Diabetes Exercise Include Physical Activities?
In this article about diabetes exercise, the word exercise can be used interchangeably with ‘physical activity’. It is defined as bodily movement produced by the contraction of skeletal muscle that increases energy expenditure.
Diabetes has an increasing trend in prevalence and incidence of type 2 diabetes. Currently, it is estimated that almost 60 million United State residents are having pre-diabetes, which is a condition where blood sugar level are above normal. This will have an increasing risk for type 2 diabetes. Just to let you know that Type 2 diabetes is a significant cause of mortality and morbidity related to cardiovascular diseases, diabetic retinopathy (blindness), kidney disease (nephropathy), nerve disease (neuropathy)and even amputation. Regular physical activity is able to prevent or delay the onset of diabetic complication, however, most people with type 2 diabetes is having sedentary lifestyle instead.
Physical activity and exercise is one of the important elements in preventing and managing diabetes. It has been proven that regular physical activity improves blood sugar control and prevents or delays the onset of complications; along with improve lipid profile, blood pressure, cardiovascular events, mortality and increased quality of life. Structured intervention with physical activity and modest weight loss is able to lower type 2 diabetes risk up to 58% in high risk populations.
WHAT IS THE RELATIONSHIP BETWEEN EXERCISE AND DIABETES?
By following diabetes exercise, it will increase insulin sensitivity so that the cells are able to use any available insulin better in order to uptake glucose during and after activity. Besides that, when the muscle contract during exercise, it will stimulate other mechanisms which will allows the cell to uptake glucose and use it for energy even thought the insulin is not available.
There are several factors that influence exercise fuel use; the most important are the intensity and the duration of exercise. By increasing the intensity of the exercise, there is a greater reliance on carbohydrate as long as there is sufficient amount available in the muscle or blood. In the beginning of the exercise, glycogen will provide the fuel for the working muscles. As the glycogen stores depleted, muscle will start to use the circulating blood glucose along with free fatty acid released from the adipose tissues. Lipid storage is more readily used for longer duration activity.
According to American College of Sports Medicine (ACSM) evidence, it is stated that physical activity will cause an increased in the glucose uptake into active muscles balanced by the hepatic glucose production.
AEROBIC EXERCISE EFFECT
In individuals with type 2 diabetes, when they perform moderate exercise, muscle will start to utilize the blood sugar and it is usually rise more than hepatic glucose production. Therefore, the blood sugar levels tend to decline. The effects of single bout of aerobic exercise on insulin action depend on duration and intensity. The effect of moderate aerobic exercise will increase the insulin action and glucose tolerance for more than 24 hours, but less than 72 hours. On the other hand, for brief intense aerobic exercise, plasma catecholamine level will increase which will cause a major increase in glucose production. Therefore, high blood sugar (hyperglycemia) will happened and persist for 1-2 hours.
RESISTANCE EXERCISE EFFECT
There are limited studies about the acute effects of a single bout of resistance training on blood glucose level in type 2 diabetes subjects. However, resistance exercise results in lower fasting blood glucose level 24 hours after exercise in individuals with impaired fasting glucose
AEROBIC + RESISTANCE TRAINING
A combination of both aerobic and resistance training may be more effective than either type of the exercise alone. One of the result from resistance training is increase in muscle mass where could contribute to blood glucose uptake without altering the muscle capacity to respond to insulin. On the other hand, aerobic exercise enhances the blood glucose uptake via greater insulin action.
Due to the presence of diabetes-related health complication such as cardiovascular diseases, hypertension, neuropathy, retinopathy will be complicated. Please consult your doctor to ensure that you could start exercise.
It is recommended that people with diabetic should exercise at least five times in a week with no more than 2 consecutive days between bouts of activity.
Diabetes exercise should be at least moderate intensity. In the beginning, one should take is slowly and do it at your own pace. As time passes by, you could start increasing your intensity of exercise. One of the ways to make sure that you are performing moderate intensity is that you should still be able to talk around one sentence without feeling breathless.
People with diabetic should engage in a minimum of 150 min of exercise in a week.
