Why Exercise Is Non-Negotiable with Diabetes
Why Exercise Is Non-Negotiable with Diabetes: diabetes is just one of the many chronic ailments prevalent in the U.S., Europe, and developing countries; out of 4 people in the world, 3 people with diabetes belong to developing nations. With millions of people suffering each year and millions newly diagnosed every year in the world.
And whether you have type 1 or 2 diabetes, making healthy lifestyle choices in exercise, physical, diet, and mental health management is vital for keeping this life-threatening illness.
It is performed for various reasons: to aid growth and improve strength, prevent aging, develop muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, improving health and enjoyment. Many individuals choose to exercise outdoors where they can congregate in groups, socialize, and enhance well-being.
In terms of health benefits, the amount of recommended exercise depends upon the goal, type of exercise, and person’s age. Even doing a small amount of exercise is healthier than doing none.
Physical exercises are generally grouped into three types, depending on the overall effect they have on the human body:
- Aerobic exercise is any physical activity that uses large muscle groups and causes the body to use more oxygen than resting. The goal of aerobic exercise is to increase cardiovascular endurance. Examples of aerobic exercise include running, cycling, swimming, brisk walking, skipping rope, rowing, hiking, dancing, playing tennis, continuous training, and long-distance running.
- Anaerobic exercise, which includes strength and resistance training, can firm, strengthen, and increase muscle mass and improve bone density, balance, and coordination. Examples of strength exercises are push-ups, pull-ups, lunges, squats, bench presses. Anaerobic exercise also includes weight training, functional training, eccentric training, interval training, sprinting, and high-intensity interval training, increasing short-term muscle strength.
- Flexibility exercises stretch and lengthen muscles—activities such as stretching help improve joint flexibility and keep muscles limber. The goal is to improve the range of motion, which can reduce the chance of injury.
Types of exercise can also be classified as dynamic or static. ‘Dynamic’ exercises such as steady running tend to produce a lowering of the diastolic blood pressure during exercise due to the improved blood flow. Conversely, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly, albeit transiently, during the performance of the exercise.
|Type of adaptation||Endurance
|Muscle hypertrophy||↔||↑ ↑ ↑|
|Muscle strength and power||↔ ↓||↑ ↑ ↑|
|Muscle fiber size||↔ ↑||↑ ↑ ↑|
|Myofibrillar protein synthesis||↔ ↑||↑ ↑ ↑|
|Neuromuscular adaptations||↔ ↑||↑ ↑ ↑|
|Anaerobic capacity||↑||↑ ↑|
|Lactate tolerance||↑ ↑||↔ ↑|
|Endurance capacity||↑ ↑ ↑||↔ ↑|
|Capillary growth (angiogenesis)||↑ ↑||↔|
|Mitochondrial biogenesis||↑ ↑||↔ ↑|
|Mitochondrial density and oxidative function||↑ ↑ ↑||↔ ↑|
|Bone mineral density||↑ ↑||↑ ↑|
|Inflammatory markers||↓ ↓||↓|
|Ability in activities of daily living||↔ ↑||↑ ↑|
|Basal metabolic rate||↑||↑ ↑|
|Percent body fat||↓ ↓||↓|
|Lean body mass||↔||↑ ↑|
|Resting insulin levels||↓||↓|
|Insulin sensitivity||↑ ↑||↑ ↑|
|Insulin response to the glucose challenge||↓ ↓||↓ ↓|
|Resting heart rate||↓ ↓||↔|
|Stroke volume (resting and maximal)||↑ ↑||↔|
|Systolic blood pressure (resting)||↔ ↓||↔|
|Diastolic blood pressure (resting)||↔ ↓||↔ ↓|
|Cardiovascular risk profile||↓ ↓ ↓||↓|
Physical exercise is important for maintaining physical fitness and can contribute to maintaining a healthy weight, regulating the digestive system, building and maintaining healthy bone density, muscle strength, joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Some studies indicate that exercise may increase life expectancy and the overall quality of life. People who participate in moderate to high levels of physical exercise have a lower mortality rate compared to individuals who, by comparison, are not physically active. Moderate levels of exercise have been correlated with preventing aging by reducing inflammatory potential. The majority of the benefits from exercise are achieved with around 3500 metabolic equivalents (MET) minutes per week, diminishing returns at higher levels of activity. For example, climbing stairs for 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or bicycling for transportation 25 minutes daily would together achieve about 3000 MET minutes a week. A lack of physical activity causes approximately 6% of the burden of disease from coronary heart disease, 7% of type 2 diabetes, 10% breast cancer, and 10% of colon cancer worldwide. Overall, physical inactivity causes 9% of premature mortality worldwide.
