Undulatory physical resistance training program increases maximal strength in elderly type 2 diabetics

Gilberto Monteiro dos Santos Fábio Tanil Montrezol Luciana Santos Souza Pauli Angélica Rossi Sartori-Cintra Emilson Colantonio Ricardo José Gomes Rodolfo Marinho Leandro Pereira de Moura José Rodrigo Pauli About the authors

Abstracts

Objective

To investigate the effects of a specific protocol of undulatory physical resistance training on maximal strength gains in elderly type 2 diabetics.

Methods

The study included 48 subjects, aged between 60 and 85 years, of both genders. They were divided into two groups: Untrained Diabetic Elderly (n=19) with those who were not subjected to physical training and Trained Diabetic Elderly (n=29), with those who were subjected to undulatory physical resistance training. The participants were evaluated with several types of resistance training’s equipment before and after training protocol, by test of one maximal repetition. The subjects were trained on undulatory resistance three times per week for a period of 16 weeks. The overload used in undulatory resistance training was equivalent to 50% of one maximal repetition and 70% of one maximal repetition, alternating weekly. Statistical analysis revealed significant differences (p<0.05) between pre-test and post-test over a period of 16 weeks.

Results

The average gains in strength were 43.20% (knee extension), 65.00% (knee flexion), 27.80% (supine sitting machine), 31.00% (rowing sitting), 43.90% (biceps pulley), and 21.10% (triceps pulley).

Conclusion

Undulatory resistance training used with weekly different overloads was effective to provide significant gains in maximum strength in elderly type 2 diabetic individuals.

Muscular strength; Physical education and training; Aging; Aged; Diabetes mellitus, type 2


Objetivo

Verificar os efeitos de um protocolo de treinamento físico resistido ondulatório nos ganhos de força máxima em idosos diabéticos do tipo 2.

Métodos

Participaram do estudo 48 indivíduos, com idade entre 60 e 85 anos, de ambos os gêneros. Eles foram divididos em dois grupos: Idosos Diabéticos Não Treinados (n=19), com aqueles não submetidos ao treinamento físico, e Idosos Diabéticos Treinados (n=29), que foram submetidos ao protocolo de treinamento físico resistido ondulatório. Os idosos foram avaliados em diversos equipamentos de musculação, antes e após o treinamento resistido ondulatório, por meio do teste de uma repetição máxima. Os participantes realizaram o treinamento resistido ondulatório três vezes por semanas, durante um período de 16 semanas. A sobrecarga do programa foi alternada, sendo em 1 semana equivalente a 50% de uma repetição máxima e, na outra semana, a 70% de uma repetição máxima. A análise estatística revelou diferenças significativas (p<0,05) entre os resultados dos testes pré e pós-período de treinamento resistido ondulatório em um período de 16 semanas.

Resultados

Os ganhos médios de força foram de 43,20% (extensão de joelho), 65,00% (flexão de joelho), 27,80% (supino sentado máquina), 31,00% (remada sentado), 43,90% (bíceps pulley) e 21,10% (trícepspulley).

Conclusão

O protocolo de treinamento resistido ondulatório utilizado com sobrecargas semanais diferentes foi eficiente em proporcionar significativos ganhos de força máxima em idosos diabéticos do tipo 2.

Força muscular; Educação física e treinamento; Envelhecimento; Idoso; Diabetes mellitus tipo 2


INTRODUCTION

Diabetes mellitus (DM) is a high-incidence disease in Brazil and the world, especially type 2 DM (DM2). This type of diabetes primarily affects adults and the elderly, and has a close relation with obesity. Type 2 DM is a multifactoral condition, characterized by disorders of intermediate metabolism resulting from decreased secretion of insulin and/or decrease in its action (insulin resistance) in peripheral tissues (skeletal muscle and adipose tissue), resulting in hyperglycemia.(1DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004;88(4):787-835, ix. Review.,2Kaul K, Tarr JM, Ahmad SI, Kohner EM, Chibber R. Introduction to diabetes mellitus. Adv Exp Med Biol. 2012;771:1-11. Review.) Additionally, other comorbidities may arise along the course of the disease, such as retinopathy, peripheral and autonomic neuropathy, nephropathy, etc. The reduction of muscle mass is a common clinical aspect and is related to the negative protein turnover (proteolysis) in diabetic patients.(1DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004;88(4):787-835, ix. Review.,2Kaul K, Tarr JM, Ahmad SI, Kohner EM, Chibber R. Introduction to diabetes mellitus. Adv Exp Med Biol. 2012;771:1-11. Review.)

