Strength Training Regimen for Normal Weight Diabetics (STRONG-D)

描述（由申请人提供）：正常体重的2型糖尿病（NWD）患者的死亡风险高于超重或肥胖患者。NWD可能具有与脂肪组织成比例的较少的瘦肌肉质量，这可能导致这种较高的死亡风险。力量训练增加肌肉质量而不是减少体重，并且可以对抗身体组成中与年龄相关的变化，这种变化导致更高的脂肪质量和减少的肌肉质量（即，肌肉减少症）。因此，力量训练可能因此有助于NWD而不是体重减轻，如推荐用于超重/肥胖的2型糖尿病（T2 DM）个体。此外，NWD中的力量训练可以消除种族/民族之间内脏肥胖的已知差异。这可能对新世界发展的管理产生重大影响。目前，缺乏关于NWD有效生活方式建议的数据，NWD可以代表高达1/5的T2 DM患者。身体活动建议强调有氧运动，这可能不适合NWD。体脂评估，而不是体重指数，可能是NWD更好的诊断工具，并更好地为治疗性生活方式改变干预提供信息，以控制血糖，并最终缓解明显较高的死亡率 发现了这个群体。力量训练，而不是有氧运动为重点的方案，可能是一个更合适的治疗建议。为了确定NWD的最佳运动方案，我们建议在Palo Alto医学基金会（PAMF）（一个大型的、基于社区的、多专业的门诊护理机构）实施一项三组随机对照试验，比较力量训练与有氧训练与联合（力量+有氧）训练在NWD中用于T2 DM管理的临床有效性。测量的主要结局将是T2 DM控制的改善（例如，%血红蛋白A1 c降低）。过程测量将包括身体健康的变化（例如，虽然组合（力量+有氧）活动的益处已经在超重/肥胖糖尿病患者中得到很好的证明，但目前几乎没有证据推荐这种方案用于NWD。正常体重糖尿病患者力量训练方案（STRONG-D）研究的目的是确定NWD的最佳运动方案，NWD的死亡率高于超重/肥胖糖尿病患者。

DESCRIPTION (provided by applicant): Normal weight individuals with type 2 diabetes (NWD) have higher risk of mortality than overweight or obese individuals. NWD may have less lean muscle mass in proportion to adipose tissue, which may contribute to this higher risk of mortality. Strength training increases muscle mass rather than reducing body weight and can combat the age-related shift in body composition that results in higher fat mass and decreased muscle mass (i.e., sarcopenia). Thus, strength training may therefore be helpful for NWD rather than weight loss, as is recommended for overweight/obese individuals with type 2 diabetes (T2DM). Additionally, strength training in NWD could eliminate known differences in visceral adiposity across racial/ethnic groups. This may have significant implications for management of NWD. Currently, there is a lack of data on effective lifestyle recommendations for NWD, who can represent up to 1 in 5 individuals with T2DM. Physical activity recommendations emphasize aerobic exercise, which may not be appropriate for NWD. Body fat assessment, rather than body mass index, may be a better diagnostic tool in NWD, and better inform therapeutic lifestyle change interventions to control glucose and ultimately alleviate the significantly higher mortality discovered for this group. Strength training, rather than aerobic-focused regimens, may be a more appropriate treatment recommendation. In order to determine the best exercise regimen for NWD, we propose to implement a three- arm randomized control trial comparing the clinical effectiveness of strength training vs. aerobic training vs. combined (strength + aerobic) training for T2DM management among NWD at the Palo Alto Medical Foundation (PAMF), a large, community-based, multi-specialty ambulatory care setting. The primary outcome for measurement will be improvement in T2DM control (e.g., % hemoglobin A1c reduction). Process measures will include changes in physical fitness (e.g., VO2 max), and change in body composition (DEXA scans).While the benefits of combined (strength + aerobic) activity have been well demonstrated in overweight/obese diabetics, there currently exists little evidence to recommend this regimen in NWD. The goal of the Strength Training Regimen for Normal weiGht Diabetics (STRONG-D) Study is to determine the best exercise regimen for NWD, who experience greater mortality than overweight/obese diabetics.