Diabetes Flashcards
• Rationale – prevalence, epidemiology • Recap – glycaemic control • Pathophysiology of different types of diabetes • Pathophysiology of comorbidities • Acute exercise and glycaemic control • Chronic PA and diabetes • Exercise prescription for individuals with diabetes
How is Endurance Training defined
“Endurance training” is defined as any exercise designed to increase cardiovascular fitness, often defined as an increase in the maximal uptake of oxygen
How is Resistance Training defined
“Resistance training” is defined as any exercise designed to improve the strength and size of skeletal musculature
What is the main measure of glycaemic control and what does it tell us?
The main measure of glycemic control is glycosylated hemoglobin (HbA1c), which gives an overall indication of glycemic control over the previous 12 weeks
In what way can resistance training improve glycaemic control?
o It is postulated that resistance training improves glycemic control by a different mechanism than aerobic training, mainly through an increase in muscle mass (since skeletal muscle is the main glucose sink for the body) and by increasing glucose transporter type 4 (GLUT-4) expression
o A meta-analysis of the effects of resistance training by Umpierre et al involving four studies and a total of 261 subjects demonstrated an improvement in HbA1c of 0.57% (0.01%–1.14%)
What effect may diabetes have on lean body mass?
Diabetes appears to have an effect on both lean body mass and muscle quality, perhaps due to poor vascular supply and peripheral neuropathy
How might diabetes affect mental health?
One neglected impact of diabetes on patients is impaired emotional well-being and an increased risk of depression
What are the American Diabetes Association recommendations for weekly physical activity volume (in minutes)
Although more work needs to be done to resolve this issue, it appears that the current American Diabetes Association recommendation of more than 150 minutes per week is sound.
Evidence comparing benefits to glycaemic control of different exercise types suggest that there is not much difference between endurance and strength training. How does this benefit the exercise practitioner who might have a number of clients with different exercise capacities and clinical complications?
o There did not seem to be any overall benefit of one training modality over another, in terms of glycemic control, with each modality reducing HbA1c by approximately 0.5%.
o This means that the modality of exercise chosen to improve glycemic control can be matched according to the comorbidities of the patient.
o In addition, strength training was done less often (approximately 2–3 times per week), so this might be an easier intervention to implement in a sedentary population
Why might a programme combining both endurance and resistance based exercise be of most benefit to diabetic patients? (consider the clustering of metabolic disease risk factors)
o Resistance training has well-documented benefits in terms of muscle mass, muscle strength, and level of function, while aerobic training has an independent impact on cardiovascular endurance.
o This suggests that a combination regime might be the best overall intervention in type 2 diabetes, if one considers issues other than just glycemic control.
o In addition, the fact that strength training provided similar glycemic benefits with a lower training frequency per week suggests that if the two modalities are combined, they should not occur together on the same day of the week, so as to maximize any synergistic effects.
What is one of the main barriers to physical activity cited by diabetic patients
o The main barrier to physical activity cited by all patients, regardless of ethnicity, comorbidities, age, or sex is a perceived “lack of time.”
o Adherence to standard exercise prescriptions involving prolonged submaximal aerobic exertion has been shown to be extremely poor
High intensity training would not be recommended to patients with which common complications of diabetes
o Impaired neural function
o Inability to sense whether they are maintaining proper form, possibly inducing high risk of injury
What is ‘the metabolic syndrome’?
Although “metabolic syndrome” has numerous definitions, it is generally defined as a clustering of cardio-metabolic risk factors associated with insulin resistance. Metabolic syndrome has been shown to greatly increase the risk of type 2 diabetes
Which cardiometabolic risk factors contribute to the metabolic syndrome?
The cardio-metabolic risk factors consist of increased central obesity (waist circumference), increased blood pressure, increased triglycerides, decreased HDL-C, and increased fasting plasma glucose
The benefits of exercise to diabetic patients are clear. But what does the author suggest needs to be determined with further research?
Further study needs to be done to determine what the “minimum effective dose” is for each of the various exercise interventions, and how best to combine them.
What should determine the ratio of resistance to endurance training in a patient’s exercise programme?
Since there is no evidence currently for an ideal ratio of resistance to aerobic training, this should be determined according to the patient’s comorbidities such as musculoskeletal issues or coronary artery disease.