Individuals can increase fitness by increasing physical activity levels. Increases in muscle size from resistance training are primarily determined by diet and testosterone. This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population. Studies have shown that exercising in middle age leads to better physical ability later in life.
Early motor skills and development are also related to physical activity and performance later in life. Children who are more proficient with motor skills early on are more inclined to be physically active and thus tend to perform well in sports and have better fitness levels. Early motor proficiency positively correlates to childhood physical activity and fitness levels, while less proficiency in motor skills results in a more sedentary lifestyle.
The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct correlation between physical inactivity and cardiovascular mortality, and physical inactivity is an independent risk factor for the development of coronary artery disease. Low levels of physical exercise increase the risk of cardiovascular disease mortality.
Children who participate in physical exercise experience greater loss of body fat and increased cardiovascular fitness. Studies have shown that academic stress in youth increases the risk of cardiovascular disease in later years; however, these risks can be greatly decreased with regular physical exercise. There is a dose-response relationship between the amount of exercise performed from approximately 700–2000 kcal of energy expenditure per week and all-cause mortality and cardiovascular disease mortality in middle-aged and older men. The greatest potential for reduced mortality is seen in sedentary individuals who become moderately active. Studies have shown that since heart disease is the leading cause of death in women, regular exercise in aging women leads to healthier cardiovascular profiles. The most beneficial effects of physical activity on cardiovascular disease mortality can be attained through moderate-intensity activity (40–60% of maximal oxygen uptake, depending on age). Persons who modify their behavior after myocardial infarction to include regular exercise have improved rates of survival. Persons who remain sedentary have the highest risk for all-cause and cardiovascular disease mortality. According to the American Heart Association, exercise reduces the risk of cardiovascular diseases, including heart attack and stroke.
Although there have been hundreds of studies on physical exercise and the immune system, there is little direct evidence of its connection to illness. Epidemiological evidence suggests that moderate exercise has a beneficial effect on the human immune system, an effect which is modeled in a J curve. Moderate exercise has been associated with a 29% decreased incidence of upper respiratory tract infections (URTI). Still, studies of marathon runners found that their prolonged high-intensity exercise was associated with an increased risk of infection occurrence. However, another study did not find the effect. Immune cell functions are impaired following acute sessions of prolonged, high-intensity exercise, and some studies have found that athletes are at a higher risk for infections. Studies have shown that strenuous stress for long durations, such as training for a marathon, can suppress the immune system by decreasing the concentration of lymphocytes. The immune systems of athletes and nonathletes are generally similar. Athletes may have a slightly elevated natural killer cell count and cytolytic action, but these are unlikely to be clinically significant.
Vitamin C supplementation has been associated with a lower incidence of upper respiratory tract infections in marathon runners.
Biomarkers of inflammation such as C-reactive protein, associated with chronic diseases, are reduced in active individuals relative to sedentary individuals. The positive effects of exercise may be due to its anti-inflammatory effects. In individuals with heart disease, exercise interventions lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk marker. The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.
A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survival rates. According to the review, “[there] was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer-specific, and colon cancer-specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers.” Evidence suggests that exercise may positively affect cancer survivors’ health-related quality of life, including factors such as anxiety, self-esteem, and emotional well-being. For people with cancer undergoing active treatment, exercise may also positively affect health-related quality of life, such as fatigue and physical functioning. This is likely to be more pronounced with higher intensity exercise. Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise. Due to various factors, some individuals with cancer cachexia have a limited capacity for physical exercise. Compliance with prescribed exercise is low in individuals with cachexia, and clinical trials of exercise in this population often suffer from high drop-out rates.
