# Exercise as it relates to Disease/Effects of aerobic exercise on type 1 diabetes

Type 1 Diabetes Mellitus (T1DM) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. It is an inflammatory autoimmune disease of the pancreas, resulting in a lack of insulin. Risk factors for developing Type 1 Diabetes include:
   * Genetics
   * Environmental
   * Gestational Infection
   * Childhood Infection
The rate of diabetes in Australia has shown a steady increase from 2.4% in 1995 to 3.8% in 2007–08.
In 2007-08, 10% of the Australian population who suffered from diabetes (82,000 people) reported they had Type 1 diabetes, while 2% of people with diabetes did not know which type of diabetes they had.

## Aerobic Exercise

Type 1 diabetes mellitus sufferers often tend to avoid participating in aerobic exercise due to fear of enhancing more acute symptoms relating to the disease. Although this practice may reduce the immediate effects T1DM places on the body, it may increase the prevalence of other lifestyle complications including:
* Increased weight gain
* Decreased muscle mass
* Decreased bone density
* Decrease insulin sensitivity
* Decreased life expectancy
* Increased risk of lifestyle diseases
These problems can affect common everyday tasks such as making it difficult to walk up a flight of stairs. They also dramatically affect the long term health of the patient.

### Benefits of Aerobic Exercise

Recent research has shown sufficient evidence to indicate that aerobic exercise does not negatively affect Type I diabetes mellitus symptoms and is completely safe for patients suffering with well-controlled diabetes mellitus. Aerobic exercise has been shown to:
* Improve glucose tolerance
* Reduce insulin requirements/increase insulin sensitivity
* Potentially lower glycosylated haemoglobin
* Reduced risk of CVD, hypertension, colon cancer, obesity and osteoporosis
* Increased overall life expectancy
* Increased CV endurance, muscle fitness and flexibility
Aerobic exercise also contributes to psychological health benefits which may include:
* Improved self-esteem
* Enhanced sense of well-being
* Improved social interaction skills

### Recommendations- Aerobic Exercise

In order to gain the maximum benefits from aerobic exercise, the following recommendations should be followed:
* 5 sessions/week
* 60-90% MHR depending on individual
* 30-90 mins
* Each training program may need to be personalised with GP recommendations and a pre-screening check
This research may show that aerobic exercise, when taking correct responsibility for the varying insulin requirements, reduces the symptoms of T1DM. Even though this predominantly refers to med-high intensity over med-long duration, everyday occurrences will also have a positive effect on minimising symptoms of the disease. These may include:
* Walking to work
* Taking stairs rather than escalator/lift
* Taking dog for a run on a more common basis

## Precautions

Although research suggests that aerobic exercise is safe to participate in some considerations must be taken:
* Discuss intended training plan with doctor prior to commencing.
* Frequently monitor blood-glucose levels during exercise.
* Cease exercise if any abnormal symptoms appear.

## Further reading

* http://www.who.int/diabetes/publications/diabetes_booklet/en/index.html
* http://www.diabetes.org/living-with-diabetes/treatment-and-care/
* http://www.diabetes.ca/files/riddell--final.pdf

## References

* ↑ "Lernmark, Å. (1999). Type 1 diabetes. Clinical chemistry, 45(8), 1331-1338 http://www.clinchem.org/content/45/8/1331.full
* 1 2 3 4 5 "Eisenbarth, G. S. (1986). "Type I Diabetes Mellitus." New England Journal of Medicine 314(21): 1360-1368 http://www.hindawi.com/journals/ari/2012/457546/
* 1 2 "National Health Survey, 1995, 2001, 2004-05 and 2007-08 http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4820.0.55.001main+features32007-08
* 1 2 "Zisser, H., Sueyoshi, M., Krigstein, K., Szigiato, A., & Riddell, M. C. (2012). Advances in exercise, physical activity and diabetes mellitus. International Journal Of Clinical Practice (Supplement), 6662-71. doi:10.1111/j.1742-1241.2011.02856.x http://www.yorku.ca/mriddell/documents/Zisseretal2012.pdf
* 1 2 3 4 "Cohen ST, Jacobson AM. Psychological benefits of exercise. In: Ruderman NB, Devlin JT, Schneider SH, Kriska A, editors. Handbook of exercise in diabetes. 2nd ed. Alexandria, VA: American Diabetes Association; 2002 http://www.australianprescriber.com/magazine/30/5/article/911.pdf
* 1 2 3 "Pedersen, O., H. Beck-Nielsen, et al. (1980). "Increased Insulin Receptors after Exercise in Patients with Insulin-Dependent Diabetes Mellitus." New England Journal of Medicine 302(16): 886-892 http://www.nejm.org/doi/full/10.1056/NEJM198004173021603
* 1 2 3 4 5 6 7 "KOMATSU, W. R., BARROS NETO, T. L., CHACRA, A. R., & DIB, S. A. (2010). Aerobic Exercise Capacity and Pulmonary Function in Athletes With and Without Type 1 Diabetes. Diabetes Care, 33(12), 2555-2557. doi:10.2337/dc10-0769 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992189/