RESIST! Blood-flow Restriction Resistance Training for Improving Insulin Sensitivity in Type 2 Diabetes
NCT ID: NCT04222231
Last Updated: 2023-06-13
Study Results
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Basic Information
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UNKNOWN
NA
24 participants
INTERVENTIONAL
2019-10-28
2024-03-01
Brief Summary
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Detailed Description
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Muscle is of particular importance for glucose homeostasis, since in healthy people it accounts for 80-90% of postprandial insulin-stimulated glucose disposal. After cellular uptake of glucose by the specialized glucose transporter 4 (GLUT4), glucose is phosphorylated and stored as glycogen. In individuals with obesity or T2D, the capacity for insulin to facilitate glucose uptake and glycogen synthesis is impaired. This reduced response of a given insulin concentration to exert its biological effect is termed insulin resistance. Subsequent diminished insulin secretion due to β-cell failure results in fasting hyperglycemia and overt diabetes. Importantly, muscle insulin resistance is the initial defect occurring in the development of T2D and precedes the clinical development of the disease by up to 20 years.
Thus, the preservation of skeletal muscle function is essential for people with T2D who have an increased risk of sarcopenia. On the one hand high intensity resistance training (HIT) with 80 % one-repetition maximum (%1-RM) is a well-recognized strategy to improve muscle strength and glycemic control for individuals with T2D, on the other hand elderly or obese people may not be able to tolerate these high loads. Blood flow restriction training (BFRT) with low loads (20-30% 1-RM) has consistently demonstrated comparable effects to HIT and seems to be a promising alternative to increase muscle function.
During the BFRT the muscle becomes hypoxic due to a brief occlusion of venous blood flow using a tourniquet while exercising. Consequently metabolites like lactate, growth hormone (GH) and insulin like growth factor (IGF-1) are released and result in muscle hypertrophy through activating the collagen synthesis and the recruitment of satellite cells. Furthermore cell swelling based on venous blood pooling, reactive hyperemia and metabolite accumulation has been shown to increase protein synthesis by activating the mammalian Target of Rapamycin Complex 1 (mTORC1) pathway. Also, BFRT increases the level of reactive oxygen species (ROS) which may lead to higher glucose uptake during exercise. Last but not least higher threshold motor units (fast twitch fibers) are recruited due to hypoxia and metabolite accumulation.
Although there is a significant inverse relationship between muscle strength and the risk of cardiovascular mortality, cardiovascular adaptations to resistance training are under-explored and poorly understood.
The study therefore aims to investigate the metabolic and cardiovascular effects of BFRT with low loads in individuals with T2D.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
BASIC_SCIENCE
NONE
Study Groups
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Blood-flow restriction resistance training
Resistance training with low loads (15-30% RM) in combination with a brief occlusion of venous blood flow using a tourniquet while exercising.
Blood-flow restriction resistance training
Training program: After 10 minutes of warm-up the participant performs three exercises with BFRT for the lower extremities. The intensity is about 15-30% of 1-RM.
Classical resistance training
Resistance training with high loads (60-80% RM).
Classical resistance training
Training program: After warm-up the participant performs three exercises for lower body. The intensity is about 60-80% of 1-RM.
Interventions
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Blood-flow restriction resistance training
Training program: After 10 minutes of warm-up the participant performs three exercises with BFRT for the lower extremities. The intensity is about 15-30% of 1-RM.
Classical resistance training
Training program: After warm-up the participant performs three exercises for lower body. The intensity is about 60-80% of 1-RM.
