How people with diabetes can still exercise at healthy levels

Should Diabetics Avoid High-intensity Exercise?

When deciding what type of exercise program is best, people with diabetes must understand their bodies and how they respond to resistance training or high-intensity exercise. Many individuals prefer eccentric exercise, as we can be three-times stronger eccentrically than concentrically.

Diabetes is one of the most prevalent metabolic conditions facing Americans, as well as millions of others worldwide. Learning to manage one’s diabetic condition can be a challenging journey. Type 1, Type 2, Gestational, and other types of diabetes can have a significant impact on the quality and longevity of life when going un-diagnosed or when poorly treated.

Thankfully, Family Physicians and Endocrinologists play an integral role in the education and management of their patients’ conditions. But Physical Therapists, Occupational Therapists, Chiropractors, and Athletic Trainers can also improve the wellbeing of their patients dealing with diabetes.

Movement is Medicine

If you have followed TherapySpark for any length of time, you know we encourage physical activity for many types of musculoskeletal conditions. We believe, as many of you do, that movement is medicine.

From the intricate movements of the hand to the dynamic and powerful movements of the lower body, good biomechanics are incredibly important to function. Motor control, joint stability, strength, power, endurance and speed are all components that lead to improved movement and can be the foundation to wellness and independence. But, exercise also plays a key role in managing metabolic conditions as well!

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Exercise and Type II Diabetes

We all know that physical activity is important to health by keeping bones and muscles strong and our cardiopulmonary system functioning at its best. From an early age, we are also taught that exercise can reduce the risk of certain diseases, like Type II diabetes.

In fact, the American College of Sports Medicine gives the highest level of evidence that supports the metabolic benefits of exercise for Type II diabetics. Exercise can reduce the risk of developing Type II Diabetes by 58%!1

Exercise and Type I Diabetes

For those who are living with Type I diabetes, exercise also plays an important role in overall health. Of course, this requires diligence in monitoring blood glucose levels before, during, and after exercise. However, with proper maintenance and intensity of exercise, it is possible to reduce long-term complications of disease progression while maintaining a high quality of life.

The type of exercise we do will elicit different results for each of us. For instance, cardiovascular training alone may not deliver the muscle and bone benefits of resistance training. Some level of higher intensity training can have short- and long-term effects on blood glucose levels due to the release of multiple hormones2. Getting to know our body and how it responds to exercise is challenging. But that does not mean that we have to eliminate high-intensity exercise altogether.

Choosing the Right Exercise Program for Diabetics

When deciding what type of exercise program is best, people with diabetes must understand their bodies and how they respond to resistance training or high-intensity exercise. Many individuals prefer eccentric exercise, as we can be three-times stronger eccentrically than concentrically. Higher force production with lower rates of perceived exertion make it a great way to train and combat the effects of sarcopenia, which every single one of us faces.

Eccentric Exercise for Diabetics

Researchers studied the effects of eccentric-only loading of the lower extremities on people with impaired glucose tolerance. They measured its effect on muscle strength, physical function, and body composition. Participants exercised on the Eccentron with individually calculated resistance based on each person’s maximum capacity, and closed-chain movement.

After 36 Eccentron sessions over 12 weeks, the participants showed meaningful improvements in quadriceps strength, six-minute walk test, and body mass. Notably, there was no impact on insulin sensitivity. By the end of the exercise sessions, participants gained an average of 20lbs in quadriceps resistance strength, could walk 183 feet during the six-minute test, and had more lean mass.

Meanwhile, the control group (no exercise) saw a decrease of 6.3lb in quad strength, only 10 feet in the six-minute test, and less lean mass. This study shows that eccentric exercise can greatly benefit physical strength and performance, without adverse effects on insulin sensitivity!

However, too much of a good thing isn’t beneficial either. Another study looked at the effects of downhill running as a form of eccentric exercise for non-diabetic individuals. Immediately following a downhill run, the non-diabetic participants showed worsened insulin sensitivity3.

This reaction could be the result of muscle injury, too much exercise (or too intense), and the uncontrolled nature of the exercise itself. Downhill running is a high-impact, open-chain movement that could easily lead to over-exertion. Instead, a closed-chain movement with controlled resistance is a safer way to facilitate eccentric exercise.

High-intensity Exercise for Diabetics

Similarly, Type II Diabetics have seen significant improvements in strength and function with high-intensity exercise. In this study, people with Type II diabetes participated in high-intensity exercise programs with either eccentric resistance and aerobics, or aerobics only4.

All participants showed long-term improvement in glycemic control with improved lean thigh mass, and improved physical performance characteristics. Participants who had the eccentric exercise saw even greater improvements in these areas, compared to those who only performed aerobics4.

Managing Diabetes with Exercise

Diabetics have and will continue to learn new ways to function as researchers learn more about the disease. Better regulation of glucose and insulin levels along with more convenient and accurate testing methods will also help each person learn how to better live with their condition. Exercise is medicine and eccentric exercise continues to show that it can provide more benefit to the targeted population than traditional exercise programs. These studies contribute to an evidence-based practice, showing the benefits and safety precautions of exercise for diabetics. You can help your diabetic clients remain healthy and reduce the effects of disease progression with a safely managed exercise program.

 

Jeffrey Johnson, MA, ATC
Assistant Director – Provider & Product Management
BTE  

References

  1. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-e167. https://pubmed.ncbi.nlm.nih.gov/21115758/
  2. Colberg SR, Laan R, Dassau E, Kerr D. Physical activity and type 1 diabetes: time for a rewire?. J Diabetes Sci Technol. 2015;9(3):609-618. https://journals.sagepub.com/doi/10.1177/1932296814566231
  3. Kirwan JP, Hickner RC, Yarasheski KE, Kohrt WM, Wiethop BV, Holloszy JO. Eccentric exercise induces transient insulin resistance in healthy individuals. J Appl Physiol 1992;72: 2197–2202. https://pubmed.ncbi.nlm.nih.gov/1629073/
  4. Marcus RL, Lastayo PC, Dibble LE, Hill L, McClain DA. Increased strength and physical performance with eccentric training in women with impaired glucose tolerance: a pilot study. J Womens Health (Larchmt). 2009 Feb;18(2):253-60. https://pubmed.ncbi.nlm.nih.gov/19183097/
  5. Marcus RL, Smith S, Morrell G, Addison O, Dibble LE, Wahoff-Stice D, Lastayo PC. Comparison of combined aerobic and high-force eccentric resistance exercise with aerobic exercise only for people with type 2 diabetes mellitus. Phys Ther. 2008 Nov;88(11):1345-54. https://pubmed.ncbi.nlm.nih.gov/18801851/