The process of sarcopenia that occurs in senescence is an important aspect that increases the risk of development of insulin resistance and DM2. The etiology of sarcopenia involves various factors, such as loss of motor neurons and cell apoptosis, resulting in a considerable decrease in the number of muscle fibers, especially those for rapid contraction (type II fibers), leading to diminished strength and functional quality of the skeletal muscle.(3Larsson L, Sjödin B, Karlsson J. Histochemical and biochemical changes in human skeletal muscle with age in sedentary males, age 22--65 years. Acta Physiol Scand. 1978;103(1):31-9.,4Lexell J, Taylor CC, Sjostrom M. What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year-old men. J Neurol Sci. 1988;84(2-3):275-94.)

The greatest part of the change is associated with aging, and resistance physical exercise can modify this process, or at least mitigate it. Recent scientific evidences are precise in showing that resistance training can prevent the decline in aged-related muscle mass besides maintaining plasticity and capacity for hypertrophy, even during the 10th decade of life, attenuating dynapenia.(5Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol. 1988;64(3):1038-44.,6Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263(22):3029-34.)

The consequences of skeletal muscle reduction related to aging are diverse, including reduced muscle strength and potency, with a greater frequency of falls and fractures, lower resting metabolic rate, reducing the capacity for oxidizing lipids and an increase in abdominal adiposity. With the increased body fat and physical inactivity, glucose uptake measured by insulin in the skeletal muscle of elderly patients diminished considerably.(7Bunprajun T, Henriksen TI, Scheele C, Pedersen BK, Green CJ. Lifelong Physical Activity Prevents Aging-Associated Insulin Resistance in Human Skeletal Muscle Myotubes via Increased Glucose Transporter Expression. PLoS One. 2013;8(6):e66628.)

All these factors contribute towards the loss of autonomy and independence, favoring the development of the metabolic syndrome, with an elevated risk of death by cardiovascular diseases. In this way, maintenance of muscle mass may contribute towards the prevention of disease development, such as obesity, dyslipidemia, and DM2.(8Rosenberg IH. Sarcopenia: origins and clinical relevance. Clin Geriatr Med. 2011;27(3):337-9.)Various studies showed that the capacity to react to strength training is preserved in elderly individuals and diabetics, with significant gains in physical capacity.(5Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol. 1988;64(3):1038-44.,6Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263(22):3029-34.,9Newton RU, Hakkinen K, Hakkinen A, McCormick M, Volek J, Kraemer WJ. Mixed-methods resistance training increases power and strength of young and older men. Med Sci Sports Exerc. 2002;34(8):1367-75.

10 Porter MM, Nelson ME, Singh MAF, Layne JE, Morganti CM, Trice I, et al. Effects of long-term persistence training and detraining on strength and physical activity in older women. J Aging Phys Act. 2002;10(3):260-70.

11 Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353-5.

12 Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.

13 Herriott MT, Colberg SR, Parson HK, Nunnold T, Vinik AI. Effects of 8 weeks of flexibility and resistance training in older adults with type 2 diabetes. Diabetes Care. 2004;27(12):2988-9.

14 Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, et al. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil. 2005;86(8):1527-33.
-1515 Ibañez J, Izquierdo M, Argüelles I, Forga L, Larrión JL, García-Unciti M, et al. Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care. 2005;28(3):662-7.)

Periodization of resistance training or the changes planned in volume and intensity of the exercise are used to maximize the gains in strength and functional conditioning. In this sense, various types of resistance training have been developed. The most common types of training are those with linear (classic) and non-linear (undulatory) characteristics. The big difference between the two plans of work is that in the undulatory periodized training, changes in intensity and volume of the exercise are more frequent and can occur between the days of training, or between the weeks of training.(1616 Fleck SJ. Non-linear periodization for general fitness & athletes. J Hum Kinet. 2011;29A:41-5.,1717 Prestes J, Frollini AB, de Lima C, Donatto FF, Foschini D, de Cassia Marqueti R, et al. Comparison between linear and daily undulatory periodized resistance training to increase strength. J Strength Cond Res. 2009;23(9):2437-42.) In response to resistance training, it is possible to notice an increase in baseline energy expenditure, reduction in body adiposity and lower level of inflammatory process (inflammatory cytokines), and increased glucose uptake by means of increased expression of the glucose type 4 transporter (Glut-4) in skeletal muscle in obese and diabetic individuals.(9Newton RU, Hakkinen K, Hakkinen A, McCormick M, Volek J, Kraemer WJ. Mixed-methods resistance training increases power and strength of young and older men. Med Sci Sports Exerc. 2002;34(8):1367-75.

