Physical Activity/Exercise and Type 2 Diabetes

Department of Medicine, University of Ottawa, Canada.
Diabetes Care (Impact Factor: 8.57). 11/2004; 27(10):2518-39. DOI: 10.2337/diaspect.18.2.88
Source: PubMed

ABSTRACT 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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    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. Key PointsBoth continuous moderate intensity exercise training (CMIET) alone and CMIET combined with a single weekly bout of high intensity interval training (CMIET + HIIT) elicit 'possibly beneficial' clinically meaningful improvements in cardiorespiratory fitness.Cardiorespiratory fitness improved by ~1.0 MET in the CMIET + HIIT exercise intervention group, which likely leads to important long-term prevention implications as a 1 MET increase in cardiorespiratory fitness has been linked with an 18% reduction in deaths due to CVD.There was 100% adherence to interval sessions in the CMIET + HIIT group, suggesting this combination of training can be well-tolerated in previously inactive overweight/obese individuals.
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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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    ABSTRACT: We used a two-stage study design to evaluate whether variations in the peroxisome proliferator-activated receptors (PPAR) and the PPAR gamma co-activator 1 (PGC1) gene families (PPARA, PPARG, PPARD, PPARGC1A, and PPARGC1B) are associated with type 2 diabetes (T2D) risk. Stage I used data from a genome-wide association study (GWAS) from Shanghai, China (1019 T2D cases and 1709 controls) and from a meta-analysis of data from the Asian Genetic Epidemiology Network for T2D (AGEN-T2D). Criteria for selection of single nucleotide polymorphisms (SNPs) for stage II were: (1) P < 0.05 in single marker analysis in Shanghai GWAS and P < 0.05 in the meta-analysis or (2) P < 10(-3) in the meta-analysis alone and (3) minor allele frequency ≥ 0.10. Nine SNPs from the PGC1 family were assessed in stage II (an independent set of middle-aged men and women from Shanghai with 1700 T2D cases and 1647 controls). One SNP in PPARGC1B, rs251464, was replicated in stage II (OR = 0.87; 95% CI: 0.77-0.99). Gene-body mass index (BMI) and gene-exercise interactions and T2D risk were evaluated in a combined dataset (Shanghai GWAS and stage II data: 2719 cases and 3356 controls). One SNP in PPARGC1A, rs12640088, had a significant interaction with BMI. No interactions between the PPARGC1B gene and BMI or exercise were observed.
    Annals of Human Genetics 01/2014; 78(1):23-32. DOI:10.1111/ahg.12044


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