Physical activity and Type 2 diabetes

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Physical activity and Type 2 diabetes

• Dr Alison Kirk
• Lecturer in Sports Biomedicine
• University of Dundee

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Outline of presentation

• Characteristics of diabetes
• Prevention through lifestyle
• Management through lifestyle
• Current physical activity guidelines
• Specifics for people with diabetes
• Increasing motivation

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Characteristics of Diabetes

• Diabetes is a state of chronic hyperglycaemia
  (high blood sugar) which may result from many
  environmental and genetic factors, often acting
  jointly WHO 1980
• Type 1 diabetes (10 - 15)
• Auto-immune disease directed at the pancreas
  which affects the beta cells of the pancreas
  resulting in an absolute deficiency of insulin
• Average age 14 years, quick onset, managed by
  insulin
• Type 2 diabetes (85 - 90)
• Involves variable degrees of defective insulin
  secretion due to beta cell dysfunction
  impaired insulin action (insulin resistance).
  Secretion uptake of insulin is impaired
• Average age 60 years, 80 overweight, slower
  onset, managed by diet physical activity
  Tablets Insulin

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United kingdom - Three million by 2010
3000
Type 1
Type 2
2500
2000
Diabetes prevalence (thousands)
1500
1000
500
0
1995
2000
2010
Amos et al 1997
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Causes of diabetes epidemic

• Type 2 diabetes - an alternative definition
• Type 2 diabetes should be regarded as a
  deficiency state, with the deficiency being that
  of physical activity Dr Bill Burr Exercise and
  sport in diabetes, 1999.

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Prevention of Type 2 diabetes

• 2 multicentre trials (Finland USA)
• Finish Study (Tuomileto et al, 2001)
• 522 people with Impaired Glucose Tolerance (IGT)
• IGT is an intermediate category between normal
  glucose tolerance and overt Type 2 diabetes
• People with IGT have a high risk of developing
  Type 2 diabetes
• Study participants randomised to either an
  intervention group or control group
• Intervention group receive regular, detailed,
  individualised advice on physical activity diet
  plus standard care
• Control group receive standard care alone
• Study participants followed for an average of 3.2
  years
• Results demonstrated progression of Type 2
  diabetes was 58 lower in the intervention group,
  compared to control group

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Finish Diabetes Prevention Study
(Tuomileto et al, 2001)
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Prevention of Type 2 diabetes

• USA Study (Diabetes Prevention Programme Research
  group, 2002)
• 3234 people with Impaired Glucose Tolerance (IGT)
• Half of participants from ethic minority groups
• All participants receive standard care then
  randomised to
• Placebo group
• Pharmacological intervention (850mg of metformin
  twice daily)
• Individualised lifestyle intervention (intensive,
  multi-component diet physical activity
  intervention)
• Results demonstrated, compared to placebo group,
  progression to Type 2 diabetes was 58 lower in
  lifestyle intervention group and 31 lower in the
  pharmacological intervention group
• Results similar in men and women and in all
  ethnic minority groups
• Both studies provide strong evidence for the use
  of lifestyle interventions to prevent or delay
  the development of Type 2 diabetes

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USA Diabetes prevention study
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Benefits of Physical activity

• Type 2 diabetes
• Better blood glucose control (Boulé 2001)
• Improved insulin sensitivity
• glucose lowering effect
• Overall difference of 0.6 in HbA1c (exercise
  alone)
• 0.76 in HbA1c (exercise diet)
• Improve physical mental health
• Potential to reduce development progression of
  diabetes complications
• Type 1 diabetes
• Little benefit in long term glycaemic control
• Often run sugars high in fear of having a hypo
• Insufficient circulating insulin - Exercise can
  cause an increase in blood glucose

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Benefits of Physical activity

• Type 1 Type 2 diabetes

Healthy heart

• Reduce cardiovascular risk factors
• Reduction in weight
• Reduction in blood pressure
• Improvements in lipids (cholesterol etc)
• Improve fitness
• Reduce stress

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Walking the best medicine for diabetes Frank B.
Hu - 2003

