Physical Activity in Diabetes: Difference between revisions

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</ref><ref>Koivisto VA, Yki-Jarvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1986;1:445–81.</ref>. Thus, the consistency of an individual’s activity throughout the years is essential to ensure getting the benefits of exercise on insulin sensitivity.   
</ref><ref>Koivisto VA, Yki-Jarvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1986;1:445–81.</ref>. Thus, the consistency of an individual’s activity throughout the years is essential to ensure getting the benefits of exercise on insulin sensitivity.   


== '''Benefits of Physical Activities in Diabetes''' ==
== Benefits of Physical Activities in Diabetes ==
Physical activity has been shown to decrease cardiovascular risk and mortality<ref name=":3">Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P.What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542–51. doi:10.1007/s00125-011-2403-2.
Physical activity has been shown to decrease cardiovascular risk and mortality<ref name=":3">Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P.What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542–51. doi:10.1007/s00125-011-2403-2.
</ref>, in addition to improving lipid profile and endothelial function<ref>40. Fuchsjäger-Mayrl G, Pleiner J,Wiesinger GF, Sieder AE, Quittan M, NuhrMJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25(10):1795–801. doi:10.2337/diacare.25.10.1795.
</ref>, in addition to improving lipid profile and endothelial function<ref>40. Fuchsjäger-Mayrl G, Pleiner J,Wiesinger GF, Sieder AE, Quittan M, NuhrMJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25(10):1795–801. doi:10.2337/diacare.25.10.1795.
Line 39: Line 39:
Currently, around 50% of patients with T1D are either overweight or obese. They also have higher waist and hip circumferences when compared to healthy controls<ref>Szadkowska A,Madej A, Ziolkowska K, Szymanska M, Jeziorny K,Mianowska B, et al. Gender and age dependent effect of type 1 diabetes on obesity and altered body composition in young adults. Annals of Agricultural and Environmental Medicine: AAEM. 2015;22(1):124–8. doi:10.5604/12321966.1141381.</ref>. Comorbidities, often associated with excess body weight, reduce the benefits of good metabolic control<ref>Chillaron JJ, Benaiges D,Mane L, Pedro-Botet J, Flores Le-Roux JA. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.</ref>. Thus, controlling body weight in patients with diabetes is necessary due to the well-known relationship between obesity and cardiovascular disease (CVD)<ref>de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2014;37(10): 2843–63. doi:10.2337/dc14-1720.</ref>.
Currently, around 50% of patients with T1D are either overweight or obese. They also have higher waist and hip circumferences when compared to healthy controls<ref>Szadkowska A,Madej A, Ziolkowska K, Szymanska M, Jeziorny K,Mianowska B, et al. Gender and age dependent effect of type 1 diabetes on obesity and altered body composition in young adults. Annals of Agricultural and Environmental Medicine: AAEM. 2015;22(1):124–8. doi:10.5604/12321966.1141381.</ref>. Comorbidities, often associated with excess body weight, reduce the benefits of good metabolic control<ref>Chillaron JJ, Benaiges D,Mane L, Pedro-Botet J, Flores Le-Roux JA. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.</ref>. Thus, controlling body weight in patients with diabetes is necessary due to the well-known relationship between obesity and cardiovascular disease (CVD)<ref>de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2014;37(10): 2843–63. doi:10.2337/dc14-1720.</ref>.


Some researchers reported that in addition to changing Type 2 diabetic patients' life style, exercise has positive effects on weight loss, waist circumference, fasting glucose plasma and insulin serum levels<ref>M, C. (2018). ''What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. - PubMed NCBI'' . ''Ncbi.nlm.nih.gov''.
Carroll &  Dudfield reported that in addition to changing Type 2 diabetic patients' life style, exercise has positive effects on weight loss, waist circumference, fasting glucose plasma and insulin serum levels<ref>M, Carroll. 2018. "What Is The Relationship Between Exercise And Metabolic Abnormalities? A Review Of The Metabolic Syndrome. - Pubmed - NCBI  
</ref>.  
</ref>.  


<br>
== '''Barriers to Physical Activities/ Risk Factors''' ==
Addressing perceived barriers to performing recommended PA levels in this population is crucial for planning effective PA-promoting interventions<ref name=":6">Alghafri, T., Alharthi, S. M., Mohd, Y., Farsi, A., Bannerman, E., Craigie, A. M., & Anderson, A. S. (2017). Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman : a cross-sectional survey. <nowiki>https://doi.org/10.1136/bmjopen-2017-016946</nowiki></ref>.
 
