# Exercise as it relates to Disease/Effect of physical activity on Diabetes Mellitus
### What is the background to this research?

Non-Insulin-Dependent Diabetes Mellitus (NIDDM) is a metabolic disorder which is defined as having an increased resistance to insulin and an inability for your pancreas to secret insulin effectively. This type of metabolic disease is associated with many health problems such as, Coronary Heart Disease, Kidney failure and many more (5). The background to this research stems from the current theory that physical activity can limit the prevalence of chronic diseases and is this article considering whether regular physical activity aided by a proper diet can prevent further people being diagnosed with Non-Insulin-Dependent Diabetes Mellitus (NIDDM)

### Where is the research from?

The research was gathered using Alumni who graduated from the university of Pennsylvania and had attended the university from 1928 to 1947 The lead author in this article has been involved with other research papers, and it appears they have spent a large amount of time working in this field. It can be assumed that the study being conducted may have had other pre-assumed findings, and the researchers may have lead the study into trying to confirm these findings, given the type of candidates picked. The study itself was performed extensively to try and determine if what they were stating was true. And that was can regular physical activity reduce the rate of NIDDM.

### What kind of research was this?

The study was conducted using qualitative measures, the group of participants were given multiple questionnaires starting in the year 1962 where the study had started collecting the data necessary, which was further followed by a similar but different questionnaire again in 1976. The data gathering was spread out through 14 years with all participants varying in health status.

### What did the research involve?

The participants in the study were required to complete two questionnaires on lifestyle habits and health over the phone. All up there were 5990 men who originally agreed to be a part of the study and undertake the necessary components of the research, which included surveys in both 1962 and 1976 while also tracking their health status throughout the 14 years. The data used in this study was collected by conducting phone interviews from previous students who had attended the university and were available to complete both surveys. By collecting research through these means, it leaves questions around its validity. Collecting data over the people, requires participants to individually account for their own lifestyle habits, this method assumes a certain amount of error given that People can over or underestimate their physical activity and their lifestyles.The study commenced in 1962 where the first questionnaire was issued, relating to lifestyle and general health. When the first survey was issued, 80 percent of the research participants had completed it, when the second survey came out in 1976 only 70% of the participants responded. Both surveys contain similar questions, however It wasn’t specified what was different it just indicated that there was a difference. both containing the core questions which were indicators of NIDDM. The health questions were, BMI (Body mass index), family history of diabetes and hypertension, and the lifestyle the questions were on their physical activity levels and their energy expenditure with a special focus on leisure time. They assigned a number in kilocalories to each activity, and calculations where given for each participant to determine their energy expenditure and fitness levels in activates. They also looked at general movement required for day to day life. The initial recruitment for participants was quite narrow, they only looked at males (4), they were only looking at men who had attended the university during years that have been stated above. The participation level had dropped even further when the second survey was sent out, making the study group very narrow. Given the duration of this study, it’s understandable that participation levels would drop off given that circumstances can arise.

### What were the basic results?

One of the important findings was linked to BMI and age. In this study, they found a positive coloration with men being over the age of 55 and having a high BMI, gave them a three times higher chance of being diagnosed with NIDDM then men who were under the age of 45 and being in the lowest category for BMI measures (the measures for BMI range from 14.1 to 46.0). The men in the study who had previously been diagnosed with hypertension before 1962 had twice as likely chance of developing diabetes while undergoing the study compared to those who had a precursor to hypertension. This would most likely be due to poor health and being a part of a study that last 14 years long (2). The purpose of this research was to determine whether regular physical activity decrease the chances of being diagnosed with NIDDM. The finding was age appropriate physical activity and activity during leisure time decreased the chances of diabetes by nearly half. The combination of moderate and vigorous activity gave the best result for decreasing your chances of developing NIDDM. (Kilocalorie scores range from 0 to 14,700). What was an interesting finding being, that during this study a total of 202 men were diagnosed with diabetes.

