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Sunday, December 5, 2010

Combining aerobic and resistance training appears helpful for patients with diabetes

ScienceDaily (Nov. 23, 2010) ? Performing a combination of aerobic exercise and resistance training was associated with improved glycemic levels among patients with type 2 diabetes, compared to patients who did not exercise, according to a study in the November 24 issue of JAMA. The level of improvement was not seen among patients who performed either aerobic exercise or resistance training alone.

Although it is generally accepted that regular exercise provides substantial health benefits for individuals with type 2 diabetes, the exact exercise type (aerobic vs. resistance vs. both) has been unclear. "Given that the 2008 Federal Physical Activity Guidelines recommend aerobic exercise in combination with resistance training, the unanswered question as to whether for a given amount of time the combination of aerobic and resistance exercise is better than either alone has significant clinical and public health importance," the authors write.

Timothy S. Church, M.D., M.P.H., Ph.D., of Louisiana State University System, Baton Rouge, La., and colleagues conducted the HART-D trial, which compared among 262 sedentary women and men with type 2 diabetes the effect of aerobic training, resistance training, and a combination of both on change in hemoglobin A1c levels (HbA1c; a minor component of hemoglobin [the substance of red blood cells that carries oxygen to the cells] and to which glucose [blood sugar] is bound; HbA1c levels are used to monitor the control of diabetes mellitus). Study participants were 63.0 percent women, 47.3 percent nonwhite, average age of 56 years, HbA1c level of 7.7 percent and duration of diabetes of 7.1 years. The individuals were enrolled in the 9-month exercise program between April 2007 and August 2009. Forty-one participants were assigned to the nonexercise control group; 73 to resistance training sessions; 72 to aerobic exercise sessions; and 76 to combined aerobic and resistance training.

The researchers found that the absolute change in HbA1c in the combination training group vs. the control group was -0.34 percent. In neither the resistance training (-0.16 percent) nor the aerobic (-0.24 percent) groups were changes in HbA1c significant compared with those in the control group. The prevalence of increases in hypoglycemic medications were 39 percent in the control, 32 percent in the resistance training, 22 percent in the aerobic, and 18 percent in the combination training groups.

"Only the combination exercise group improved maximum oxygen consumption compared with the control group. All exercise groups reduced waist circumference from [-.75 to -1.1 inches] compared with the control group," the authors write. The resistance training group lost an average of 3.1 lbs. fat mass and the combination training group lost an average of 3.7 lbs., compared with the control group.

"The primary finding from this randomized, controlled exercise trial involving individuals with type 2 diabetes is that although both resistance and aerobic training provide benefits, only the combination of the 2 were associated with reductions in HbA1c levels," the researchers write. "It also is important to appreciate that the follow-up difference in HbA1c between the combination training group and the control group occurred even though the control group had increased its use of diabetes medications while the combination training group decreased its diabetes medication uses."

Editorial: Combined Aerobic and Resistance Exercise for Patients With Type 2 Diabetes

Ronald J. Sigal, M.D., M.P.H., of the University of Calgary, Alberta, Canada, and Glen P. Kenny, Ph.D., and Dr. Sigal of the University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, write in an accompanying editorial that this study provides important evidence on the effects of aerobic and resistance training on improving hemoglobin A1c levels.

"Based on the results of the HART-D trial, patients with type 2 diabetes who wish to maximize the effects of exercise on their glycemic control should perform both aerobic and resistance exercise. The HART-D trial clarifies that, given a specific amount of time to invest in exercise, it is more beneficial to devote some time to each form of exercise rather than devoting all the time to just one form of exercise."

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Timothy S. Church, MD, MPH, PhD; Steven N. Blair, PED; Shannon Cocreham, BS; Neil Johannsen, PhD; William Johnson, PhD; Kimberly Kramer, MPH; Catherine R. Mikus, MS; Valerie Myers, PhD; Melissa Nauta, BS; Ruben Q. Rodarte, MS, MBA; Lauren Sparks, PhD; Angela Thompson, MSPH; Conrad P. Earnest, PhD. Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes. JAMA, 2010;304(20):2253-2262 DOI: 10.1001/jama.2010.1710

Note: If no author is given, the source is cited instead.

View the original article here

Wednesday, October 27, 2010

Postoperative high blood sugar appears to be associated with surgical site infection

ScienceDaily (Sep. 25, 2010) ? High blood glucose levels after surgery may be an important risk factor for infection at the surgical site in patients having general surgery, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.

Surgical site infection accounts for 14 percent to 17 percent of hospital-acquired infections, making it the third most common type of infection acquired at health-care facilities and the most common among patients having surgery, according to background information in the article. "Studies have shown that these infections prolong the hospital length of stay after surgery, increase rehospitalization rates and dramatically increase the use of emergency services and health care costs," the authors write.

Ashar Ata, M.B.B.S., M.P.H., and colleagues at Albany Medical College, Albany, N.Y., reviewed the medical records of patients who had general or vascular surgery between Nov. 1, 2006, and April 30, 2009. A total of 2,090 patients were randomly selected from a quality improvement database and then matched with medical records to obtain information about postoperative glucose values. These values were available for 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal.

Overall, 7.42 percent of the patients developed surgical site infections, including 14.11 percent of those who had colorectal surgery, 10.32 percent who had vascular surgery and 4.36 percent of those who had other general surgery.

Among general surgery patients, factors associated with surgical site infection included age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose (hyperglycemia). However, after adjusting for postoperative blood glucose level, all other factors were not significant predictors of infection. A subanalysis of colorectal surgery patients found that a postoperative serum glucose level higher than 140 milligrams per deciliter was the only significant predictor of surgical site infection.

Among vascular surgery patients, operative time and diabetes were the only significant predictors of surgical site infection, which was not associated with postoperative hyperglycemia.

Hyperglycemia may impair the immune system, and insulin may have anti-inflammatory and other anti-infective activities. However, it is possible that the accumulation of other risk factors for surgical site infection cause hyperglycemia rather than vice versa; hence, further study is needed, the authors note.

"In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," they continue. "If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an independent risk factor for postsurgical infection in general surgery patients, this would give surgeons a modifiable variable to reduce the incidence of postoperative infection."