Metabolic Effects of Exercise Training Among Fitness-Nonresponsive Patients With Type 2 Diabetes: The HART-D Study
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OBJECTIVE: To evaluate the impact of exercise training (ET) on metabolic parameters among participants with type 2 diabetes mellitus (T2DM) who do not improve their cardiorespiratory fitness (CRF) with training. RESEARCH DESIGN AND METHODS: We studied participants with T2DM participating in the Health Benefits of Aerobic and Resistance Training in Individuals With Type 2 Diabetes (HART-D) trial who were randomized to a control group or one of three supervised ET groups for 9 months. Fitness response to ET was defined as a change in measured peak absolute oxygen uptake (ΔVO2peak, in liters per minute) from baseline to follow-up. ET participants were classified based on ΔVO2peak into fitness responders (ΔVO2peak ≥5%) and nonresponders (ΔVO2peak <5%), and changes in metabolic profiles were compared across control, fitness responder, and fitness nonresponder groups. RESULTS: A total of 202 participants (mean age 57.1 ± 7.9 years, 63% women) were included. Among the exercise groups (n = 161), there was substantial heterogeneity in ΔVO2peak; 57% had some improvement in CRF (ΔVO2peak >0), with only 36.6% having a ≥5% increase in VO2peak. Both fitness responders and nonresponders (respectively) had significant improvements in hemoglobin A1c and measures of adiposity (ΔHbA1c: −0.26% [95% CI −0.5 to −0.01] and −0.26% [−0.45 to −0.08]; Δwaist circumference: −2.6 cm [−3.7 to −1.5] and −1.8 cm [−2.6 to −1.0]; Δbody fat: −1.07% [−1.5 to −0.62] and −0.75% [−1.09 to −0.41]). No significant differences were observed in the degree of change of these metabolic parameters between fitness responders and nonresponders. Control group participants had no significant changes in any of these metabolic parameters. CONCLUSIONS: ET is associated with significant improvements in metabolic parameters irrespective of improvement in cardiorespiratory fitness.
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A person may experience an improvement in V̇O2 peak without a corresponding reduction in fasting glucose levels, despite improvements in HbA1c, waist circumference, and body fat percentage.
“For instance, a person may experience an improvement in V̇O2 peak, without a corresponding reduction in fasting glucose levels, despite showing significant improvements in HbA1c, waist circumference, and body fat percentage across all subjects [610].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [610]
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- Authors
- Pandey, A., Swift, D. L., McGuire, D. K., Ayers, C. R., Neeland, I. J., Blair, S. N., Johannsen, N., Earnest, C. P., Berry, J. D., & Church, T. S.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- East Carolina University (US)
- University of South Carolina (US)
- Louisiana State University (US)
- Texas A&M University (US)
- Pennington Biomedical Research Center (US)
- Corresponding author
- Berry, Jarett D.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-06-17
- Volume
- 38
- Issue
- 8
- Pages
- 1494-1501
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4512133
- OpenAlex
- W1928905715
- Cited by
- 83
- References
- 36
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 11 · 2023: 7 · 2022: 9 · 2021: 6 · 2020: 11 · 2019: 12 · 2018: 7 · 2017: 8 · 2016: 4 · 2015: 3
- FWCI
- 14.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Civil War Book Review (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK0-68298, R01DK068298)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, exercise training, cardiorespiratory fitness, peak oxygen uptake, aerobic exercise, resistance training, glycemic control, HbA1c, adiposity, waist circumference, fat mass
- MeSH terms
- Diabetes Mellitus, Type 2, Exercise Test, Female, Health Status, Glycated Hemoglobin, Humans, Male, Middle Aged, Oxygen Consumption, Physical Fitness, Exercise, Adiposity, Resistance Training
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