Sunday, November 27, 2016

Diabetes and Exercise Rehabilitation

Morgan Walker, B.S., ACSM EP-C

Type II diabetes mellitus (T2DM) is a metabolic disease characterized by peripheral insulin resistance resulting in hyperglycemia.1 Other co-morbidities such as hypertension, dyslipidemia and obesity often accompany this disease.  For these reasons, exercise prescription has long been a very important component of care for diabetes.  The goal of exercise for this disease is to increase muscle mass and lose excess body fat.

Myocytes (muscle cells, muscle fibers) house insulin receptors which binds to glucose and allows it into the cell for metabolism.  Because diabetes renders many of these resistant, it would be intuitive to create more space for more receptors to increase blood glucose uptake.  Resistance training for this population focuses on increasing muscle surface area for housing more receptors.  Cardiovascular exercise plays the role of weight management and cardiovascular health management.  

Table: FITT Principle for Diabetes.1
Type of Exercise
Frequency
Intensity
Duration
Aerobic
3-7 d/wk
No more than 2 consecutive days between sessions
12-15 on RPE scale
At least 150 min/wk

Resistance
2-3 d/wk
Moderate-vigorous
(50%-80%)
8-15 reps, 1-3 sets depending on exercise
Range of Motion, static stretching
With resistance training
N/A
10-30 s per muscle group

The exercise physiologist must know the precautions and recommendations for the disease to ensure client safety during and after exercise.2 Medications and their effects on exercise are important as well although those topics are beyond the scope of this blog.  If not treated with effective pharmacotherapy and exercise rehabilitation, T2DM can be detrimental to one’s health and quality of life. Refer to the American Diabetes Association for more information on the management of this disease.


References
1 Ehrman J., Gordon P., Visich P. & Keteyian S. Clinical Exercise Physiology-3rd edition. 2013.

2 Albright, Ann. Exercise Precautions and Recommendations for Patients With Autonomic Neuropathy. Diabetes Spectrum. Volume 11 Number 4, 1998, Pages 231-237.

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