Why Is Exercise and Physiotherapy Been Called the ‘Silver Bullet’ in Diabetes Treatment
Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death, and a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death.
In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes and approximately 1.25 million American children and adults have type 1 diabetes.
The risk for diabetes increases with age, making diabetes common in older adults. In fact, approximately 25% of adults over the age of 60 years have diabetes.
Diabetes means that your blood glucose (sugar) level is too high. Your body’s cells need glucose for energy. When you eat, your pancreas releases the hormone insulin, which helps the glucose from food get into your cells. People with diabetes do not make enough insulin or do not use insulin well, causing glucose to build up in their blood and not reach their cells. This can lead to complications including damage to the heart, eyes, kidneys, and feet.
While type 1 diabetes is usually thought of as beginning in childhood and type 2 diabetes as a beginning in adulthood, it is becoming more clear that adults—including older adults—can develop new-onset type 1 diabetes and that children can develop type 2 diabetes.
It’s important to add that diabetes is a risk factor for a lot of chronic medical conditions and a precursor of a lot of other co-morbidities like hypoglycemia, hypertension, dyslipidemia, cardiovascular diseases, heart attack, stroke, blindness, eye dysfunctions, kidney diseases and amputation.
Type 2 Diabetes
People with type 2 diabetes do not make or use insulin well. This is the most common type of diabetes and typically occurs in people who are overweight and inactive. Other risk factors include a family history of the disease, older age, certain ethnicities (blacks, Hispanics, American Indians and Asian-Americans), polycystic ovary syndrome, and a history of gestational diabetes (diabetes in pregnancy).
Acute Effects of Exercises:
Several factors influence exercise fuel use, but the most important are the intensity and duration of physical activity. Any activity causes a shift from predominant reliance on Free Fatty Acids at rest to a blend of fat, glucose, and muscle glycogen, with a small contribution from amino acids.
With increasing exercise intensity, there is a greater reliance on carbohydrate as long as sufficient amounts are available in muscle or blood. Early in exercise, glycogen provides the bulk of the fuel for working muscles. As glycogen stores become depleted, muscles increase their uptake and use of circulating blood glucose, along with Free Fatty Acids released from adipose tissue.
Physical Activity causes increased glucose uptake into active muscles balanced by hepatic glucose production, with a greater reliance on carbohydrate to fuel muscular activity as intensity increases.
When you have type 2 diabetes, physical activity is an integral part of your treatment plan. It’s also important to have a healthy diet plan and maintain your blood glucose level through drug therapy or insulin, if necessary.
In a new study of people with diabetes, engaging in a six-month moderate-intensity exercise program led to significant health improvements. Specifically, they had decreases in fat in the abdomen, liver and around the heart, all of which is associated with an increased risk of heart disease.
In case you aren’t aware, heart disease is the number one cause of death among people with type 2 diabetes. It’s estimated that at least 65 percent of those with diabetes die from some form of heart disease or stroke.
While the exercise program didn’t lead to direct changes in heart function, the reductions in dangerous visceral fat around key organs – as well as reductions in pericardial fat, which is the second layer of fat around the heart – will undoubtedly improve heart health among this at-risk population.
Also noteworthy about the study was the relatively small amount of exercise needed to prompt such beneficial changes. The participants exercised between 3.5 and 6 hours a week (and ended the program with a 12-day trekking expedition), which is a reasonable goal for most people.
Further, the benefits were gained from exercise alone; no other lifestyle or dietary changes were made, which shows just how powerful staying active can be in improving your health — even if you’ve already been diagnosed with a potentially chronic disease.
Insulin sensitivity is increased when you engage yourself in a bout of exercise, so your cells are better able to use any available insulin to take up glucose during and after activity.
When your muscles contract during activity, it stimulates another mechanism that is completely separate of insulin. This mechanism allows your cells to take up glucose and use it for energy whether insulin is available or not.
This is how exercise can help lower blood glucose in the short term. And when you are active on a regular basis, it can also eventually lower it substantially.
Staying fit and active throughout your life will enable you to better control your diabetes and keep your blood glucose level in the correct range. Controlling your blood glucose level is essential to preventing long-term complications, such as peripheral neuropathy and kidney disease.
