Exercise….Really?
Does exercise really make a difference in type 2 diabetes?
Focus on the exercise that you can do, rather than what you can’t.
For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years.
In a scientific paper published just last week it was found that physical activity commenced soon after the diagnosis of type 2 diabetes reduced the risk of cardio-vascular disease (heart attack and stroke). The effect of exercise was beneficial in itself in reducing the risk of health problems, even if the person had started medication to lower blood glucose levels, blood pressure and cholesterol http://jaha.ahajournals.org/content/3/3/e000828.abstract
There is also firm and consistent evidence that programs of increased physical activity and modest weight loss reduce the incidence of type 2 diabetes in individuals with Impaired Glucose Tolerance (IGT). http://care.diabetesjournals.org/content/29/6/1433.full
Boulé et al undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of more than 8 weeks duration on HbA1c (A1C) and body mass index in people with type 2 diabetes.
After the program of exercise the HbA1C was significantly lower, even if the BMI (weight) had not been lowered. http://care.diabetesjournals.org/content/29/6/1433.full
Never too old to ride a bike. Do it safely, have a medical checkup before you start a new exercise program.
Aerobic exercise
The amount and intensity recommended for aerobic exercise vary according to goals.
The evidence is strong that to improve glycemic control, assist with weight maintenance, and reduce risk of Cardio Vascular Disease (heart attack, stroke), it is recommend that at least 150 minutes per week of moderate-intensity aerobic physical activity and/or at least 90 min/week of vigorous aerobic exercise.
This exercise would be best prescribed by an exercise physiologist, available on the Medicare plans through your GP.
The physical activity should be distributed over at least 3 days/week and with no more than 2 consecutive days without physical activity.
Performing more than 4 hours per week of moderate to vigorous aerobic and/or resistance exercise physical activity is associated with greater CVD risk reduction compared with lower volumes of activity.
For long-term maintenance of major weight loss (≥13.6 kg/30 lb), larger volumes of exercise (7 h/week of moderate or vigorous aerobic physical activity) may be helpful.
With the help and guidance of an exercise physiologist you can find some exercise that will give you health benefits safely
Resistance exercise
In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance exercise three times a week, targeting all major muscle groups, progressing to three sets of 8–10 repetitions at a weight that cannot be lifted more than 8–10 times (8–10 RM).
To ensure resistance exercises are performed correctly, maximize health benefits, and minimize the risk of injury, it is recommend that initial supervision and periodic reassessments are undertaken by a qualified exercise physiologist, as was done in the clinical trials.
Barriers to Exercise
Table 1— Barriers to physical activity among low-income patients with type 2 diabetes from http://care.diabetesjournals.org/content/28/5/1209.full#T1
| Barrier | |
| I have health problems that keep me from exercising | 2.78 ± 2.10 |
| I do not have anyone to exercise with | 2.77 ± 2.10 |
| I have trouble getting back to exercise after a break in my routine | 2.69 ± 1.99 |
| I have joint pain that keeps me from exercising | 2.57 ± 1.85 |
| My leg pain is too bad to exercise | 2.52 ± 1.86 |
| Exercise is physically painful | 2.48 ± 1.86 |
| I do not have enough time at home to exercise | 2.42 ± 1.68 |
| I do not have the right equipment to exercise | 2.18 ± 1.75 |
| I do not have enough time during or after work to exercise | 2.16 ± 1.47 |
| There is not enough time in my schedule to exercise | 1.97 ± 1.46 |
Accessing an Exercise Physiologist
“Patients who have both a GP Management Plan (GPMP) and Team Care Arrangements (TCAs) have access to allied health individual services on the Medicare Benefits Schedule. Eligible patients can claim a maximum of five (5) allied health services per calendar year. The five allied health services can be made up of one type of service (e.g. five exercise physiologist services) or a combination of different types of services.
In addition, patients with a GPMP and type 2 diabetes can also access Medicare rebates for up to eight (8) allied health group services per calendar year. Group programs do not have to be limited to type 2 diabetes groups only.
Relevant group programs for type 2 diabetes patients may include:
- Fitness or weight management group services; or
- Blood glucose monitoring services. (From http://exerciseismedicine.org.au/wp-content/uploads/2011/09/Referrals-to-AEPs-under-Medicare.pdf )
What Are Your Barriers?
You might like to download and compete this Exercise Benefits/Barriers Scale and discuss it with your GP.
Be Safe, Ask Questions.
Kind Regards,
David – Diabetes Educator @ Diabetes Counselling Online
Yes.
Interesting article. Exercise is a major element of my diabetes control (I’ve had it 40 years). I was in my 40’s, suffering a little bit of mid life man flu and feeling like a wet blanket. So with that it was time to make a change so I took up running. It has gone from a lap of the beach (1k) with my dog to half marathons and now triathlon. I train 6-8 hours a week cycling, running, swimming and gym. I do this with work and family as well.
I think that my insulin pump has also made my transition to a very active fitness life, so much easier. There are not many extremes with it and the smaller doses of insulin help a great deal. My pump has liberated me to try things I never though possible etc completing triathlons. This has also increased my mental health and my wellness means I am happier and more settled than I ever remember.
It’s important to ensure you test regularly and stay in contact with your diabetes health team but when you exercise for performance it’s a no brained to do this as you want every support to maintain your fitness.
A diabetic without exercise is a time-bomb. I cannot tell you how many times my eye doctor, dentist and endo, have told me how many diabetics they treat who are falling a part. I don’t let it depress me but let it animate me to keep pushing because I know that my effort will keep me intact for my family and in the future, my happy retirement. Exercise, there is so much to live for.
Thanks Dave for your input here. Much appreciated to have stories like yours, starting from nothing to the level you have reached today.
We all have the ability to do something in the way of exercise. I recall back in 2000 when Sydney had the Olympics, and more importantly the Paralympics: watching people who had the emotional / psychological strength to do something with their damaged bodies. It was inspirational for me.
My point is, people like you are an inspiration Dave. Thank you
For those people who may need a little strengthening, like Dave says, use your team to help you get there: the counsellors here, your exercise physiologist, and other members of your team where you feel you lack strength / room for improvement in your diabetes self care plan.
Cheers,
David – Diabetes Educator @ Diabetes Counselling Online