(First paragraph) Flexibility is often downplayed as unimportant to fitness. However, flexibility training is imperative to maintain full range of motion (ROM) of joints, particularly in individuals with type 2 diabetes, who may experience limited joint mobility due to glycation of joint structures (1). Maladies such as “frozen shoulder” are common complaints in type 2 diabetes (2)

Colberg, Sheri R.

Herriot, Matthew T.

Nunnold, Tanja

Parson, Henri K.

Vinik, Aaron I.

English

Old Dominion University

Old Dominion UniversityODU Digital CommonsHuman Movement Sciences Faculty Publications Human Movement Sciences2004Effects of 8 Weeks of Flexibility and ResistanceTraining in Older Adults With Type 2 DiabetesMatthew T. HerriotOld Dominion UniversitySheri R. ColbergOld Dominion University, scolberg@odu.eduHenri K. ParsonTanja NunnoldOld Dominion UniversityAaron I. VinikFollow this and additional works at: https://digitalcommons.odu.edu/hms_fac_pubsPart of the Endocrinology, Diabetes, and Metabolism Commons, and the Exercise PhysiologyCommonsThis Article is brought to you for free and open access by the Human Movement Sciences at ODU Digital Commons. It has been accepted for inclusionin Human Movement Sciences Faculty Publications by an authorized administrator of ODU Digital Commons. For more information, please contactdigitalcommons@odu.edu.Repository CitationHerriot, Matthew T.; Colberg, Sheri R.; Parson, Henri K.; Nunnold, Tanja; and Vinik, Aaron I., "Effects of 8 Weeks of Flexibility andResistance Training in Older Adults With Type 2 Diabetes" (2004). Human Movement Sciences Faculty Publications. 66.https://digitalcommons.odu.edu/hms_fac_pubs/66Original Publication CitationHerriott, M. T., Colberg, S. R., Parson, H. K., Nunnold, T., & Vinik, A. I. (2004). Effects of 8 weeks of flexibility and resistance trainingin older adults with type 2 diabetes. Diabetes Care, 27(12), 2988-2989. doi:10.2337/diacare.27.12.2988Effects of 8 Weeks of Flexibility andResistance Training in Older Adults WithType 2 DiabetesMATTHEW T. HERRIOTT, MSED1SHERI R. COLBERG, PHD1HENRI K. PARSON, PHD2TANJA NUNNOLD, MSED1AARON I. VINIK, MD, PHD2F lexibility is often downplayed as un-important to fitness. However, flexi-bility training is imperative tomaintain full range of motion (ROM) ofjoints, particularly in individuals withtype 2 diabetes, who may experience lim-ited joint mobility due to glycation ofjoint structures (1). Maladies such as “fro-zen shoulder” are common complaints intype 2 diabetes (2).Conflicting evidence exists about theeffect of resistance training on flexibility.For healthy adults, such training will im-prove flexibility as long as exercises incor-porate a full ROM, opposing musclegroups (agonist and antagonist) aretrained, and flexibility exercises are done.However, combined strength and flexibil-ity training may not be as effective as flex-ibility training alone for improving jointROM in shoulder abduction (3), althoughstrength training alone may increase it(4). Thus, the purpose of this study was todetermine whether 8 weeks of combinedtraining improves flexibility in olderadults with and without type 2 diabetes.RESEARCH DESIGN ANDMETHODS — Nine individuals withtype 2 diabetes (5 men and 4 women) and10 sedentary control subjects (6 men and4 women) participated. The mean age forthe two groups (type 2 diabetic and con-trol subjects) was 50.6  2.8 and 54.7 2.8 years, respectively, and BMI was sim-ilar prior to training (32.0  2.4 and33.1  1.4 kg/m2). Height, weight, fast-ing blood, body composition (skinfolds),and resting 12-lead electrocardiogramdata were collected, as well as peak aero-bic capacity (VO2 peak) on a cycle er-gometer. All measurements were repeatedexactly 48–72 h following the completionof training.Tests of flexibility included thosetaken with an inclinometer (spine, kneeflexion, and hip flexion and extension)and shoulder ROM, prayer sign (5), andmodified sit-and-reach flexibility tests.Subjects performed one-repetition maxi-mum (1-RM) testing at a local YMCA oneight different resistance