• Cross sectional study
• People with Type 1 Type 2 diabetes

• People who walk at least
• 2 hours/week at self selected pace
• 37 lower risk of
• cardiovascular mortality
• 39 lower risk of
• all cuase mortality

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Benefits of Physical activity
Type 1 Type 2 diabetes

• Enhance quality of life and well-being
• Reduce depression and anxiety
• People who do no physical activity are over 3
  times more likely to have moderate to severe
  depression than those who are physically active
• Increased energy and self confidence
• Maintain independence
• Improvements in cardiorespiratory, muscular
  fitness bone health will make it easier to
  perform every day activities and will reduce the
  risk of falls
• Sociable
• Perform every day activities

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If exercise could be packed in a pill, it would
be the single most widely prescribed and
beneficial medicine in the nation
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How much physical activity do you need to do to
improve your health or become fitter ?
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3 x 20 minutes, moderate to vigorous intensity
exercise per week
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Are there any specific recommendations for people
with diabetes?

• Encourage some form of physical activity at
  least every second day
• Favourable effects of activity on glycaemic
  control deteriorate within 48hrs of participation
• Intensity of activity should be comfortable
  realistic to that individual
• Start slowly and gradually build up
• Remember any increase in activity level is
  better than nothing
• No significant complications of diabetes then no
  restrictions on type of activity
• Encourage activities they enjoy
• If complications exist there may certain types
  of activity which will be more beneficial than
  others

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Specific sportsPeople with diabetes on insulin

• Some restrictions
• Ballooning
• Gliding
• Motorcycle racing
• Parachuting
• Power boat racing
• Rowing
• Underwater swimming

• Ban on participation
• Bobsleigh
• Boxing
• Flying
• Horse racing
• Motor car racing
• Paragliding

www.runsweet.com
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Risks of exercise

• Hypoglycaemia
• Sports injuries
• Worsening of microvascular complications

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Hypoglycaemia

• People at risk
• Type 1 diabetes
• Type 2 diabetes treated with insulin
• Level of glucose in blood falls to low (lt4mmol/L)
• Sweating, racing heart, shaking, tingle in lips,
  pale, confused
• Symptoms can be difficult to recognise during
  exercise
• Nature of exercise - Long duration/high
  intensity, unfamiliar activity

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Treatment

• Stop exercising
• Fast acting carbohydrate (sugary drink, glucose
  tablet)
• Follow with a starchy snack (sandwich)

• Prevention
• Monitor blood glucose
• Before, during gt1hr, after
• Adjustments to Insulin dose - Depend on
  intensity/duration
• Extra food intake
• Injection sites - Avoid injecting into active
  muscle

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Increasing motivation
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Diabetic Activity Levels

• 60-80 people with Type 1 2 remain inactive
• More attempts to exercise. Greater frequency of
  exercise relapse
• Barriers
• Type 1 - Time, Motivation, cost
• Type 2 - Physical discomfort, too overweight,
  lack of support
• Both - Complexity of diabetes regime,
  complications of diabetes, risk of hypoglycaemia
• Characteristics, motivations and barriers
  suggest that an individualised approach to
  physical activity promotion may be more
  appropriate

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Variables associated with physical activity
behaviour

• Compared to other self care behaviours people
  with diabetes report lowest self efficacy for
  physical activity
• Greatest belief in effectiveness of medication
  lowest belief in effectiveness of physical
  activity
• 76 percent advised to increase physical active
  only 21 percent received guidance. In comparison
  76 percent of people with Type 2 diabetes
  received detailed dietary guidance (Ary et al
  1986).
• People with Type 1 diabetes indicated that they
  do not receive adequate education, support or
  encouragement for physical activity (Marsden
  1996)

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Current research

• Investigation of different methods of physical
  activity promotion in people with Type 2 diabetes

• Currently recruiting 140 participants
• Comparison of physiological, psychological,
  behavioural effects of 3 different interventions
• Cost effective analyses
• Contact Jodi Barnett (project manager 01382
  86859)

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Thank you a.kirk_at_dundee.ac.uk