When you exercise, your muscles get the glucose they need, and in turn, your blood glucose level goes down and doesn’t matter if you’re insulin resistant or if you don’t have enough insulin. In either case, exercise can reduce the glucose in your blood. Muscles can use glucose without insulin when you’re exercising.
If you’re insulin resistant, exercise actually makes your insulin more effective. That is—your insulin resistance goes down when you exercise, and your cells can use the glucose more effectively.
Combined aerobic and resistance and other types of training.
A combination of aerobic and resistance training may be more effective for blood glucose management than either type of exercise alone. Any increase in muscle mass that may result from resistance training could contribute to blood glucose uptake without altering the muscle’s intrinsic capacity to respond to insulin, whereas aerobic exercise enhances its uptake via a greater insulin action, independent of changes in muscle mass or aerobic capacity.
However, all reported combination training had a greater total duration of exercise and caloric use than when each type of training was undertaken alone. Mild-intensity exercises such as tai chi and yoga have also been investigated for their potential to improve blood glucose management, with mixed results.
A combination of aerobic and resistance exercise training may be more effective in improving blood glucose control than either alone; however, more studies are needed to determine if total caloric expenditure, exercise duration, or exercise mode is responsible.
Safe exercise participation can be complicated by the presence of diabetes-related health complications such as CVD, hypertension, and neuropathy. For individuals desiring to participate in low-intensity PA such as walking, health care providers should use clinical judgment in deciding whether to recommend pre-exercise testing. Conducting exercise stress testing before walking is unnecessary. No evidence suggests that it is routinely necessary as a CVD diagnostic tool, and requiring it may create barriers to participation.
For exercise more vigorous than brisk walking or exceeding the demands of everyday living, sedentary and older diabetic individuals will likely benefit from being assessed for conditions that might be associated with risk of cardiovascular diseases (CVD), contraindicate certain activities, or predispose to injuries, including severe peripheral neuropathy, severe autonomic neuropathy, and preproliferative or proliferative retinopathy.
Before undertaking new higher-intensity Physcial Activity, they are advised to undergo a detailed medical evaluation and screening for BG control, physical limitations, medications, and macrovascular and microvascular complications.
This assessment may include a graded exercise test depending on the age of the person, diabetes duration, and the presence of additional CVD risk factors. The prevalence of symptomatic and asymptomatic coronary artery disease (CAD) is greater in individuals with type 2 diabetes and maximal graded exercise testing can identify a small proportion of asymptomatic persons with severe coronary artery obstruction. Most young individuals with a low CAD risk may not benefit from preexercise stress testing.
In the Look AHEAD trial, although exercise-induced abnormalities were present in 1,303 (22.5%) participants, only older age was associated with increased prevalence of all abnormalities during maximal testing. A systematic review of the U.S. Preventive Services Task Force (USPSTF) concluded that stress testing should not be routinely recommended to detect ischemia in asymptomatic individuals with a low CAD risk (<10% risk of a cardiac event more than 10 years) because the risks from invasive testing done after a false-positive test outweigh the benefits of its detection. The lower the CAD risk, the higher the chance of a false positive.
Current guidelines attempt to avoid automatic inclusion of lower-risk individuals with type 2 diabetes, stating that exercise stress testing is advised primarily for previously sedentary individuals with diabetes who want to undertake activity more intense than brisk walking. The goal is to more effectively target individuals at higher risk for underlying CVD.
In general, electrocardiogram (ECG) stress testing may be indicated for individuals matching one or more of these criteria:
• Age >40 years, with or without CVD risk factors other than diabetes
• Age >30 years and
• Type 1 or type 2 diabetes of >10 years in duration
• Cigarette smoking
• Proliferative or preproliferative retinopathy
• Nephropathy including microalbuminuria
• Any of the following, regardless of age
• Known or suspected CAD, cerebrovascular disease, and/or peripheral artery disease (PAD)
• Autonomic neuropathy
• Advanced nephropathy with renal failure
It is now well established that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life.
Structured interventions combining physical activities and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of physical activity on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training.
The benefits of physical training have been discussed, along with recommendations for varying activities, physical activity-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for physical activity with diabetes-related complications.
This is now a great opportunity for you to visit us and discuss your situation and priorities for physical activity and how we can help you bring down the scourge of DIABETES and its co-morbidities.