 2 diabetes may be of greater benefit to BG control than either aerobic or resistance exercise alone However, the total duration of exercise and caloric expenditure was greatest with combined training in all studies done to date 51 , , , and both types of training were undertaken together on the same days. No studies have yet reported whether daily, but alternating, training is more effective or the BG effect of isocaloric combinations of training.

Milder forms of PA, such as yoga and tai chi, may benefit control of BG 98 , , , , , although their inclusion is not supported conclusively at this time.

Individuals with type 2 diabetes are encouraged to increase their total daily, unstructured PA to gain additional health benefits. Nonexercise activity thermogenesis i.

In an observational study, obese individuals sat for about 2. Moreover, use of objective measures such as step counters may enhance reaching daily goals. A meta-analysis of 26 studies with a total of 2, primarily nondiabetic participants 8 RCTs and 18 observational studies found that pedometer users increased PA by An important predictor of increased PA was the use of a goal, such as to take 10, steps per day Flexibility training may be included as part of a PA program, although it should not substitute for other training.

Older adults are advised to undertake exercises that maintain or improve balance , , which may include some flexibility training, particularly for many older individuals with type 2 diabetes with a higher risk of falling Although flexibility exercise stretching has frequently been recommended as a means of increasing joint range of motion ROM and reducing risk of injury, two systematic reviews found that flexibility exercise does not reduce risk of exercise-induced injury , A small RCT found that ROM exercises modestly decreased peak plantar pressures 94 , but no study has directly evaluated whether such training reduces risk of ulceration or injury in type 2 diabetes.

However, flexibility exercise combined with resistance training can increase ROM in individuals with type 2 diabetes and allow individuals to more easily engage in activities that require greater ROM around joints. Supervised and combined aerobic and resistance training may confer health additional benefits, although milder forms of PA such as yoga have shown mixed results. Persons with type 2 diabetes are encouraged to increase their total daily unstructured PA.

Flexibility training may be included but should not be undertaken in place of other recommended types of PA. While hyperglycemia can be worsened by exercise in type 1 diabetic individuals who are insulin deficient and ketotic due to missed or insufficient insulin , very few persons with type 2 diabetes develop such a profound degree of insulin deficiency. Therefore, individuals with type 2 diabetes generally do not need to postpone exercise because of high BG, provided that they are feeling well.

If hyperglycemic after a meal, individuals with type 2 diabetes will still likely experience a reduction in BG during aerobic work because endogenous insulin levels will likely be higher at that time ADA E level recommendation.

Of greatest concern to many exercisers is the risk of hypoglycemia. In individuals whose diabetes is being controlled by lifestyle alone, the risk of developing hypoglycemia during exercise is minimal, making stringent measures unnecessary to maintain BG Glucose monitoring can be performed before and after PA to assess its unique effect. Activities of longer duration and lower intensity generally cause a decline in BG levels but not to the level of hypoglycemia 9 , 29 , 75 , , While very intense activities can cause transient elevations in BG , , , intermittent high-intensity exercise done immediately after breakfast in individuals treated with diet only reduces BG levels and insulin secretion In insulin or insulin secretagogue users, who frequently have the effects of both exercise and insulin to increase glucose uptake, PA can complicate diabetes management , , , If controlled with diet or other oral medications, most individuals will not need carbohydrate supplements for exercise lasting less than an hour.

Intense, short exercise requires lesser or no carbohydrate intake Later-onset hypoglycemia is a greater concern when carbohydrate stores i. In particular, high-intensity exercise e.

In such cases, the consumption of 5—30 g of carbohydrate during and within 30 min after exhaustive, glycogen-depleting exercise will lower hypoglycemia risk and allow for more efficient restoration of muscle glycogen 31 , Persons with type 2 diabetes not using insulin or insulin secretagogues are unlikely to experience hypoglycemia related to PA. Users of insulin and insulin secretagogues are advised to supplement with carbohydrate as needed to prevent hypoglycemia during and after exercise.

