The role of exercise in chronic disease conditions

  • by

If you, a friend or family member suffer from diabetes or a chronic disease (further references supplied @ the end of this article) then you must read the following.

The summary and references below have previously formed part of seminars I have presented to medical practitioners and clinics in order to build an awareness of the essential need for exercise when managing chronic disease conditions.  The information has been obtained utilizing an article published by Professor James Sharman within Exercise and Sports Science Australia.

The role of resistance and aerobic exercise in patients with Type 2 Diabetes Mellitus (T2DM)

  • T2DM is the fastest growing chronic disease affecting more than 3.2 million Australians (2005)1 ,and there are an estimated 275 new cases diagnosed each day1
  • For patients with T2DM exercise is highly beneficial and should be encouraged.

Why?

  • It delays the progression of the disease,
  • improves glycaemic control,
  • promotes maintenance of healthy body composition,
  • minimises the risks associated with cardiovascular disease (CVD).

Exercise:

Improves glycaemic control

via:

  • Increased blood glucose uptake in skeletal muscle,
  • improved insulin sensitivity/resistance,
  • reduced reliance on diabetic medication3.

Improves body composition

via:

  • a reduction in body weight,
  • reduction in visceral adiposity,
  • and increasing lean muscle mass4.

Reduces CVD related risk factors

via improvements in:

  • endothelial function,
  • hypertension,
  • hyperlipidemia and blood lipid profile,
  • myocardial structure and function,
  • resistance to ischaemia2,4.

When prescribing exercise for T2DM there are cardiac related considerations:

  • The main concern is the presence of CAD. Screening provides a risk stratification tool to guide prescription and determine whether a stress test is recommended.
  • With that said, the risk of an adverse cardiac event is small and the benefits of exercise substantially outweigh the risk4.

The main Non- Cardiac related considerations of exercise prescription in T2DM are:

Hypoglycaemic events

  • look for shakiness, weakness, abnormal sweating, nervousness, confusion, anxiety, tingling in the mouth and fingers and hunger2.
  • However, these events are more common in patients with T1DM, low or variable blood glucose readings, longer duration of T2DM, and lower body mass index.

Peripheral arterial disease:

  • Extra care needs to be taken when prescribing exercise due to the increased risk of foot trauma. High impact exercises are avoided.
  • Exercises can include walking at reduced speed and weight bearing activities2.

Eye disease (retinopathy or macular degeneration):

  • Need to avoid activities that increase intraocular pressure such as: high intensity aerobic or resistance exercise, valsalva manoeuvre or head down activities2.

Diabetic neuropathy:

  • Currently no recommendations for exercise training, however

both aerobic / resistance training would improve physical capabilities / quality of life of these patients2.

What are the exercise recommendations for patient with T2DM:

Mode of exercise Frequency (Days/week) Duration (minutes/week) Intensity
Cardiorespiratory& Resistance exercise 32 or more 125minutes total60mintues (included in above time) Vigorous8-10 exercises2-4 sets, lifted no more than 8-10 times*, 1-2 min rest between sets.
Cardiorespiratory only 3-7 210minutes Moderate intensity

* Resistance training reps should be performed at a weight that cannot be lifted more than 8-10 times.

Adherence to exercise

This is sometimes difficult due to barriers such as: perceived benefits, self-efficacy, competence, motivation, support, lack of supervision, conditions such as anxiety, depression, possible cost associated with exercise training6, 7.

By implementing effective strategies like – Ongoing individual and group consultations, OR supervised training sessions these barriers can be conquered.

In Summary:

Regular exercise is a feasible, low cost and crucial part of achieving optimal health and improving the quality of life in patients with T2DM.

At zusma I provide clients with education/tools/strategies and exercise guidelines to better understand and manage their conditions.

Please contact jeremy@zusma.com.au if you would like further information.

References:

  1. Barr, E. et al. Ausdiab report: The Australian diabetes, obesity and lifestyle study. 2005
  2. Colberg, S. et al. Exercise and type 2 diabetes: American college of sports medicine and the American diabetes association: Joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exec. 2010; 42:2282-2303.
  3. Norris, S et al. Long term non pharmacological weight loss interventions for adults with type 2 diabetes. Cochrane Database System Review. 2005; 18:762-774.
  4. Marwick, T. et al. Exercise training for type 2 diabetes mellitus: Impact on cardiovascular risk: A scientific statement from the American heart association. Circulation. 2009; 119:3244-3262.
  5. Hordern, M. et al. Exercise prescription for patients with type 2 diabetes and pre diabetes: A position statement from Exercise & Sports Science Australia. J SCi Med Sport. 2012;15:25-31.
  6. Woodward, C. et al. Enhancing adherence to prescribed exercise: Structured behavioural interventions in clinical exercise programs. Journal of Cardiopulmonary Rehabilitation. 2001;21:201-209
  7. Swift, C. et al. Attitudes and beliefs about exercise among persona with non-insulin dependent diabetes. Diabetes Education 1995; 21:533-540.

Further reading on the role of exercise in patients with chronic disease:

Hypertension

Sharman, J; Stowasser, M. Australian Association of Exercise and Sports Science position statement on exercise and hypertension. J Sci Med Sport. 2009;12:252-257.

Cardiovascular diseases

Kelley, G and Kelley, K.  Impact of progressive resistance training on lipids and lipoproteins in adults: A meta-analysis of randomized controlled trials. Preventive medicine. 2009. 48:9-19.

Cancer

Hayes, S. Australian Association of Exercise and Sports Science position stand: Optimizing cancer outcomes through exercise. J Sci Med Sport. 2009;12:428-434.

Chronic kidney disease

Smart, N. et al. Exercise & Sports Science Australia position statement on exercise and chronic kidney disease. J Sci Med Sport. 2013;Article in Press.

Osteoporosis

Bennell, K. et al. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14:4-9.

Falls prevention

Tiedemann, A. et al. Exercise & Sports Science Australia position statement on exercise and falls prevention in older people. J Sci Med Sport. 2011;14:489-495.

Leave a Reply

Your email address will not be published. Required fields are marked *