# Exercise as it relates to Disease/Excessive sitting inhibits Insulin function in Type 2 Diabetes
### Prevalence

It is not uncommon for people to spend one-half of their waking day sitting. Changes in the modern society are giving people the opportunity for a more sedentary lifestyle such as watching TV, sitting in a car or using the computer. This estimates that nearly 70% of Australian adults, almost 12 million people, conduct in sedentary behaviours daily.

## Sedentary Behaviours and Insulin resistance

Evidence suggests that every two hours you spend sitting in front of the TV increases your risk for Type 2 diabetes (T2d) and other chronic diseases by 14 percent. This excessive sitting has an immediate effect on how our bodies are able to metabolize glucose increasing the risk factors for T2d.
When we are sedentary our muscles are not used, our body needs to work harder to assist with metabolizing foods (mostly carbohydrates) and storing the glucose for energy. This can put large amount of stress on the insulin producing Beta cells and we quickly become more insulin resistant (IR).

## Type 2 Diabetes

T2d can be defined as insufficient levels of insulin or the body not being able to use insulin effectively (Insulin resistance).

### T2d characteristics include

-Inability to control metabolic pathways and blood glucose levels
- Insulin resistance and insulin deficient
-Obesity and being physical inactive
-High levels of sedentary behaviours are associated with increased risk of having t2d
All this increased sitting and decreased Physical activity has a profound negative effect on almost every aspect of our health. In particular type 2 diabetes. T2d results from a combination of genetic and environmental factors. The risk has a strong association with lifestyle factors such as type of occupation, socioeconomic status, overweight and obese individuals, dietary factors and the amount of daily movement one engages in. It is estimated that up to 60% of type 2 diabetes can be prevented. People at risk of t2d can delay and even prevent this disease by engaging in a healthy lifestyle.
The less active you are, our metabolic function decreases the activity of an enzyme called lipoprotein lipase (LDL) which is associated with higher triglyceride levels and lower HDL levels (the ‘good’ cholesterol).
Also fuel mobilization is controlled during exercise. If exercise is sustained, a decrease in insulin secretion and increases in blood sugar levels (glucagon, catecholamines, cortisol secretion), which aids in the metabolism of fats, proteins and carbohydrates.

## Physical activity and Sedentary behaviour guidelines

- Follow Canadian Sedentary Behaviour Guidelines for Youth and Children
- Australia's Physical Activity and Sedentary Behaviour Guidelines and American Diabetes Association recommends engaging in some form of general moderate exercise (walking, jogging, gardening) for most of and preferably all day. The guidelines also recommend some resistance training at least 2 days per week to reduce the time spent being sedentary.

## Recommended strategies to reduce time seated

| What | Explain | Suggestions | Why | Recommended by |
| The enduring Mover Framework | Involves Stand, Walk, Push elements | -Stand at least 50% a day and once an hour. -Walk 10,000 or more steps per day -Push: exercise at least twice per week | -Sitting is hazardous to all forms of our health. - decrese risk of bone fracture, muscle loss | Dr. James Levine, Professor of Medicine, Mayo Clinic. |
| Workspace movement Friendly | Decreasing time spent sitting at a desk | -Using: A standing desk -an exercise peddler -Sit on a yoga ball -Take frequent breaks | Prolonged Periods of limited muscle activity can reduce insulin action. | -Department of Health Aust -Canadian Sedentary Behaviour Guidelines -Dr. James Levine (inventor of the standing desk) |
| Break it up | Frequent interruptions in Sedentary time | Take standing breaks as often as possibly or every 30-45 mins. | -Associated with metabolic risk improvements -A study suggests that, Glucose mmol/L after active breaks was reduced compared with no break. | -Association of Sedentary Behaviours -The department of Health: Sedentary Behaviour Guidelines |
| Limit Screen time | Limit time spent using electronic media (8). | -No more than 2 hours a day -Allocated specific times for electrical media (not in daylight hours) - Reward good behaviour with active family time | | Lower levels of screen time are associated with reduced health risks -Insulin levels drop with too much sitting | Department of Health -Make your move -sit less-Be Active for Life. |

## Further reading

Enduring Mover Framework
The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)
Video: Workouts can't undo damage done from sitting all day

