Changes in Body Fat Distribution and Fitness Are Associated With Changes in Hemoglobin A1c After 9 Months of Exercise Training

Results From the HART-D Study

  1. Timothy S. Church, MD, MPH, PHD3
  1. 1Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
  2. 2Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3Pennington Biomedical Research Center, Department of Preventive Medicine, Baton Rouge, Louisiana
  4. 4Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
  5. 5Sport Health and Exercise Science, Department for Health, University of Bath, Bath, U.K.
  6. 6John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana
  1. Corresponding author: Timothy S. Church,{at}


OBJECTIVE To investigate the associations between changes in body composition and fitness after exercise training and changes in hemoglobin A1c (HbA1c) in individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS Participants (n = 201) were randomized to aerobic, resistance, or combined training for 9 months. HbA1c, waist circumference, total and trunk fat mass, appendicular fat mass, lean body mass, isokinetic leg muscle strength, peak O2 uptake, and estimated METs were assessed at baseline and follow-up. Change in HbA1c was evaluated across quartiles of change in body composition and fitness.

RESULTS Change in HbA1c was associated with changes in body weight (r = 0.13, P = 0.052), waist circumference (r = 0.17, P = 0.013), trunk fat mass (r = 0.19, P = 0.005), and estimated METs (r = −0.16, P = 0.023). There was a trend in change in HbA1c across quartiles of waist circumference (P = 0.011), trunk fat mass (P = 0.020), and estimated METs (P = 0.011). Participants with increased estimated METs and reduced trunk fat mass had greater odds of having reduced HbA1c after training (3.48, 1.46–8.31). Finally, participants with increased estimated METs and reduced waist circumference were 2.81 (1.13–6.98) times more likely to have reduced HbA1c and type 2 diabetes medication use than those who without improved fitness and central adiposity.

CONCLUSIONS In patients with type 2 diabetes, a reduction in central adiposity and increase in fitness were the most prominent predictors of the change in HbA1c in response to exercise training.

  • Received November 21, 2012.
  • Accepted March 7, 2013.

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