# Exercise as it relates to Disease/resistance training VS aerobic training in diabetics

Diabetes mellitus (DM) or more commonly known as just diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Diabetes is due to either of the following two factors: the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. Resistance training and aerobic training are both major therapeutic remedies for type 2 diabetics. Unfortunately physical activity is often overseen when looking at ways to improve those who are diagnosed.
General Symptoms include:
Comparison of Type 1 and Type 2 Diabetes :
| | Type 1 Diabetes | Type 2 Diabetes |
| Onset | Sudden | Gradual |
| Age at onset | Mostly in children | Mostly in adults |
| Body Size | Thin or normal | Often obese |
| Ketoacidosis | Common | Rare |
| Autoantibodies | Usually present | Absent |
| Endogenous insulin | low or absent | absent |
| Concordance in identical twin | 50% | 90% |
| Prevelance | ~10% | ~90% |

## Resistance Training

Resistance training involves using a weight or band as a resistance. General recommendations include doing 8-10 exercises per session, performing 2-4 sets with the ability to complete 8-12 repetitions on 2-3 non consecutive days a week.
Performing a program such as the one above combined with a moderate weight loss program with result in a decrease in HbA1c. Patients aged 60–80 with type 2 diabetics showed an improvement in glycaemic control. Resistance training twice a week also demonstrated to improve insulin sensitivity and fasting glycemia whilst decreasing abdominal fat in participants with type 2 diabetes. Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and importantly, result in improved glucose tolerance and insulin sensitivity.

## Aerobic Training

Aerobic training has shown to reduce Hba1c by approximately 0.66%, an amount that would be expected to reduce the risk of diabetic complications significantly. Patients with insulin dependent diabetes mellitus undergoing aerobic circuit training had significant improvements in their cardiorespiratory endurance, muscle strength, lipid profile and glucose regulation. Glycosylated haemoglobin A1c of type 2 diabetics was reduced by 0.96% (p<0.5). Following a well structured aerobic interval training 2-3 times a week for 30–60 minutes will result in insulin sensitivity and muscle glucose uptake alteration.

## Recommendations

Following a well-structured concurrent training program will result in improved glycaemic control in both type 1 and type 2 diabetics. Aerobic training should consist of 2-3 sessions a week each for around 60minutes (including warm up and cool down). Resistance training is prescribed 2-3 times a week, using weights or elastic bands. Participants should aim for 2-3 sets of 8-12 repetitions at 55-75% 1 repetition maximum. Combining resistance training and aerobic training in the same session is an option although it is recommended to alternate the days.
If you are training with someone and they start getting
Normal Week
| | Type of Training | Duration (mins) |
| Monday | Aerobic | 60 |
| Tuesday | Resistance | 60 |
| Wednesday | Aerobic | 60 |
| Thursday | Resistance | 60 |
| Friday | Aerobic | 60 |
| Saturday | Rest Day | - |
| Sunday | Rest Day | - |
Weekends should still include some type of physical activity rather than doing nothing at all. Going for a swim, walking the dog or doing some sort of exercise is better than nothing at all.

## Considerations

Physical activity results in an increase in insulin sensitivity, insulin independent glucose uptake, and glucose usage by the muscle. Therefor diabetics run the risk of going hypoglycemic or hyperglycemic when exercising. It is important that individuals with diabetes use trial and error when starting a new exercise regime to know how much carbohydrates (glucose) they need to intake before during and after exercise to avoid hypo/hyperglycemia. If the individual does happen to start acting “strange” (weaker, uncoordinated, can’t speak) it is much better to assume they don’t have enough glucose in their body and give them jelly beans or a sugary drink than to do nothing at all

## Conclusion

Resistance training and aerobic training will significantly improve glycemic control. When combining the two in a concurrent training program, it will result in superior effect when comparing to solely focusing on the one type of training There are no major factors that result in one type of training being better than the other. Combining resistance training with aerobic training for 30–60 minutes, 2-3 times a week will have positive effects on diabetes. Everyone individual reacts differently to exercise so it is important to monitor glucose levels when starting new exercise. This type of exercise regime should become a habit as the greater effects are seen over a longer term.

## Further reading

Australian Diabetes Council: http://www.australiandiabetescouncil.com/
Diabetes Australia: http://www.diabetesaustralia.com.au/
Health Direct: http://www.healthdirect.gov.au/diabetes

## References

* 1 2 National Diabetes Data Group. (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28(12), 1039-1057
* ↑ Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., ... & Braun, B. (2010). Exercise and type 2 diabetes the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147-e167
* ↑ Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN 978-1-4377-0324-5
* 1 2 Dunstan, D. W., Daly, R. M., Owen, N., Jolley, D., De Courten, M., Shaw, J., & Zimmet, P. (2002). High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes care, 25(10), 1729-1736
* ↑ 1. Boulé, N. G., Haddad, E., Kenny, G. P., Wells, G. A., & Sigal, R. J. (2001). Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Jama, 286(10), 1218-1227
* ↑ 2. Mosher, P. E., Nash, M. S., Perry, A. C., LaPerriere, A. R., & Goldberg, R. B. (1998). Aerobic circuit exercise training: effect on adolescents with well-controlled insulin-dependent diabetes mellitus. Archives of physical medicine and rehabilitation, 79(6), 652-657.
* 1 2 3 Sigal, R. J., Kenny, G. P., Boulé, N. G., Wells, G. A., Prud'homme, D., Fortier, M., ... & Jaffey, J. (2007). Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 DiabetesA Randomized Trial. Annals of internal medicine, 147(6), 357-369
* ↑ Meade, A. The highs and lows of diabetes and exercise (2008). Sports Dieticians Australia. Volume 29 (1), 1-7
* ↑ Kennedy, L. (2001). Self-Monitoring of Blood Glucose in Type 2 Diabetes Time for evidence of efficacy. Diabetes Care, 24(6), 977-978.