10 Porter MM, Nelson ME, Singh MAF, Layne JE, Morganti CM, Trice I, et al. Effects of long-term persistence training and detraining on strength and physical activity in older women. J Aging Phys Act. 2002;10(3):260-70.

11 Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353-5.

12 Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.
-1313 Herriott MT, Colberg SR, Parson HK, Nunnold T, Vinik AI. Effects of 8 weeks of flexibility and resistance training in older adults with type 2 diabetes. Diabetes Care. 2004;27(12):2988-9.,1818 Strasser B, Pesta D. Resistance training for diabetes prevention and therapy: experimental findings and molecular mechanisms. Biomed Res Int. 2013;2013:805217. Review.,1919 Ahmadizad S, Ghorbani S, Ghasemikaram M, Bahmanzadeh M. Effects of short-term nonperiodized, linear periodized and daily undulatory periodized resistance training on plasma adiponectin, leptin and insulin resistance. Clin Biochem. 2014;47(6):417-22.) Although both types of training (linear and undulatory) result in increased strength, and improvements in metabolism and functional aptitude, some studies indicate that the results are more positive with undulatory periodization.(1717 Prestes J, Frollini AB, de Lima C, Donatto FF, Foschini D, de Cassia Marqueti R, et al. Comparison between linear and daily undulatory periodized resistance training to increase strength. J Strength Cond Res. 2009;23(9):2437-42.,1919 Ahmadizad S, Ghorbani S, Ghasemikaram M, Bahmanzadeh M. Effects of short-term nonperiodized, linear periodized and daily undulatory periodized resistance training on plasma adiponectin, leptin and insulin resistance. Clin Biochem. 2014;47(6):417-22.

20 Miranda F, Simão R, Rhea M, Bunker D, Prestes J, Leite RD, et al. Effects of linear vs. daily undulatory periodized resistance training on maximal and submaximal strength gains. J Strength Cond Res. 2011;25(7):1824-30.
-2121 Foschini D, Araújo RC, Bacurau RF, De Piano A, De Almeida SS, Carnier J, et al. Treatment of obese adolescents: the influence of periodization models and ACE genotype. Obesity (Silver Spring). 2010;18(4):766-72.) Such a fact may be related to the greater stress presumably required with this type of training, and, consequently, more effective neuromuscular adaptations.

As long as our results show positive adaptations in response to undulatory resistance training (URT), new studies are needed with protocols having specific characteristics as to intensity, zone of repetition, and recovery interval to evaluate maximal force, both of lower and upper limbs, especially in elderly type 2 diabetes patients.

OBJETIVE

To verify the effects of an undulatory physical resistance training protocol on maximal strength gains in elderly type 2 diabetic individuals.

METHODS

Initially, the study counted on 70 volunteers; however, as per the exclusion criteria, 48 elderly diabetic individuals of both genders, which had entered the multidisciplinary quality of life program developed at the Department Preventive Medicine of Unimed, in the city of Santos, state of São Paulo, remained at the end of the experiment.

All experiments were carried out in the city of Santos during the years 2011 and 2012. The study was performed in accordance with the principles of the Declaration of Helsinki, and was previously submitted to and approved by the Research Ethics Committee of the Universidade Federal de São Paulo, under protocol number 0524/11. The volunteers signed an Informed Consent Form before starting the physical training program.

Selection was made by a physician, following the criteria and guidelines established by the American Diabetes Association.(2222 American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005;28 Suppl 1:S4-S36.) Only type 2 diabetic individuals who used antidiabetic drugs and were not dependent on insulin were included, with an age range of 60 to 85 years. The individuals were randomly divided into two groups: Untrained Diabetic Elderly (UDE, n=19), with 13 men; and Trained Diabetic Elderly (TDE, n=29), with 24 women. The participants of the UDE group had the right to be submitted to the same training program soon after the intervention period, with the purpose of offering a physiological response similar to that of the TDE. In order to participate in the project, all individuals declared that they did had not engaged in any type of regular physical activity or supervised exercise in the previous 6 months.