training ma-chines (five upper and three lower body).Subjects performed flexibility and re-sistance training on 3 nonconsecutivedays of the week over an 8-week period.During each training session, they per-formed three sets of 8–12 repetitions ofeach of the eight exercises for which their1-RM had been determined, done at 50,60, and 70% of their individual 1-RM (6).After each exercise session, subjects per-formed various standard flexibility exer-cises that stretched the major musclesgroups of the chest, shoulders, and legsfor 10–30 s each.Subject characteristics were com-pared using Student’s t tests. Repeated-measures ANOVA was used to comparetype 2 diabetic and control groups onmeasures of strength and flexibility. Thelevel of significance was set at P  0.05.RESULTS — Type 2 diabetic and con-trol subjects were well matched for age,body weight, BMI, percent body fat, andVO2 peak. Type 2 diabetic subjects dif-fered from control subjects only on theiroverall blood glucose control (HbA1c),which was higher in the type 2 diabeticgroup (pretraining 7.2  0.3 vs. 5.7 0.1%) and not significantly lowered bytraining.Individual measures of flexibilitywere similar between the type 2 diabeticand control groups both before and aftertraining. Only the type 2 diabetic group,however, significantly improved on anyflexibility measure with training, specifi-cally the modified sit-and-reach, left kneeflexion, and left hip flexion measures; nomeasure for control subjects improvedsignificantly. Additionally, the type 2diabetic group increased overall lowerbody flexibility (including right and leftknee flexion and hip flexion/extension)significantly more than control subjects(Fig. 1).As for strength testing, the 1-RM val-ues for type 2 diabetic subjects did notdiffer from control subjects before or aftertraining. Both groups exhibited signifi-cant strength gains, though, on almostevery resistance machine tested, with un-changed peak aerobic capacity.CONCLUSIONS — Eight weeks ofcombined flexibility and resistance train-ing caused significant strength gains inolder adults with and without type 2diabetes. Flexibility gains were somewhatlimited but occurred only in the type 2diabetic subjects despite similar initiallevels of flexibility.The average strength increases of 36and 41% for upper and lower body exer-cises, respectively, after 8 weeks of thrice-weekly resistance training are similar toprior research (7,8). Subjects doing cir-cuit weight training for 8 weeks have ex-perienced strength gains ranging from 15to 43% (7). Adults with type 2 diabetes,impaired glucose tolerance, or hyperinsu-linemia have also shown a 38 and 50%● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●From the 1Department of Exercise Science, Sport, Physical Education, and Recreation, Old DominionUniversity, Norfolk, Virginia; and the 2Department of Medicine, The Strelitz Diabetes Institutes, EasternVirginia Medical School, Norfolk, Virgina.Address correspondence and reprint requests to Sheri R. Colberg, PhD, ESPER Department, Old Domin-ion University, Norfolk, VA 23529. E-mail: scolberg@odu.edu.Received for publication 12 August 2004 and accepted on 20 August 2004.Abbreviations: 1-RM, one-repetition maximum; ROM, range of motion.A table elsewhere in this issue shows conventional and Système International (SI) units and conversionfactors for many substances.© 2004 by the American Diabetes Association.B R I E F R E P O R T2988 DIABETES CARE, VOLUME 27, NUMBER 12, DECEMBER 2004increase in upper body and lower bodystrength, respectively, after 20 weeks ofvariable resistance training (8).In healthy populations, combinedstrength and flexibility training is not aseffective as flexibility training alone forimproving joint ROM in shoulder abduc-tion (3). In older adults, both strengthtraining alone and combined strength andaerobic training increase joint ROM sig-nificantly when compared with aerobicalone or no training (4). In older women,sit-and-reach test flexibility improves by13% from 10 weeks of resistance trainingalone (5). It is impossible