ABSTRACT Diabetes mellitus is the most prevalent non communicable disease in Indian population. In the next 15 to 20 years India is expected to be the diabetic capital of the world. Type 2 diabetes mellitus caused predominantly by insulin resistance is the major contributor to the total diabetic percentage. Increase in obesity also increases the risk of type 2 diabetes mellitus. This research study evaluates the impact of combined resisted and aerobic exercises in bringing down the levels of HbA1C and also waist circumference. This helps in improving the glycemic control of patients with Diabetes mellitus and their quality of life

K Ramachandran

M Elumalai

R Mathangi

S S Subramanian

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ISSN: 0975-8585 
November - December 2014  RJPBCS   5(6)  Page No. 800 
Research Journal of Pharmaceutical, Biological and Chemical 
Sciences 
 
 
Impact of Combined Resisted and Aerobic Exercises on Obesity and Glycemic 
Control on Type 2 Diabetic Mellitus. 
 
SS Subramanian1, R Mathangi2*, K Ramachandran1, and M Elumalai3. 
 
1
Sree Balaji college of Physiotherapy, Bharath University, Chennai -100, & Research Scholar, University of Madras, Tamil 
Nadu, India. 
2
Department of Biochemistry, Sree Balaji Dental College and Hospital, Bharath University & Research Scholar, Bharathiar 
University, Coimbatore, Tamil Nadu, India. 
3
Department of Pharmacology, Sree Balaji Dental College and Hospital, Bharath University, Chennai -100, Tamil Nadu, 
India. 
 
 
ABSTRACT 
 
Diabetes mellitus is the most prevalent non communicable disease in Indian population. In the next 
15 to 20 years India is expected to be the diabetic capital of the world. Type 2 diabetes mellitus caused 
predominantly by insulin resistance is the major contributor to the total diabetic percentage. Increase in 
obesity also increases the risk of type 2 diabetes mellitus. This research study evaluates the impact of 
combined resisted and aerobic exercises in bringing down the levels of HbA1C and also waist circumference. 
This helps in improving the glycemic control of patients with Diabetes mellitus and their quality of life. 
Keywords: Resisted exercise, HbA1C, Diabetes, Waist circumference. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
*Corresponding author 
 
ISSN: 0975-8585 
November - December 2014  RJPBCS   5(6)  Page No. 801 
INTRODUCTION 
 
Type 2 diabetes remains one of the most challenging global health problems. With increasing 
prevalence the burden will escalate [1]. Visceral obesity is considered a major risk factor for impaired glucose 
tolerance, Type 2 diabetes mellitus and cardiovascular disease [2].  
 
Obesity has reached epidemic proportions globally and has become a major public health concern [3]. 
85% of world population has sedentary life style (WHO 2011). Passive life style is a risk factor for obesity [4]. 
Waist Circumference may be a stronger predictor for identification of metabolic and cardiovascular disease 
associated risk factors [5].
 
 
As of 2000, the number of obese adults has increased to over 300 million. Contrary to conventional 
wisdom, the obesity epidemic is not restricted to industrialized societies; in developing countries, it is 
estimated that over 115 million people suffer from obesity-related problems [6].  
 
The combination of obesity, hypertension, and poor glycemic control are associated with an increased 
relative mortality in Type 2 diabetes mellitus [7].  Combined aerobic and resisted exercises are effective in 
improving glycemic control [8]. Glycosylated Hemoglobin( HbA1C) is a better predictor of diabetes mellitus [9]. 
This research study aims at evaluating the combined effects of Aerobic and resisted exercises on Type 2 
diabetic mellitus among Indian population. 
 
MATERIALS AND METHODS 
 
After obtaining ethical committee approval for this research study, special diabetic camps were 
conducted at Chennai and subjects were recruited consent form from all the subjects were recruited. Consent 
forms from all the subjects were recorded. 100 known Type 2 diabetic mellitus subjects were at random 
allotted in two groups. 
 
Inclusion Criteria  
 
Known Type 2 diabetic mellitus of both sex between 30-60years, on due diabetic medication. 
 