Excluded from the group, whether at selection or during the experimental period, were those individuals who presented with limitations or muscular, joint, or bone diseases; diseases that could compromise the cardiovascular response to the physical training; use of psychotropic substances, such as alcohol and/or other drugs; chronic complications caused by diabetes (autonomic neuropathy, nephropathy, and retinopathy). The volunteers with an attendance under 85% or with three consecutive absences were also excluded. Evasion from the program was greater among male individuals in the TDE. This explains the smaller number of men for this group at the end of the program.

The anthropometric evaluations (weight and height) were performed by a single evaluator, using a digital scales (Filizola® Campo Grande, MS, Brazil), and a stadiometer affixed to the wall (Sanny® Fortaleza, CE, Brazil), as per previous description.(2323 Jelliffe DB. Evaluación del estado nutrición de la comunidad. Ginebra: Organización Mundial de La Salud; 1968.) From the results obtained, the body mass index (BMI) was calculated. This analysis was only made at the beginning of the experiment in order to establish the profile of the sample studied.

To evaluate blood glucose, a few precautions were taken regarding the procedures, such as: a) the time for collections was between 7:00 am and 8:00 am; b) the participants were kept in fasting state for 12 hours; c) before blood was collected, it was verified that the subjects had not participated in any physical activity on the day before the test; d) all were to remain sitting in a comfortable chair for 10 minutes before the blood was collected; e) the blood was collected by a specialized nurse, using appropriate materials for the procedure. Blood glucose was measured using a specific commercial kit (Laborlab®, Paulínia, SP, Brazil), following the manufacturer’s recommendations. Just like with the anthropometric analyses, fasting blood glucose was done only at the beginning of the experiment, in order to establish the profile of the sample studied.

The maximal strength test was done according to the following steps: (1) the participants were familiarized with the equipment during 2 weeks (three sessions/week), using the minimal resistance of the equipment; (2) for the test, the individuals first participated in a warm-up activity, consisting of stretching and performing 20 repetitions with minimal load in the equipment of the test; at the end of the warm-up, the volunteers had 3 minutes of recovery period; (3) next, the 1RM test began, in which the individuals performed two repetitions of the proposed exercise; if they were able to perform it, they had a 5-minute recovery period, and then a new attempt was made with a heavier load; (4) the steps were followed until the moment in which the individuals were able to do only one repetition, thus obtaining the maximal load for each exercise proposed. It is important to emphasize that each person had, at most, five attempts to attain a load regarding the 1RM. When more than five attempts were necessary, the test was performed on another day. The evaluations were done before and after the end of the program, and the last evaluation was performed 72 hours after the last exercise session.

Undulatory physical resistance training protocol

The diabetic elderly individuals were submitted to resistance exercises on body building equipment or with free weights (dumbbells), lasting 50 minutes, with a weekly frequency of 3 days (Monday, Wednesday, and Friday), with a series prescribed for each exercise, reaching three series along the program (total duration of 16 weeks).

During the first week, the volunteers performed the physical training initiating with a load equivalent to 50%, with one series on Monday, two on Wednesday, and three series on Friday. During the second week, training began with a load equivalent to 70%, with one series on Monday, two on Wednesday, and three series on Friday. From the third week on, the three series were maintained for each exercise, alternating each week of the work load (50% on odd weeks – 1st, 3rd, 5th, 7th, 9th, 11th, 13th, and 15th week - and 70% on the even weeks – 2nd, 4th, 6th, 8th, 10th, 12th, 14th, and 16th week). The equipment used was Nakagin (SP, Brazil).

Periodization of training was based on the recommendation of progressive strength training for initiating adults and type 2 diabetics(2424 Colberg SR, Albright AL, Blissmer BJ, Braun B, Chasan-Taber L, Fernhall B, Regensteiner JG, Rubin RR, Sigal RJ; American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2010;42(12):2282-303.,2525 American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687-708. Review.). In this way, the protocol consisted of a weekly alteration of the intensity divided into a week of moderate overload (70% of 1RM, 8 repetitions) and a week of light overload (50% of 1RM, 12 repetitions).

Figure 1 shows the model of URT used. The interval between the series depended on the load adopted at the training session, with 2-minute intervals for the weeks with moderate loads and one minute for the weeks with light loads.