to discern whateffect the resistance training per se had onour subjects, since flexibility training alsooccurred, but type 2 diabetic subjects aloneexhibited significantly improved sit-and-reach scores from the combination.Undeniably, individuals with type 2diabetes are more prone to contracturesthat can potentially limit joint mobility(2,9). Loss of shoulder ROM is related tothe duration of diabetes and the presenceof other diabetes complications (10).None of our subjects, however, had anyshoulder joint limitations or severe diabe-tes-related complications before training.Moreover, the type 2 diabetic subjectshad mean blood glucose levels that wereelevated, although not severely, abovenormal values. Thus, it is likely that ourtype 2 diabetic subjects may have beenexperiencing fewer joint limitations thana more poorly controlled diabetic popu-lation (9). Still, only type 2 diabetic sub-jects significantly improved flexibilityfollowing training, perhaps overcomingmore subtle deleterious effects of diabeteson joint mobility.In conclusion, older adults with type2 diabetes without impaired flexibilitymay still enhance certain measures ofjoint ROM by participating in combinedstrength and resistance training. Diabetesper se does not preclude such individualsfrom participating in resistance trainingand from improving strength.Acknowledgments— This research was fullysupported by a grant from the American Dia-betes Association.We gratefully acknowledge the NorfolkYMCA for their assistance and the use of theirfacility.References1. Aoki Y, Yazaki K, Shirotori K, YanagisawaY, Oguchi H, Kiyosawa K, Furuta S: Stiff-ening of connective tissue in elderly dia-betic patients: relevance to diabeticnephropathy and oxidative stress. Diabe-tologia 36:79–83, 19932. Balci N, Balci MK, Tuzuner S: Shoulderadhesive capsulitis and shoulder range ofmotion in type II diabetes mellitus. J Dia-betes Complications 13:135–140, 19993. Girouard CK, Hurley BF: Does strengthtraining inhibit gains in range of motionfrom flexibility training in older adults?Med Sci Sports Exerc 27:1444–1449, 19954. Fatouros IG, Taxildaris K, Kalapothara-kos SP, Aggelousis N, Athanasopoulos S,Zeeris I, Katrabasas I: The effects ofstrength training, cardiovascular trainingand their combination on flexibility of in-active older adults. Int J Sports Med 23:112–119, 20025. Barbosa AR, Santarem JM, Filho WJ, Ma-rucci MF: Effects of resistance training onthe sit-and-reach test in elderly women. JStrength Cond Res 16:14–18, 20026. American College of Sports Medicine:Progression models in resistance trainingfor healthy adults (Position Stand). MedSci Sports Exerc 34:364–380, 20027. Dunstan DW, Puddey IB, Beilin LJ, BurkeV, Morton AR, Stanton KG: Effects of ashort-term circuit weight training pro-gram on glycaemic control in NIDDM. Di-abetes Res Clin Pract 40:53–61, 19988. Smutok MA, Reece C, Kokkinos PF,Farmer CM, Dawson PK, DeVane J,Patterson J, Goldberg AP, Hurley BF: Ef-fects of exercise training modality on glu-cose tolerance in men with abnormalglucose regulation. Int J Sports Med 15:283–289, 19949. Arkkila PE, Kantola IM, Viikari JS: Limitedjoint mobility in non-insulin-dependent di-abetic (NIDDM) patients: correlation tocontrol of diabetes, atherosclerotic vasculardisease, and other diabetic complications.J Diabetes Complications 11:208–217, 199710. Tinley P, Taranto M: Clinical and dynamicrange-of-motion techniques in subjectswith and without diabetes mellitus. J AmPodiatr Med Assoc 92:136–142, 2002Figure 1—Change in combined lower body and spine flexibility measures following 8 weeks offlexibility and resistance training. CON, control subjects; DM, type 2 diabetic patients.Herriot and AssociatesDIABETES CARE, VOLUME 27, NUMBER 12, DECEMBER 2004 2989

Effects of 8 Weeks of Flexibility and Resistance Training in Older Adults With Type 2 Diabetes

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Effects of 8 Weeks of Flexibility and Resistance Training in Older Adults With Type 2 Diabetes

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