Different studies in many communities identified variable barriers. One study of barriers among Irish patients with T2D concluded the perceived boring nature of exercise, lack of time, physical pain and depression were the commonest reported major barriers to exercise, and are, therefore, the main issues that need to be overcome when attempting to increase exercise levels in obese Irish patients with T2DM<ref>Egan, A. M., Mahmood, W. A. W., Fenton, R., Redziniak, N., Tun, T. K., Sreenan, S., & Mcdermott, J. H. (2017). Barriers to exercise in obese patients with type 2 diabetes, (March 2013), 635–638. <nowiki>https://doi.org/10.1093/qjmed/hct075</nowiki></ref>. Another study in Oman reported lack of willpower, low resources and low social support (especially in females) as the most common barriers to performing leisure PA<ref name=":6" />. Whilst fear of hypoglycemia, work schedule, loss of control over diabetes , and low levels of fitness were identified by identified by Razeau et al<ref>Razeau, A. N. N. E. O. B., & Ircescu, H. O. M. (2008). Barriers to Physical Activity Among Patients With Type 1 Diabetes, ''31''(11), 2108–2109. <nowiki>https://doi.org/10.2337/dc08-0720</nowiki>.
</ref>.
 
'''Other barriers include<ref>Diabetes and Physical Activity Practice Synopsis October 22, 2015. American Association of Diabetics Educators.</ref>:'''
* Fatigue
* Lack self-motivation
* Low self-efficacy
* Fear being injured or have been injured recently
* Lack self-management skills, such as the ability to set personal goals, monitor progress, or reward progress toward such goals
* Barriers related to exercise facilities such as parks, sidewalks, bicycle trails or safe and convenient pleasant walking paths .
 
On the other hand, Perceived well-being, knowledge of insulin pharmacokinetics, implementation of strategies to reduce the probability of exercise-induced hypoglycemia, and greater social support were associated with fewer barriers. Moreover, having someone with whom to perform physical activity was also associated with fewer barriers<ref>Brazeau, A., Rabasa-Lhoret, R., Strychar, I., & Mircescu, H. (2008). Barriers to Physical Activity Among Patients With Type 1 Diabetes. ''Diabetes Care'', ''31''(11), 2108-2109. doi:10.2337/dc08-0720
</ref>.


== Resources  ==
== Resources  ==

Revision as of 18:24, 11 January 2018

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Definitions/Statistics[edit | edit source]

Physical activity is defined as any bodily movement produced by skeletal muscles that result in energy expenditure.It includes all forms of activity, such as everyday walking or cycling to get from A to B, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organized and competitive sport[1]. Exercise is a subset of physical activity that is planned,structured, repeated and has a final or an intermediate objective to the improvement or maintenance of physical fitness[2]

Diabetes is a metabolic condition in which the body does not produce sufficient insulin to regulate blood glucose levels or where the insulin produced is unable to work effectively[3]. There are two main types of diabetes:

  • Type 1 diabetes (T1D) is an auto-immune condition in which the cells that produce insulin are destroyed so lifelong treatment with insulin is required to prevent death.
  • Type 2 diabetes (T2D) accounts for at least 90% of all cases of diabetes[4]. It occurs when the body either stops producing enough insulin for its needs or becomes resistant to the effect of insulin produced. The condition is progressive requiring lifestyle management (diet and exercise) at all stages. Over time most people with type 2 diabetes will require oral drugs and or insulin. Type 2 diabetes may remain undetected for many years[5].

The estimated diabetes prevalence worldwide for 2011 was 366 million and it is expected to affect 552 million people by 2030[6].In England, 6% of people aged 17 years or older had diagnosed with diabetes in 2013[3].

A UK based study in 2004, which studied both type 1 and type 2 diabetes patients, found that only 34% of patients took some form of physical activity and only 9% of these patients exercised sufficiently to achieve a large change in heart rate or breathing[7].

Physical Activity and the Prevention of T2D[edit | edit source]

There is a 30% to 40% lower risk of metabolic syndrome and type 2 diabetes in at least moderately active people compared with those who are sedentary[1].

In a study of female registered nurses aged 34–59 years at baseline, women who reported engaging in vigorous exercise at least once a week had a lower incidence of self-reported type 2 diabetes during the 8 years of follow-up than did women who did not exercise weekly[8]. Similar findings were observed between exercise and incidence of type 2 diabetes in a 5-year prospective study of male physicians aged 40–84 years[9]. Likewise, in a large cohort of postmenopausal women aged 55–69 years, the 12-year incidence of diabetes was lower in those women who reported any physical activity compared with the sedentary women[10].