Figure 1
Experimental design of undulatory periodization. 1RM: test with one maximal repetition; Rep: repetitions

Ten exercises were selected, working both the agonist and antagonist muscles of each movement, without provoking muscular imbalance. Exercises for the abdominal and lumbar regions were not forgotten, since these are essential for stabilization and balance of many movements. The muscle groups shown on chart 1 were evaluated and trained. Also included were the following exercises: sitting development with dumbbells, standing plantar flexion, partial abdominal exercises, and lumbar extension. The latter exercises were not evaluated by the difficulty of performing the maximal load test or adjustments during training.

Chart 1
Type of exercise and muscles involved in the program of physical resistance training used in evaluating the test with one single maximal repetition

Work load adjustment was made throughout the time that the subject performed with the established load, 15 repetitions in training at 50% of 1RM (going back to the 12 repetitions) and 12 repetitions in training at 70% of 1RM (going back to the 8 repetitions). The UDE group received no intervention and was instructed to not change their lifestyle habits during this period of the physical training protocol.

Statistical analysis

Initially, all data were submitted to the Kolmogorov-Smirnov test, with the purpose of determining if their distributions of probability presented as parametric or non-parametric. All the data showed normal distribution. Values were expressed as mean ± standard deviation (SD). To compare the behaviors of the TDE and UDE groups along time, according to each variable of interest, the model of variance analysis (ANOVA) with repeated measurements was used, followed by Bonferroni’s post-testing. The values were considered statistically significant when p<0.05. For all these procedures, the GraphPad Prism statistical software, version 3.02 (GraphPad Software, San Diego, CA, USA) was used.

RESULTS

The results in reference to characterization of the sample were extracted from the databank of the participants in the multidisciplinary quality of life program, of the Preventive Medicine Sector of Unimed, in the city of Santos. The anthropometric variables evaluated obtained parametric distribution for both groups (age, body mass, stature, and BMI). The BMI indicated that the participants were within the range considered as pre-obese, with an increased risk of comorbidities, according to the World Health Organization (WHO).(2626 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253.) Capillary glucose demonstrated that all individuals presented with altered glycemic levels, which is characteristic of type 2 diabetic individuals (Table 1).

Table 1
Anthropometric and fasting glucose characteristics of the groups of Untrained and Trained Diabetic Elderly at baseline

In the 1RM test, the statistical analysis revealed significant differences between the pre- and post-period results of the TDE intervention group. The participants in this group obtained significant gains in maximal strength in all exercises performed (knee extension and flexion, supine, and triceps and biceps pulley) (Table 2). These results indicate that the URT was effective in increasing the maximal strength in elderly diabetics after 16 weeks of intervention. Such a fact, however, was not observed in the UDE group.

Table 2
Data obtained from the test with a single maximal repetition of each exercise, as per group and time

DISCUSSION

In an attempt of intervention and health improvement, especially an increase in maximal strength, which might have repercussions in terms of positive changes in the body, such as increased autonomy, independence, and metabolic changes,(1818 Strasser B, Pesta D. Resistance training for diabetes prevention and therapy: experimental findings and molecular mechanisms. Biomed Res Int. 2013;2013:805217. Review.) in the present study an URT protocol was used with changes in weekly intensity and volume. As to elderly diabetic patients, the mean increases in strength for each muscle group evaluated in the study were very significant.

The biggest mean increase in strength was observed for the movement of knee flexion (65.1%), followed by movements of knee extension and biceps pulley (43.2% and 43.9%), respectively. The movements of knee extension and knee flexion are fundamental in daily life activities for squatting, rising, and in moving around, and are of vital importance for this population. The increased strength of the muscles involved in elbow flexion (biceps pulley) of 43.9% relative to the pre-training condition was able to help the individuals in performing their daily tasks and work which require the use of upper limbs such as, for example, transporting a bag of purchases from the grocery store, hanging clothes on a line to dry and then remove them, carry objects, etc. It seems that this increased strength in elbow flexor muscles is related to the fact that the brachial biceps muscles, brachial, and radial muscles participate in the movement both in the biceps pulley and in sitting rowing, which could justify, a least in part, this increased gain in strength.

The effects of the process of aging, associated with physical inactivity, act in different manners on the upper and lower limbs. The decline in strength seems to be much more accentuated in the lower limbs.(2727 Grimby G, Danneskiold-Samsøe B, Hvid K, Saltin B. Morphology and enzymatic capacity in arm and leg muscles in 78-81 year old men and women. Acta Physiol Scand. 1982;115(1):125-34.