Current treatment strategies promote combination therapies to address the three major defects in type 2 diabetes: impaired peripheral glucose uptake liver, fat, and muscle , excessive hepatic glucose release with glucagon excess , and insufficient insulin secretion. Medication adjustments for PA are generally necessary only with use of insulin and other insulin secretagogues , To prevent hypoglycemia, individuals may need to reduce their oral medications or insulin dosing before and possibly after exercise 83 , Before planned exercise, short-acting insulin doses will likely have to be reduced to prevent hypoglycemia.

Newer, synthetic, rapid-acting insulin analogs i. If only longer-acting insulins such as glargine, detemir, and NPH are being absorbed from subcutaneous depots during PA, exercise-induced hypoglycemia is not as likely , although doses may need to be reduced to accommodate regular participation in PA.

Doses of select oral hypoglycemic agents glyburide, glipizide, glimepiride, nateglinide, and repaglinide may also need to be lowered in response to regular exercise training if the frequency of hypoglycemia increases , These medications generally do not affect exercise responses, with some notable exceptions.

They may also block adrenergic symptoms of hypoglycemia, increasing the risk of undetected hypoglycemia during exercise. Diuretics, however, may lower overall blood and fluid volumes resulting in dehydration and electrolyte imbalances, particularly during exercise in the heat.

Statin use has been associated with an elevated risk of myopathies myalgia and myositis , particularly when combined with use of fibrates and niacin An extended discussion on medications can be found in the Handbook of Exercise in Diabetes Medication dosage adjustments to prevent exercise-associated hypoglycemia may be required by individuals using insulin or certain insulin secretagogues.

Individuals with angina and type 2 diabetes classified as moderate or high risk should preferably exercise in a supervised cardiac rehabilitation program, at least initially Moreover, some individuals who have an acute myocardial infarction may not experience chest pain, and up to a third may have silent myocardial ischemia 45 , For individuals with PAD, with and without intermittent claudication and pain in the extremities during PA, low-to-moderate walking, arm-crank, and cycling exercise have all been shown to enhance mobility, functional capacity, exercise pain tolerance, and QOL , Lower extremity resistance training also improves functional performance measured by treadmill walking, stair climbing ability, and QOL measures Vascular alterations are common in diabetes, even in the absence of overt vascular disease.

Endothelial dysfunction may be an underlying cause of many associated vascular problems 45 , In addition to traditional risk factors, hyperglycemia, hyperinsulinemia, and oxidative stress contribute to endothelial damage, leading to poor arterial function and greater susceptibility to atherogenesis 45 , 82 , Both aerobic and resistance training can improve endothelial function 46 , , but not all studies have shown posttraining improvement Known CVD is not an absolute contraindication to exercise.

Individuals with angina classified as moderate or high risk should likely begin exercise in a supervised cardiac rehabilitation program. PA is advised for anyone with PAD. Mild to moderate exercise may help prevent the onset of peripheral neuropathy Individuals without acute foot ulcers can undertake moderate weight-bearing exercise, although anyone with a foot injury or open sore or ulcer should be restricted to non—weight-bearing PA.

All individuals should closely examine their feet on a daily basis to prevent and detect sores or ulcers early and follow recommendations for use of proper footwear. Previous guidelines stated that persons with severe peripheral neuropathy should avoid weight-bearing activities to reduce risk of foot ulcerations , However, recent studies indicated that moderate walking does not increase risk of foot ulcers or reulceration in those with peripheral neuropathy , Peripheral neuropathy affects the extremities, particularly the lower legs and feet.

Hyperglycemia causes nerve toxicity, leading to nerve damage and apoptosis , , which causes microvascular damage and loss of perfusion. Individuals with peripheral neuropathy and without acute ulceration may participate in moderate weight-bearing exercise. Comprehensive foot care including daily inspection of feet and use of proper footwear is recommended for prevention and early detection of sores or ulcers.

Moderate walking likely does not increase risk of foot ulcers or reulceration with peripheral neuropathy. Moderate-intensity aerobic training can improve autonomic function in individuals with and without CV autonomic neuropathy CAN , , ; however, improvements may only be evident after an acute submaximal exercise Screening for CAN should include a battery of autonomic tests including HR variability that evaluate both branches of the autonomic nervous system.