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

Reading through this research article the results are like what other research papers say, and that says that regular physical activity, and the more recent finding regarding high intensity training, will lead a much healthier lifestyle that will decrease the chances of developing a chronic disease and in this case diabetes. There was enough evidence to suggest that regular physical activity will improve your health status and reduce the occurrence of Non-Insulin Dependent Diabetes Mellitus. The population sample was quite limited, and they only picked male candidates. Given the lack of diversity, the results produced might not be as definitive as other findings (6). They were only able to collect data off a small population sample due to some participants only being able to answer the first survey and not the second.

### Practical advice

This research has looked at an issue that has been a health problem for quite some time now. They undertook a study examining methods that have previously been proposed to work. Which is that, regular physical activity and reducing leisure time will reduce the occurrence of Non-Insulin-Dependent Diabetes Mellitus. More research is needed to determine if it will stop it all together. What is also important to point out is, that undertaking an exercise program or research study with participants that have diabetes and other health conditions requires proper cautions to be in place as there are considerations that need to be made with dealing with diabetes (3).

### Further information/Resources

Here are a few articles that look at the same disease but examine other aspects.
- Dietary Fiber, Glycemic Load, and Risk of Non-insulin-dependent Diabetes Mellitus in Women
- Increased incidence of non-insulin-dependent diabetes mellitus among adolescents
- Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23)
- Prevention of Type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise The 6-year Malmö feasibility study
- Body Fat Distribution and Risk of Non-Insulin-dependent Diabetes Mellitus in Women: The Nurses' Health Study
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

#### References

BEATY, T. H., NEEL, J. V. AND FAJANS, S. S. IDENTIFYING RISK FACTORS FOR DIABETES IN FIRST DEGREE RELATIVES OF NON-INSULIN DEPENDENT DIABETIC PATIENTS In-text: (4): 4. BEATY T, NEEL J, FAJANS S. IDENTIFYING RISK FACTORS FOR DIABETES IN FIRST DEGREE RELATIVES OF NON-INSULIN DEPENDENT DIABETIC PATIENTS. American Journal of Epidemiology [Internet]. 1982 [cited 12 September 2018];115(3):380-397.
Journal HELMRICH, S. P., RAGLAND, D. R., LEUNG, R. W. AND PAFFENBARGER, R. S. Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus In-text: (5): 5. Helmrich S, Ragland D, Leung R, Paffenbarger R. Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus. New England Journal of Medicine [Internet]. 1991 [cited 22 August 2018];325(3):147-152.
Journal HORTON, E. S. Role and Management of Exercise in Diabetes Mellitus In-text: (3) : 3. Horton E. Role and Management of Exercise in Diabetes Mellitus. Diabetes Care [Internet]. 1988 [cited 12 September 2018];11(2):201-211.
Journal THORNE, M. C., WING, A. L. AND PAFFENBARGER, R. S. CHRONIC DISEASE IN FORMER COLLEGE STUDENTS. VII. EARLY PRECURSORS OF NONFATAL CORONARY HEART DISEASE1 In-text: (6) : 6. THORNE M, WING A, PAFFENBARGER R. CHRONIC DISEASE IN FORMER COLLEGE STUDENTS. VII. EARLY PRECURSORS OF NONFATAL CORONARY HEART DISEASE1. American Journal of Epidemiology [Internet]. 1968 [cited 12 September 2018];87(3):520-529.
Journal WILSON, P. W., MCGEE, D. L. AND KANNEL, W. B. OBESITY, VERY LOW DENSITY LIPOPROTEINS, AND GLUCOSE INTOLERANCE OVER FOURTEEN YEARS In-text: (2) : 2. WILSON P, McGEE D, KANNEL W. OBESITY, VERY LOW DENSITY LIPOPROTEINS, AND GLUCOSE INTOLERANCE OVER FOURTEEN YEARS. American Journal of Epidemiology [Internet]. 1981 [cited 13 September 2018];114(5):697-704.
Journal ZIMMET, P., DOWSE, G., FINCH, C., SERJEANTSON, S. AND KING, H. The epidemiology and natural history of niddm-lessons from the South Pacific In-text: (1) : 1. Zimmet P, Dowse G, Finch C, Serjeantson S, King H. The epidemiology and natural history of niddm-lessons from the South Pacific. Diabetes / Metabolism Reviews [Internet]. 1990 [cited 13 September 2018];6(2):91-124.