The document discusses the effect of exercise on type 2 diabetes mellitus and insulin resistance in adults. It finds that both aerobic and resistance exercise are beneficial for managing diabetes by lowering blood glucose levels, increasing insulin sensitivity, and reducing HbA1c levels. Specifically, a study found that resistance training was more effective than aerobic exercise at lowering plasma glucose levels and improving long-term glucose control. The document concludes that exercise should be encouraged for all diabetics to help manage their symptoms and reduce health complications.

1. The Effect of Exercise on Type 2 Diabetes Mellitus & Insulin Resistance in Adults Jessica Evans Metabolic Diseases & Exercise Faculty of Health Science & Medicine, Bond University.

2. Introduction Diabetes mellitus is a serious medical condition which is characterized by ↑ levels of glucose in the blood and inability to either produce or react appropriately to insulin. Type 2 diabetes (T2DM) is the most common form of the disease with 80-90% of cases diagnosed which is often associated with obesity and other lifestyle factors. T2DM is often termed non-insulin dependent or adult onset diabetes & presents in middle-age. Diabetes is a major risk factor for serious medical complications. Diabetes mellitus is Australia’s fastest growing disease and is now at epidemic levels with an estimated 7% of adults diagnosed with T2DM12357.

3. Some quick facts: Diabetes mellitus is Australia's fastest growing disease in which there are an estimated 7% of the adult population diagnosed with T2DM1. 260-280 people newly diagnosed each day (100,000 per year) T2DM costs the Australian health system $3 BN annually with ¼ of hospital beds are occupied by diabetic patients1. By end of 2010, 1.7 million Australians will be diabetic, 70% of will die prematurely from stroke or heart attack1. Another 200,000 Australians, nearly 600 daily, are moving from overweight (BMI 25-30) to obese (BMI>30) category - strongly associated with T2DM1.

4. Introduction - The incidence of T2DM in various age brackets; body mass index (BMI); and physical activity status with the greatest incidence of diabetes being seen in people >45 years; the overweight and obese BMI categories and people who are sedentary1. (Barr et al, 2006).

5. Insulin resistance Perez-Martin, 2001

6. Insulin resistance T2DM is characterized by insulin resistance meaning the cells respond inadequately to the insulin produced by the beta cells of the pancreas6. Insulin resistance can develop independent of T2DM and is linked with sedentary lifestyle and obesity which alters the effect of insulin on glucose metabolism7. All T2DM sufferers show a degree of insulin resistance in the beginning which eventually leads to cessation of insulin production6(pancreas packs it in).

7. Introduction continued Research has shown that exercise is beneficial for T2DM by improving insulin sensitivity (↓ insulin resistance), ↓ blood glucose levels immediately after exercise & a ↓ in the HbA1c. Another major goal is to ↓ the risk of diabetic complications which occurs due to systemic atherosclerosis Current exercise guidelines: (Marwick et al, 2009).

8. Long term complications of T2DM Diabetes is a major risk factor for serious medical complications including myocardial infarction (MI); cerbrovascular disease (stroke); renal failure; diabetic ulcers; diabetic neuropathy, diabetic retinopathy, PVD/PAD & Charcot foot.

11. Aims/ purpose The aim is to investigate the potential beneficial effects of exercise on the management and prevention of type 2 diabetes mellitus (T2DM) and insulin resistance in adults.

12. Methods/ Data Analysis The purpose was to compare the effects of 10 weeks of resistance training to aerobic treadmill exercise . The study used 23 subjects with type 2 diabetes which were aged between 45 – 65 years and previously inactive3. Exercise Protocol: 2 exercise groups (n =10) randomly assigned. A 12 week pre-intervention glycemic monitoring period and then completed 10 weeks of exercise intervention3. Exercise sessions 3 x wk for 10 weeks, with HR, BP, and blood glucose measured before and after exercise3. The treadmill exercise program increased intensity and workload from 20 minutes at 60% max HR to 30 minutes at 75% max HR. The resistance group performed 3 sets of 8-10 reps of whole body strength training3.

13. Results Results of plasma glucose showed a significant ↓ after exercise in both exercise groups. The biggest ↓ in glucose was in resistance training groups after 10 wk program where 80% of the subjects fell in the normal glucose recommendation range . In contrast only 20% of the subjects fell into the normal range with treadmill exercise3. (Bweir et al, 2009)

14. Results The results from the study showed that resistance exercise was much more effective in ↓ plasma glucose (post exercise) and for long term glucose control (HbA1c). Although both aerobic and resistance training had a positive effect on glucose control³ (Bweir et al, 2009).

15. Conclusion The results from numerous studies in the last 10 years have shown very beneficial effects of both aerobic and resistance training on T2DM. Exercise ↓ blood glucose levels, ↑ in insulin sensitivity, ↓ in HbA1c & the potential ↓ risk of long term complications such as MI, stroke, diabetic ulcers, retinopathy of eyes, diabetic neuropathy and renal failure if implemented early on in the disease, and management of symptoms and disease in the long term1234567.

16. Conclusion continued (Boule et al, 2001).

17. Conclusion continued (Poehlman et al, 2000).

18. Conclusion continued In conclusion, both aerobic and resistance exercise is very beneficial for T2DM patients. Aerobic exercise ↑ insulin sensitivity and resistance training ↓HbA1c³. All exercise↓ blood glucose immediately post-ex. Exercise should be encouraged in all diabetics but caution in regards to CI’s including exercise within 30 mins of taking insulin, blood glucose is <5.6 mmol/L and avoid weight bearing exercise if the subject has ulcers & is overweight1234567.

19. References 1. Barr, E.L.M; Magliano, D.J; Zimmet, P.Z; Polkinghorne, K.R; Atkins, R.C; Dunstan, D.W; Murray, S.G; & Shaw, J.E. The Australian diabetes, obesity and lifestyle study (Ausdiab Study). International diabetes institute, Australia. 2006. 2. Boule, N.G; Haddad, E; Kenny, G.P; Wells, G.A; & Sigal, R.J. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus – a meta-anaylsis of controlled clinical trials. JAMA. 2001; Vol. 286(10): 1218-1227. 3. Bweir, S; Al-Jarrah, M; Almalty,A-M; Maayah, M; Smirnova, I.V; Novikova, L; & Stehno-Bittel, L. Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes. Diabetolgy & Metabolic syndrome. 2009; Vol. 1(27). 4. Cuff, D.J; Meneilly, G.S; Martin, A; Ignaszewski, A; Tildesley, H.D; & Frohlich, J.J. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003; Vol. 26(11): 2977-2982. 5. Marwick, T.H; Hordern, M.D; Miller, T; Chyun, D.A; Bertoni, A.G; Blumenthal, R.S; Philippides, G; & Rocchini, A. Exercise training for type 2 diabetes mellitus. Circulation. 2009; Vol. 119: 3244-3262. 6. Perez-Martin, A; Raynaud, E; & Mercier, J. Insulin resistance and associated metabolic abnormalities in muscle: effects of exercise. Obesity reviews. 2001; Vol. 2: 47-59. 7. Poehlman, E.T; Dvorak, R.V; DeNino, W.F; Brochu, M; & Ades, P.A. Effects of resistance training and endurance training on insulin sensitivity in non-obese, young women: a controlled randomized trial. JCEM. 2000; Vol. 85: 2463-2468.

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