The evidence is very uncertain about aerobic physical exercises on anxiety and serious adverse events for adults with hematological malignancies. Aerobic physical exercises may result in little to no difference in mortality, quality of life, and physical functioning. These exercises may result in a slight reduction in depression. Furthermore, aerobic physical exercises probably reduce fatigue.
The neurobiological effects of physical exercise are numerous and involve a wide range of interrelated effects on brain structure, brain function, and cognition. A large body of research in humans has demonstrated that regular aerobic exercise (e.g., 30 minutes every day) induces persistent improvements in certain cognitive functions, healthy alterations in gene expression in the brain, and beneficial forms of neuroplasticity and behavioral plasticity; some of these long-term effects include: increased neuron growth, increased neurological activity (e.g., c-Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior, improved declarative, spatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory. The effects of exercise on cognition have important implications for improving academic performance in children and college students, improving adult productivity, preserving cognitive function in old age, preventing or treating certain neurological disorders, and improving the overall quality of life.
In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following regular exercise over the course of several months. People who regularly perform aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional control, inhibitory control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial memory, and information processing speed. The transient effects of exercise on cognition include improvements in most executive functions (e.g., attention, working memory, cognitive flexibility, inhibitory control, problem-solving, and decision making) and information processing speed for a period of up to 2 hours after exercising.
Aerobic exercise induces short- and long-term effects on mood and emotional states by promoting positive affect, inhibiting negative affect, and decreasing the biological response to acute psychological stress. Over the short term, aerobic exercise functions as both an antidepressant and euphoriant, whereas regular exercise produces general improvements in mood and self-esteem.
Regular aerobic exercise improves symptoms associated with various central nervous system disorders and may be used as an adjunct therapy for these disorders. There is clear evidence of exercise treatment efficacy for major depressive disorder and attention deficit hyperactivity disorder. The American Academy of Neurology‘s clinical practice guideline for mild cognitive impairment indicates that clinicians should recommend regular exercise (two times per week) to individuals who have been diagnosed with this condition. Reviews of clinical evidence also support exercise as an adjunct therapy for certain neurodegenerative disorders, particularly Alzheimer’s disease and Parkinson’s disease. Regular exercise is also associated with a lower risk of developing neurodegenerative disorders. A large body of preclinical evidence and emerging clinical evidence supports the use of exercise as an adjunct therapy for treating and preventing drug addictions. Regular exercise has also been proposed as an adjunct therapy for brain cancers.
Several medical reviews have indicated that exercise has a marked and persistent antidepressant effect in humans, an effect believed to be mediated through enhanced BDNF signaling in the brain. Several systematic reviews have analyzed the potential for physical exercise in the treatment of depressive disorders. The 2013 Cochrane Collaboration review on physical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies. Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication; the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild-moderate depression and mental illness in general. One systematic review noted that yoga might be effective in alleviating symptoms of prenatal depression. Another review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over a 2–4 month period. These benefits have also been noted in old age, with a review conducted in 2019 finding that exercise is an effective treatment for clinically diagnosed depression in older adults.
A meta-analysis from July 2016 concluded that physical exercise improves the overall quality of life in individuals with depression relative to controls.
Continuous aerobic exercise can induce a transient state of euphoria, colloquially known as a “runner’s high” in distance running or a “rower’s high” in crew, through the increased biosynthesis of at least three euphoriant neurochemicals: anandamide (an endocannabinoid), β-endorphin (an endogenous opioid), and phenethylamine (a trace amine and amphetamine analog).
Preliminary evidence from a 2012 review indicated that physical training for up to four months might increase sleep quality in adults over 40 years of age. A 2010 review suggested that exercise generally improved sleep for most people and may help with insomnia. Still, there is insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep. A 2018 systematic review and meta-analysis suggested that exercise can improve sleep quality in people with insomnia.
One 2013 study found that exercising improved sexual arousal problems related to antidepressant use.