Exclusion Criteria  
 
Type I Diabetic subjects, bed ridden diabetic subjects, subjects with uncontrolled diabetes and 
subjects who did not volunteer to participate in the study. 
 
Place and duration of the study 
 
The research study was conducted at Sree Balaji College of Physiotherapy, Chennai – 100 during the 
period from May 2013 to October 2013. 
 
Tools of measurement 
 
All the subjects waist circumference at iliac crest were measured at baseline, after 3 month and 6 
month and all the subjects fasting various sample were taken and their HbA1c was evaluated at baseline, 3
rd
 
month and after 6 month completion of the research. 
 
All participants were instructed not to change their usual diet and to continue their duly prescribed 
medication by their physician. 
 
Group I (Controls) were asked to maintain their inactive life style, Group II (Experimental subjects) 
have performed 3 days of Aerobic exercises per week and two days of resisted exercises per week using an 
inflatable physioball, for a period of 6 months. While aerobic activities involved proper stretching, warming up, 
aerobic activity and cooling period, resisted exercises involved 10 set of exercises with an inflatable physioball, 
where subjects own body weight forms the resistance. The resisted exercise training was done at the 
ISSN: 0975-8585 
November - December 2014  RJPBCS   5(6)  Page No. 802 
physiotherapy department of sree Balaji College of physiotherapy.chennai. Progression was made as per the 
guidelines of ACSM and ADA. 
 
RESULTS 
 
In the control group, Obese subjects with type 2 Diabetes mellitus who did not perform any physical 
activity the waist circumference was found to increase 2.4cm from the mean value in the first 3 months and 5 
cm increase from the mean value was found at the end of 6 months period. 
 
Similarly the HbA1C levels also increased by 0.22% in the first 3 months and 0.41 % at the end of the 6 
month duration indicating poor glycemic control. 
 
The results of waist circumference for the test group which underwent the resisted and aerobic 
exercise training showed considerable decrease in waist circumference. The waist circumference decreased 
4.28 cm from the mean value at the 3
rd
 month and 8 cm decrease in waist circumference was found at the end 
of 6 months. 
 
The HbA1C levels of the test group showed considerable reduction.0.66% decrease from mean value 
was found at the end of 3 months and 1.33% decrease from the mean value was found at the end of the 6 
months period. 
 
The results of waist circumference and HbA1c of all the subjects all the controls and test group 
subjects statistically analysed and results  are as follows. 
  
Results of paired” t” test of Group I and II and mean values on Waist Circumference and HbA1c levels 
 
Table 1: Results of paired  T test for waist circumference measured at 3
rd
 month and 6 th month within  group I (Control) 
 
Group I Mean ±SD P value 
Control 115.82±11.09 
˂0.01 
˂0.01 
After3rd month 
After 6
th
 month 
118.22±10.89* 
121.28±11.05
 *
 
Note:  – * p value is found to be statistically  Significant. 
 
Table 2: Results of paired  T test for HbA1C levels measured at 3
rd
 month and 6 th month within  group I (Control)HbA1C 
levels 
 
Group I Mean ±SD P Value 
At the start (o th Month) 7.63±0.54 
˂ 0.001 
˂ 0.0001 
After 3
rd
 month 
After 6
th
 month 
7.85±0.55** 
8.26± 0.54*** 
Note : ***-P value  Statistically very highly significant 
          * *-p value statistically  significant 
 
Table 3:  Results of paired  T test  for waist circumference(cm) measured at 3
rd
 month and 6 th month within  group II 
(Test Group) 
 
Group II Mean ±SD P Value 
Pre treatment 116.44±10.37 
˂ 0.001 
˂ 0.001 
Post treatment 3
rd
 Month 
Post Treatment 6
th
 month 
112.26±9.91** 
108.46±9.77** 
Note ; ** -p value statistically highly significant. 
 
