Background: Although lifestyle modification has been recommended for Type 2 diabetic patients, little is known about the effect of combined exercise (aerobic and resistance training) on macrovascular complications and metabolic parameters. The purpose of this study was to investigate the effects of 6 weeks of lifestyle modification including combined exercise program on body composition, physical fitness, the risk of macrovascular complications and metabolic parameters in Type 2 diabetic patients.
Methods: Thirty-five patients with type 2 diabetes were selected as research participants from I-Hospital in Incheon Metropolitan City. Patients were randomized into a lifestyle modification group (n = 23) and a control group (n = 12). Six weeks of lifestyle modification included supervised core and circuit resistance exercise (3 times/week), unsupervised aerobic exercise (2~3 times/week) and diet counseling (once a week) by clinical nutritionist. Body composition, blood pressure, physical
fitness, macrovascular complications risk (baPWV, ABI), metabolic parameters including glucose, insulin, homeostasis of insulin resistance (HOMA-IR), HbA1c, total cholesterol (TC), Gamma Glutamyl Transferase (GGT) were measured before and after the intervention.
Results: After the 6 weeks of lifestyle modification, the significant improvements were found in body
composition and overall physical fitness levels (P < .05), whereas HbA1c, TC, GGT were significantly decreased after the intervention (P < .05). Further multiple regression analysis showed the changes in lean mass, VO2max were predictors for changes in HbA1c levels after the lifestyle
modification. On the other hand, arterial stiffness was not significantly changed but maintained.
Conclusion: Lifestyle modification including combined exercise program had beneficial effects on body composition, physical fitness, glycemic control, metabolic parameters in Type 2 diabetic patients. Moreover, combined exercise including resistance training did not show any side-effects and maintained the level of arterial stiffness.

Keywords: Arterial stiffness, HbA1c, Diabetes, Combined exercise, Lifestyle modification

1. 통계청. 2009년 사망원인통계 결과. 2010.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.
   
3. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001;44 Suppl 2:S14-21.
   
4. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, projections. Diabetes Care 1998;21:1414-31.
   
5. Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, et al. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care 2006;29:226-31.
   
6. Acton KJ, Burrows NR, Moore K, Querec L, Geiss LS, Engelgau MM. Trends in Diabetes Prevalence Among American Indian and Alaska Native Children, Adolescents, Young Adults. Am J Public Health 2002;92:1485-90.
   
7. Kannel WB, McGee DL. Diabetes and cardiovascular disease. JAMA 1979;241:2035-8.
   
8. Yuan S, Liu Y, Zhu L. Vascular complications of diabetes mellitus. Clin Exp Pharmacol Physiol 1999;26:977-8.
   
9. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis. JAMA 2002;287:2570-81.
   
10. Wing RR, Epstein LH, Paternostro-Bayles M, Kriska A, Nowalk MP, Gooding W. Exercise in a behavioral weight control programme for obese patients with type 2 (non-insulin-dependent) diabetes. Diabetogia 1998;31:902-9.
11. Agurs-Collins TD, Kumanyika SK, Ten Have TR, Adams-Campbell LL. A randomized controlled trial of Weight reduction and exercise for diabetes management in older African American subjects. Diabetes Care 1997;20:1503-11.
    
12. Mensing C, Boucher J, Cypress M, Weinger K, Mulcahy K, Barta P, et al. National standards for diabetes self-management education. Diabetes Care 2002;25 Suppl1:S140-7.
    
13. Parker B, Noakes M, Luscombe N, Clifton P. Effects of a high-protein, high-mononsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 2002;25:425-30.
    
14. Giacca A, Groenewoud Y, Tsui E, McClean P, Zinman B. Glucose production, utilization and cycling in response to moderate exercise on obese subjects with type 2 diabetes and mild hyperglycemia. Diabetes 1998;47:1763-70.
    
15. Kang J, Kelley DE, Robertson RJ, Goss FL, Suminski RR, Utter AC, et al. Substrate utilization and glucose turnover during exercise of varing intensities in individuals with NIDDM. Med Sci Sports Exerc 1999;31:82-9.
    
16. Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Koyama H, et al. Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Res Clin Pract 2004;65:85-93.
    
17. Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS. Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, hypercholesterolemia. Diabetes Care 2009;32:1531-5.
    
18. Hurley BF, Seals DR, Ehsani AA, Cartier LJ, Dalsky GP, Hagberg JM, et al. Effects of high intensity strength training on cardiovascular function. Med Sci Sports Exerc 1984;16:483-8.
    
19. Harris KA, Holly RG. Physiological response to circuit weight training in borderline hypertensive subject. Med Sci Sports Exerc 1987;19:246-52.
    
