EXERCISE AND DIABETES
Section snippets
ACUTE IMPACT OF EXERCISE
Most exercises can be divided into categories of low, moderate, and strenuous activity. In general, low activities may be considered as those that do not cause heavy breathing, produce only a mild elevation in heart rate, and usually do not affect blood glucose unless done for over 10 minutes.3, 4, 49 Moderate activity tends to cause noticeably heavier breathing, pulse rate increases of over 100 beats per minute, and blood glucose elevations if done for less than 10 minutes; if done for over 10
CARDIOVASCULAR BENEFITS OF EXERCISE TO PATIENTS WITH DIABETES
Physical activity remains a critical component of the management for patients with established diabetes. Given the high rates of cardiovascular disease in patients with type 2 diabetes, exercise programs are particularly important to reduce risk factors for vascular complications. Numerous studies have documented the ability of exercise to lower glucose levels and improve insulin action.44, 70, 105, 107, 117
Information about long-term exercise has been based on programs using regimens of
EXERCISE AS A MEANS OF PREVENTING TYPE 2 DIABETES
Given the relationship between sedentary lifestyles and glucose intolerance,14, 15, 16, 17, 18 and the ability of exercise to lower glucose and improve insulin action, ongoing physical activity has been proposed as a means of delaying or preventing the onset of type 2 diabetes mellitus. Individuals who maintain a physically active lifestyle have a reduced risk of impaired glucose tolerance and type 2 diabetes.55 The most powerful support for the role of physical activity in the prevention of
RISKS OF EXERCISE TO PATIENTS WITH DIABETES
While physical activity provides much benefit to patients with diabetes, there are associated risks that increase with severity of diabetes and complications. In the most general terms, exercise can be problematic to diabetic patients because of the risk of hyperglycemia (from either insufficient insulin or excess glucose), hypoglycemia (through either excess insulin action or insufficient glucose), risk of worsening complications, or consequences of complications (Box 1). The potential for
RECOMMENDATIONS FOR PATIENTS WITH DIABETES
Given the positive and negative effects of exercise on the patient with diabetes, a balance must be created between unmodified encouragement and excessive caution. Figure 1 depicts this balance and some of the factors affecting the placement of the fulcrum. Early in the course of diabetes, the benefits of exercise generally outweigh the risks. As diabetes progresses, safeguards should be put into place involving potential need for snacks and more frequent testing during and following activity.
SUMMARY
As rates of diabetes mellitus and obesity continue to increase, physical activity continues to be a fundamental form of therapy. Exercise influences several aspects of diabetes, including blood glucose concentrations, insulin action and cardiovascular risk factors. Blood glucose concentrations reflect the balance between skeletal muscle uptake and ambient concentrations of both insulin and counterinsulin hormones. Difficulties in predicting the relative impact of these factors can result in
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Address reprint requests to Stuart R. Chipkin, MD, Division of Endocrinology, Diabetes and Metabolism, Baystate Medical Center, 759 Chestnut Street, Room S2620, Springfield, MA 01199, e-mail: [email protected]