28 Poulin MJ, Vandervoort AA, Paterson DH, Kramer JF, Cunningham DA. Eccentric and concentric torques of knee and elbow extension in young and older men. Can J Sport Sci. 1992;17(1):3-7.

29 Lynch NA, Metter EJ, Lindle RS, Fozard JL, Tobin JD, Roy TA, et al. Muscle quality. I. Age-associated differences between arm and leg muscle groups. J Appl Physiol.1999;86(1):188-94.
-3030 Nikolić M, Malnar-Dragojević D, Bobinac D, Bajek S, Jerković R, Soić-Vranić T.. Age-related skeletal muscle atrophy in humans: an immunohistochemical and morphometric study. Coll Antropol. 2001;25(2):545-53.) In this way, it is expected that for sedentary individuals, the response to physical strength training is more evident in the lower limbs, since these are the ones least trained. Since in the present study there were participants who were not physically active elderly individuals, this response to training was observed, revealing an increase in strength greater for the lower limbs.

In the other exercises performed, also verified were mean increases in strength for the movement of chest press (27.8%) and triceps pulley (21.1%). Such a fact demonstrates that the physical training developed was efficient in increasing the strength of the participants. Nevertheless, an even more accentuated increase was expected in this variable for the movement of forearm extension, since in the chest press and in dumbbells shoulder press, the triceps muscle also participates in putting forth strength, resulting, therefore, in a sum of recruited muscles in the movement.

The particularity of this study was in the proposal of an URT protocol, with a frequency of three times a week, with different intensity and volume each weak, performed in a periodic manner (load increase). This type of training with the objective of increasing the maximal strength of elderly diabetic individuals has been explored very few times in literature. When compared to the various protocols of physical strength training used in type 2 diabetics, the physical training we propose proved very efficient in promoting increased strength.(8Rosenberg IH. Sarcopenia: origins and clinical relevance. Clin Geriatr Med. 2011;27(3):337-9.

Newton RU, Hakkinen K, Hakkinen A, McCormick M, Volek J, Kraemer WJ. Mixed-methods resistance training increases power and strength of young and older men. Med Sci Sports Exerc. 2002;34(8):1367-75.

10 Porter MM, Nelson ME, Singh MAF, Layne JE, Morganti CM, Trice I, et al. Effects of long-term persistence training and detraining on strength and physical activity in older women. J Aging Phys Act. 2002;10(3):260-70.

11 Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353-5.
-1212 Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.) Studies in literature performed with other populations (children and young adults), have also observed more significant responses in maximal strength and metabolic parameters (for example: insulin sensitivity) with URT relative to linear resistance training.(1717 Prestes J, Frollini AB, de Lima C, Donatto FF, Foschini D, de Cassia Marqueti R, et al. Comparison between linear and daily undulatory periodized resistance training to increase strength. J Strength Cond Res. 2009;23(9):2437-42.,2121 Foschini D, Araújo RC, Bacurau RF, De Piano A, De Almeida SS, Carnier J, et al. Treatment of obese adolescents: the influence of periodization models and ACE genotype. Obesity (Silver Spring). 2010;18(4):766-72.)

In our study, the mean increase in strength of the lower limbs was 54.15%, and of the upper limbs, 30.95% in 16 weeks of physical training; these results are similar or superior to those found in literature.(8Rosenberg IH. Sarcopenia: origins and clinical relevance. Clin Geriatr Med. 2011;27(3):337-9.

Newton RU, Hakkinen K, Hakkinen A, McCormick M, Volek J, Kraemer WJ. Mixed-methods resistance training increases power and strength of young and older men. Med Sci Sports Exerc. 2002;34(8):1367-75.

10 Porter MM, Nelson ME, Singh MAF, Layne JE, Morganti CM, Trice I, et al. Effects of long-term persistence training and detraining on strength and physical activity in older women. J Aging Phys Act. 2002;10(3):260-70.

11 Ishii T, Yamakita T, Sato T, Tanaka S, Fujii S. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353-5.
-1212 Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-82.,2323 Jelliffe DB. Evaluación del estado nutrición de la comunidad. Ginebra: Organización Mundial de La Salud; 1968.) However, one needs to mention that such a fact may be related to the characteristic of the sample, which consisted of diabetic elderly individuals, who were not physically active, and unfamiliar with strength training. According to the principles of training, physically trained individuals (i.e., highly fit) presented with lower adaptive responses to a physical exercise program.(3131 Fleck SJ, Kraemer WJ. Fundamentos do treinamento de força muscular. Porto Alegre: Artmed; 2006.)

