***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The purpose of this study was to investigate the effect of diabetes , motor nerve impairment , and training status on neuromuscular function by concurrent assessment of the torque-velocity relationship and muscle fiber conduction velocity ( MFCV ) . METHODS Four groups were studied ( n = 12 each ) : sedentary patients with diabetes in the first ( lower ) and fourth ( higher ) quartile of motor nerve conduction velocity ( D1 and D4 , respectively ) , trained diabetic ( TD ) patients , and nondiabetic sedentary control ( C ) subjects .  Maximal isometric and isokinetic contractions were assessed over a wide range of angular velocities for the elbow flexors and knee extensors to evaluate the torque-velocity relationship .  Simultaneously , MFCV was estimated from surface electromyography of the vastus lateralis and biceps brachii . RESULTS Isometric strength was similar among groups . The dynamic strength of elbow flexors was reduced in patients with diabetes at the higher contraction speeds . The strength of knee extensors was lower in sedentary patients with diabetes at all velocities considered , with significantly lower values in D1 than that in D4 at 60 ° , 90 ° , and 120 ° ·s(-1 ) , whereas it was similar between TD and C subjects , especially at low contraction velocities . At the vastus lateralis , but not the biceps brachii , MFCV was lower in D1 and D4 as compared with TD and C subjects , showing similar values . CONCLUSIONS Muscle weakness in diabetes affects also the upper limb , although to a lower extent than the lower limb , is only partly related to motor nerve impairment , and is dependent on contraction velocity . Exercise training might counteract diabetes-induced alterations in muscle fiber contractile properties and MFCV CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination . OBJECTIVE To examine the benefits of aerobic training alone , resistance training alone , and a combination of both on hemoglobin A(1c ) ( HbA(1c ) ) in individuals with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c ) levels of 6.5 % or higher were enrolled in the 9-month exercise program between April 2007 and August 2009 . INTERVENTION Forty-one participants were assigned to the nonexercise control group , 73 to resistance training 3 days a week , 72 to aerobic exercise in which they expended 12 kcal/kg per week ; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week . Main Outcome Change in HbA(1c ) level . Secondary outcomes included measures of anthropometry and fitness . RESULTS The study included 63.0 % women and 47.3 % nonwhite participants who were a mean ( SD ) age of 55.8 years ( 8.7 years ) with a baseline HbA(1c ) level of 7.7 % ( 1.0 % ) . Compared with the control group , the absolute mean change in HbA(1c ) in the combination training exercise group was -0.34 % ( 95 % confidence interval [ CI ] , -0.64 % to -0.03 % ; P = .03 ) . The mean changes in HbA(1c ) were not statistically significant in either the resistance training ( -0.16 % ; 95 % CI , -0.46 % to 0.15 % ; P = .32 ) or the aerobic ( -0.24 % ; 95 % CI , -0.55 % to 0.07 % ; P = .14 ) groups compared with the control group . Only the combination exercise group improved maximum oxygen consumption ( mean , 1.0 mL/kg per min ; 95 % CI , 0.5 - 1.5 , P < .05 ) compared with the control group . All exercise groups reduced waist circumference from -1.9 to -2.8 cm compared with the control group . The resistance training group lost a mean of -1.4 kg fat mass ( 95 % CI , -2.0 to -0.7 kg ; P < .05 ) and combination training group lost a mean of -1.7 ( -2.3 to -1.1 kg ; P < .05 ) compared with the control group . CONCLUSIONS Among patients with type 2 diabetes mellitus , a combination of aerobic and resistance training compared with the nonexercise control group improved HbA(1c ) levels . This was not achieved by aerobic or resistance training alone . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00458133 The aim of this study was to test the hypothesis that individual differences in the response of maximal O(2 ) uptake ( VO(2max ) ) to a st and ardized training program are characterized by familial aggregation . A total of 481 sedentary adult Caucasians from 98 two-generation families was exercise trained for 20 wk and was tested for VO(2max ) on a cycle ergometer twice before and twice after the training program . The mean increase in VO(2max ) reached approximately 400 ml/min , but there was considerable heterogeneity in responsiveness , with some individuals experiencing little or no gain , whereas others gained > 1.0 l/min . An ANOVA revealed that there was 2.5 times more variance between families than within families in the VO(2max ) response variance . With the use of a model-fitting procedure , the most parsimonious models yielded a maximal heritability estimate of 47 % for the VO(2max ) response , which was adjusted for age and sex with a maternal transmission of 28 % in one of the models . We conclude that the trainability of VO(2max ) is highly familial and includes a significant genetic component Background Reductions in skeletal muscle mass and increased adiposity are key elements in the aging process and in the pathophysiology of several chronic diseases . Systemic low grade inflammation associated with obesity has been shown to accelerate the age-related decline in skeletal muscle . The aim of this investigation was to determine the effects of 12 months of progressive resistance training ( PRT ) on systemic inflammation , and whether reductions in systemic inflammation were associated with changes in body composition . We hypothesized that reductions in systemic inflammation following 12 months of PRT in older adults with type 2 diabetes would be associated with reductions in adiposity and increases in skeletal muscle mass . Methods Participants ( n = 103 ) were r and omized to receive either PRT or sham-exercise , 3 days a week for 12 months . C-reactive protein ( CRP ) was used to assess systemic inflammation . Skeletal muscle mass and total fat mass were determined using bioelectrical impedance . Results Twelve months of PRT tended to reduce CRP compared to sham exercise ( β = −0.25 , p = 0.087 ) . Using linear mixed-effects models , the hypothesized relationships between body composition adaptations and CRP changes were significantly stronger for skeletal muscle mass ( p = 0.04 ) and tended to be stronger for total fat mass ( p = 0.07 ) following PRT when compared to sham-exercise . Using univariate regression models , stratified by group allocation , reductions in CRP were associated with increases in skeletal muscle mass ( p = 0.01 ) and reductions in total fat mass ( p = 0.02 ) in the PRT group , but not in the sham-exercise group ( p = 0.87 and p = 0.32 , respectively ) . Conclusions We have shown for the first time that reductions in systemic inflammation in older adults with type 2 diabetes following PRT were associated with increases in skeletal muscle mass . Furthermore , reductions in CRP were associated with reductions in adiposity , but only when associated with PRT . Lifestyle interventions aim ed at reducing systemic inflammation in older adults with type 2 diabetes should therefore incorporate anabolic exercise such as PRT to optimize the anti-inflammatory benefits of favorable body composition adaptations OBJECTIVE To determine the efficacy of high-intensity progressive resistance training ( PRT ) on glycemic control in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS We performed a 16-week r and omized controlled trial in 62 Latino older adults ( 40 women and 22 men ; mean + /- SE age 66 + /- 8 years ) with type 2 diabetes r and omly assigned to supervised PRT or a control group .  