Mechanism of effects of exercise
Resistance training and subsequent consumption of a protein-rich meal promote muscle hypertrophy and gains in muscle strength by stimulating myofibrillar muscle protein synthesis (MPS) and inhibiting muscle protein breakdown (MPB). The stimulation of muscle protein synthesis by resistance training occurs via phosphorylation of the mechanistic target of rapamycin (mTOR) and subsequent activation of mTORC1, which leads to protein biosynthesis in cellular ribosomes via phosphorylation of mTORC1’s immediate targets (the p70S6 kinase and the translation repressor protein 4EBP1). The suppression of muscle protein breakdown following food consumption occurs primarily via increases in plasma insulin. Similarly, increased muscle protein synthesis (via activation of mTORC1) and suppressed muscle protein breakdown (via insulin-independent mechanisms) has also been shown to occur following ingestion of β-hydroxy β-methyl butyric acid.
Aerobic exercise induces mitochondrial biogenesis and an increased capacity for oxidative phosphorylation in skeletal muscle mitochondria, which is one mechanism by which aerobic exercise enhances submaximal endurance performance. These effects occur via an exercise-induced increase in the intracellular AMP: ATP ratio, thereby triggering the activation of AMP-activated protein kinase (AMPK), which subsequently phosphorylates peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), the master regulator of mitochondrial biogenesis.
Other peripheral organs
Developing research has demonstrated that many of the benefits of exercise are mediated through skeletal muscle as an endocrine organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and multiple anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases. Exercise reduces levels of cortisol, which causes many health problems, both physical and mental. Endurance exercise before meals lowers blood glucose more than the same exercise after meals. There is evidence that vigorous exercise (90–95% of VO2 max) induces a greater degree of physiological cardiac hypertrophy than moderate exercise (40 to 70% of VO2 max). Still, it is unknown whether this has any effects on overall morbidity and/or mortality. Both aerobic and anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac volume (aerobic exercise) or myocardial thickness (strength training). Ventricular hypertrophy, the thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to exercise. keywords: Diabetes, exercise, Countries, U.S
Central nervous system
Public health measures
Multiple component community-wide campaigns are frequently used to increase a population’s level of physical activity. A 2015 Cochrane review, however, did not find evidence supporting a benefit. The quality of the underlying evidence was also poor. However, there is some evidence that school-based interventions can increase activity levels and fitness in children. Another Cochrane review found evidence that certain types of exercise programs, such as those involving gait, balance, coordination, and functional tasks, can improve balance in older adults. Following progressive resistance training, older adults also respond with improved physical function. A Survey of brief interventions promoting physical activity found that they are cost-effective, although there are variations between studies.
Environmental approaches appear promising: signs that encourage the use of stairs and community campaigns may increase exercise levels. For example, the city of Bogotá, Colombia, blocks off 113 kilometers (70 mi) of roads on Sundays and holidays to make it easier for its citizens to get exercise. Such pedestrian zones are part of an effort to combat chronic diseases and to maintain a healthy BMI. keywords: Diabetes, exercise, chronic ailment
To identify which public health strategies are effective, a Cochrane overview of reviews is in preparation.
Physical exercise was said to decrease healthcare costs, increase the rate of job attendance, and increase the number of effort women put into their jobs. There is some level of concern about additional exposure to air pollution when exercising outdoors, especially near traffic.
Children will mimic the behavior of their parents about physical exercise. Parents can thus promote physical activity and limit the number of time children spend in front of screens.
Children who are overweight and participate in physical exercise experience a greater loss of body fat and increased cardiovascular fitness. According to the Centers for Disease Control and Prevention in the United States, children and adolescents should do 60 minutes or more of physical activity each day. Implementing physical exercise in the school system and ensuring an environment in which children can reduce barriers to maintain a healthy lifestyle is essential.
The European Commission‘s Directorate-General for Education and Culture (DG EAC) has dedicated programs and funds for Health Enhancing Physical Activity (HEPA) projects within its Horizon 2020 and Erasmus+ program, as research showed that too many Europeans are not physically active enough. Financing is available for increased collaboration between players active in this field across the EU and worldwide, the promotion of HEPA in the EU and its partner countries, and the European Sports Week. The DG EAC regularly publishes a Eurobarometer on sport and physical activity.