## References

* ↑ Hamilton, M., Hamilton, D. and Zderic, T. (2007). The role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56(11), pp.2655--2667
* ↑ Abs.gov.au, (2014). Australian Bureau of Statistics. [online] Available at: http://www.abs.gov.au/ [Accessed 30 Sep. 2014].
* ↑ 8. Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines
* ↑ George, E., Rosenkranz, R. and Kolt, G. (2013). Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act, 10(1), p.20.
* ↑ Hamilton, M., Hamilton, D. and Zderic, T. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56(11), pp.2655--2667.
* ↑ Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines. [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines [Accessed 26 Sep. 2014].
* ↑ Hamilton, M., Hamilton, D. and Zderic, T. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56(11), pp.2655--2667.
* ↑ Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines. [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines [Accessed 26 Sep. 2014].
* ↑ George, E., Rosenkranz, R. and Kolt, G. (2013). Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act, 10(1), p.20.
* ↑ Nelson, K., Boyko, E. and Reiber, G. (2002). Diet and Exercise Among Adults With Type 2 Diabetes. Third National Health and Nutrition Examination Survey.
* ↑ 8. Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines
* ↑ Nelson, K., Boyko, E. and Reiber, G. (2002). Diet and Exercise Among Adults With Type 2 Diabetes. Third National Health and Nutrition Examination Survey.
* ↑ tephens et al (2011). Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake. Metabolism. 60(7):941–949
* ↑ Stephens et al (2011). Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake. Metabolism. 60(7):941–949
* ↑ 7. Nelson, K., Boyko, E. and Reiber, G. (2002). Diet and Exercise Among Adults With Type 2 Diabetes. Third National Health and Nutrition Examination Survey.
* ↑ 8. Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines
* ↑ Abs.gov.au, (2014). Australian Bureau of Statistics. [online] Available at: http://www.abs.gov.au/ [Accessed 30 Sep. 2014].
* ↑ Abs.gov.au, (2014). Australian Bureau of Statistics. [online] Available at: http://www.abs.gov.au/ [Accessed 30 Sep. 2014].
* ↑ 11. Hamilton, M., Hamilton, D. and Zderic, T. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56(11), pp.2655--2667.
* ↑ Stephens et al (2011). Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake. Metabolism. 60(7):941–949
* ↑ 7. Nelson, K., Boyko, E. and Reiber, G. (2002). Diet and Exercise Among Adults With Type 2 Diabetes. Third National Health and Nutrition Examination Survey.
* ↑ 7. Nelson, K., Boyko, E. and Reiber, G. (2002). Diet and Exercise Among Adults With Type 2 Diabetes. Third National Health and Nutrition Examination Survey.
* ↑ 8. Health.gov.au, (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines
* ↑ Csep.ca, (2014). CSEP - Read the Guidelines. [online] Available at: http://www.csep.ca/english/view.asp?x=949 [Accessed 30 Sep. 2014].
* ↑ George, E., Rosenkranz, R. and Kolt, G. (2013). Chronic disease and sitting time in middle-aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act, 10(1), p.20.
* ↑ George, E., Rosenkranz, R. and Kolt, G. (2013). Chronic disease and sitting time in middle -aged Australian males: findings from the 45 and Up Study. Int J Behav Nutr Phys Act, 10(1), p.20.
* ↑ Associations of sedentary behaviour, sedentary bouts and breaks in sedentary time with cardio metabolic risk in children with a family history of obesity. (2013). PLOS One, 8(11), p.791.
* ↑ Associations of sedentary behaviour, sedentary bouts and breaks in sedentary time with cardio metabolic risk in children with a family history of obesity. (2013). PLOS One, 8(11), p.791.
* ↑ Healy, G., Wijndaele, K., Dunstan, D., Shaw, J., Salmon, J., Zimmet, P. and Owen, N. (2008). Objectively measured sedentary time, physical activity, and metabolic risk the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes care, 31(2), pp.369--371.
* ↑ Dunstan, D., Kingwell, B., Larsen, R., Healy, G., Cerin, E., Hamilton, M., Shaw, J., Bertovic, D., Zimmet, P., Salmon, J. and others, (2012). Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes care, 35(5), pp.976--983.
* ↑ Associations of sedentary behaviour, sedentary bouts and breaks in sedentary time with cardio metabolic risk in children with a family history of obesity. (2013). PLOS One, 8(11), p.791.
* ↑ 6. Lakerveld, J., et al.(2013). ‘The effects of a lifestyle on leisure time sedentary behaviors in adults at risk: The Hoorn Prevention Study, a randomized controlled trial’. Preventative Medicine. Vol. 57, pp. 351 - 356.