Written by IROAGANACHI.V.C., OD, MSC DIA 2022.

Introduction.

The implementation of physical exercise (PA) in the management of type two diabetes (T2DM) according to (Kirwan et al., 2017) have improved insulin sensitivity and high blood glucose level. PA has also reduced overall morbidity and mortality following diabetes complication base on some review studies of (Mendes et al., 2016).

Exercise recommendation for individuals living with diabetes is at least three times a week to seven days (150 to 300 minutes/week ). With two or three consecutive sessions depending on patients current aerobic capacity, or submaximal exercise test achieved. Patients comorbidities, frequency, intensity, time and type (FITT) of exercise is also important in the prescription of exercise.

Since diabetes (Martín-Timón et al., 2014) is an independent risk factor for cardiovascular disease(CVD), exercise according to (Kirwan et al., 2017) have shown effectiveness in the prevention of cardiovascular events in persons living with diabetes. Following the requirement of this critical reflective summary, I will reflect on the following topics:

1. Importance of aerobic and resistance exercise in the management and prevention of diabetes.
2. Effect of high sedentary time on diabetes management.
3. The importance of behavioral techniques for the uptake and sustenance of prescribed exercise.

The above topics, are relevant to me because they introduced facts and substantial evidence on the benefits of physical exercise in diabetes population.

Importance of aerobic and resistance exercise in the management and prevention of diabetes.

A study from (Picard et al., 2021) identified aerobic exercise and resistance training to have improved heart rate variations and overall mortality from cardiovascular events from patients living with type two diabetes. This satisfies the important of physical exercise in the prevention and management of diabetes. It is important to note that aerobic exercise involves the use of large body muscles during exercise, which can be achieved through running, jogging and cycling. While resistance training involves the use of body weight, or machine weight in exercise sessions.

A systematic review from (Grgic et al., 2018) found resistance training to be effective in the regulation of high blood glucose, insulin sensitivity, hyperlipidemia and hypertension. Also resistance training were found to improve total muscle mass and bone mineral density, which helps against the prevalence of sarcopenia (loss of muscle mass) due to type two diabetes, frequently seen in older patients. Base on the evidence available aerobic and resistance physical exercise will be beneficial for the prevention and management of type two diabetes. DM exercise sessions may be further investigated if inclusion in the initial stage of diabetes management will be relevant.

Effect of high sedentary time on diabetes management.

(Rockette-Wagner et al., 2015) Identified sedentary time to be counterproductive to the gains of physical exercise. This was reviewed in a diabetic population In a quest to establish the effect of physical exercise against sedentary time. They found that sedentary time increased the risk of type two diabetes in those already at risk of diabetes while there was a reduced risk associated with those with lower sedentary time. From relevant evidence available, It may be true that sedentary time may be a new disease. As such, patients and clinicians should work together to prevent high sedentary time for individuals living with diabetes to ensure healthy lifestyle. This can be achieved through behavioral techniques during patients interview and advocacy for police’s that will encourage strategies feasible to reduce sedentary time, especially at home, work places and learning centers.

The importance of behavioral techniques for the uptake and sustenance of prescribed exercise.

It has been identified by (Sankaran et al., 2019) that some app can help improve patients motivation on regulation or monitoring the effects of physical exercise on their health, motivating them to engage in prescribed physical exercise, and follow up their health progress. For example: observing their improved blood glucose, blood pressure and total cholesterol. It will be necessary for clinicians to have adequate knowledge about the positive influence of some health apps, that may be feasible in ensuring patients compliance following exercise prescription.

Conclusion.

Diabetes management involving aerobic and resistance physical exercise have helped reduce and prevent DM complications. It may be important that it is initiated at the diagnosis stage for effective result. While high sedentary time should be mutually addressed (patient and health professional) for diabetes prevention. Behavioral techniques may be feasible in motivating diabetic patients to engage in prescribed physical exercise, however further studies on the effectiveness of behavioral techniques on physical exercise on diabetes populations may be necessary.

References:

GRGIC, J., SCHOENFELD, B. J., DAVIES, T. B., LAZINICA, B., KRIEGER, J. W. & PEDISIC, Z. 2018. Effect of resistance training frequency on gains in muscular strength: a systematic review and meta-analysis. Sports Medicine, 48, 1207-1220.

KIRWAN, J. P., SACKS, J. & NIEUWOUDT, S. 2017. The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84, S15.

MARTÍN-TIMÓN, I., SEVILLANO-COLLANTES, C., SEGURA-GALINDO, A. & DEL CAÑIZO-GÓMEZ, F. J. 2014. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World journal of diabetes, 5, 444.

MENDES, R., SOUSA, N., ALMEIDA, A., SUBTIL, P., GUEDES-MARQUES, F., REIS, V. M. & THEMUDO-BARATA, J. L. 2016. Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review. British journal of sports medicine, 50, 1379-1381.

PICARD, M., TAUVERON, I., MAGDASY, S., BENICHOU, T., BAGHERI, R., UGBOLUE, U. C., NAVEL, V. & DUTHEIL, F. 2021. Effect of exercise training on heart rate variability in type 2 diabetes mellitus patients: A systematic review and meta-analysis. PloS one, 16, e0251863.

ROCKETTE-WAGNER, B., EDELSTEIN, S., VENDITTI, E. M., REDDY, D., BRAY, G. A., CARRION-PETERSEN, M. L., DABELEA, D., DELAHANTY, L. M., FLOREZ, H. & FRANKS, P. W. 2015. The impact of lifestyle intervention on sedentary time in individuals at high risk of diabetes. Diabetologia, 58, 1198-1202.

SANKARAN, S., DENDALE, P. & CONINX, K. 2019. Evaluating the impact of the HeartHab app on motivation, physical activity, quality of life, and risk factors of coronary artery disease patients: multidisciplinary crossover study. JMIR mHealth and uHealth, 7, e10874.