Given the likelihood of silent ischemia, HR, and BP abnormalities, individuals with CAN should have physician approval and possibly undergo stress testing to screen for CV abnormalities before commencing exercise Exercise intensity may be accurately prescribed using the HR reserve method a percentage of the difference between maximal and resting HR, added to the resting value to approximate oxygen consumption during submaximal exercise with maximal HR directly measured, rather than estimated, for better accuracy 48 , The presence of CAN doubles the risk of mortality 48 , and indicates more frequency of silent myocardial ischemia , orthostatic hypotension, or resting tachycardia 76 , CAN also impairs exercise tolerance and lowers maximal HR , Although both sympathetic and parasympathetic dysfunctions can be present, vagal dysfunction usually occurs earlier.

Slower HR recovery after PA is associated with mortality risk 38 , Individuals with CAN should be screened and receive physician approval and possibly an exercise stress test before exercise initiation. Exercise intensity is best prescribed using the HR reserve method with direct measurement of maximal HR. In diabetic individuals with proliferative or preproliferative retinopathy or macular degeneration, careful screening and physician approval are recommended before initiating an exercise program.

Activities that greatly increase intraocular pressure, such as high-intensity aerobic or resistance training with large increases in systolic BP and head-down activities, are not advised with uncontrolled proliferative disease, nor are jumping or jarring activities, all of which increase hemorrhage risk 1. Diabetic retinopathy is the main cause of blindness in developed countries and is associated with increased CV mortality , Individuals with retinopathy may receive some benefits, such as improved work capacity, after low- to moderate-intensity exercise training 16 , While PA has been shown to be protective against development of age-related macular degeneration , very little research exists in type 2 diabetes.

Individuals with uncontrolled proliferative retinopathy should avoid activities that greatly increase intraocular pressure and hemorrhage risk. ACSM evidence category D. Both aerobic and resistance training improve physical function and QOL in individuals with kidney disease , , , although BP increases during PA may transiently elevate levels of microalbumin in urine.

Resistance exercise training is especially effective in improving muscle function and activities of daily living, which are normally severely affected by later-stage kidney disease Before initiation of PA, individuals with overt nephropathy should be carefully screened, have physician approval, and possibly undergo stress testing to detect CAD and abnormal HR and BP responses 1 , Exercise should be begun at a low intensity and volume because aerobic capacity and muscle function are substantially reduced, and avoidance of the Valsava maneuver or high-intensity exercise to prevent excessive increases in BP is advised 1.

Supervised, moderate aerobic exercise undertaken during dialysis sessions, however, has been shown to be effective as home-based exercise and may improve compliance , Microalbuminuria, or minute amounts of albumin in the urine, is common and a risk factor for overt nephropathy 45 and CV mortality Tight BG and BP control may delay progression of microalbuminuria , , along with exercise and dietary changes 81 , Exercise training delays the progression of diabetic nephropathy in animals 89 , , but few evidence is available in humans.

Exercise training increases physical function and QOL in individuals with kidney disease and may even be undertaken during dialysis sessions. The presence of microalbuminuria per se does not necessitate exercise restrictions. Most American adults with type 2 diabetes or at highest risk for developing it do not engage in regular PA; their rate of participation is significantly below national norms Additional strategies are needed to increase the adoption and maintenance of PA.

One of the most consistent predictors of greater levels of activity has been higher levels of self-efficacy 2 , 55 , 68 , which reflect confidence in the ability to exercise Social support has also been associated with greater levels of PA 93 , , , supporting the role of social networks in the spread of obesity Counseling delivered by health care professionals may be a meaningful source of support and effective source for delivery 7 , The availability of facilities or pleasant and safe places to walk may also be important predictors of regular PA When prescribing PA for the prevention or control of type 2 diabetes, the effects of the dose of the prescription on adherence are small Therefore, practitioners are encouraged to use factors such as choice and enjoyment in helping determine specifically how an individual would meet recommended participation.

Affective responses to exercise may be important predictors of adoption and maintenance, and encouraging activity at intensities below the ventilatory threshold may be most beneficial , , Many individuals with, or at risk of developing, type 2 diabetes prefer walking as an aerobic activity , and pedometer-based interventions can be effective for increasing aerobic activity 30 , , Finally, the emerging importance of sedentary behaviors in determining metabolic risk , suggests that future interventions may also benefit from attempting to decrease sitting time and periods of extended sedentary activity.