Dunstan et al.,(3232 Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002;25(10):1729-36.) based on resistance physical training with progressive loads, initiating with 50% and ending the training period with loads reaching 80% of 1RM, with a duration of physical exercise program of 6 months, obtained results similar to those found in this study as to strength gain in elderly diabetic individuals. However, different from the present study, the greatest strength gain was obtained in the upper limbs of trained elderly diabetics.(3232 Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002;25(10):1729-36.) On the other hand, Cauza et al.,(1414 Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, et al. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil. 2005;86(8):1527-33.)when using a program of physical resistance training with increased intensity and volume with a progressive increase of working loads and a duration of 16 weeks, in a population of adults with DM2, also observed good responses to strength training in this specific population. Similar to the results of the present study, Cauza et al. also observed greater increases in strength in lower limbs when compared to the upper limbs.(1414 Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, et al. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil. 2005;86(8):1527-33.)

In another study, also with a population of older diabetic women, with a mean age of 68 years, Guido et al. obtained results similar to those of the present study, observing that resistance training for 24 weeks, with progressive intensities every 4 weeks, initiating at 60% and reaching up to 80% of 1RM, was capable of increasing the strength of lower limbs, especially of the extensor muscles of the knee.(3333 Guido M, Lima RM, Benford R, Leite TK, Pereira RW, Oliveira RJ. Efeitos de 24 semanas de treinamento resistido sobre índices da aptidão aeróbia de mulheres idosas. Rev Bras Med Esporte. 2010;16(4):259-63.) Although the results obtained in literature point to increased strength with linear training, one of the positive aspects observed in URT is that the execution (routine) of the exercises becomes less monotonous and therefore, there is greater attendance of the program participant.(1616 Fleck SJ. Non-linear periodization for general fitness & athletes. J Hum Kinet. 2011;29A:41-5.)

The increase in the strength obtained with resistance physical training in the present study may result in better quality of life and in autonomy of the participants. Strength is a very important physical capability, which, when increased, also affords improvement of other capacities, such as agility and balance, which is extremely important in order to avoid accidents at home in senior citizens.(3434 Silva A, Almeida GJ, Cassilhas RC, Cohen M, Peccin MS, Tufik S, et al. Equilíbrio, coordenação e agilidade de idosos submetidos à prática de exercícios físicos resistidos. Rev Bras Med Esporte. 2008;14(2):88-93.) Ferreira and Gobbi(3535 Ferreira L, Gobbi S. Agilidade geral e agilidade de membros superiores em mulheres de terceira idade treinadas e não treinadas. Rev Bras Cineantropom Desempenho Hum. 2003;5(1):46-53.) verified that active older women, who consequently have better levels of strength, show better levels of agility in the lower limbs when compared to sedentary older women.

Taking into consideration that with aging there is the so-called “sarcopenia” phenomenon, which is the decrease of muscle mass, and that the capacity of the muscle to generate strength in human beings declines especially after 60 years of age,(3636 Häkkinen K, Pakarinen A, Newton RU, Kraemer WJ. Acute hormone responses to heavy resistance lower and upper extremity exercise in young versus old men. Eur J Appl Physiol Occup Physiol. 1998;77(4):312-9.)one can say that resistance training performed by the participants contributed towards retarding this process, allowing additional gains in strength throughout 16 weeks. However, new studies are needed with active diabetic individuals and for a greater period of time, in order to evaluate the results of the program proposed in this study.

CONCLUSION

According to the sample studied, and taking into consideration the limitations of the present study (smaller number of female individuals in the group of Untrained Diabetic Elderly relative to the group Trained Diabetic Elderly, besides the short intervention period – 16 weeks), it was possible to conclude that the undulatory resistance physical training protocol used proved efficient in providing significant increases in maximal strength, both in lower and upper limbs in type 2 diabetic individuals who are not physically active. We suggest that the program proposed herein be used as a different alternative in strength training for the aged type 2 diabetic population, and especially, in reference to healthcare professionals who treat this specific population.

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Publication Dates

  • Publication in this collection
    Oct-Dec 2014

History

  • Received
    28 Apr 2014
  • Accepted
    29 Aug 2014
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