By Peter Laird, MD
Exercise is an important adjunct in the treatment and even the prevention of Type II diabetes. An interesting study in the Journal of the American Medical Association revealed that it is not only the amount of exercise that is important, but also, the combined effect of both aerobic and resistence training:
Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes
Conclusions: Among patients with type 2 diabetes mellitus, a combination of aerobic and resitance training compared with nonexercise control group improved HbA1c levels. This was not achieved by aerobic or resistance training alone.
A related article in the New York Times expands upon the details in an interview with the lead author, Dr. Timothy S. Church, director of preventive medicine research at Pennington Biomedical Research Center at Louisiana State University.:
After nine months of observed exercise, participants who did the combination training lowered their blood level of the glucose marker HbA1c to 7.3 percent from 7.7 percent, on average, a drop that corresponds to a significantly reduced risk of heart disease, Dr. Church said. The improvements in the other exercise groups were not significantly different from those in the non-exercise group.
Dr. Church said he was surprised but added that the findings made sense. “Diabetes is the failure to control the amount of sugar in your blood, and the biggest user of blood sugar is skeletal muscle,” he said. “The healthier your skeletal muscle, the more blood sugar it’s chewing up and taking out of the blood.”
It is likely that this information will apply not only to patients with diabetes, but the general population as well as renal disease patients who have the added burden of overcoming sarcopenia, wasting of the muscles. The metabolic potential of increasing skeletal muscle as an adjunct to medical therapy is an area that needs further investigation. I have often wondered whether large muscle mass improves control of phosphorus since that is a major component of muscle activity. A simple study would be weight training in dialysis patients to see if it impacts phosphorus control. In fact, a rather interesting study from the recent ASN connects PTH elevations to the presence of metabolic syndrome.
Metabolic Syndrome in CKD Patients May Be Linked to PTH
When taken as a continuous predictor, each standard deviation increase of natural log transformed PTH was associated with a 26% higher odds of having metabolic syndrome. The association of PTH with metabolic syndrome was not modified by age or gender.
Taken together, it would be prudent for some young investigator to make their Renal Fellowship research project a simple cross over study of patients with elevated PTH and CKD and use the intervention of aerobic and resistance training to see if this intervention improves PTH and PO4 as well. In the mean time, I will continue to use exercise as a key component to my own mineral-bone metabolism which I have long believed helps keep my PO4 normal even without any binders at all. The metabolic potential of active skeletal muscle training should be explored further not only for diabetic patients, but CKD patients as well.
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