Obesity Management Resistance training for obese, type 2 diabetic adults: a review of the evidence A. P. Hills 1 , S. P. Shultz 1 , M. J. Soares 2 , N. M. Byrne 1 , G. R. Hunter 3 , N. A. King 1 and A. Misra 4 1 School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD; 2 Curtin Health Innovation Research Institute, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 3 Human Studies Department, University of Alabama at Birmingham, Birmingham, AL, USA; 4 Department of Diabetes and Metabolic Diseases, Fortis Hospitals (Vasant Kunj and NOIDA), New Delhi and NOIDA, India Received 3 July 2009; revised 20 September 2009; accepted 13 October 2009 Address for correspondence: Professor AP Hills, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia. E-mail: a.hills@qut.edu.au Summary In both developed and developing countries, increased prevalence of obesity has been strongly associated with increased incidence of type 2 diabetes mellitus (T2DM) in the adult population. Previous research has emphasized the impor- tance of physical activity in the prevention and management of obesity and T2DM, and generic exercise guidelines originally developed for the wider popu- lation have been adapted for these specific populations. However, the guidelines traditionally focus on aerobic training without due consideration to other exercise modalities. Recent reviews on resistance training in the T2DM population have not compared this modality with others including aerobic training, or considered the implications of resistance training for individuals suffering from both obesity and T2DM. In short, the optimal mix of exercise modalities in the prescription of exercise has not been identified for it benefits to the metabolic, body composition and muscular health markers common in obesity and T2DM. Similarly, the underlying physical, social and psychological barriers to adopting and maintain- ing exercise, with the potential to undermine the efficacy of exercise interventions, have not been addressed in earlier reviews. Because it is well established that aerobic exercise has profound effects on obesity and T2DM risk, the purpose of this review was to address the importance of resistance training to obese adults with T2DM. Keywords: Aerobic exercise, body weight, resistance training, type 2 diabetes mellitus. obesity reviews (2010) 11, 740–749 Introduction The global epidemic of obesity (1) has contributed to a concomitant increase in the prevalence of type 2 diabetes mellitus (T2DM) (2,3). Both conditions are escalating at a frightening rate, are prevalent in adults and youth and are not restricted to the developed world (2–4). The increasing prevalence of obesity and the associated dysfunctional state of adipose tissue are the major contributors to the incidence of T2DM (5). Obesity and the cluster of condi- tions known as the metabolic syndrome (i.e. dysglycaemia, dyslipidemia, hypertension and a procoagulant state) (6) are the precursors of T2DM and cardiovascular disease (7). Given the close interplay between obesity and T2DM in many individuals, the term ‘diabesity’ has been used to portray this relationship (8). Because of its growing preva- lence, greater attention is required regarding how best to treat diabesity. Lifestyle modification, specifically changes in diet, physical activity (PA) and exercise is considered the cornerstone of both obesity and T2DM management (9). PA substantially reduces the risk of T2DM, particu- larly in individuals with an increased baseline risk such as the obese (10). PA guidelines for the adult population have evolved over the last decade, as seen in Fig. 1. The 1995 obesity reviews doi: 10.1111/j.1467-789X.2009.00692.x 740 © 2009 The Authors obesity reviews © 2009 International Association for the Study of Obesity 11, 740–749