# Exercise as it relates to Disease/Benefits of aerobic training for people with type 2 diabetes
#### What is Type II Diabetes

Type II Diabetes is a lifelong ‘lifestyle disorder’ effecting the metabolic system of the human body. Type II diabetes affects the pancreas where it: does not produce enough insulin for normal functioning , this insulin does not work properly and the body/cells have developed a ‘insulin resistance’ whereby they no longer respond to insulin effectively. Insulin is a vital hormone within the human body it opens channels into the cells allowing glucose to be removed from the blood and used by the cell. Type II Diabetes is the most common form especially in a society where obesity is so apparent and on the increase. Type II diabetes affects 85-90% of all people who have diabetes (Type 1 affecting 10-15%) and around 981,212 (as of June 30, 2014) people in Australia have the disease, this number is on the rise as obesity and unhealthy eating become more and more common.[1,2]

#### Causes of Type II Diabetes

There are many causes for Type II Diabetes, including a combination of Environmental and Genetic factors. The risk of contracting Type II Diabetes is increased in people genetically predisposed to the disease. Some lifestyle risk factors include
* Being overweight/obese
* Consuming poor diet, with high levels of fat and sugars.
* High blood pressure.
* Low levels of activity/high level of being sedentary during day.
* Smoking.[1,2,9]

#### People at Risk

Alongside the lifestyle risk factors there are people who have a predisposition to acquiring diabetes. Population groups with increased risk include:
* People with family history
* Over age of 55
* Overweight and over age of 45
* High Blood Pressure and over age of 45
* Aboriginal or Torres Strait Islander Background and over age of 35
* Pacific Island, Indian subcontinent or Chinese background and age of 35
* Woman with gestational diabetes. [1,2,3]

#### Symptoms

In most cases of diabetes no symptoms are present, other signs are ignored due to aging. Symptoms include:
* Passing more urine
* Itchiness, skin infections
* Slow healing cuts
* Blurred vision
* Mood swings
* Hungriness
* Tiredness and lethargy
* Excessive thirst
* Gradual increase in weight
* Headaches
* Cramps
* Dizziness [1,2,3]

#### Management

In the early stages of Type II Diabetes modifications in diet and exercise plans can be effective, but as the disease progresses oral medication may be necessary to control blood glucose and even insulin injections in more developed cases. [4]

## Effects of Aerobic Exercise for People with Type II Diabetes
#### Benefits

Aerobic exercise can be performed as and effective management or preventative strategy reducing the effects of Type II Diabetes. Aerobic exercise has been shown to:
* Improve metabolic control including glycaemic control/ Increased Insulin Sensitivity: Increased aerobic exercise intensity improves glycaemic control and insulin sensitivity. Aerobic exercise has a major effect on regulation of blood glucose levels because it increases the uptake of glucose directly from blood into muscle cells. It does this by utilising the GLUT- 4 transporter, the Glut-4 transporter is a protein which regulates glucose and is located in adipose tissue and skeletal muscle. The protein (GLUT 4) is increased by up to 4 times post exercise improving insulin sensitivity. This increased level of the protein can last 24–72 hours post exercise.
* Weight loss (strongly correlated with diabetes):It is known that diet along with a well-structured aerobic exercise program can reduce weight loss and help improve the effects of diabetes. Body fat reduction alone (i.e. through liposuction or other artificial methods) will not have a positive effect on diabetes, it is when weightloss is achieved alongside a aerobic program that positive affects will be noticed.
* Reduced risk of CVD a disease strongly correlated with Diabetes
* Increased Aerobic Capacity. [5,6,7,8]

#### Recommendations

| | Aerobic |
| Duartion Frequency Type Intensity | 90 Mins of Vigourous Exercise or 150mins of low/moderate exercise per week, start with lower durations in beginning e.g. 60mins total vigorous/ 100mins low/moderate depending on fitness level. Every 2–3 days as insulin sensitivity is increased for 24–72 hours post exercise. Low impact preferred such as cross trainer/swimming/rowing/cycling 40-60% of VO2 max or 40-70% of Max HR |
[7]

#### Considerations

Always consult physician or doctor prior to training program training can put stress on individuals and could be potentially harmful. Low impact exercise is recommended as a large propotion of Type II diabetes sufferers are overweight and sports such as running can harm joints. A prescreening form should be used to identify any risk areas, and all individuals should have personally constructed programs. [6]

#### Conclusion

Conclusion: Type II Diabetes affects a large population group within Australia. Contraction of the disease is a combination of genetic and environmental factors, in saying this the disease can be prevented and managed with an appropriate diet, exercise regime and by altering other lifestyle factors. Aerobic exercise is highly beneficial for those living with the disease and should definitely be implemented in any management strategy.

## Further reading

Diabetes Australia http://www.diabetesaustralia.com.au/
Better Health Channel http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_Type_2
Type 2 Diabetes: Medline Plus http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm

## References

↑ 1. Better Health Channel. Diabetes Type 2 [Internet]. Melbourne: Better Health Channel; 2014 [cited 2014 September 2]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_Type_2
↑ 2. Jump up to: a b c 1. Diabetes Australia. Type 2 Diabetes [Internet]. Canberra: Diabetes Australia; 2013 [cited 2014 September 1]. Available from: http://www.diabetesaustralia.com.au/Understanding-Diabetes/What-is-Diabetes/Type-2-Diabetes/
↑ 3. "A consensus statement from the American Diabetes Association ." Physical Activity/Exercise and Type 2 Diabetes Vol. 29 (2006): n. pag. http://care.diabetesjournals.org/. Web. 28 Sept. 2014.
↑ 4 (2006). A consensus statement from the American Diabetes Association . Physical Activity/Exercise and Type 2 Diabetes, Vol. 29. Retrieved September 28, 2014, from http://care.diabetesjournals.org/content/29/
↑ 5 Boule, N. G., Haddad, E., Kenny, G. P., Wells, G. A., & Sigal, R. J. (2002). Effects Of Exercise On Glycemic Control And Body Mass In Type 2 Diabetes Mellitus: A Meta-analysis Of Controlled Clinical Trials. Scandinavian Journal of Medicine and Science in Sports, 12(1), 60-61.
↑ 6 (2008). Exercise Training for Type 2 Diabetes Mellitus: Impact on Cardiovascular Risk: A Scientific Statement From the American Heart Association. Circulation, Vol, 1-29.
↑ 7 Overview. (n.d.). NPS MedicineWise. Retrieved September 29, 2014, from http://www.nps.org.au/conditions/hormones-metabolism-and-nutritional-problems/diabetes-type-2/for-individuals/overview
↑ 8 Albright A, Franz M et al. Exercise and Type 2 Diabetes – ACSM Position Stand. Medicine & Science in Sports & Exercise [Internet]. 2000 [cited 2014 September 18];32(7): 1345-1360. Available from: http://zh9bf5sp6t.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=American+College+of+Sports+Medicine+position+stand.+Exercise+and+type+2+diabetes&rft.jtitle=Medicine+and+science+in+sports+and+exercise&rft.au=Albright%2C+A&rft.au=Franz%2C+M&rft.au=Hornsby%2C+G&rft.au=Kriska%2C+A&rft.date=2000-07-01&rft.issn=0195-9131&rft.eissn=1530-0315&rft.volume=32&rft.issue=7&rft.spage=1345&rft_id=info:pmid/10912903&rft.externalDocID=10912903&paramdict=en-US
↑ 9 Welcome to Diabetes Australia. (n.d.). Diabetes Australia. Retrieved September 30, 2014, from http://www.diabetesaustralia.com.au/