Diabetes and Exercise in the Elderly

Abstract

Type 2 diabetes mellitus is highly prevalent among the elderly. Age-associated changes in body composition, obesity and sedentary behavior are some of the main factors responsible for the increased prevalence of diabetes in this population. Elderly patients experience important and specific issues, including the association of comorbidities and geriatric syndromes, use of many medications, the presence of dependencies and frailty. Physical activity has been shown to be as effective for the treatment of diabetes in the elderly as in younger patients, so that its practice must be strongly encouraged. Resistive activities are preferable for the frail and vulnerable diabetic elderly. Aerobic activities should be prescribed whenever possible, and the association of both modalities is the best choice. Moderate- to high-intensity exercises are more effective for glycemic control and, unlike previously thought, are generally safe for the elderly population. The frequency of exercising should be at least 3 days/week for aerobic and 2 days/week for resistance activities. Balance exercises may be beneficial in special situations. In the elderly patient, special care must be taken for: the presence of contraindications for the practice of each exercise modality; the interactions and limitations imposed by medications, chronic comorbidities and geriatric syndromes; the higher possibility of developing hypoglycemia, especially if insulin is used for treatment, and the prevention of orthostatic hypotension that may be worsened by dehydration. The prescription of exercises tailored for each patient's preferences and limitations is highly effective not only for glycemic control, but also for improving independence, self-esteem and quality of life.

Factors associated with glycemic control in community-dwelling elderly individuals with type 2 diabetes mellitus in Zhejiang, China: a cross-sectional study

“…Physical activity and exercise have been demonstrated to be beneficial for individuals with T2DM by optimally controlling metabolic risk factors for diabetes management [16, 17]. Exercise-mediated glucose metabolism improvement might be attributed to adiposity and insulin resistance reduction, although the effective strategy of exercise (e.g., to what extent) to regulate glycemic homeostasis in elderly diabetic patients remains largely unknown [18–20]. The age-sensitive nature of HbA1c during ageing prompts the need to establish cutoff points of adiposity index for identifying the elderly population with abnormal glucose metabolism and other metabolic risks [21, 22].…”

Exercise and diet in the management of nonalcoholic fatty liver disease

“…Prevention of cardiovascular events has also been examined in a Cochrane systematic review of 11 trials, which concluded that the Mediterranean diet may modulate important cardiovascular risk factors (such as lower cholesterol and low-density lipoprotein), however meta-analysis was precluded by the vast 11 4 heterogeneity of the dietary interventions studied [20]; similar 11 5 conclusions have been drawn by non-Cochrane systematic JIG reviews (21]. Although it is likely that these data can be directly 117 extrapolated to people with NAFLD and metabolic syndrome, 118 there are no randomized trials examining the Mediterranean 119 diet's effect on clinically important liver related outcomes. A 120 small crossover trial (n = 12) in patients with biopsy proven 121 NAFLD of a Mediterranean diet for 6 weeks with crossover to 122 standard diet at 6 weeks, demonstrated reduced insulin resis- 123 tance and hepatic steatosis, independent of weight loss (22].…”

Efecto de la educación para la salud en pacientes con diabetes mellitus tipo 2 del centro de salud de Atotonilco de Tula, Hidalgo, México

“…La actividad física ha demostrado ser tan eficaz para el tratamiento de la diabetes en los ancianos como en los pacientes más jóvenes, por lo que su práctica debe ser fuertemente alentada. La prescripción de ejercicios adaptados a las preferencias y limitaciones de cada paciente es altamente eficaz no sólo para el control glucémico, sino también para mejorar la independencia, la autoestima y la calidad de vida (15).…”

“…(2005), donde se demuestra un decremento significativo en el porcentaje de HbA1c, tal como se obtuvo en la presente investigación. En pacientes diabéticos se recomiendan los ejercicios aerobios, aunque actualmente el uso de los ejercicios de resistencia con pequeñas cargas no está contraindicado en los diabéticos no complicados (13,15,16). Las intervenciones estructuradas de la práctica de ejercicio, al menos durante 8 semanas, evidencia una disminución promedio de 0,66 % de los niveles de la Hb A1c en personas con DMT2 aun sin cambios significativos del índice de masa corporal (IMC) (7).…”