Objective To evaluate the effects of resistance training on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus (T2DM) and overweight/obesity. Design Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources PubMed, Web of Science, Scopus, Science Direct, Cochrane Library and Google Scholar databases were searched from inception up to May 2024. The search strategy included the following keywords: diabetes, resistance exercise and strength training. Eligibility criteria for selecting studies RCTs published in English comparing resistance training alone with non-exercising standard treatment. Participants were adults diagnosed with T2DM and concurrent overweight/obesity (body mass index (BMI) ≥25 kg/m 2 ). Results A total of 18 RCTs qualified involving 1180 patients (48.6/51.4 female/male ratio; 63.3±7.0 years; 29.3±4.3 kg/m 2 ). Waist circumference (standardised mean differences (SMD) −0.85 cm, 95% CI −1.66 to −0.04), waist-to-hip ratio (SMD −0.72, 95% CI −1.30 to −0.15), high-density lipoprotein cholesterol (SMD +0.40 mg/dL, 95% CI 0.07 to −0.72), triglycerides (SMD −0.54 mg/dL, 95% CI −1.06 to −0.02), fasting blood glucose (SMD −0.65 mmol/L, 95% CI −1.19 to −0.12), fasting insulin (SMD −0.74 uIU/mL, 95% CI −1.12 to −0.36) and glycated haemoglobin (SMD −0.32%, 95% CI −0.63 to −0.01) improved compared with standard treatment. The risk of bias was low to unclear, and the quality of evidence was very low to moderate. Conclusions Resistance training as a standalone exercise intervention in the management and treatment of T2DM with concurrent overweight/obesity is associated with many cardiometabolic benefits when compared with standard treatment without exercise. PROSPERO registration number CRD42022355612.
Non-exercise equations developed from self-reported physical activity can estimate maximal oxygen uptake (VO(2)max) as well as submaximal exercise testing. The International Physical Activity Questionnaire (IPAQ) is the most widely used and validated self-report measure of physical activity. This study aimed to develop and test a VO(2)max estimation equation derived from the IPAQ-Short Form (IPAQ-S). College-aged males and females (n = 80) completed the IPAQ-S and performed a maximal exercise test. The estimation equation was created with multivariate regression in a gender-balanced subsample of participants, equally representing five levels of fitness (n = 50) and validated in the remaining participants (n = 30). The resulting equation explained 43% of the variance in measured VO(2)max (SEE = 5.45 ml·kg(-1)·min(-1)). Estimated VO(2)max for 87% of individuals fell within acceptable limits of error observed with submaximal exercise testing (20% error). The IPAQ-S can be used to successfully estimate VO(2)max as well as submaximal exercise tests. Development of other population-specific estimation equations is warranted.
Apply It! • Understand the importance of accurate measures of heart rate during submaximal exercise testing to estimate the client's V̇O 2max . • Delineate the most appropriate formula to estimate maximal heart rate for a given population to provide more accurate exercise intensity prescriptions. • Identify ways to reduce the error in estimating V̇O 2max when using submaximal exercise testing.
FigureChristine is a sedentary 52-year-old woman with prediabetes and a body mass index of 34 kg/m2. Her personal physician has provided a medical clearance, with no restrictions for exercise. Christine is an avid fan of the Biggest Loser television program and has read about high-intensity interval training online and in several women’s magazines; she is convinced that this is the answer to losing weight and improving her health. She is interested in purchasing a large personal training package from you only if you put her on a high-intensity program and act as a boot camp instructor to help motivate her. You suspect that a high-intensity program is not appropriate for Christine, but you really need some new clients because business has been slow lately. Will you take her as a client? After all, Christine’s doctor cleared her for exercise, and you will monitor her closely. Or will you refuse to take Christine as a client with the requirement that you put her on a high-intensity program? Exercise professionals are faced regularly with ethical issues and must make decisions about the best way to handle situations that can sometimes be difficult. Many professional organizations have a code of ethics to guide members of the profession in making these difficult decisions. Professionals are expected to adhere to the code of ethics to preserve the integrity of the profession and to prevent exploitation of the client or patient. Maintaining the integrity of the profession not only benefits the client but also other individuals who are part of that profession. A “code of ethics” is defined as a guide of principles designed to help professionals conduct business honestly and with integrity. A code of ethics document may outline the mission and values of the organization, how professionals are supposed to approach problems, the ethical principles based on the organization’s core values and the standards to which the professional will be held (5). The American College of Sports Medicine (ACSM) Code of Ethics for certified and registered professionals is intended to help all certified and registered ACSM Credentialed Professionals (ACSMCP) establish and maintain a high level of ethical conduct, as defined by standards by which an ACSMCP may determine the appropriateness of his or her conduct (Table). The code applies to all ACMCPs, regardless of ACSM membership status (applies to both members and nonmembers). The principles and standards outlined in the Code of Ethics are general statements expressing the ethical and professional ideals certificants and registrants are expected to display in their professional activities