Moderate resistance training reduces intermuscular adipose tissue and risk factors of atherosclerotic cardiovascular disease for elderly patients with type 2 diabetes

Abstract Aim This study aimed to assess the impact of moderate resistance training on intermuscular adipose tissue (IMAT) in elderly patients with type 2 diabetes and the independent effect of IMAT reduction on metabolic outcomes. Methods In this randomized controlled trial, 85 patients with type 2 diabetes were assigned to either the resistance training group (42 participants) or the control group (43 participants) for a 6‐month intervention. The primary outcome was changes in IMAT measured by computed tomography scan and magnetic resonance imaging using the interactive decomposition of water and fat with echo asymmetry and least squares qualification sequence. Secondary outcomes included changes in metabolic parameters. Results Thirty‐seven participants in each group completed the study. The IMAT area (measured by a computed tomography scan) in the resistance group decreased from 5.176 ± 1.249 cm 2 to 4.660 ± 1.147 cm 2 , which is a change of −0.512 ± 0.115 cm 2 , representing a 9.89% decrease from the least‐squares adjusted mean at baseline, which was significantly different from that of the control group (a change of 0.587 ± 0.115 cm 2 , a 10.34% increase). The normal attenuation muscle area (representing normal muscle density) in the resistance group increased from 82.113 ± 8.776 cm 2 to 83.054 ± 8.761 cm 2 , a change of 1.049 ± 0.416 cm 2 , a 1.3% increase, which was significantly different from that of the control group (a change of −1.113 ± 0.416 cm 2 , a 1.41% decrease). Homeostasis model assessment 2 of beta cell function (HOMA2‐β; increased from 52.291 ± 24.765 to 56.368 ± 21.630, a change of 4.135 ± 1.910, a 7.91% increase from baseline) and ratio of insulin increase to blood glucose increase at 30 min after the oral glucose tolerance test (∆I30/∆G30; increased from 4.616 ± 1.653 to 5.302 ± 2.264, a change of 0.715 ± 0.262, a 15.49% increase) in the resistance group were significantly improved compared with those in the control group, which had a change of −3.457 ± 1.910, a 6.05% decrease in HOMA2‐β, and a change of −0.195 ± 0.262, a 3.87% decrease in ∆I30/∆G30, respectively. Adjusting for sex, age, diabetes duration, baseline IMAT, and the dependent variable at baseline, linear regression showed that the change in IMAT area was not related to the change in HOMA2 insulin resistance (β = −0.178, p = .402) or the change in HOMA2‐β (β = −1.891, p = .197), but was significantly related to the changes in ∆I30/∆G30 (β = −0.439, p = .047), 2‐h postprandial glucose (β = 1.321, p = .026), diastolic blood pressure (β = 2.425, p = .018), normal attenuation muscle area (β = −0.907, p = .019) and 10‐year risk of atherosclerotic cardiovascular disease (β = 0.976, p = .002). Conclusion Low‐level, moderate resistance training reduces IMAT content. Even a small reduction in IMAT may be related to a decrease in risk factors for atherosclerotic cardiovascular disease, but this small reduction may not be sufficient to reduce insulin resistance.