Advertisement
Mayo Clinic Proceedings Home

Association of Muscular Strength and Incidence of Type 2 Diabetes

      Abstract

      Objective

      To examine the association between muscular strength and incident type 2 diabetes, independent of cardiorespiratory fitness (CRF).

      Patients and Methods

      A total of 4681 adults aged 20 to 100 years who had no type 2 diabetes at baseline were included in the current prospective cohort study. Participants underwent muscular strength tests and maximal treadmill exercise tests between January 1, 1981, and December 31, 2006. Muscular strength was measured by leg and bench press and categorized as age group- and sex-specific thirds (lower, middle, and upper) of the combined strength score. Type 2 diabetes was defined on the basis of fasting plasma glucose levels, insulin therapy, or physician diagnoses.

      Results

      During a mean follow-up of 8.3 years, 229 of the 4681 patients (4.9%) had development of type 2 diabetes. Participants with the middle level of muscular strength had a 32% lower risk of development of type 2 diabetes (hazard ratio, 0.68; 95% confidence interval, 0.49-0.94; P=.02) compared with those with the lower level of muscular strength after adjusting for potential confounders, including estimated CRF. However, no significant association between the upper level of muscular strength and incident type 2 diabetes was observed.

      Conclusion

      A moderate level of muscular strength is associated with a lower risk of type 2 diabetes, independent of estimated CRF. More studies on the dose-response relationship between muscular strength and type 2 diabetes are needed.

      Abbreviations and Acronyms:

      ACLS (Aerobics Center Longitudinal Study), BMI (body mass index), CRF (cardiorespiratory fitness), HR (hazard ratio), MET (metabolic equivalent task), PA (physical activity), RE (resistance exercise), 1-RM (1-repetition maximum), T2D (type 2 diabetes)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization
        Diabetes [fact sheet].
        (World Health Organization website)
        • Myers J.
        • Atwood J.E.
        • Froelicher V.
        Active lifestyle and diabetes [editorial].
        Circulation. 2003; 107: 2392-2394
        • Jeon C.Y.
        • Lokken R.P.
        • Hu F.B.
        • van Dam R.M.
        Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review.
        Diabetes Care. 2007; 30: 744-752
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        • 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
        • Lee D.C.
        • Sui X.
        • Church T.S.
        • Lee I.M.
        • Blair S.N.
        Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men.
        Diabetes Care. 2009; 32: 257-262
        • Wei M.
        • Gibbons L.W.
        • Mitchell T.L.
        • Kampert J.B.
        • Lee C.D.
        • Blair S.N.
        The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men.
        Ann Intern Med. 1999; 130 ([published correction appears in Ann Intern Med. 1999;131(5):394]): 89-96
        • Sui X.
        • Hooker S.P.
        • Lee I.M.
        • et al.
        A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women.
        Diabetes Care. 2008; 31: 550-555
        • Kawakami R.
        • Sawada S.S.
        • Lee I.M.
        • et al.
        Long-term impact of cardiorespiratory fitness on type 2 diabetes incidence: a cohort study of Japanese men.
        J Epidemiol. 2018; 28: 266-273
        • Wolfe R.R.
        The underappreciated role of muscle in health and disease.
        Am J Clin Nutr. 2006; 84: 475-482
        • Artero E.G.
        • Lee D.C.
        • Lavie C.J.
        • et al.
        Effects of muscular strength on cardiovascular risk factors and prognosis.
        J Cardiopulm Rehabil Prev. 2012; 32: 351-358
        • Pollock M.L.
        • Franklin B.A.
        • Balady G.J.
        • et al.
        Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription; an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association.
        Circulation. 2000; 101: 828-833
        • Grøntved A.
        • Pan A.
        • Mekary R.A.
        • et al.
        Muscle-strengthening and conditioning activities and risk of type 2 diabetes: a prospective study in two cohorts of US women.
        PLoS Med. 2014; 11: e1001587
        • Grøntved A.
        • Rimm E.B.
        • Willett W.C.
        • Andersen L.B.
        • Hu F.B.
        A prospective study of weight training and risk of type 2 diabetes mellitus in men.
        Arch Intern Med. 2012; 172: 1306-1312
        • Shiroma E.J.
        • Cook N.R.
        • Manson J.E.
        • et al.
        Strength training and the risk of type 2 diabetes and cardiovascular disease.
        Med Sci Sports Exerc. 2017; 49: 40-46
        • Sallis J.F.
        • Saelens B.E.
        Assessment of physical activity by self-report: status, limitations, and future directions.
        Res Q Exerc Sport. 2000; 71: 1-14
        • Jurca R.
        • Lamonte M.J.
        • Barlow C.E.
        • Kampert J.B.
        • Church T.S.
        • Blair S.N.
        Association of muscular strength with incidence of metabolic syndrome in men.
        Med Sci Sports Exerc. 2005; 37: 1849-1855
        • Jackson A.W.
        • Lee D.C.
        • Sui X.
        • et al.
        Muscular strength is inversely related to prevalence and incidence of obesity in adult men.
        Obesity (Silver Spring). 2010; 18: 1988-1995
        • Blair S.N.
        • Kannel W.B.
        • Kohl H.W.
        • Goodyear N.
        • Wilson P.W.
        Surrogate measures of physical activity and physical fitness: evidence for sedentary traits of resting tachycardia, obesity, and low vital capacity.
        Am J Epidemiol. 1989; 129: 1145-1156
        • Blair S.N.
        • Kohl III, H.W.
        • Barlow C.E.
        • Paffenbarger Jr., R.S.
        • Gibbons L.W.
        • Macera C.A.
        Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men.
        JAMA. 1995; 273: 1093-1098
        • Ruiz J.R.
        • Sui X.
        • Lobelo F.
        • et al.
        Association between muscular strength and mortality in men: prospective cohort study.
        BMJ. 2008; 337: a439
        • Artero E.G.
        • Lee D.C.
        • Ruiz J.R.
        • et al.
        A prospective study of muscular strength and all-cause mortality in men with hypertension.
        J Am Coll Cardiol. 2011; 57: 1831-1837
        • Balke B.
        • Ware R.W.
        An experimental study of physical fitness of Air Force personnel.
        U S Armed Forces Med J. 1959; 10: 675-688
        • Pollock M.L.
        • Bohannon R.L.
        • Cooper K.H.
        • et al.
        A comparative analysis of four protocols for maximal treadmill stress testing.
        Am Heart J. 1976; 92: 39-46
        • American College of Sports Medicine
        ACSM's Guidelines for Exercise Testing and Prescription.
        9th ed. Lippincott Williams & Wilkins, Philadelphia, PA2014
        • Kohl III, H.W.
        • Gordon N.F.
        • Scott C.B.
        • Vaandrager H.
        • Blair S.N.
        Musculoskeletal strength and serum lipid levels in men and women.
        Med Sci Sports Exerc. 1992; 24: 1080-1087
        • American Diabetes Association
        2. Classification and diagnosis of diabetes.
        Diabetes Care. 2015; 38: S8-S16
        • National Institute of Diabetes and Digestive and Kidney Diseases
        Risk factors for type 2 diabetes.
        (National Institute of Diabetes and Digestive and Kidney Diseases website) (Published November 2016. Accessed March 30, 2018)
        • Williams M.A.
        • Haskell W.L.
        • Ades P.A.
        • et al.
        Resistance exercise in individuals with and without cardiovascular disease: 2007 update; a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism.
        Circulation. 2007; 116: 572-584
        • Janssen I.
        • Heymsfield S.B.
        • Ross R.
        Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.
        J Am Geriatr Soc. 2002; 50: 889-896
        • Eves N.D.
        • Plotnikoff R.C.
        Resistance training and type 2 diabetes: considerations for implementation at the population level.
        Diabetes Care. 2006; 29: 1933-1941
        • Kohrt W.M.
        • Kirwan J.P.
        • Staten M.A.
        • Bourey R.E.
        • King D.S.
        • Holloszy J.O.
        Insulin resistance in aging is related to abdominal obesity.
        Diabetes. 1993; 42: 273-281
        • Schnohr P.
        • O'Keefe J.H.
        • Marott J.L.
        • Lange P.
        • Jensen G.B.
        Dose of jogging and long-term mortality: the Copenhagen City Heart Study.
        J Am Coll Cardiol. 2015; 65: 411-419
        • Armstrong M.E.
        • Green J.
        • Reeves G.K.
        • Beral V.
        • Cairns B.J.
        • Million Women Study Collaborators
        Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of women in the United Kingdom.
        Circulation. 2015; 131: 721-729
        • Miyachi M.
        Effects of resistance training on arterial stiffness: a meta-analysis.
        Br J Sports Med. 2013; 47: 393-396