and can help guide the decisions of the exercise professional.TABLE: ACSM’s Code of Ethics for Certified and Registered ProfessionalsScope of practice and confidentiality are two areas that can present ethical dilemmas for the exercise professional. Scope of practice is the range of responsibility that determines the boundaries within which a profession operates and defines what tasks a professional can do, with whom the professional can work, what settings are appropriate, and what type of oversight is necessary (4,6). Each ACSM certification has its own unique scope of practice that is further delineated as job tasks and finally as knowledge and skill statements. Certified professionals are expected to adhere to the job tasks and skills outlined by ACSM to be considered operating within the boundaries of their certification. It is challenging when clients ask exercise professionals to go beyond their scope of practice. For example, clients may ask for advice on nutritional supplements or ask to be put on a diet. They might complain about shoulder pain and ask you what you think is wrong with it. In these cases, it usually is more appropriate to refer the client to the appropriate professional such as a registered dietician or a physician rather than to go beyond one’s scope of practice.FigureExercise professionals have a great deal of access to private information, most often associated with a patient’s medical history. However, clients and patients often share many other elements about their lives with exercise professionals, even when that information is not solicited. Although it can be tempting to discuss something with a colleague or tell a story to friends or family members, exercise professionals have the ethical responsibility to maintain confidentiality at all times. Individuals in supervisory roles often are faced with difficult situations that affect employees or members of their facility. Abiding by the ACSM Code of Ethics also can help guide these decisions. Consider the following situation. Samantha Smith, B.S., ACSM-HFS, fitness director at a corporate fitness center, needs to replace a group exercise instructor who is leaving the company. The vice president of the company regularly works out in the fitness center and knows that a new instructor needs to be hired within the next 2 weeks. He casually mentions that his girlfriend likes to take exercise classes and, the next day, his girlfriend applies for the job. She has been taking Zumba classes for about a year but has never taught any type of class and is not certified. Although Samantha knows that this job candidate is not qualified, she feels pressure to hire her because she is the vice president’s girlfriend. The scope of practice and performance domains for the ACSM-HFS certification identify management as an essential responsibility. An examination of the job tasks with associated knowledge and skill statements can help Samantha justify her decision that a more qualified individual is needed to teach safe and effective group exercise classes. Specifically, the job task states that the HFS “establishes policies and procedures for the management of health fitness facilities based on accepted safety and legal guidelines, standards, and regulations” (3). In the previous example, it was a conflict of interest for the vice president to suggest his girlfriend be hired for a position within the company he worked for,but conflicts of interest commonly occur. The ACSM Ethical and Professional Conduct Committee has defined a conflict of interest as “a significant financial interest in a business or other direct or indirect personal gain or consideration provided by a business that may compromise or have the appearance of compromising an ACSM member’s professional judgment (2). Company X might offer to provide a fitness director with $500 worth of free fitness apparel in exchange for requiring the group exercise instructors to wear Company X clothing when teaching class. Is this a conflict of interest? Most conflict of interest statements include disciplinary statements that allow the profession to define a standard of conduct and ensure that individual practitioners meet this standard. If an individual does not act according to the standard of conduct, he or she can be disciplined by the professional organization. This allows professionals who abide by the acceptable standard of conduct to practice with the knowledge that they will not be undermined by individuals who have questionable professional ethics. It also helps to maintain public trust in the profession. For example, the profession suffers when there is a news item about an individual who was injured by a personal trainer who was not certified, certified by an organization that is not credible, or performs duties that are outside of his or her scope of practice. The ACSM discipline policy is: “Any ACSMCP may be disciplined or lose his or her certification or registry status for conduct which, in the opinion of the Executive Committee of the ACSM Committee on Certification and Registry Boards (CCRB), goes against the principles set forth in this Code. Such cases will be reviewed by the ACSM CCRB Ethics Subcommittee, which may include a liaison from the ACSM Committee on Ethics and Professional Conduct, as needed, based on the ACSM membership status of the ACSMCP. The ACSM Ethics Subcommittee will make an action recommendation to the ACSM CCRB Board’s Executive Council for final review and approval” (1). In addition to ACSM’s Code of Ethics for certified and registered professionals, there also is a Code of Ethics for members of ACSM (http://www.acsm.org/join-acsm/membership-resources/code-of-ethics). This code of ethics also may help you make decisions about the health and safety of your clients and patients and protect against members or professionals who are deficient in ethical conduct.