Large-scale trials such as the DPP and Look AHEAD provide some insight into successful lifestyle interventions that help promote PA by incorporating goal setting, self-monitoring, frequent contact, and stepped-care protocols 56 , 60 , 71 , Delivering these programs requires extensive access to resources, staff, and space, although they are cost-effective overall , These large studies are multifactorial, targeting several behaviors that include PA, but include multiple behavior interventions that also require changes in diet and focusing on weight loss or management Therefore, strategies for PA intervention in weight management are highly relevant to this population Fewer RCTs solely targeted PA behavior in individuals with or at risk of developing type 2 diabetes , , The results have been mixed, with some showing increased PA 67 , , , and others showing no effect , , Effective short-term programs have used print 67 , phone 44 , , , in-person , , or Internet 92 , delivery.

Long-term effectiveness of such interventions has not been assessed Efforts to promote PA should focus on developing self-efficacy and fostering social support from family, friends, and health care providers. Encouraging mild or moderate PA may be most beneficial to adoption and maintenance of regular PA participation. Lifestyle interventions may have some efficacy in promoting PA behavior. Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications.

Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. Most persons with type 2 diabetes can perform exercise safely as long as certain precautions are taken. The inclusion of an exercise program or other means of increasing overall PA is critical for optimal health in individuals with type 2 diabetes.

The authors have no financial support or professional conflicts of interest to disclose related to the article's content. ADA: Judith G. Regensteiner, PhD; Richard R. Rubin, PhD; and Ronald J. Individual name recognition is stated in the acknowledgments at the end of the statement.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. See accompanying article, p. National Center for Biotechnology Information , U. Journal List Diabetes Care v. Diabetes Care. Sheri R. Ronald J. Judith G. Bryan J. Richard R. Ann L. Find articles by Barry Braun. Author information Copyright and License information Disclaimer.

Corresponding author: Sheri R. Colberg, ude. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

See " Exercise and Type 2 Diabetes " on page This article has been cited by other articles in PMC. Abstract Although physical activity PA is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. Introduction Diabetes has become a widespread epidemic, primarily because of the increasing prevalence and incidence of type 2 diabetes.

Diagnosis, classification, and etiology of diabetes Currently, the American Diabetes Association ADA recommends the use of any of the following four criteria for diagnosing diabetes: 1 glycated hemoglobin A1C value of 6. Treatment goals in type 2 diabetes The goal of treatment in type 2 diabetes is to achieve and maintain optimal BG, lipid, and blood pressure BP levels to prevent or delay chronic complications of diabetes 5. Several biological mechanisms support a hypothesis of muscle-strengthen activities reducing the risk of type 2 diabetes and cardiovascular disease.

Resistance training has been shown to increase muscle mass, reduce BMI, improve insulin sensitivity, and increase glucose transport. It is unclear if these associations in short duration trials of biomarkers translate into reduced rates of incident disease.

The few studies examining weight lifting and incident cases of type 2 diabetes and cardiovascular disease have reported inconsistent results. Therefore, to provide additional information, in a large, prospective cohort of older women, we examined the associations of strength training with incident type 2 diabetes and cardiovascular disease. We analyzed data from the Women's Health Study — a completed randomized trial examining low-dose aspirin and vitamin E for the prevention of cardiovascular disease and cancer among 39 healthy women, conducted from to Following the scheduled conclusion of the trial, women have been followed in an observational study.

For this study, the 37 women who returned the month questionnaire that included a question on strength training were eligible. We excluded women with missing information on physical activity on this questionnaire, described below. For diabetes analyses, we excluded women with diabetes diagnosis before the month questionnaire, resulting in an analysis sample of 33 For cardiovascular disease, we excluded women with cardiovascular disease diagnoses before the month questionnaire, resulting in an analysis sample of 34 Women provided written consent to participate, and the study was approved by the institutional review board of Brigham and Women's Hospital.

On the baseline health questionnaire and periodically during follow-up, women reported their walking pace, flights of stairs climbed, and time spent per week in various leisure time activities or groups of activities.

