# Exercise as it relates to Disease/Exercise Prescription for Type 2 Diabetes

Type II diabetes is a metabolic disease that affects insulin levels within the body. The pancreas still produces insulin, however the amount is insufficient to the body’s needs and does not work effectively. Exercise is known to reduce the risk of developing Type II Diabetes. Although for those already diagnosed, regular physical activity can aid in reducing the severity of their condition.

## Background

Type II Diabetes is the most common form of diabetes world-wide. There is no known cause for this condition; however there are a number of risk- factors that aid in developing this metabolic disease.
These include environmental and genetic factors such as; physical inactivity, poor nutrition, overweight/obesity, family history, increased age and race. Developing diabetes increases ones risk of developing major health complications later in life, such as heart disease, stroke, high blood pressure as well as neuropathies and retinopathies. Currently there is no known cure for this metabolic disease. The best way to manage and decrease the severity of Type II Diabetes is through interventions such as: physical activity, diet and pharmaceuticals.
Diabetes is a growing epidemic world-wide, with 347 million people suffering from this condition; of this 90% of people are classified as a Type II Diabetic. Although, due to the subtlety of symptoms and lack of awareness of Type II Diabetes, a large population actually have the disease but are completely unaware. As age increases, the risk of developing this form of diabetes also increases. However with the growing childhood obesity rate the age of onset is significantly decreasing. It is also more prevalent in Aboriginal, Torres Strait Islander and Maori populations.

## Type II Diabetes & Physical Activity Prescription

Those with Type II Diabetes have elevated blood glucose levels due to the insufficient working of insulin within the body. Physical activity is beneficial for diabetics, as it helps improve glycemic control and other diabetes complications. Engaging in regular physical activity increases insulin sensitivity and allows for greater uptake of glucose, lowering blood glucose levels. It has been determined that when exercise is conducted, the glucose transporter protein GLUT-4 is able to move to the plasma membrane to allow for the uptake of glucose without insulin. GLUT-4 translocation is enhanced with exercise for up to 72 hours post exercise, allowing for skeletal muscle to uptake glucose more efficiently. In turn, participating in regular physical activity assists in the lowering of plasma glucose levels as well as an increase in insulin sensitivity. Also, physical activity in combination with a healthy diet aids in weight loss and reducing other diabetes risk factors such as heart disease and high blood pressure.

#### Aerobic Training

A person with Type II Diabetes should follow the below FITT principle to determine their training regime. Each person will have a tailored training program depending on the severity of their condition, current fitness levels and relative adiposity.
Frequency: 3–7 days per week
Intensity: Each session should include
   * 40-60% Light - moderate exercise
   * > 60% Vigorous exercise
Time: Training session of greater than 30 minutes most days of the week is recommended for those with Type II Diabetes. This can be split into the following:
   * > 150 minutes per week of light - moderate exercise
   * > 90 minutes per week of vigorous exercise
Type: Weight baring and non-weight baring exercises should be included depending on person. Examples include: walking, swimming and cycling.

#### Resistance Training

To begin a resistance exercise regime, it must first be determined what a person's 1 rep max (1RM) is equal to. This refers to the maximum amount of weight a person can lift in one single repetition. Once this has been established, the following resistance program can be prescribed:
* Resistance level should be set between 30-50% of 1RM
* 8-10 repetitions for upper body exercises, including
      * Arm curls, bench press, military press
* 10-15 repetitions for lower body exercises, including
      * Squats, heel raises, knee extensions
* At least 8 exercises for both upper and lower body muscle groups
* Up to 3 sets per exercise
* Alternate between upper body and lower body exercises
* Rest time in between exercises between 30–60 seconds
* The use of lower repetitions combined with high resistances increases muscle strength
* The use of higher repetitions with low resistances increases endurance
Resistance training should be included in physical activity sessions at least 2 days per week.

## Conclusion

There is no known cure for Type II Diabetes. However, the effects can be lessened through a healthier diet and in particular, exercise. Combining a resistance training regime with aerobic exercise can not only help with weight management, but also aids in lowering plasma glucose levels and increasing insulin sensitivity within cells. This significantly reduces the severity of Type II Diabetes and allows the patient to decrease their risks of long term and ongoing problems associated with diabetes.

## Further reading

Diabetes Australia Diabetes Information Sheet - Diabetes and Exercise

## References

* 1 2 World Health Organisation (2012). Diabetes. http://www.who.int/mediacentre/factsheets/fs312/en/index.html Accessed on 16 Oct 2012.
* ↑ The Australian Government: Department of Health and Ageing (2010). The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). http://www.diabetesaustralia.com.au/PageFiles/937/AUSDRISK%20Web%2014%20July%2010.pdf Accessed on 15 Oct 2012.
* ↑ Stewart KJ. Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension. JAMA: the journal of the American Medical Association 2002;288(13):1622-1631.
* ↑ Diabetes Australia (2012). Diabetes Australia - Diabetes Australia. http://www.diabetesaustralia.com.au/ Accessed on 15 Oct 2012.
* ↑ Herman WH, Smith PJ, Thompson TJ, Engelgau MM, Aubert RE. A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes. Diabetes Care 1995;18(3):382-387.
* ↑ Shaw J, Sicree R, Zimmet P. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87(1):4-14.
* ↑ Kennedy JW, Hirshman MF, Gervino EV, Ocel JV, Forse RA, Hoenig SJ, et al. Acute exercise induces GLUT4 translocation in skeletal muscle of normal human subjects and subjects with type 2 diabetes. Diabetes 1999;48(5):1192-1197.
* 1 2 3 Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, et al. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc 2000;32(7):1345
* ↑ Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and Type 2 diabetes A consensus statement from the American Diabetes Association. Diabetes Care 2006;29(6):1433-1438.
* ↑ Kravitz L. The 25 most significant health benefits of physical activity and exercise. IDEA Fitness Journal 2007;4(9):54-63.
* ↑ Type 2 Diabetes is linked to loneliness which may activate the body's physiological stress response. Mint 2019.