Table 4: Results of paired  T test for HbA1C(%) measured at 3
rd
 month and 6 
th
 month within  group II 
 
Group II Mean ±SD P Value 
Pre treatment 7.88±0.49 
˂ 0.001 
˂ 0.001 
Post treatment 3
rd
 Month 
Post Treatment 6
th
 month 
7.22±0.44** 
6.65±0.38** 
Note: ** – p value is found to be  highly statistically  Significant. 
ISSN: 0975-8585 
November - December 2014  RJPBCS   5(6)  Page No. 803 
DISCUSSION 
 
Type 2 diabetes, though poorly understood, is known to be a disease characterized by an inadequate 
beta-cell response to the progressive insulin resistance that typically accompanies advancing age, inactivity, 
and weight gain [10]. The disease accounts for substantial morbidity and mortality from adverse effects on 
cardiovascular risk and disease-specific complications such as blindness and renal failure. The increasing global 
prevalence of type 2 diabetes is tied to rising rates of obesity [11] in part a consequence of social trends 
toward higher energy intake and reduced energy expenditure. However, the mechanisms that underlie 
individual differences in the predisposition to obesity remain obscure. 
 
 The concept that exercise is medicine [12] is gaining popularity all over the world. Physicians along with 
medicines also recommend increased physical activity for better quality of life, American college of sports 
medicine has recommended that an adult individual needs 150 mins of moderate physical activity per week 
[13]. Prescription of exercise for health and disease prevention has roots that began in antiquity more than 
two millennia ago. Individuals and concepts to remember are that Susruta of India was the first “recorded” 
physician to prescribe moderate daily exercise [14,15].
 
 
 The global epidemic of overweight and obesity – “globesity” - is rapidly becoming a major public health 
problem in many parts of the world [16].
  
World Health Organization (WHO) in its latest projections indicate 
that globally in 2008 approximately 1.5 billion adults (age 20+) were overweight and at least 500 million adults 
were obese. WHO further projects that by 2015, at least 2.3 billion adults will be overweight and more than 
700 million will be obese. Overweight and obesity are associated with an increased risk of developing 
hypertension and diabetes [17-21].
 
 
As displayed in the Table a decrease in waist circumference 4cm from mean value during 3
rd
 month 
and a decrease in waist circumference of  8cm  from mean after  6month among  experimental subjects 
indicates that combined  aerobic and resisted exercises are effective in obese subjects in reducing abdominal 
obesity. 
 
Health care spending of a obese person is 25% more than an average person of that age [22] a major 
economic benefit for obese Type 2 diabetic patient as an outcome of this study. 
 
Improved muscle quality, decreased inflammation increased Adipotectin levels [24] an increased 
muscle mass on composition [23]
 
and a decrease in cardiovascular risk factors [25] 
 
Wood, 1991 being other 
benefits following lowering of waist circumference, another major outcome of this study benefiting Type 2 
diabetic who have done combined Aerobic and resisted exercises. 
 
Reduction in HbA1C levels can reduce the risk of developing micro and macro vascular complications 
of diabetes [26] as Type 2 diabetes mellitus is a silent disease which begins to develop several years before it is 
clearly diagnosed, a better understanding of its pathophysiology, is a pre requisite to detect individuals at high 
risk of diabetes earlier and consequently to design and develop preventive strategies [27]. 
 
A reduction of 1.3%in HbA1C in 3months and 2% decrement in HbA1C at 6months period among 
subjects who have performed combined Aerobic and resisted exercises findings are similar to a study where a 
decrease in HbA1C by 1.2% [28]. 
 
1% decrease of HbA1C reduces the risk of stroke by 11% subjects in the experimental group have 
benefited by a reduction in the risk of developing stroke by 22 %. Also 1% decrease in HbA1c reduces the risk 
of micro vascular disease by 37% hence experimental subjects have benefited by 74% against micro vascular 
disease hence by improving glycemic control. 1% decrement in HbA1C reduces the risk of myocardial ischemia 
by 14% hence subjects who have performed combined Aerobic and resisted exercises have a reduced risk of 
myocardial ischemia by 28% [29].
 
