Exercise for people living with obesity, diabetes and heart disease: clinical and functional outcomes and quality of life.

Exercise training studies have shown exercise to be beneficial for people with T2DM in the absence of symptomatic cardiovascular disease and, separately, for those with cardiovascular disease in the absence of T2DM. The intended studies will bring together these two groups of individuals that merge clinically in more advanced stages of disease. Until now, these patients with multiple morbidity have been excluded from almost all exercise interventions, but make up substantial patient numbers for those with primary diagnoses for either diabetes or cardiovascular disease. In this project, aerobic and resistance (strength) exercise training will be combined for volunteers with obesity-related T2DM, complicated by cardiovascular disease. By introducing combined aerobic and resistance exercise to this group of volunteers this may improve exercise and functional capacities, glucose control and quality of life. This is a randomised clinical trial with participants randomised to either the Exercise or Control groups after a series of baseline tests comprising aerobic and strength capacities, functional capacities, glucose control and quality of life (QoL). The aerobic and resistance exercise training intervention is for 6 months at moderate intensities and will be supervised for the first 2 months in a hospital gymnasium, with the remaining 4 months in community fitness centres. . The Control group will undergo sham exercise training, consisting of stretching exercises. During the 24 week study, volunteers will attend the exercise facility on three days per week. The aerobic and resistance training exercise group will perform 20 minutes of aerobic exercise at a heart rate intensity equivalent to 50 – 60 % of VO2peak determined at baseline (0 wk) and then gradually increased so that by week 4 the volunteers will be exercising at between 60 - 70% of VO2peak. The aerobic exercise will be performed using a cycle ergometer. . As volunteers progress, they will gradually be given more choice of exercise modes such as walking on treadmill, rowing and stair climbing. While for moderate intensity resistance training (dynamic exercise involving concentric and eccentric contractions) will be performed for 30 minutes. During the first and second weeks of training, the resistance will be set at 50-60% of each individual 3 RM that is determined at baseline (0 wk). Further, each individual will continue the targeted resistance at 60 - 70 % of current 3 RM. Prior to each session the volunteers will need 5 – 10 minutes warm up and end with a 5 – 10 minutes cool down and stretching period. The resistance training program for the Moderate Intensity group will use free weights and a multiple station weight machine. Eight exercises will be used for training; bench press, leg extension, upright row, lateral pull down, standing leg curl, dumbbell seated biceps curl, dumbbell triceps kickback, and abdominal curl. All volunteers need to perform each repetition in a slow, controlled manner, with rest of 90 – 120s between sets. Three sets of 8 – 10 repetitions will be perform for all exercises. All sessions will be supervised to ensure volunteers perform the exercise using the correct techniques and appropriate amount of weight and rest intervals. Training workload will be increased regularly as tolerated especially for the High Intensity group. At 12 weeks the 3 RM test will be repeated to establish a new baseline Subjects will not be blinded to treatment and will be informed that they should see improvement in flexibility as an outcome.