# Exercise as it relates to Disease/The benefits of aerobic exercise as an adjunct therapy for controlling type 2 diabetes mellitus

This page critiques the 2015 article Blood glucose response to aerobic exercise training program among patients with type 2 diabetes mellitus at the University of Nigeria Teaching Hospital, Enugu South-East, Nigeria by Ezema et al.

## $_{Whatisthebackgroundtothisresearch?}$

Exercise is extremely important as an adjunct therapy to medication and diet for type 2 diabetes as it. assists in both prevention and management of the disease. Structure activity has an effect on reducing the glycosylated haemoglobin enough to decrease the risk of diabetic complications, however, aerobic exercise has a more significant effect than resistance training on fasting blood sugar. Exercise has also been shown to have significant improvements on glycemic control and causes a reduction in visceral adipose tissue presence.

## $_{Whereistheresearchfrom?}$

This study was conducted at the Enugu Campus of the University of Nigeria in the Medical Rehabilitation Department. Ezema is an established author with many papers researching the effect of exercise on a variety of body functions in the Nigerian population. This article was published in the International Journal of Diabetes in Developing Countries, a peer-reviewed journal edited by experts in the field with a wide international reach.
There were no conflicts of interest for the researchers writing the paper. The paper was first published in 2015 and can be downloaded for free as a PDF..

## $_{Whatkindofresearchwasthis?}$

This study is a randomised controlled trial with age-matched controls. It was conducted over a period of 8 weeks with the intervention consisting of a continuous training program vs sedentary control group. Due to this paper being a randomised controlled trial, the level of evidence of this article is considered level II by the National Health & Medical Research Council in Australia. A randomised control trial is the second best possible method of research and as it is able to show that the effects occur due to the application of a different treatment method. The PEDro scale, which is valid tool for measuring the quality and methodology of clinical trials, rates this paper as 4/10 due to the criterion it fulfils, which means it is a fair quality trial. If there was no mention of a criterion, it was assumed that it wasn't fulfilled.
PEDro Scoring :
| Random Allocation | Y |
| Concealed Allocation | N |
| Baseline Comparability | Y |
| Subjects Blinded | N |
| Therapists Blinded | N |
| Assessors Blinded | N |
| Adequate Follow-up | N |
| Intention-to-treat Analysis | N |
| Between-group Analysis | Y |
| Point Estimates & Variability | Y |

## $_{Whatdidtheresearchinvolve?}$

A group of 54 volunteers were obtained from the diabetes clinic at the University of Nigeria Teaching Hospital in Enugu, Nigeria. There were 27 male and 27 female participants all diagnosed with type 2 diabetes mellitus, ranging from 40 to 55 years old. They were equally divided into either the exercise or a control group for a period of 8 weeks.

### Exercise group

* 10-minute warm up
* exercise on a bicycle ergometer at moderate intensity
* Started with a 45-minute session, increased to a 60-minute session after 2-weeks
* 10-minute cool-down
* Exercise 3-times per week

### Control

* Instructed not to undertake any structured physical activity

### Outcome measures

* Physiological measures: resting heart rate and blood pressure
* Anthropometric: weight, height and body mass index
* Blood sample
* Fasting plasma blood glucose
* Stress Test: YMCA Sub-maximal cycle ergometry test

## $_{Whatwerethebasicresults?}$

The exercise group had a significant improvement in aerobic capacity and significant reduction in blood glucose and blood pressure over the control group.
Therefore, the main significant findings of the paper were:
* An increase in the aerobic capacity correlated with a decrease in fasting blood sugar level
* Decrease in blood pressure in the exercise group over the control group
The authors of the study state 'there is a negative correlation between VO2 max and Fasting Blood Glucose', but also mentions that these recommendations are limited to South-East Nigeria and therefore aren't generalisable to the entire type 2 diabetes population.
A few limitations to consider are the limited number of participants, single exercise regime and lack of longer-term follow up. This study has determined these are limitations and has specifically advised future studies to address them.

## $_{Whatconclusionscanwetakefromthisresearch?}$

Between this trial and other articles in the area, it can be concluded that there are positive associations between the management of type 2 diabetes mellitus with exercise. Although more research needs to be done into specific exercise regimes, exercise is beneficial as an adjunct therapy for type 2 diabetes mellitus. There is still some debate as the effect of resistance versus aerobic exercise however in the Nigerian population, moderate intensity exercise, three times per week is beneficial for reducing both fasting blood sugar and blood pressure. Various studies, both randomised control trials and systematic reviews have supported the view that exercise is effective in reducing diabetes risk factors in type 2 diabetics from as little as a week of training.

## $_{Practicaladvice}$

Ezema's study shows that exercise is a successful technique to assist in managing diabetes type 2 in the Nigerian population. This is important as it looks specifically at this sub-group to determine that these health benefits are relevant to these citizens. Previous studies have also shown exercise to be effective in reducing diabetic risk factors therefore exercise should be utilised as an adjunct therapy in the management of type 2 diabetes mellitus. In future studies the investigations should focus on finding a specific exercise regime for clients and overcome the limitations of the current study.

## $_{FurtherInformation}$
### Diabetes Australia

Web page: https://www.diabetesaustralia.com.au/managing-type-2
Phone: 1300 136 588

### Royal Australian College of General Practitioners

Web page: http://www.racgp.org.au/your-practice/guidelines/diabetes/

### Bupa Australia - Type 2 Diabetes

Looks at the signs, symptoms and complications of diabetes type 2
Web page: https://www.bupa.com.au/health-and-wellness/health-information/az-health-information/ci.type-2-diabetes.phi

### National Diabetes Service Scheme

Web page: http://diabetesnsw.com.au/wp-content/uploads/2014/12/Managing-sick-days-for-type-2-diabetes_green.pdf

## $_{References}$

* 1 2 3 Ezema CI, Lamina S, Onwunali AA, Ezugwu UA, Amaeze AA, Nwankwo MJ. Blood glucose response to aerobic exercise training program among patients with type 2 diabetes mellitus at the University of Nigeria Teaching Hospital, Enugu South-East, Nigeria. Int J Diabetes Dev Ctries. 2015;35(2):88-94.
* ↑ Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes. Diabetes care. 2006;29(6):1433-8.
* ↑ Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-50.
* ↑ Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. J Am Med Assoc. 2001;286(10):1218-27.
* ↑ Yang Z, Scott CA, Mao C, Tang J, Farmer AJ. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014;44(4):487-99.
* ↑ Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006(3):Cd002968.
* ↑ National Health and Medical Research Council. NHRMC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
* ↑ Barton S. Which clinical studies provide the best evidence? : The best RCT still trumps the best observational study. BMJ. 2000;321(7256):255-6.
* ↑ de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33.
* ↑ Zanuso S, Jimenez A, Pugliese G, Corigliano G, Balducci S. Exercise for the management of type 2 diabetes: a review of the evidence. Acta diabetol. 2010;47(1):15-22.
* ↑ Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes. Diabetes care. 2011;34(5):1228-37.
* ↑ Kirwan JP, Solomon TPJ, Wojta DM, Staten MA, Holloszy JO. Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus. Am J Physiol Endocrinol Metab. 2009;297(1):E151-E6.