High-Intensity Interval versus high-intensity resistance training on glycated hemoglobin and blood glucose levels in prediabetic individuals

Subjects will be randomly assigned into three equal numbers (n=20) into one of the three groups: High-intensity interval exercise, high intensity Resistance training, Control group. The exercise programme will be determined in accordance with the American collage of sport medicine (ACSM) guidelines (ACSM,2006). Parameters 1- All the subjects in 3 groups will be recommended to follow a low caloric diets for the 12 week intervention period. A low-calorie diet is usually used to achieve weight loss of 1 lb (0.5 kg) to 2 lb (0.9 kg) per week. Reducing calorie intake to 1,200 to 1,500 calories per day for women and 1,500 to 1,800 calories per day for men. Additionally, limiting fat intake to no more than 20% to 35% of the total calorie intake. Also, choosing complex carbohydrates, such as whole grains, vegetables, and fruits. About 45% to 65% of the total calorie intake will come from carbohydrate. Choosing low-fat protein sources, such as fish, poultry, and legumes (for example, pinto beans, lentils, and split peas). About 15% to 25% of the total calorie intake will come from protein. Adherence to the diet will be assessed with a diet log book, where every participant will be asked to document each meal they had everyday for 3 months of the intervention. Only one day per week will be allowed for each participant to eat what ever they want, and will also be documented in the diet log book. 2- Furthermore, subjects of the control group will be instructed to maintain their present lifestyle until the end of the project. Baseline biochemical tests will include glycated hemoglobin (HbA1c), fasting and post-prandial blood glucose (FBG)will be collected both before and 3 months at the end of the intervention period. These tests will also be repeated by their physicians at 3-monthly visits. All of the subjects will repeatedly monitor their blood sugar tests using a glucometer. Their heart rate and blood pressure will be measured. 3- Exercise training protocol All exercises will be held in the out-patient clinical of the faculty of Physical Therapy, Cairo University. Two experienced physical therapist with more than 7 years of experience will deliver each exercise program. The exercise sessions will be regularly held two or three times a week with the close supervision of the experienced physical therapists and trainers. Moreover, the probability of hypoglycaemic episodes during the sessions will be monitored and blood pressure fluctuations will be assessed regularly. Subjects will be asked not to have lunch before the exercise program, however if any hypo-glycaemic episodes, sweet items will be available. All types of exercise training were done according to the ACSM guidelines. All sessions will include 10-15 minutes of stretching and flexibility movements to warm up as well as 10-15 minutes of relaxation activities to cool down. To monitor adherence to exercise sessions, registration for attendance will be recorded. a- Group A: High-Intensity Interval Training (HIIT): HIIT involves short bursts of activity followed by a short period of rest or recovery, these exercise programs are usually performed in less than 30 minutes. Typically, the work intervals last from 15 seconds to 4 minutes and approach 80% to 95% of an individual’s maximum heart rate. Recovery intervals are generally equal to or slightly longer than the intense work interval and consist of passive rest or mild activity at 40% to 50% of the maximum heart rate. The combined work/rest interval commonly is repeated 6 to 10 times. Thus, the total HIIT exercise time ranges from 10 to 40 or more minutes depending on the actual duration of the work and rest periods. Participants in group A will be submitted to a 30 min HIIT aerobic session on a treadmill. The initial 5-min warm-up phase will be performed on the treadmill at a low load. Each training session will last 30 min and end with a 5-min recovery and relaxation phase either walking or running, based on heart rate, until the target heart rate according to the ACSM guidelines will be reached. The programme will begin with 10 min of stretching exercises for the major muscles of the upper and lower limbs and will be conducted using the maximal heart rate index (HRmax) estimated by: 220-age. First 2 weeks =60–80% of HRmax, 3rd to 12th weeks= 80–90% of HRmax .( Abd El-Kader, 2011). The protocol will start on 2 days of the week during the first month and will increase to 3 non-consecutive days per week for the remaining 2 months. B- Group B: High-intensity Resistance training program Patients in group B were submitted to a 40 min session of resistance training. The programme will begin with 10 min of stretching for the major muscles of the upper and lower limbs and then exercises on seven resistance machines will be conducted. The manual resistance machines that will be used are; shoulder press,bench press,seated bicep curl, triceps push down, lateral pull down, abdominals crunch, and leg extension. The protocol will start on 2 days of the week during the first month and will increase to 3 non-consecutive days per week. Training will start during weeks 1 and 2 with intensity 60% one-repetition maximum (1RM) and will progress to intensity 75% 1RM.The number of sets will be 1-2 during the first month. Participants will perform 3 sets of 8-10 repetitions (with a 90- 120 s rest between sets) for 40 minutes.(yavari et al.,2012).