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Effect of High- versus Low-Intensity Supervised Aerobic and Resistance Training on Modifiable Cardiovascular Risk Factors in Type 2 Diabetes; The Italian Diabetes and Exercise Study (IDES)
Open accessAbstract
BACKGROUND: While current recommendations on exercise type and volume have strong experimental bases, there is no clear evidence from large-sized studies indicating whether increasing training intensity provides additional benefits to subjects with type 2 diabetes. OBJECTIVE: To compare the effects of moderate-to-high intensity (HI) versus low-to-moderate intensity (LI) training of equal energy cost, i.e. exercise volume, on modifiable cardiovascular risk factors. DESIGN: Pre-specified sub-analysis of the Italian Diabetes and Exercise Study (IDES), a randomized multicenter prospective trial comparing a supervised exercise intervention with standard care for 12 months (2005-2006). SETTING: Twenty-two outpatient diabetes clinics across Italy. PATIENTS: Sedentary patients with type 2 diabetes assigned to twice-a-week supervised progressive aerobic and resistance training plus exercise counseling (n = 303). INTERVENTIONS: Subjects were randomized by center to LI (n = 142, 136 completed) or HI (n = 161, 152 completed) progressive aerobic and resistance training, i.e. at 55% or 70% of predicted maximal oxygen consumption and at 60% or 80% of predicted 1-Repetition Maximum, respectively, of equal volume. MAIN OUTCOME MEASURE(S): Hemoglobin (Hb) A(1c) and other cardiovascular risk factors; 10-year coronary heart disease (CHD) risk scores. RESULTS: Volume of physical activity, both supervised and non-supervised, was similar in LI and HI participants. Compared with LI training, HI training produced only clinically marginal, though statistically significant, improvements in HbA(1c) (mean difference -0.17% [95% confidence interval -0.44,0.10], P = 0.03), triglycerides (-0.12 mmol/l [-0.34,0.10], P = 0.02) and total cholesterol (-0.24 mmol/l [-0.46, -0.01], P = 0.04), but not in other risk factors and CHD risk scores. However, intensity was not an independent predictor of reduction of any of these parameters. Adverse event rate was similar in HI and LI subjects. CONCLUSIONS: Data from the large IDES cohort indicate that, in low-fitness individuals such as sedentary subjects with type 2 diabetes, increasing exercise intensity is not harmful, but does not provide additional benefits on cardiovascular risk factors. TRIAL REGISTRATION: www.ISRCTN.org ISRCTN-04252749.
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![Figure 2 Average monthly energy expenditure from supervised exercise. Energy expenditure data in LI (circles, dotted line; n = 136) and HI (squares, continuous line; n = 152) participants [mean values; means (SD) are reported below]. LI = low intensity; HI = high intensity.](/paper-figures/070e0a1ce5f3474eab3a3c783e8d1870/effect-of-high-versus-low-intensity-supervised-aerobic-and-resistance-training-figure-2.jpg)
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“After 1 year, those in the highintensity training group had a 0.17% greater improvement in A1c compared to those in the lowintensity training group.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [41]
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“Progressively increasing the duration and intensity of aerobic exercise can lead to further improvements in A1c.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [41]
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Citations
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Diet and exercise in the prevention and treatment of type 2 diabetes mellitus
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“Randomized trials have found that supervised exercise interventions improve glycated hemoglobin (A1C) (6–8), triglycerides (TG) and cholesterol (9) in people with type 2 diabetes when compared to no exercise comparison groups (10).”
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Metadata
- Authors
- Balducci, S., Zanuso, S., Cardelli, P., Salvi, L., Bazuro, A., Pugliese, L., Maccora, C., Iacobini, C., Conti, F. G., Nicolucci, A., Pugliese, G., & for the Italian Diabetes Exercise Study (IDES) Investigators
- Affiliations
- Azienda Ospedaliera Sant'Andrea (IT)
- University of Greenwich (GB)
- Associazione Fitness Metabolica O.N.L.U.S. (IT)
- Mario Negri Sud Foundation (IT)
- Corresponding author
- Pugliese, Giuseppe
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-11-21
- Volume
- 7
- Issue
- 11
- Pages
- e49297
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3504024
- OpenAlex
- W1985621733
- Cited by
- 123
- References
- 42
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 10 · 2023: 11 · 2022: 8 · 2021: 3 · 2020: 8 · 2019: 6 · 2018: 14 · 2017: 11 · 2016: 10 · 2015: 15 · 2014: 10 · 2013: 10
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, exercise intensity, high-intensity training, low-intensity training, supervised exercise, aerobic exercise, resistance training, cardiovascular risk factors, HbA1c, triglycerides, total cholesterol, coronary heart disease risk, sedentary patients, physical activity counseling, adverse events, exercise adherence, physical activity volume
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Energy Metabolism, Female, Humans, Italy, Male, Middle Aged, Physical Fitness, Risk Factors, Resistance Training
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