Type 2 Diabetes and Exercise
Type 2 Diabetes and Exercise
In this article Physio Broadbeach | Functional Health discuss Type 2 Diabetes and Exercise. Functional Health like to discuss many topics throughout our social media and websites. We believe that providing our patients information within areas of health, that may affect them, is crucial to their well being and can help us provide a better Allied Health Service.
Type 2 diabetes is one of the most prevalent conditions in Australia. According to Diabetes Australia, there are approximately 1.7 million Australians living with diabetes, with 170 new patients diagnosed every day (1 every 5 minutes). Type 2 diabetes is a condition where our body doesn’t respond to the hormone insulin as potently as it used to. Insulin is an important hormone as it regulates the uptake of glucose that we ingest to be stored until it is used as fuel for energy production. Without the actions of insulin, high levels of glucose exist in the blood which can cause a number of health issues including increasing the risk of heart disease, high blood pressure, damage to nerves (particularly in the hands and feet), eyes and kidneys.
Type 2 diabetes can be effectively managed with medications that enhance the body’s ability to use insulin, or by artificially supplementing the body with more insulin to use. However at the cornerstone of type 2 diabetes management is lifestyle modification: increasing physical activity and eating a healthy diet.
Large studies of thousands of patients with impaired glucose tolerance (the precursor to diabetes; pre-diabetes) have shown that in patients who engaged in a physically active lifestyle (150-300 minutes per week of physical activity) and consumed a diet that promoted weight loss, the incidence of new cases of diabetes was reduced by over 50% 1.
The remarkable effectiveness of exercise and physical activity in preventing type 2 diabetes is due to the fact that exercise has a very similar effect as insulin on skeletal muscle.
So whilst a diabetic patient may not respond as efficiently to insulin to take up glucose into skeletal muscle, a muscle that has been exercised will be able to take up glucose via a different pathway triggered by exercise. Additionally, the muscle becomes more sensitive to insulin as well, leading to increased glucose uptake following exercise persisting for a number of hours afterwards. This means that exercise should be completed regularly (e.g. walking 30 minutes each day) to ensure that glucose sensitivity is maintained.
A recent study in the Journal of the American Medical Association2 showed that in patients who were treated with medication and a lifestyle intervention (increased physical activity and dietary improvement), 73% of patients had a reduction in their glucose lowering medication compared to only 26% of those receiving just medication. This means that when combined, a healthy lifestyle can actually reduce the amount of glucose-lowering medications required to achieve adequate control based on the mechanisms of exercise on glucose uptake.
Exercise and Sports Science Australia, the peak body for exercise guidelines in Australia suggests that patients with diabetes should aim for 210 minutes of moderate intensity exercise (slightly out of breath but still able to hold a conversation) or 125 minutes of vigorous exercise (unable to maintain a conversation) per week.
This should ideally include both aerobic exercise (walking, jogging or swimming) as well as resistance training (weight-based exercises). Resistance training can improve the amount of muscle that we have, which increases the overall surface area that can be used to take up glucose and improve control. As an example of how to achieve this, more and more parks are being built with resistance training equipment (e.g. chest press machines or step ups) at various intervals along the walking paths. This is a great way to engage in some resistance training during an aerobic session.
Given the effects of exercise on improving our sensitivity to insulin after each session of exercise which can last for up to 48 hours, there should be no more than 2 days of inactivity in a row as this is when this effect will have worn off. However before commencing an exercise program, it is important to discuss with your GP or an Exercise Physiologist or Physiotherapist about any medical issues that might impact your ability to safely exercise. In particular, it is important to measure your blood glucose after exercise to ensure that it does not become too low after exercising.
Increasing your physical activity level is one of the most important components of managing type 2 diabetes, so if you are looking to begin but need some help getting started or have any questions, consider giving us a call at Functional Health to see how we can assist you throughout this process.
1 Hordern MD et al., 2012. Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia, Journal of Science and Medicine in Sport 15 (2012) 25–31
2 Johansen MY et al., 2017. Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial; The Journal of the American Medical Association, 318(7):637-646
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