Physical activity may reduce the risk for type 2 diabetes directly through improvements in insulin sensitivity[11]. This may be independent of any effect of activity on weight loss and fat distribution [11]. According to a cross-sectional population study, physical activity was shown to be negatively associated with insulin concentrations in two populations at high risk for diabetes that differed greatly by body mass index[12].

However, a large portion of the effect of physical activity in decreasing insulin resistance is short lived and may last only few days[13][14]. Thus, the consistency of an individual’s activity throughout the years is essential to ensure getting the benefits of exercise on insulin sensitivity.

Benefits of Physical Activities in Diabetes[edit | edit source]

Physical activity has been shown to decrease cardiovascular risk and mortality[15], in addition to improving lipid profile and endothelial function[16].

Physical activity improves insulin sensitivity[17], which is not unique to those with T2D, as patients with T1D tend to be more insulin resistant than their counterparts without diabetes[15].This effect is related to the promotion of glucose uptake in the skeletal muscles, loss of body fat in the body central part[18], the lipid products reduction and lipid oxidative capacity increase in the muscle cells[19],the insulin function increase in the organs cells involved in the exercise, the positive regulation of signaling pathway stimulation by insulin[18] glycogen reserve decrease in liver and muscles[20],the inflammatory markers change[20], the prevention of muscle atrophy, new muscle tissue being built and capillary network congestion increase in muscles[18] [20].

Currently, around 50% of patients with T1D are either overweight or obese. They also have higher waist and hip circumferences when compared to healthy controls[21]. Comorbidities, often associated with excess body weight, reduce the benefits of good metabolic control[22]. Thus, controlling body weight in patients with diabetes is necessary due to the well-known relationship between obesity and cardiovascular disease (CVD)[23].

Carroll &  Dudfield reported that in addition to changing Type 2 diabetic patients' life style, exercise has positive effects on weight loss, waist circumference, fasting glucose plasma and insulin serum levels[24].

Barriers to Physical Activities/ Risk Factors[edit | edit source]

Addressing perceived barriers to performing recommended PA levels in this population is crucial for planning effective PA-promoting interventions[25].

Different studies in many communities identified variable barriers. One study of barriers among Irish patients with T2D concluded the perceived boring nature of exercise, lack of time, physical pain and depression were the commonest reported major barriers to exercise, and are, therefore, the main issues that need to be overcome when attempting to increase exercise levels in obese Irish patients with T2DM[26]. Another study in Oman reported lack of willpower, low resources and low social support (especially in females) as the most common barriers to performing leisure PA[25]. Whilst fear of hypoglycemia, work schedule, loss of control over diabetes , and low levels of fitness were identified by identified by Razeau et al[27].

Other barriers include[28]:

  • Fatigue
  • Lack self-motivation
  • Low self-efficacy
  • Fear being injured or have been injured recently
  • Lack self-management skills, such as the ability to set personal goals, monitor progress, or reward progress toward such goals
  • Barriers related to exercise facilities such as parks, sidewalks, bicycle trails or safe and convenient pleasant walking paths .

On the other hand, Perceived well-being, knowledge of insulin pharmacokinetics, implementation of strategies to reduce the probability of exercise-induced hypoglycemia, and greater social support were associated with fewer barriers. Moreover, having someone with whom to perform physical activity was also associated with fewer barriers[29].

Resources[edit | edit source]

The Motivate2Move website, created by Wales Deanery has a useful section on physical activty and metabolic health.

