Exercise Therapy in Type 2 Diabetes

Abstract

OBJECTIVEGiven the transient nature of exercise-induced improvements in insulin sensitivity, it has been speculated that daily exercise is preferred to maximize the benefits of exercise for glycemic control. The current study investigates the impact of daily exercise versus exercise performed every other day on glycemic control in type 2 diabetic patients.RESEARCH DESIGN AND METHODSThirty type 2 diabetic patients (age 60 ± 1 years, BMI 30.4 ± 0.7 kg/m2, and HbA1c 7.2 ± 0.2%) participated in a randomized crossover experiment. Subjects were studied on three occasions for 3 days under strict dietary standardization but otherwise free-living conditions. Blood glucose homeostasis was assessed by continuous glucose monitoring over 48 h during which subjects performed no exercise (control) or 60 min of cycling exercise (50% maximal workload capacity) distributed either as a single session performed every other day or as 30 min of exercise performed daily.RESULTSThe prevalence of hyperglycemia (blood glucose >10 mmol/L) was reduced from 7:40 ± 1:00 h:min per day (32 ± 4% of the time) to 5:46 ± 0:58 and 5:51 ± 0:47 h:min per day, representing 24 ± 4 and 24 ± 3% of the time, when exercise was performed either daily or every other day, respectively (P < 0.001 for both treatments). No differences were observed between the impact of daily exercise and exercise performed every other day.CONCLUSIONSA short 30-min session of moderate-intensity endurance-type exercise substantially reduces the prevalence of hyperglycemia throughout the subsequent day in type 2 diabetic patients. When total work is being matched, daily exercise does not further improve daily glycemia compared with exercise performed every other day.

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

“…The clinical benefits of exercise training in T2DM are well documented: it reduces systemic inflammation and leads to improvements in glycaemic control, insulin sensitivity, the lipid profile, body composition, quality of life, endothelial function, cardiac function and arterial compliance [1,3,4,[9][10][11][12]. It thus follows that exercise therapy should be considered as a cornerstone in the treatment of T2DM.…”

The Relationship between Exercise, Nutrition and Type 2 Diabetes

“…While the molecular mechanisms behind these processes are beyond the scope of this chapter, it is clear that targeting insulin-independent glucose uptake through exercise could have immediate clinical benefits for individuals with insulin resistance and patients with type 2 diabetes. In line with this notion, a single bout of exercise enhances insulin sensitivity and glucose tolerance for up to 48 h after completion of an exercise session in both healthy [47][48][49] and insulin-resistant humans [50], whereas in patients with type 2 diabetes, a single session of either resistance or endurance type exercise has the capacity to reduce the prevalence and duration of hyperglycemic excursions, with the beneficial effects lasting well into the subsequent day [40,[51][52][53]. Importantly, the acute effects of each individual exercise session are retained throughout a training program, a response that holds true for both resistance and endurance type training modes [53].…”

“…Using this technology, it has been shown that even under standard diet conditions patients with type 2 diabetes who are using oral blood glucose-lowering medications can experience hyperglycemia for more than 13 h within a 24-hour period [37]. Indeed, hyperglycemic excursions persist beyond the postprandial period and continue throughout the entire day in both insulin and non-insulin-treated type 2 diabetics [39,40]. Of note is that in many of these patients, HbA 1c criteria alone suggest that diabetes is effectively controlled.…”

A single bout of exercise and postprandial hyperglycemia caused by high-fat diet

“…Recently, several studies using a continuous glucose monitoring system reported the continuous effects of a single bout of exercise on postprandial glucose response in free-living conditions. A single bout of moderate (~50% watt max and 60% heart rate reserve) and continuous exercise (45-60 min) decreased the average 24-h post-exercise blood glucose concentration and frequency of hyperglycemia (glucose concentration >10 mmol) [32][33][34][35][36] . However, the glucose-lowering effect of exercise on blood glucose concentration disappeared 48 h post-exercise 36) .…”