# Exercise as it relates to Disease/Is aerobic exercise the best form of training for preventing/reducing effects of type II diabetes?
## Background
### Prevalence

In adults, type II diabetes mellitus (t2d) accounts for 90-95% of all diagnosed cases of diabetes. Of these individuals, 80-90% of them are considered overweight/obese. Type II diabetes is and will continue to be a major health care burden, by the year 2030 the number of people who have this disease is estimated to more than double in compared to the 2000 statistics where there were 171 million reported cases in America. Right now this disease effects 346 million people world wide.

### Type II Diabetes Mellitus Defined

The initial/early characteristic of this disease is an onset of insulin resistance in body cells. T2d is known as a progressive disorder of glucose metabolism, therefore indicating that the individual may have a decreased β-cell function which would cause less insulin secretion.

### Etiology

* Insulin resistance, genetic predisposition, obesity and physical inactivity.
* Dysfunction in skeletal muscle and bone.
* Genes can increase the likelihood of excessive weight gain when an individual has 1st degree family history of t2d.
* Environmental factors and weight gain.
* High levels of sedentary behavior are associated with increased risk of having t2d.

## Effects of Type II Diabetes Mellitus

* Inability to control metabolic pathways and blood glucose levels.
* Increased chances of getting coronary heart disease.
* Low cardiovascular fitness found in patients with t2d increases their risk of developing a cardiovascular disease.
* Bone quality is reduced thanks to a decrease in osteoblast cell growth, bone fractures are higher in individuals with t2d then those who have osteoperosis.

## Current Rehabilitation Methods

* Follow the 2008 Physical Activity Guidelines.
* Engage in some form of general exercise is recommended via American Diabetes Association, American College of Sports Medicine, and American Heart Association. Physical activity increases glucose transport and skeletal muscle insulin sensitivity.

## Exercises and their ability to either prevent or reduce effects of type II diabetes

| Aerobic Exercise (AB) | Resistance Training (RT) | Anaerobic/Interval Training (AIT) | Sedentary Behavior (SB) |
| Defined: Using larger muscle groups over extended periods of time, and doing so with a high volume of repititions. Facts: ♦Increases diastolic dysfunction. ♦Improves functional capacity of cardiorespiratory system, decreases the onset of t2d. ♦Improves glycemic control, body composition, vascular and ventricular function. ♦No benefit when it comes to improving metabolic control. | Defined: Movements of high loads using resistance from either machines or weights, generally a small number of repititions. Facts: ♦Improves glycemic control, adiposity, and lipids. ♦Weight bearing exercises are key to improve bone health, therefore RT results in an increase of bone mass density. Linked: ♦Benefits are increased significantly when RT and AE are both being practiced together. ♦Does not improve aerobic capacity (AE). | Defined: Exercising at a high intensity for short bursts of time (example could include interval training), ensuring use of either phosphocreatine or glycolysis energy systems. Facts: ♦Focusing on intervals and intensity directly affects metabolic pathways. ♦Regular intervals help to increase sensitivity of insulin receptors helping to control ones blood glucose levels. ♦Exercising at anaerobic threshold reduces plasma glucose. Linked: ♦Training at ventilatory threshold reduces blood plasma glucose, which in turn improves ones aerobic capacity (AE). | Defined: Activities that are done sitting or in reclining posture that expend less than 1.5 times the basal metabolic rate, distinctly different than physical inactivity. Facts: ♦All-cause mortality increases. ♦Your body is automatically more vulnerable to diseases. ♦SB impairs physiological functions and causes the body to be more susceptible to oxidative stress. |

## Recommendations for Effective Exercise Rehabilitation

| Exercise | Recommended Activity to Either Prevent or Reduce Effects of Type II Diabetes Mellitus |
| Aerobic Exercise | 30–60 minutes of exercise, 7 days a week, ensuring to reach 60-70% of heart rate max |
| Resistance Training | Participate in a full body strength training program at a minimum of 3 days a week |
| Anaerobic/Interval Training | Ensure intensity of workout is either: VO$_{2max}$= 40-59 & 60-84% or heart rate max= 50-69 & 70-89% |
Ensure that all individuals complete a prescreening evaluation before they undergo any testing/physical exercise.

## Further reading

* American Diabetes Association recommendations for treatment and prevention
* American Heart Association general information
* American College of Sports Medicine exercise and t2d
* Videos: Combination of RT and AE benefits, Aerobic and Anaerobic blood glucose and diabetes and Type II Diabetes no case is the same

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 Wood, R.J., et al. (2012). ‘Resistance training in type II diabetes mellitus impact on areas of metabolic dysfunction in skeletal muscle and potential impact on bone’. Journal of Nutrition and Metabolism, pp. 1 - 13. doi:10.115/2012/268197
* 1 2 Jenkins, A. B., et al. (2013). ‘Segregation of a latent high adiposity phenotype in families with a history of type 2 diabetes mellitus implicates rare obesity susceptibility genetic variants with large effects in diabetes-related obesity’. PLoS ONE, Vol. 8, pp. 1 - 9.
* 1 2 3 4 Kadic, D., et al. (2013). ‘Function of β-cells and insulin resistance in long-standing type II diabetes mellitus’. Script Medica, Vol. 44, 79 - 82.
* 1 2 Lakerveld, J., et al.(2013). ‘The effects of a lifestyle on leisure-time sedentary behaviors in adults at risk: The Hoorn Prevention Study, a randomized controlled trial’. Preventative Medicine. Vol. 57, pp. 351 - 356.
* 1 2 3 4 5 6 Kiyatno. (2010). ‘Interval exercise with 1:1 work/rest ratio decreases the risk factors of type-2 diabetes mellitus and coronary heart disease’. Folica Medica Indonesiana, Vol. 46, pp. 229-232.
* 1 2 3 4 5 6 7 Johannsen, N. M., et al. (2013). ‘Categorical analysis of the impact of aerobic and resistance exercise training alone and in combination, on cardiorespiratory fitness levels in patients with type 2 diabetes’. Diabetes Care, Vol. 36, pp. 3305-3312.
* 1 2 3 Belli, T., et al. (2011).’Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women’. Diabetes Research and Clinical Practice, Vol. 93, pp. 337 - 343.
* 1 2 Brassard, P., et al.(2007). ‘Aerobic exercise training reverses diastolic dysfunction in uncomplicated well-controlled type 2 diabetics’. Diabetes. Vol. 56.
* ↑ Kafkas, M. E., et al.(2013).‘The effect of aerobic and anaerobic swimming exercises on mda, sod and gsh levels of elite swimmers’. Health Med, Vol. 7, pp. 2459 - 2565.
* ↑ Belli, T., et al.(2007).‘Lactate and ventilatory thresholds in type 2 diabetic women’. Diabetes Research and Clinical Practice, Vol. 76, pp. 18 - 23.
* 1 2 Radak, Z., et al.(2008).‘Systematic adaptation to oxidative challenge induced by regular exercise’. Free Radical Biology and Medicine, Vol. 44, pp. 153 - 159.