Written by Kira Lightfoot
Diabetes is a metabolic condition in which an individual’s body is unable to regulate levels of glucose in the blood 1. If blood glucose becomes too high or too low this can lead to both short term and long-term health complications 1. The diagnostic criteria for a person with diabetes is a higher than normal reading of fasting blood glucose levels (>5.5mmol) 1.
Diabetes can be well managed, however, it is important to remember that potential complications exist, including stroke, heart attack, kidney disease, anxiety, depression, limb amputation, and blindness. Diabetes can be managed through regular exercise 1.
Types of Diabetes
Type 1
Diabetes mellitus (T1DM) is most often diagnosed in childhood and accounts for approximately 10% of all diabetes cases 1. T1DM is an autoimmune condition in which the immune system destroys healthy cells in the pancreas that produce insulin 1. The result is that not enough insulin is produced to assist in regulating blood glucose levels. T1DM is incurable and cannot be prevented as it is not linked to modifiable lifestyle 1.
Type 2
Diabetes mellitus (T2DM) accounts for approximately 85-90% of all diabetes cases and is a condition in which the body progressively becomes resistant to insulin and/or the pancreas gradually loses the ability to produce enough insulin 1. T2DM is associated with modifiable lifestyle risk factors such as physical activity levels and diet 1. T2DM can also be linked to genetic and family related risk factors. T2DM typically develops in adults over 45 years of age but is beginning to develop in younger age groups including young adults, adolescents and even children 1.
Gestational Diabetes
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy that generally goes away after delivery 4. Being physically active can decrease the risk of developing GDM 4.
Exercise for the Management of Diabetes
Exercise can be used to help manage diabetes. Regular exercise can improve health and help individuals to achieve glycaemic, fitness and body composition goals 5. Participating in regular exercise with a combination of both aerobic and resistance-based training is encouraged for patients with diabetes 5. Aerobic exercise improves the uptake of glucose through greater insulin action, thereby reducing glycaemia. Anaerobic exercise (resistance training) increases muscle mass, improving glucose uptake into the muscles 5. Both forms of exercise can cause delayed-onset hypoglycaemia in recovery 5.
Evidence suggests that T2DM is more likely to develop in individuals who are insufficiently active 3. Exercise training, often in combination with other lifestyle strategies, has beneficial effects on preventing the onset of T2DM and improving glycaemic control in those with pre-diabetes and diabetes 3. In addition, exercise training improves cardiovascular risk profile, body composition and cardiorespiratory fitness, all strongly related to better health outcomes 3.
Modifying a person’s lifestyle by reducing sedentary time, increasing physical activity level and improving their diet with a lifestyle-intervention program can prevent or delay the development of diabetes 2. A recent study tested both lifestyle changes and the medication metformin to treat diabetes. Both reduced the occurrence of diabetes in individuals at high risk, but the lifestyle intervention was more effective than metformin treatment 2.
Exercise Guidelines
Based on industry research, it is recommended that individuals with diabetes should accumulate a minimum of 210 minutes per week of moderate-intensity exercise or 125 minutes per week of vigorous intensity exercise, with no more than two consecutive days without exercising 3.
Vigorous exercise is more time efficient and may also result in greater benefits with consideration of potential complications and contraindications 3. It is further recommended that two or more resistance training sessions per week (consisting of 2-4 sets of 8-10 repetitions using major muscle groups) should be included in the total 210 or 125 minutes of moderate or vigorous exercise, respectively 3.
Who Can Help?
Due to the high prevalence and incidence of comorbid conditions in patients with diabetes, it is recommended that exercise training programs should be written and delivered by individuals with appropriate qualifications and experience, such as an Exercise Physiologist, to recognise and accommodate potential comorbidities and complications 3.
References
- Diabetes Australia (2020). Retrieved 30 November 2020, from https://www.diabetesaustralia.com.au/about-diabetes/what-is-diabetes/
- Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. doi: 10.1056/NEJMoa012512
- Hordern, M. D., Dunstan, D. W., Prins, J. B., Baker, M. K., Singh, M. A. F., & Coombes, J. S. (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(1), 25-31. https://doi.org/10.1016/j.jsams.2011.04.005
- Padayachee, C., & Coombes, J. S. (2015). Exercise guidelines for gestational diabetes mellitus. World Journal of Diabetes, 6(8), 1033. doi: 10.4239/wjd.v6.i8.1033
- Riddell, M. C., Gallen, I. W., Smart, C. E., Taplin, C. E., Adolfsson, P., Lumb, A. N., … & Annan, F. (2017). Exercise management in type 1 diabetes: a consensus statement. The Lancet Diabetes & Endocrinology, 5(5), 377-390. http://dx.doi.org/10.1016/