This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011-2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents' acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels.
Obesity and smoking continue to be some of the nation’s top health concerns. This study explored the interrelationships among exercise, nutrition and smoking behaviors among young college adults. Undergraduate psychology students (N=612) completed an internet survey that included measures of exercise, nutrition and smoking behaviors. Analyses revealed that more males were exercising while more females were eating nutritiously. The Transtheoretical Model constructs stage of change for exercise and eating nutritiously were significantly related. There were no significant differences found for smoking behavior across the stages of change for exercise or nutrition. Health professionals and researchers should not assume that regular exercise is associated with a non-smoking status or that a non-smoking status is associated with consuming a more nutritious diet. Further research and intervention is strongly urged targeted towards both men and women among the young college adult population.
In a vascular rehabilitation program, 28% of our frail elderly patients are unable to be tested with traditional progressive exercise protocols at program entry due to the high (2.0 miles/h or 3.2 km/h) initial treadmill speeds. The purpose of this investigation was to compare a new progressive treadmill protocol which has a reduced initial speed (1.0 mile/h or 1.6 km/h) to an established protocol performed at 2.0 miles/h (3.2 km/h) to determine the comparability and reproducibility of the new protocol. Eleven patients with arterial claudication performed three symptom-limited exercise tests in random order. Two tests used the new protocol while the remaining trial used the established protocol. Claudication pain was measured using a 5-point scale. Oxygen consumption, heart rate, minute ventilation, respiratory exchange ratio and blood pressure at peak exercise were similar among the three trials. There were strong intraclass correlations for peak oxygen consumption (r = 0.97), onset of claudication (r = 0.96) and maximum walking time (r = 0.98) between the two trials using the new protocol. There was also a significant correlation between the new protocol and the established protocol for peak oxygen consumption (r = 0.90) and maximum walking time (r = 0.89). The new progressive treadmill protocol represents a valid, reliable protocol for patients with arterial claudication. This protocol may be useful for testing patients with a low functional capacity so that clinically appropriate exercise prescriptions can be established and the efficacy of treatments can be determined.
The purpose of this study was to identify the population prevalence across the stages of change (SoC) for regular physical activity and to establish the prevalence of people at risk. With support from the National Institutes of Health, the American Heart Association, and the Robert Wood Johnson Foundation, nine Behavior Change Consortium studies with a common physical activity SoC measure agreed to collaborate and share data. The distribution pattern identified in these predominantly reactively recruited studies was Precontemplation (PC) = 5% (± 10), Contemplation (C) = 10% (± 10), Preparation (P) = 40% (± 10), Action = 10% (± 10), and Maintenance = 35% (± 10). With reactively recruited studies, it can be anticipated that there will be a higher percentage of the sample that is ready to change and a greater percentage of currently active people compared to random representative samples. The at-risk stage distribution (i.e., those not at criteria or PC, C, and P) was approximately 10% PC, 20% C, and 70% P in specific samples and approximately 20% PC, 10% C, and 70% P in the clinical samples. Knowing SoC heuristics can inform public health practitioners and policymakers about the population's motivation for physical activity, help track changes over time, and assist in the allocation of resources.
To characterize physical activity and physical function by stage of change and age in older adults.One thousand two hundred thirty-four individuals completed The Yale physical activity survey (YPAS), stage of change for exercise, and the Up-and-Go physical function test.Most subjects were in the maintenance (50.4%) or precontemplation stages (21/0%). YPAS scores were higher and Upand-Go scores were lower as exercise stage increased. Physical activity and physical function scores were lower in older age groups.Higher stages were positively associated with physical activity and physical function. Age was a significant moderator variable affecting stage, physical activity, and physical function.