Eligibility Criteria
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Inclusion Criteria
* Individuals with type 2 diabetes
* BMI: 19-40 kg/m²
Exclusion Criteria
* Weight fluctuations (\> 10% in the last 6 month)
* Therapy with Glitazone, Beta blocker, Insulin
* Malignant cancer
* Heart diseases (angina pectoris, myocardial infarction, acute myocarditis or pericarditis, cardiac wall aneurysms/ stenose, untreated hypotension or hypertension, aortic stenosis, stroke, cardiac insufficiency, NYHA-class ≥II, heart arrhythmia, disturbances of blood circulation in extremities, venous insufficiency, varicose veins)
* Diabetic neuropathy
* Respiratory disease (COPD, Gold grade ≥II)
* Serious heart, kidney or liver disease: - New York Heart Association-Classification (NYHA) stage ≥ II - creatinine ≥ 1.6 mg / dl - Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) ≥ two-fold upper reference value
* Anemia (Hb \<12g / l), blood donation in the last 3 month
* Disease of the immune system (leucocytes \<5000/μl)
* Application of immunomodulatory agents (Glucocorticoids, Antihistamine, Acetylsalicylic acid)
* Application of antithrombotic agents (Anticoagulant)
* Blood clotting disorders (abnormally levels of thrombocytes \[\<150.000, \>450.000 ± 50 \], Partial thromboplastin time (PTT) \[26-36 s ± 5 s\], Quick \[70-120% ± 10%\]) or wound healing
* Thyroid disease (untreated hypothyroidism or hyperthyroidism, treatment with thiamazol)
* Epilepsy
* Application of drugs which can manipulate the thermoregulation (Antipsychotic)
* Rosacea
* Vitamine supplement (with the las 4 weeks)
* Cigarettes (or non-smokers \<1 year) alcohol consumption (men\> 30 g / d, women\> 20 g / d), drug abuse
* Severe psychiatric illness or addiction
* Risk for/ or HIV or Hepatitis B or C
* Shift work or anormal circadian rhythm
* Muscle diseases, orthopedic restrictions
* Hypersensitivity to local anaesthetic
* Pregnancy, lactation
* Metallic and magnetic implants (for example, mechanical heart valves, joint prostheses, clip after vascular surgery, middle and inner ear implants or fresh dental implants)
* Claustrophobia
* Hypohidrosis
* Participation in another intervention study within the last 3 month
30 Years
69 Years
ALL
Yes
Sponsors
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German Diabetes Center
OTHER
Responsible Party
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Principal Investigators
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Michael Roden, Prof., MD
Role: STUDY_DIRECTOR
German Diabetes Center
Locations
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German Diabetes Center
Düsseldorf, North Rhine-Westphalia, Germany
Countries
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Central Contacts
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Facility Contacts
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References
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Christiansen D, Eibye KH, Hostrup M, Bangsbo J. Blood flow-restricted training enhances thigh glucose uptake during exercise and muscle antioxidant function in humans. Metabolism. 2019 Sep;98:1-15. doi: 10.1016/j.metabol.2019.06.003. Epub 2019 Jun 12.
Loenneke JP, Fahs CA, Rossow LM, Abe T, Bemben MG. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses. 2012 Jan;78(1):151-4. doi: 10.1016/j.mehy.2011.10.014. Epub 2011 Nov 1.
Abe T, Fujita S, Nakajima T, Sakamaki M, Ozaki H, Ogasawara R, Sugaya M, Kudo M, Kurano M, Yasuda T, Sato Y, Ohshima H, Mukai C, Ishii N. Effects of Low-Intensity Cycle Training with Restricted Leg Blood Flow on Thigh Muscle Volume and VO2MAX in Young Men. J Sports Sci Med. 2010 Sep 1;9(3):452-8. eCollection 2010.
Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol (1985). 2000 Jun;88(6):2097-106. doi: 10.1152/jappl.2000.88.6.2097.
Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol (1985). 2000 Jan;88(1):61-5. doi: 10.1152/jappl.2000.88.1.61.
Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul;51(13):1003-1011. doi: 10.1136/bjsports-2016-097071. Epub 2017 Mar 4.
Mattocks KT, Jessee MB, Mouser JG, Dankel SJ, Buckner SL, Bell ZW, Owens JG, Abe T, Loenneke JP. The Application of Blood Flow Restriction: Lessons From the Laboratory. Curr Sports Med Rep. 2018 Apr;17(4):129-134. doi: 10.1249/JSR.0000000000000473.
Harreiter J, Roden M. [Diabetes mellitus-Definition, classification, diagnosis, screening and prevention (Update 2019)]. Wien Klin Wochenschr. 2019 May;131(Suppl 1):6-15. doi: 10.1007/s00508-019-1450-4. German.
Pesta DH, Goncalves RLS, Madiraju AK, Strasser B, Sparks LM. Resistance training to improve type 2 diabetes: working toward a prescription for the future. Nutr Metab (Lond). 2017 Mar 2;14:24. doi: 10.1186/s12986-017-0173-7. eCollection 2017.
Centner C, Wiegel P, Gollhofer A, Konig D. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med. 2019 Jan;49(1):95-108. doi: 10.1007/s40279-018-0994-1.
Related Links
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Other Identifiers
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DDZ_Resist
Identifier Type: -
Identifier Source: org_study_id
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