20. 안근희. 낮은 강도 순환성 저항운동이 제2형 당뇨병 환 자의 혈당대사, 인슐린 저항성 및 지질대사에 미치는 영향. 한국스포츠리서치 2005;16:113-22.
21. Miyachi M, Kawano H, Sugawara J, Takahashi K, Hayashi K, Yamazaki K, et al. Unfavorable Effects of Resistance Training on Central Arterial Compliance A Randomized Intervention Study. Circulation 2004;110:2858-63.
    
22. Yoon ES, Jung SJ, Cheun SK, Oh YS, Kim SH, Jae SY. Effects of acute resistance exercise on arterial stiffness in young men. Korean Circ J 2010;40:16-22.
    
23. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003;26:2977-82.
    
24. Dunstan DW, Vulikh E, Owen N, Jolley D, Shaw J, Zimmet P. Community center-based resistance training for the maintenance of glycemic control in adult with type 2 diabetes. Diabetes Care 2006;29:2586-91.
    
25. Okamoto T, Masuhara M, Ikuta K. Effect of low-intensity resistance training on arterial function. Eur J Appl Physiol 2011;111:743-8.
    
26. Yoshizawa M, Maeda S, Miyaki A, Misono M, Saito Y, Tanabe K, et al. Effect of 12 weeks of moderate -intensity resistance training on arterial stiffness: a randomised controlled trial in women aged 32-59 years. Br J Sports Med 2009;43:615-8.
    
27. Walter RT, Neil FG, Linda SP. ACSM’s guidelines for exercise testing and prescription. 8th ed. American College of Sports Medicine; 2010.
28. Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH. Physical Activity/Exercise and Diabetes. Diabetes Care 2004;27 Suppl 1:S58-62.
    
29. 김형돈, 김덕중. 제2형 당뇨병 환자들의 HbA1C에 따른 복합트레이닝이 동맥경화지수 및 심혈관계 질환 위험 요소에 미치는 영향. 운동과학 2007;16:369-82.
30. 지용석, 이지현, 이중철, 김주희, 이현희, 김성수. 규칙 적인 운동이 제2형 당뇨병 노인여성의 혈당, 혈중지질 수준 및 체성분에 미치는 영향. 한국체육학회지 2001;40:733-47.
31. 장지선, 홍창배, 이지은, 김홍수, 박주식, 김기진. 12주 간 복합운동이 비만 및 당뇨병을 가진 중년 여성의 신 체구성 및 동맥경화 지표에 미치는 영향. 운동과학 2006;15:105-16.
32. 임강일, 신윤아, 석민화. 비만과 당뇨 비만 여성들의 아 디포사이토카인, 인슐린 저항성 및 인슐린 분비능에 대 한 복합운동 트레이닝의 효과. 운동과학 2006;15:225-36.
33. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and -cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
    
34. 유지수, 이숙정, 이현철, 강은석, 김소헌, 박은정. 단기 간의 포괄적인 생활습관 개선프로그램이 제2형 당뇨병 환자의 당대사 및 지질대사와 체구성에 미치는 효과. 대한간호학회지 2004;34:1277-87.
35. Diabetes Prevention program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403.
    
36. Sun G, French CR, Martin GR, Younghusband B, Green RC, Xie YG, et al. Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population. Am J Clin Nutr 2005;81:74-8.
    
37. Jekal Y, Lee MK, Park S, Lee SH, Kim JY, Kang JU, et al. Association between Obesity and Physical Fitness, Hemoglobin A1c Level and Metabolic Syndrome in Korean Adults. Korean Diabetes J 2010;34:182-90.
    
38. Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory Fitness and Body Mass Index as Predictors of Cardiovascular Disease Mortality Among Men With Diabetes. Arch Intern Med 2005;165:2114 -20.
    
39. Dunstan DW, Daly RM, Owen N, Jolley D, de Courten M, Shaw J, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002;25:1729-36.
    
40. International Expert Committee. International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care 2009;32:1327-34.
    
41. Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus. Sports Med 1997;24:321-36.
    
42. Yamamoto A, Katayama Y, Tomiyama K, Hosoai H, Hirata F, Yasuda H. A short-term admission improved brachial-ankle pulse wave velocity in type 2 diabetic patients. Diabetes Res Clin Pract 2005;70:248-52.
    
43. Casey DP, Beck DT, Braith RW. Progressive Resistance Training Without Volume Increases Does Not Alter Arterial Stiffness and Aortic Wave Reflection. Exp Biol Med 2007;232:1228-35.
    
44. Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol 2009;103:972-7.
    
45. Sugawara J, Hayashi K, Yokoi T, Cortez-Cooper MY, DeVan AE, Anton MA, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness? J Hum Hypertens 2005;19:401-6.