Physical Activity/Exercise and Type 2 Diabetes

Department of Medicine, University of Ottawa, Canada.
Diabetes Care (Impact Factor: 8.42). 11/2004; 27(10):2518-39. DOI: 10.2337/diaspect.18.2.88
Source: PubMed


F or decades, exercise has been consid-ered a cornerstone of diabetes man-agement, along with diet and medication. However, high-quality evi-dence on the importance of exercise and fitness in diabetes was lacking until recent years. The last American Diabetes Associ-ation (ADA) technical review of exercise and type 2 diabetes (formerly known as non–insulin dependent diabetes) was published in 1990. The present work emphasizes the advances that have oc-curred since the last technical review was published. Major developments since the 1990 technical review include: ● Advances in basic science, increasing our understanding of the effects of ex-ercise on glucoregulation. ● Large clinical trials demonstrating that lifestyle interventions (diet and exer-cise) reduce incidence of type 2 diabe-tes in people with impaired glucose tolerance (IGT). ● Meta-analyses of structured exercise in-terventions in type 2 diabetes showing: 1) effectiveness of exercise in reducing HbA 1c , independent of body weight; and 2) association between exercise training intensity and change in HbA 1c . ● Large cohort studies showing that low aerobic fitness and low physical activity level predict increased risk of overall and cardiovascular disease (CVD) mor-tality in people with diabetes. ● Clinical trials showing effectiveness of resistance training (such as weight lift-ing) for improving glycemic control in type 2 diabetes. ● New data on safety of resistance train-ing in populations at high risk for CVD.

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    • "Most CVDs are largely preventable with regular exercise and physical activity having been shown to improve CVD risk factors. Additionally, exercise improves other diseases associated with inactivity and obesity, such as type 2 diabetes and hypertension (Fletcher et al., 1996; Sigal et al., 2006; Thompson et al., 2003). By improving CVD risk factors that contribute to the progression of the disease, the risk of all-cause mortality from CVD can be significantly reduced (Gordon et al., 1989, Gould et al., 2007, Lee et al., 2011). "
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    ABSTRACT: The purpose of this study was to compare the effectiveness of either continuous moderate intensity exercise training (CMIET) alone vs. CMIET combined with a single weekly bout of high intensity interval training (HIIT) on cardiorespiratory fitness. Twenty nine sedentary participants (36.3 ± 6.9 yrs) at moderate risk of cardiovascular disease were recruited for 12 weeks of exercise training on a treadmill and cycle ergometer. Participants were randomised into three groups: CMIET + HIIT (n = 7; 8-12 x 60 sec at 100% VO2max, 150 sec active recovery), CMIET (n = 6; 30 min at 45-60% oxygen consumption reserve (VO2R)) and a sedentary control group (n = 7). Participants in the CMIET + HIIT group performed a single weekly bout of HIIT and four weekly sessions of CMIET, whilst the CMIET group performed five weekly CMIET sessions. Probabilistic magnitude-based inferences were determined to assess the likelihood that the true value of the effect represents substantial change. Relative VO2max increased by 10.1% (benefit possible relative to control) in in the CMIET + HIIT group (32.7 ± 9.2 to 36.0 ± 11.5 mL·kg-1·min-1) and 3.9% (benefit possible relative to control) in the CMIET group (33.2 ± 4.0 to 34.5 ± 6.1 mL·kg-1·min-1), whilst there was a 5.7% decrease in the control group (30.0 ± 4.6 to 28.3 ± 6.5 mL·kg-1·min-1). It was 'unclear' if a clinically significant difference existed between the effect of CMIET + HIIT and CMIET on the change in VO2max. Both exercising groups showed clinically meaningful improvements in VO2max. Nevertheless, it remains 'unclear' whether one type of exercise training regimen elicits a superior improvement in cardiorespiratory fitness relative to its counterpart.
    Journal of sports science & medicine 09/2014; 13(3):702-7. · 1.03 Impact Factor
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    • "These practices include regular physical activity, appropriate dietary practices, daily foot care practice, compliance with the treatment regimen, and tackling complications such as hypoglycaemic episodes. [2] [3] [4] It has been proved that group based educational training programs for the patients in these areas result in improved fasting blood glucose levels, glycated hemoglobin, reduced systolic blood pressure levels, body weight, and the requirement for diabetes medication [5]. In the Indian setting, such educational programs are hardly seen. "
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    ABSTRACT: Background. Diabetes care requires a multipronged approach, wherein the patient has an important role to play. This study was undertaken to explore self-care practices of diabetic patients residing in Anand district of Gujarat. Methods. A cross-sectional study, involving 100 diabetic patients, was conducted in 2009-2010. Self-care practices in seven domains of physical activity, dietary practices, medication taking, monitoring of glucose, problem solving, foot care, and psychosocial adjustment were assessed using scores assigned to participants' responses. Results. The mean age was 60.9 (SD = 12.2) years and 57% were males. Majority (92%) were Hindus and were consulting private medical practitioners (71%). "Medication taking" was the domain with the best performance score (88.1%) and "problem solving" the worst (11.0%). The "psychosocial adjustment" of the participants was satisfactory (82.5%). Overall mean performance percentage score was 54.41%. Males had better performance scores as compared to females in areas of "physical activity, " "dietary practices, " and "problem solving. " Housewives had poorer performance scores. Total mean performance score was similar for patients on treatment from specialists and general practitioners. Conclusion. A self-care education program designed for this region should address the lacunae identified in various domains with a special emphasis on females.
    02/2014; 2014. DOI:10.1155/2014/743791
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    • "Physical activity (PA)/exercise is widely considered to be an integral element of diabetes management [4]. Several reviews [5,6] and meta-analyses [4,7-9] of laboratory-based studies demonstrate that PA/exercise can produce a clinically important improvement in glucose control in people with Type 2 diabetes (in the absence of weight loss) producing an average improvement in glycated hemoglobin A1c (HbA1c) of between −0.4% and −0.6%. While this improvement is comparable to pharmacological therapies [10], pharmacology does not provide a long-term solution to glucose control in this largely progressive condition. "
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    ABSTRACT: Physical activity (PA) and nutrition are the cornerstones of diabetes management. Several reviews and meta-analyses report that PA independently produces clinically important improvements in glucose control in people with Type 2 diabetes. However, it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care. This study will determine whether an evidence-informed multifaceted behaviour change intervention (Movement as Medicine for Type 2 Diabetes) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting. An open pilot study conducted in two primary care practices (phase one) will assess acceptability, feasibility and fidelity. Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures. A two-arm parallel group clustered pilot randomised controlled trial patients from participating primary care practices in North East England will assess acceptability, feasibility, and fidelity of the intervention (versus usual clinical care) and trial processes over a 12-month period. Consultation behaviour involving fidelity of intervention delivery, diabetes and PA related knowledge, attitudes/beliefs, intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals. We will rehearse the collection of outcome data (with the focus on data yield and quality) for a future definitive trial, through outcome assessment at baseline, one, six and twelve months. An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care. Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence-base, that is, the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes. The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents, to the best of our knowledge, the first of its kind in the United Kingdom. This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care.Trial registration: Movement as Medicine for Type 2 Diabetes (MaMT2D) was registered with Current Controlled Trials on the 14th January 2012: ISRCTN67997502. The first primary care practice was randomised on the 5th October 2012.
    Trials 02/2014; 15(1):46. DOI:10.1186/1745-6215-15-46 · 1.73 Impact Factor
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