Exercise as it relates to Disease/Type 2 diabetes and resistance exercise

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What is Type 2 Diabetes Mellitus?[edit | edit source]

Normal metabolic function of the body requires insulin to regulate glucose levels through uptake in skeletal muscle and suppression of production in the liver.[1] Homeostasis is disturbed in Type 2 Diabetes Mellitus (T2DM) often as a result of sedentary lifestyle, old age and possible genetic predispotition.[2] The disease can be characterised by insulin insensitivity and high blood glucose, with the potential to progress to insulin dependency. The 2007-08 National Health Survey found that over 3.8% of the Australian population suffers from T2DM, although actual figures may differ due to the nature of self-reported data.[3] With the incidence of T2DM on the rise, current research has uncovered evidence to suggest that resistance exercise may be helpful in combating the disease.

Why should Type 2 Diabetics participate in resistance exercise?[edit | edit source]

Exercise, diet and medication play an important role in the management of type 2 diabetes.[4] Traditionally, aerobic exercise has been prescribed to patients with type 2 diabetes as it has been associated with weight loss, improved glucose tolerance and cardiovascular fitness.[4] Recent research has found that resistance exercise is also effective at improving diabetes management and is comparable to aerobic exercise.[5]

Findings include;

  • Reduction in HbA1c levels [6]
  • Increased glucose uptake by muscles [7]
  • Improved fasting blood glucose [5][7]
  • Improved insulin resistance [4][5][7][8]
  • Improved muscle glycogen store [7]
  • Decreased medications [7]
  • Increased muscle mass [6][9]
  • Decrease in insulin levels [7]

Small, but significant reduction in HbA1c levels have been found in diabetics after completing resistance exercise regimes. A 1% decrease in HbA1c is associated with a 37% decrease in micro vascular disease and a 21% decrease in risk of diabetes-related death, showing that resistance exercise is important in the management of type 2 diabetes.[6]

Is it safe?[edit | edit source]

Much has been written about the safety of resistance exercise for type 2 diabetics because of various co-morbidities that exist such as hypertension and cardiovascular disease.[6] However, research has found that high-intensity resistance exercise elicits the same blood pressure response as daily activities such as climbing stairs or carrying groceries.[10] In fact, most research has found that the only adverse effect of resistance training is muscle soreness and that it is safe form of exercise even for patients with a high risk of cardiac events.[6][7] Patients with severe diabetic retinopathy should not do resistance exercise because of the increased risk of retinal detachment.[10] As with any exercise program, medical advice and clearance should be sought before commencement and there should be adequate supervision.

Are there any other benefits?[edit | edit source]

Resistance exercise significantly increases muscle mass and fat-free mass compared to aerobic exercise.[6] This leads to;

  • Decreased abdominal obesity [4]
  • Decreased systolic blood pressure [7][10]
  • Increased renal function [10]
  • Increased muscle strength [6][9]
  • Decreased triglycerides [7]

Resistance exercise also leads to an increase in daily physical activity.[7] Patients with arthritis or lung disease may also find that resistance exercise is easier to do than aerobic exercise.[6] Increased muscle strength also helps to reduce the risk of falls in the elderly.[4]

Recommendations[edit | edit source]

All training should be under initial supervision by a qualified exercise specialist to ensure minimal risk of injury and maximal health benefits. Additionally, some insulin-dependant patients may find it necessary to alter insulin dose prior to exercise, and should be discussed with a doctor before undertaking any new exercise programs.[11] Recommendations from the American Diabetes Association for a resistance training program are listed below.[10] A progressive resistance training (PRT) model should be followed to achieve this target program, whereby frequency, intensity and time are increased over a specified period.[9]

Frequency 2-3 times per week
Intensity 3 sets of 8-10 reps at 50-80% 1RM (30-60secs rest between sets)
Time 30-45min sessions
Type Target all major muscle groups. Can include weights, resistance bands, bodyweight

It is important to remember that resistance exercise should be part of a treatment plan that also incorporates;[11]

  • Not smoking
  • Regular physical activity
  • Maintaining a healthy weight
  • Making healthy food choices
  • Managing blood pressure and cholesterol levels

Further reading[edit | edit source]

References[edit | edit source]

  1. Kim, J., Wei, Y. & Sowers, J. (2008). Role of Mitochondrial Dysfunction in Insulin Resistance. Circulation Research, 102,401-414.
  2. Ritov, V. et al. (2009). Deficiency of electron transport chain in human skeletal muscle mitochondria in type 2 diabetes. Am J Physiol Endocrinol Metab, 298, 49-58.
  3. Diabetes. (2011). Retrieved October 22, 2011, from AIHW http://www.aihw.gov.au/diabetes/
  4. a b c d e Dunstan, D., Daly, R., Owen, N., Jolley, D., De Courten, M., Shaw, J., & Zimmet, P. (2002). High-Intensity Resistance Training Improves Glycemic Control in older Patients With Type 2 Diabetes. Diabetes Care, 25(10), 1729-1736.
  5. a b c Eves, N., & Plotnikoff, R. (2006). Resistance Training and Type 2 Diabetes. Diabetes Care, 29(8), 1933-1940.
  6. a b c d e f g h Irvine, C., & Taylor, N. (2009). Progressive resistance exercise improves glycaemic control in people with type 2 diabetes mellitus: a systematic review. Australian Journal of Physiotherapy, 55, 237-246.
  7. a b c d e f g h i j Castaneda, C., Layne, J., Munoz-Orains, L., Gordon, P., Walsmith, J., Foldvari, M., Nelson, M. (2002). A Randomized Controlled Trial of Resistance Exercise Training to Improve Glycemic Control on Older Adults with Type 2 Diabetes. Diabetes Care, 25(12), 2335-2341.
  8. Fenicchia, L., Kanaley, J., Azevedo, J., Miller, C., Weinstock, R., Carhart, R., & Ploutz-Synder, L. (2004). Influence of Resistance Exercise Training on Glucose Control in Women With Type 2 Diabetes. Metabolism, 53(3), 284-289. http://www.portalsaudebrasil.com/artigospsb/diab104.pdf
  9. a b c Ibanez, J., Izquierdo, M., Arguelles, I., Forga, L., Larrion, J., Garcia-Unciti, M., Gorostiaga, E. (2005). Twice-Weekly Progressive resistnace Training Decreases Abdominal Fat ans Improves Insulin Sensitivty in Older Men With Type 2 Diabetes. Diabetes Care, 28(3), 662-667
  10. a b c d e Sigal, R., Kenny, G., Wasserman, D., Castaneda-Sceppa, C., & White, R. (2006). Physical Activity/Exercise and Type 2 Diabetes. Diabetes Care, 29(6), 1433-1438.
  11. a b Type 2 Diabetes. (2011, September 7). Retrieved October 22, 2011, from Diabetes Australia http://www.diabetesaustralia.com.au/en/Understanding-Diabetes/What-is-Diabetes/Type-2-Diabetes/