# Exercise as it relates to Disease/Can Leisure time physical activity help prevent type 2 diabetes?

This is a critique of a paper based on the impact of leisure time physical activity on people who are at a high risk of developing Type 2 diabetes. This was written for a Health, Disease and Exercise assignment.
The Paper: Laaksonen, D., Lindstrom, J., Lakka, T., Eriksson, J., Niskanen, L., Wikstrom, K., Aunola, S., Keinanen-Kiukaanniemi, S., Laakso, M., Valle, T., Ilanne-Parikka, P., Louheranta, A., Hamalainen, H., Rastas, M., Salminen, V., Cepaitis, Z., Hakumaki, M., Kaikkonen, H., Harkonen, P., Sundvall, J., Tuomilehto, J. and Uusitupa, M. (2017). Physical Activity in the Prevention of Type 2 Diabetes: The Finnish Diabetes Prevention Study.

### What Is The Background To This Research?

Diabetes is currently the fastest growing chronic disease in Australia. Around 85% of all accounted cases of diabetes are type 2 diabetes and it continues to increase.
What is Type 2 Diabetes?
Type 2 diabetes is a progressive disease where the body either cannot produce insulin or becomes highly resistant towards it. Type 2 diabetes can be caused by both genetics and lifestyle choices. People with a type 2 diabetes history are at a greater risk of developing the disease with unhealthy choices such as obesity and physical inactivity also increases the risk of developing it.
Lack of physical activity is a large discussing point regarding it can be used to prevent the onset of type 2 diabetes. The following are believed effects of physical activity on type 2 diabetes:
* It can help reduce blood glucose level
* Helps reduce susceptibility to arteriosclerosis as people with type 2 diabetes are more likely to develop this.
* It helps maintain Cholesterol levels.
* It helps insulin to work in a more efficient manner
The aim of this study was to determine whether leisure time physical activity can be used to prevent Type 2 diabetes from people who are at a high risk.

### Where Is The Research From?

The study was conducted by the Finnish Diabetes prevention study group along with the following associations:
* The Academy Of Finland
* Finland Ministry of Education
* The Norvo Nordisk Foundation
* Finnish Diabetes Research Foundation
* Kuopio University Hospital
* Juho Vainio Foundation

### What Kind Of Research Was This?

This study was conducted using a multicentre, randomized control trial. A multicentre trial is a trial that has been conducted in more than one clinic or centre. A randomised control trial means that the participants were placed in a group at random without the researchers or participants having the option to pick which group.
The advantages of such a method is that it reduces selection bias, It allows different options to be analysed against each other, and is considered the Gold standard for testing so is readily accepted. The Disadvantages of this method are they can be quite expensive and it usually takes a long time to conduct these trials.

### What Did The Research Involve?

The research was conducted using 522 participants from 5 different study centres. All participants were between the age of 40-65 years of age and had impaired glucose tolerance. Of all the participants 487 completed a questionnaire at the baseline stage and at least once during the follow up that measured the previous 12 months of leisure time physical activity. Participants were split into two groups the intervention group and the controlled one.

### What Were The Basic Results?

The data obtained shows that participants from the intervention group reported that 37% undertook less than 1 hour a week of moderate to vigorous intensity of leisure time physical activity (LTPA) while 41% undertook more than 2.5 hours of moderate to vigorous intensity of LTPA. While in the controlled group 39% of the participants undertook less than 1 hour a week of moderate to vigorous intensity of LTPA while 40% undertook more than 2.5 hours of moderate to vigorous intensity of LTPA.
During the follow up period it was learnt that 107 of the participants had developed type 2 diabetes. 41 of these were from the intervention group while 66 of the participants who developed the disease were in the controlled group. After taking accounting for major risk factors of diabetes, smoking status, group age and sex the data showed that participants in the upper third of change in LTPA were 80% less likely to develop diabetes. Results showed that increased intensity and structured LTPA reduced the risk of high risk individuals developing diabetes. As with any study there are weaknesses that need to be accounted for when interpreting the data obtained. Since most of the physical exercise is self-reported there are tendencies for people to overestimate how much exercise they did and the intensity which they undertook. Another detailed limitation was their inability to record other objective measures of LTPA.

### What conclusions can we take from this research?

* A mixture of endurance training and resistance training undertaken at moderate level intensity at least stopped the progression from a client having impaired glucose tolerance to developing type 2 diabetes.
* Structured LTPA of increased intensity had the greatest effect during the exercise intervention.
* Lifestyle changes and low intensity exercise also seem to reduce the risk of developing type 2 diabetes.

### Practical advice

The main practical advice that can be passed on from this research is that any form of physical activity can be beneficial for people at a high risk of developing type 2 diabetes. People must remember that exercise alone isn’t enough when trying to prevent the development of the disease. Lifestyle choices and diet play a large role in the overall impact exercise can have on people.

### Further Information and Research

For further information regarding the impact of exercise on type 2 diabetes, you can either contact a professional or have a read through the following articles:
* Exercise and Diabetes: https://www.diabetesaustralia.com.au/exercise
* Physical Activity and Type 2 Diabetes: https://www.adea.com.au/wp-content/uploads/2013/08/PHYSICAL-ACTIVITY-2009.pdf
* Exercise and type 2 Diabetes: http://www.medscape.com/viewarticle/715313

## = References

* ↑ Diabetesaustralia.com.au (2017) Diabetes in Australia
* ↑ Betterhealth (2017) Diabetes type 2
* ↑ M. Leontis RN et al (2017) Type 2 Diabetes and Exercise
* 1 2 3 4 5 6 Laaksonen et al (2004) Physical Activity in the Prevention of Type 2 Diabetes: The Finnish Diabetes Prevention Study.
* ↑ Fedorov B (2005) The design of multicentre trials. - PubMed - NCBI
* ↑ Dtsch Arztebl (2011) Randomized Controlled Trials—an Indispensible (sic) Part of Clinical Research, pg 661-662