Exercise as Therapy: Type 2 Diabetes

 

Photo Credit: Diabetes Help

In 2012, 29.1 million Americans or 9.3% of the population had diabetes. My father was diagnosed with type 2 diabetes 15 years ago, he was only 36. Although my father is 6  foot tall and weighs 162 pounds I think it’s safe to mention that he does not fall into the norms of what a type 2 diabetic looks like. He has always been slender and has worked his entire life, so it was a very big surprise when he was diagnosed.

 

Background

If you have type 2 diabetes your body does not use insulin properly. This is called insulin resistance, check out my previous blog over insulin resistance At first, your pancreas makes extra insulin to make up for it. But, overtime it isn’t able to keep up and cannot make enough insulin to keep your blood glucose at normal levels. Type 2 Diabetes, also known as non-insulin dependent diabetes mellitus, is a metabolic disease characterized by hyperglycemia and abnormal glucose, fat, and protein metabolism. The disease is a result of insulin resistance in the striated muscle tissue and beta-cell defect, which prevent the insulin resistance from being compensated for by enhanced insulin secretion.2 Type 2 diabetes was present for several years before the diagnosis was made, and more than half of all newly diagnosed diabetics exhibit signs of late diabetic complications. In particular, these include macrovascular disease in the form of coronary heart disease, stroke and lower extremity ischemia, although microvascular complications such as nephropathy, which is damage to the kidneys and retinopathy, a diabetic complication that affects the eyes. In patients with newly diagnosed type 2 diabetes, the prevalence of peripheral arteriosclerosis is 15%, coronary heart disease 15%, stroke 5%, retinopathy 5–15% and microalbuminuria 30%. Furthermore, the prevalence of other risk factors is high. Thus, 80% are overweight, 60–80% have hypertension and 40–50% have dyslipidemia. The mortality is two- to fourfold that of the population in general, with approximately 75% of the deaths being due to cardiovascular disease 1

Physical Training

Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2 diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result, ratings of perceived exertion rather than heart rate may need to be used for moderating intensity for physical activity. Although walking may be the most convenient low-impact mode, some people, because of peripheral neuropathy and or/ foot problems, may need to do non-weight bearing activities.2

Type and Amount of Training

Aerobic training and strength training involving many repetitions has been shown to be effective training for individuals with type 2 diabetes. Aerobic exercise helps your body use insulin better. It makes your heart and bones strong, relieves stress, improves blood circulation, and reduces risk for heart disease by lowering blood glucose and blood pressure and improving cholesterol levels. American Diabetes Association recommends moderate to vigorous intensity aerobic exercise, aiming for 30 minutes at least 5 days a week or a total of 150 minutes per week. Spreading activity out over at least 3 days during the week and try not go more than 2 days in a row without exercising. Strength training makes your body more sensitive to insulin and can lower blood glucose. It helps to maintain and build strong muscles and bones, reducing the risk for osteoporosis and bone fractures. The more muscle you have, the more calories you burn—even when your body is at rest. Amount of strength training may include at least 2 times per week in addition to aerobic activity. Some strength training activities include: weight machines or free weights, using resistance bands, lifting light weights or objects like canned goods or water bottles at home, and calisthenics or exercises that use your own body weight to work your muscles (examples are push-ups, sit ups, squats, and planks).3

References:

 

1Pedersen, B.K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. Scandinavian Journal of Medicine & Science in Sports, (16)S1, 3-63. doi:10.1111/j.1600-0838.2006.00520.x

2Albright, A., Franz, M., Hornsby, G., Kriska, A., Marrero, D., Ullrich, I., & Verity, L.S. (2000). American College of Sports Medicine position stand. Exercise and type 2 diabetes. Journal of Medicine and Science in Sports and Exercise 37(7), 1345-1360. doi: 10.1097/00005768-200007000-00024