Two weekly sessions of combined aerobic and resistance exercise are sufficient to provide beneficial effects in subjects with Type 2 diabetes mellitus and metabolic syndrome

This study was performed to establish whether only 2 sessions per week of combined aerobic and resistance exercise are enough to reduce glycated hemoglobin (HbA1c) and to induce changes in skeletal muscle gene expression in Type 2 diabetes mellitus (DM2) subjects with metabolic syndrome. Eight DM2 subjects underwent a 1-yr exercise program consisting of 2 weekly sessions of 140 min that combined aerobic [at 55–70% of maximal oxygen uptake (VO2max)] and resistance circuit training [at 60–80% of 1 repetition maximum (RM)]. The training significantly improved VO2max) (from 33.5±3.8 ml/kg/min to 38.2±3.5 ml/kg/min, p=0.0085) and muscle strength (p<0.05). Changes over baseline were significant for HbA1c, reduced by 0.45% (p=0.0084), fasting blood glucose (from 8.8±1.5 to 6.9±2.2 mmol/l, p=0.0132), waist circumference (from 98.9±4.8 to 95.9±4.6 cm, p=0.0054), body weight (from 87.5±10.7 to 85.7±10.1 kg, p=0.0375), systolic blood pressure (from 137±15 to 126±8 mmHg, p=0.0455), total cholesterol (from 220±24 to 184±13 mg/dl, p=0.0057), and LDL-cholesterol (from 150±16 to 105±15 mg/dl, p=0.0004). Mitochondrial DNA/nuclear DNA ratio at 6 and 12 months did not change. There was a significant increase of mRNA of peroxisome proliferator-activated receptor (PPAR)-γ after 6 months of training(p=0.024); PPARα mRNA levels were significantly increased at 6 (p=0.035) and 12 months (p=0.044). The mRNA quantification of other genes measured [mitochondrially encoded cytochrome c oxidase subunit II (MTCO2), cytochrome c oxidase subunit Vb (COX5b), PPARγ coactivator 1α (PGC-1α), glucose transporter 4 (GLUT 4), forkhead transcription factor BOX O1 (FOXO-1), carnitine palmitoyltransferase 1 (CPT-1), lipoprotein lipase (LPL), and insulin receptor substrate 1 (IRS-1)] did not show significant changes at 6 and 12 months. This study suggests that a twice-per-week frequency of exercise is sufficient to improve glucose control and the expression of skeletal muscle PPARγ and PPARα in DM2 subjects with metabolic syndrome.