 
 
 
 
 
ISSN: 0975-8585 
November - December 2014  RJPBCS   5(6)  Page No. 804 
CONCLUSION 
 
Combined resisted exercises and aerobic training helps in improving glycemic control in type 2 
diabetic subjects and  type 2 diabetic subjects have added advantage against prevention of micro and macro 
vascular complications. 
 
REFERENCES 
  
[1] Whiting DR, Guariguata L, Weil C, Shaw J. Diab Res Clin Pract 2011 ;94(3):311–21.  
[2] Rexrode KM, Hennekens CH, Willett WC, Colditz GA, Stampfer MJ, Rich-Edwards JW, et al. JAMA 1997 
; 277(19):1539–45.  
[3] Swinburn BA, Sacks G, Hall KD, McPherson K, Fine good DT, Moodie ML, et al. Lancet 2011; 
378(9793):804–14.  
[4] Barnes AS. Obesity and Sedentary Lifestyles. Tex Heart Inst J 2012; 39(2):224–7.  
[5] Baik I, Ascherio A, Rimm EB, Giovannucci E, Spiegelman D, Stampfer MJ, et al.. 2000 1;152(3):264–71.  
[6] http://www.who.int/nutrition/topics/expert_consultation_wc_whr/en/ 
[7] Diem DP, Deplazes M, Fajfr R, Bearth A, Müller B, Christ ER, et al. Diabetologia 2003; 46(11):1581–5.  
[8] Tokmakidis SP, Zois CE, Volaklis KA, Kotsa K, Touvra A-M.. Eur J Appl Physiol 92 (4-5):437–42.  
[9] Predictive value of HbA1c for incident diabetes among subjects with impaired glucose tolerance—
analysis of the Indian Diabetes Prevention Programmes A. Ramachandran, C. Snehalatha, A. Samith 
Shetty and A. Nanditha 
[10] Stumvoll M, Goldstein BJ, van Haeften TW. Lancet 2008;371:2153-2156 
[11] Zimmet P, Alberti KG, Shaw J. Nature 2001;414:782-787. 
[12] Karpovich PV. Arch Phys Med Rehabil 49: 66–76. 
[13] Hauben D.Acta Chir Plast 28; 65–68. 
[14] Garber CE et al. Med Sci Sports Exerc 2011;43:1334–1359. 
[15] Charles M. Tipton. Adv Physiol Edu 2014;38:109-117 
[16] World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO 
consultation. World Health Organ Tech Rep Ser. 2000;894.  
[17] Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Obes Res 2000;8:605–19.  
[18] Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM, et al. JAMA 2005;293:1868–
74. 
[19] Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE, et al. Ann Intern Med 
1998;128:81–8.  
[20] Wannamethee SG, Shaper AG. Diabetes Care 1999;;22:1266–72.  
[21] Gelber RP, Gaziano JM, Manson JE, Buring JE, Sesso HD. Am J Hypertens 2007;20:370 
[22] Lancet 2010, OECD health Data. 
[23] Chambliss HO. Clin J Sport Med 2005;;15(2):113–5.  
[24] Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Int J Med Sci 
2007;4(1):19–27.  
[25] Wood PD, Stefanick ML, Williams PT, Haskell WL. N Engl J Med 1991;15;325(7):461–6.  
[26] Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000; 355 (9200): 253–9.  
[27] Adam G Tabák,  Markus Jokela, Tasnime N Akbaraly,  Eric J Brunner, Mika Kivimäki, and Daniel R Witte 
The Lancet 2009;373 (9682) : 2215–21.  
[28] Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, et al. Arch Phys Med 
Rehabil 2005;86(8):1527–33.  
[29] I M Stratton. Diabetologia 2006; 49(8):1761–9.  


Impact of Combined Resisted and Aerobic Exercises on Obesity and Glycemic Control on Type 2 Diabetic Mellitus

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Impact of Combined Resisted and Aerobic Exercises on Obesity and Glycemic Control on Type 2 Diabetic Mellitus

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