Any form of aerobic exercise which will cause an increase in the heart rate is beneficial including brisk walking, swimming, jogging, cycling, and hiking and so on.
HYPOGLYCEMIA AND PHYSICAL ACTIVITY
Individual with type 1 diabetes has a higher risk of developing hypoglycemia which is known as low blood sugar level. People with type 2 diabete will have a lower risk unless they are on insulin injection.
When you are out for exercise, it is important to bring glucometer and carbohydrate-containing food.
If you are experiencing dizziness, shakiness of hand, heart beat increases, neck started to sweat. Follow the step below:
- Check your blood sugar level. If it is <5 mmol/L, consume fast acting carbohydrate such as glucose tabs, 200ml of orange juice or sport drinks, 3 unit of candy. Choose either one.
- Repeat blood glucose test after 15-20 min.
- If it is still low, take another serving of fast acting carbohydrate.
- After you feel better, make sure you have regular meals and snacks as planned in order to keep your blood sugar level within recommendation range.
Do remember that always follow your own pace. If you are able to do 10 minute, then it is fine. Start with 10 min and gradually increase to 20 min and 30 min. Please make sure that you are well hydrated before, during and after exercise.
Consult a dietitian in order to discuss carbohydrate intake and exercise adjustment
- S. Department of Health and Human Services Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta (GA): U.S. Department of Health and Human Services Centers for Disease Control and Prevention; 2008
- Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 2006; 20(4):216 –23
- Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE. Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract 2008;79(3): 405–11
- Ghosh S, Khazaei M, Moien-Afshari F, et al. Moderate exercise attenuates caspase-3 activity, oxidative stress, and inhibits progression of diabetic renal disease in db/db mice. Am J Physiol Renal Physiol 2009;296(4):F700 –F708
- Howorka K, Pumprla J, Haber P, KollerStrametz J, Mondrzyk J, Schabmann A. Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc Res 1997;34(1): 206 –14
- Loimaala A, Huikuri HV, Koobi T, Rinne M, Nenonen A, VuoriI. Exercise training improves baroreflex sensitivity in type 2 diabetes. Diabetes 2003;52(7):1837– 42
- Bajpeyi S, Tanner CJ, Slentz CA, et al. Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. J Appl Physiol 2009;106(4):1079 – 85
- Braun B, Zimmermann MB, Kretchmer N. Effects of exercise intensity on insulin sensitivity in women with non–insulindependent diabetes mellitus. J Appl Physiol 1995;78(1):300 – 6
- Boon H, Blaak EE, Saris WH, Keizer HA, Wagenmakers AJ, van Loon LJ. Substrate source utilisation in long-term diagnosed type 2 diabetes patients at rest and during exercise and subsequent recovery. Diabetologia 2007;50(1):103–12
- Borghouts LB, Wagenmakers AJ, Goyens PL, Keizer HA. Substrate utilization in non-obese Type II diabetic patients at rest and during exercise. Clin Sci (Lond) 2002;103(6):559 – 66
- Bergman BC, Butterfield GE, Wolfel EE, Casazza GA, Lopaschuk GD, Brooks GA. Evaluation of exercise and training on muscle lipid metabolism. Am J Physiol 1999;276(1 Pt 1):E106 –E17
- Bweir S, Al-Jarrah M, Almalty AM, et al. Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes. Diabetol Metab Syndr 2009;1:27
- Minuk HL, Vranic M, Hanna AK, Albisser AM, Zinman B. Glucoregulatory and metabolic response to exercise in obese non-insulin-dependent diabetes. Am J Physiol 1981;240:E458 –E464
- Boule NG, Weisnagel SJ, Lakka TA, et al. Effects of exercise training on glucose homeostasis: the HERITAGE family study. Diabetes Care 2005;28(1):108–14
- Cartee GD, Young DA, Sleeper MD, Zierath J, Wallberg-Henriksson H, Holloszy JO. Prolonged increase in insulin-stimulated glucose transport in muscle after exercise. Am J Physiol 1989;256(4 Pt 1): E494 –E499
- Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003;26(11):2977–82