Women were categorized based on minutes per week spent strength training and aerobic activities during the past year. Baseline information was collected on age, height, weight, smoking habits, menopausal status, hormone use, and parental history of myocardial infarction before age 60 years.

Dietary habits including alcohol consumption were assessed using a semi-quantitative food questionnaire. We ascertained type 2 diabetes and cardiovascular disease using standard methods of the Women's Health Study as described previously.

Cases of type 2 diabetes were validated using the American Diabetic Association criteria through a telephone interview, supplemental questionnaire, and medical records. Study physicians reviewed medical records to confirm cases of cardiovascular disease. Participant characteristics were described by minutes per week of strength training.

Multivariable adjusted model 1 : adjusted for age, smoking status, alcohol consumption, vegetable and fruit intake, saturated fat intake, total caloric intake, parental history of myocardial infarction, postmenopausal status, hormone therapy, randomization arm during the trial period;.

Multivariable adjusted model 2 : multivariable adjusted model 1, additionally adjusting for time spent in other activities lower intensity activities and either strength training or aerobic activity ;. Multivariable adjusted model 3 : multivariable adjusted model 2, additionally adjusted for body mass index BMI , calculated as weight kg divided by height squared m 2.

Nested models were used to examine the effects of different levels of potential confounder adjustment. Multivariable model 2 controlled for the overall physical activity volume to examine strength training independent of other physical activities, while model 3 examines the effects of controlling or potentially over-adjusting for the potential intermediate of BMI. The proportional hazards assumption was tested and found to meet the assumptions.

The joint association of strength training and aerobic activity was modeled using multivariable adjusted model 2. Due to the low number of cases among those who participated in strength training but no aerobic activities, we did not formally test for statistical interaction. Participant characteristics by categories of time spent strength training are displayed in Table 1. At the time of the month questionnaire, On average, women were Women who reported participating in any amount of strength training were more likely to have a lower BMI, more likely to engage in healthy dietary patterns, and less likely to be a current smoker compared to women who did not participate in strength training.

From to , women developed type 2 diabetes average follow-up of Further adjustment for body mass index attenuated the associations of strength training or aerobic activity with type 2 diabetes. Additionally adjusting for BMI did not substantially alter the associations of strength training or aerobic activity with cardiovascular disease. Engaging in both strength training and aerobic activity was associated with a greater rate reduction of type 2 diabetes and cardiovascular disease compared to aerobic activity alone Table 4.

Similar trends were observed when examining cardiovascular disease Table 4. Adjusted for age, smoking status, dietary habits, alcohol intake, postmenopausal status, hormone use, parental history of myocardial infarction, trial randomization, and time spent in lower intensity and conditioning activities.

Consistent evidence has shown that aerobic physical activity is associated with decreased rates of type 2 diabetes and cardiovascular disease. In a large cohort of older women, we observed that participating in strength training was associated with a significant reduction in both type 2 diabetes and cardiovascular disease compared to not participating in strength training when adjusting for time spent in other activities.

These findings are similar to studies conducted in a cohort of men and women from the Health Professionals Follow-up Study and Nurses' Health Study, which reported that weight lifting was associated with reduced rates of type 2 diabetes. Women who participated in higher amounts of both strength training and aerobic activity had a greater reduction in type 2 diabetes than those who engaged in higher levels of strength training or aerobic activity alone.

These data give evidence that the benefits of strength training and aerobic activity are independent and additional benefit may be conferred by participation in both even after controlling for total minutes spent in physical activity. Similar findings of larger magnitude of risk reduction with the combination of both types of activity also were observed in the Nurses' Health Study. This significantly larger weight loss may account for the lack of effect within the individual arms.

A similar effect of body weight was also seen in the WHS data where after controlling for BMI, the association of strength training and type 2 diabetes was attenuated and became statistically non-significant. It is also possible that adjusting for BMI when examining strength training and diabetes may be over-adjustment, removing part of the causal pathway. Previous studies examining biomarkers and risk factors may provide a mechanistic explanation of the independent benefit of strength training.

Resistance training has been shown to increase muscle mass and reduce BMI, potentially leading to greater insulin sensitivity.