Glycemic control , metabolic syndrome abnormalities , body composition , and muscle glycogen stores were determined before and after the intervention . RESULTS Sixteen weeks of PRT ( three times per week ) result ed in reduced plasma glycosylated hemoglobin levels ( from 8.7 + /- 0.3 to 7.6 + /- 0.2 % ) , increased muscle glycogen stores ( from 60.3 + /- 3.9 to 79.1 + /- 5.0 mmol glucose/kg muscle ) , and reduced the dose of prescribed diabetes medication in 72 % of exercisers compared with the control group , P = 0.004 - 0.05 . Control subjects showed no change in glycosylated hemoglobin , a reduction in muscle glycogen ( from 61.4 + /- 7.7 to 47.2 + /- 6.7 mmol glucose/kg muscle ) , and a 42 % increase in diabetes medications . PRT subjects versus control subjects also increased lean mass ( + 1.2 + /- 0.2 vs. -0.1 + /- 0.1 kg ) , reduced systolic blood pressure ( -9.7 + /- 1.6 vs. + 7.7 + /- 1.9 mmHg ) , and decreased trunk fat mass ( -0.7 + /- 0.1 vs. + 0.8 + /- 0.1 kg ; P = 0.01 - 0.05 ) . CONCLUSIONS PRT as an adjunct to st and ard of care is feasible and effective in improving glycemic control and some of the abnormalities associated with the metabolic syndrome among high-risk older adults with type 2 diabetes OBJECTIVE To investigate changes in body composition after 12 months of high-intensity progressive resistance training ( PRT ) in relation to changes in insulin resistance ( IR ) or glucose homeostasis in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS One-hundred three participants were r and omized to receive either PRT or sham exercise 3 days per week for 12 months . Homeostasis model assessment 2 of insulin resistance ( HOMA2-IR ) and glycosylated hemoglobin ( HbA1c ) were used as indices of IR and glucose homeostasis . Skeletal muscle mass ( SkMM ) and total fat mass were assessed using bioelectrical impedance . Visceral adipose tissue , mid-thigh cross-sectional area , and mid-thigh muscle attenuation were quantified using computed tomography . RESULTS Within the PRT group , changes in HOMA2-IR were associated with changes in SkMM ( r = −0.38 ; P = 0.04 ) and fat mass ( r = 0.42 ; P = 0.02 ) . Changes in visceral adipose tissue tended to be related to changes in HOMA2-IR ( r = 0.35 ; P = 0.07 ) . Changes in HbA1c were related to changes in mid-thigh muscle attenuation ( r = 0.52 ; P = 0.001 ) . None of these relationships were present in the sham group ( P > 0.05 ) . Using ANCOVA models , participants in the PRT group who had increased SkMM had decreased HOMA2-IR ( P = 0.05 ) and HbA1c ( P = 0.09 ) compared with those in the PRT group who lost SkMM . Increases in SkMM in the PRT group decreased HOMA2-IR ( P = 0.07 ) and HbA1c ( P < 0.05 ) compared with those who had increased SkMM in the sham group . CONCLUSIONS Improvements in metabolic health in older adults with type 2 diabetes were mediated through improvements in body composition only if they were achieved through high-intensity PRT Hispanics are at increased risk of morbidity and mortality due to their high prevalence of diabetes and poor glycemic control . Strength training is the most effective lifestyle intervention to increase muscle mass but limited data is available in older adults with diabetes . We determined the influence of strength training on muscle quality ( strength per unit of muscle mass ) , skeletal muscle fiber hypertrophy , and metabolic control including insulin resistance ( Homeostasis Model Assessment –HOMA-IR ) , C-Reactive Protein ( CRP ) , adiponectin and Free Fatty Acid ( FFA ) levels in Hispanic older adults . Sixty-two community-dwelling Hispanics ( > 55 y ) with type 2 diabetes were r and omized to 16 weeks of strength training plus st and ard care ( ST group ) or st and ard care alone ( CON group ) . Skeletal muscle biopsies and biochemical measures were taken at baseline and 16 weeks . The ST group show improved muscle quality ( mean±SE : 28±3 ) vs CON ( -4±2 , p<0.001 ) and increased type I ( 860±252µm2 ) and type II fiber cross-sectional 
    Output:
    
Generally , training-induced adaptations in skeletal muscle are seen as changes in contractile proteins , mitochondrial function , metabolic regulation , intracellular signalling , transcriptional responses and neuromuscular modifications .
The main adaptation with clinical relevance would include an improved oxidative capacity derived from aerobic training , in addition to neuromuscular remodelling derived from resistance training .
Both training modalities improve insulin sensitivity and reduce cardiovascular risk .
Taken together , the modifications that occur at the genetic , metabolic and neuromuscular levels , work correlatively to optimise substrate delivery , mitochondrial respiratory capacity and contractile function during exercise