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ 1.0 1.1 Officers, C. M. (n.d.). Start Active , Stay Active.
  2. ↑ Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports (Washington, D.C. : 1974), 100(2), 126–31. https://doi.org/10.2307/20056429)
  3. ↑ 3.0 3.1 England, P. H. (n.d.). Adult obesity and type 2 diabetes About Public Health England.
  4. ↑ National Collaborating Centre for Chronic Conditions. Type 2 diabetes. National clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians, 2008. 
  5. ↑ International Diabetes Federation. Types of diabetes. Secondary International Diabetes Federation. Types of diabetes. http://www.idf.org/types-diabetes.
  6. ↑ DIABETES IN THE UK 2012 Key statistics on diabetes. (2012), (April).
  7. ↑ Thomas N, Alder E, Leese GP. Barriers to physical activity in patient with diabetes. Postgrad Med J 2004; 80:287–91.
  8. ↑ Manson JE, Rimm EB, Stampfer MJ, et al. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991;338:774–8.
  9. ↑ Manson JE, Nathan DM, Krolewski AS, et al. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992;268:63–7.
  10. ↑ Folsom AR, Kushi LH, Hong CP. Physical activity and incident diabetes mellitus in postmenopausal women. Am J Public Health 2000;90:134–8mellitus. Exerc Sport Sci Rev 1999; 27:1–35.
  11. ↑ 11.0 11.1 Ivy JL, Zderic TW, Fogt DL. Prevention and treatment of noninsulin-dependent diabetes 16. Manson JE, Rimm EB, Stampfer MJ, et al. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991;338:774–8.
  12. ↑ Kriska AM, Pereira MA, Hanson RL, et al. Association of physical activity and serum insulin concentrations in two populations at high risk for type 2 diabetes but differing by BMI. Diabetes Care 2001;24:1175–80.
  13. ↑ Heath GW, Gavin JR 3rd, Hinderliter JM, et al. Effects of exercise and lack of exercise on glucose tolerance and insulin sensitivity. J Appl Physiol 1983;55:512–17.
  14. ↑ Koivisto VA, Yki-Jarvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1986;1:445–81.
  15. ↑ 15.0 15.1 Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P.What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542–51. doi:10.1007/s00125-011-2403-2.
  16. ↑ 40. Fuchsjäger-Mayrl G, Pleiner J,Wiesinger GF, Sieder AE, Quittan M, NuhrMJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25(10):1795–801. doi:10.2337/diacare.25.10.1795.
  17. ↑ 41. Hawley JA. Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab Res Rev. 2004;20(5):383–93. doi:10.1002/dmrr.505.
  18. ↑ 18.0 18.1 18.2 Teixeira-Lemos, E., Nunes, S., Teixeira, F., & Reis, F. (2011). Regular physical exercise training assists in preventing type 2 diabetes development: focus on its antioxidant and anti-inflammatory properties. Cardiovascular Diabetology, 10(1), 12. doi:10.1186/1475-2840-10-12
  19. ↑ Turcotte, L. P., & Fisher, J. S. (2008). Skeletal Muscle Insulin Resistance: Roles of Fatty Acid Metabolism and Exercise. Physical Therapy, 88(11), 1279–1296. http://doi.org/10.2522/ptj.20080018
  20. ↑ 20.0 20.1 20.2 Praet, S., & van Loon, L. (2009). Exercise therapy in Type 2 diabetes. Acta Diabetologica, 46(4), 263-278. doi:10.1007/s00592-009-0129-0
  21. ↑ Szadkowska A,Madej A, Ziolkowska K, Szymanska M, Jeziorny K,Mianowska B, et al. Gender and age dependent effect of type 1 diabetes on obesity and altered body composition in young adults. Annals of Agricultural and Environmental Medicine: AAEM. 2015;22(1):124–8. doi:10.5604/12321966.1141381.
  22. ↑ Chillaron JJ, Benaiges D,Mane L, Pedro-Botet J, Flores Le-Roux JA. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol. 2015;40(1):53–60.
  23. ↑ de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2014;37(10): 2843–63. doi:10.2337/dc14-1720.
  24. ↑ M, Carroll. 2018. "What Is The Relationship Between Exercise And Metabolic Abnormalities? A Review Of The Metabolic Syndrome. - Pubmed - NCBI
  25. ↑ 25.0 25.1 Alghafri, T., Alharthi, S. M., Mohd, Y., Farsi, A., Bannerman, E., Craigie, A. M., & Anderson, A. S. (2017). Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman : a cross-sectional survey. https://doi.org/10.1136/bmjopen-2017-016946
  26. ↑ Egan, A. M., Mahmood, W. A. W., Fenton, R., Redziniak, N., Tun, T. K., Sreenan, S., & Mcdermott, J. H. (2017). Barriers to exercise in obese patients with type 2 diabetes, (March 2013), 635–638. https://doi.org/10.1093/qjmed/hct075
  27. ↑ Razeau, A. N. N. E. O. B., & Ircescu, H. O. M. (2008). Barriers to Physical Activity Among Patients With Type 1 Diabetes, 31(11), 2108–2109. https://doi.org/10.2337/dc08-0720.
  28. ↑ Diabetes and Physical Activity Practice Synopsis October 22, 2015. American Association of Diabetics Educators.
  29. ↑ Brazeau, A., Rabasa-Lhoret, R., Strychar, I., & Mircescu, H. (2008). Barriers to Physical Activity Among Patients With Type 1 Diabetes. Diabetes Care, 31(11), 2108-2109. doi:10.2337/dc08-0720

 

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