Worldwide there has been a large shift toward less physically demanding work. This has been accompanied by increasing mechanized transportation, a greater prevalence of labor-saving technology in the home, and fewer active recreational pursuits. Personal lifestyle changes, however, can correct the lack of physical exercise.
Research published in 2015 suggests that incorporating mindfulness into physical exercise interventions increases exercise adherence and self-efficacy and positively affects both psychologically and physiologically.
Social and cultural variation: an exercise in diabetes
Exercising looks different in every country, as do the motivations behind exercising. In some countries, people exercise primarily indoors, while in others, people primarily exercise outdoors. People may exercise for personal enjoyment, health, well-being, social interactions, competition or training, etc. These differences could potentially be attributed to a variety of reasons, including geographic location and social tendencies.
In Colombia, for example, citizens value and celebrate the outdoor environments of their country. In many instances, they utilize outdoor activities as social gatherings to enjoy nature and their communities. In Bogotá, Colombia, a 70-mile stretch of road known as the Ciclovía is shut down each Sunday for bicyclists, runners, rollerbladers, skateboarders, and other exercisers to work out and enjoy their surroundings.
keywords: Diabetes, exercise, chronic ailment
Similar to Colombia, citizens of Cambodia tend to exercise socially outside. In this country, public gyms have become quite popular. People will congregate at these outdoor gyms to utilize the public facilities and organize aerobics and dance sessions, which are open to the public.
Sweden has also begun developing outdoor gyms called utegym. These gyms are free to the public and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats, and run through forests to stay healthy and enjoy the natural world around them. This works particularly well in Sweden due to its geographical location.
Exercise in some areas of China, particularly among retired, seems to be socially grounded. Dances are held in public parks; these gatherings may include Latin dancing, ballroom dancing, tango, or even the jitterbug. Dancing in public allows people to interact with those they would not normally interact with, allowing for health and social benefits.
These sociocultural variations in physical exercise show how people in different geographic locations and social climates have varying motivations and exercise methods. Physical exercise can improve health and well-being and enhance community ties and appreciation of natural beauty. keywords: Diabetes, exercise, Countries, U.S
Nutrition and recovery
Proper nutrition is as important to health as exercise. When exercising, it becomes even more important to have a good diet to ensure that the body has the correct ratio while providing ample micronutrients to aid the body with the recovery process following strenuous exercise.
Active recovery is recommended after participating in physical exercise because it removes lactate from the blood more quickly than inactive recovery. Removing lactate from circulation allows for an easy decline in body temperature, which can also benefit the immune system. An individual may be vulnerable to minor illnesses if the body temperature drops too abruptly after physical exercise.
Excessive exercise or overtraining occurs when a person exceeds their body’s ability to recover from strenuous exercise.
History Diabetes, exercise, chronic ailment
The benefits of exercise have been known since antiquity. Dating back to 65 BCE, Marcus Cicero, Roman politician and lawyer, stated: “It is exercise alone that supports the spirits and keeps the mind in vigor.” The exercise was also seen to be valued later in history during the Early Middle Ages to survive by the Germanic peoples of Northern Europe.
More recently, exercise was regarded as a beneficial force in the 19th century. After 1860, Archibald MacLaren opened a gymnasium at the University of Oxford and instituted a training regimen for 12 military officials. This regimen was assimilated into the training of the British Army, which formed the Army Gymnastic Staff in 1860 and made sport an important part of military life. Several mass exercise movements were started in the early twentieth century as well. The first and most significant of these in the UK was the Women’s League of Health and Beauty, founded in 1930 by Mary Bagot Stack, which had 166,000 members in 1937.
The link between physical health and exercise (or lack of it) was further established in 1949 and reported in 1953 by a team led by Jerry Morris. Dr. Morris noted that men of similar social class and occupation (bus conductors versus bus drivers) had markedly different rates of heart attacks, depending on the level of exercise they got: bus drivers had a sedentary occupation and a higher incidence of heart disease, while bus conductors were forced to move continually and had a lower incidence of heart disease.
Whatever the latest diet or exercise trend, whatever bullshit lines the personal trainer at the gym is feeding you, and whatever the latest scientific research is telling us, losing weight revolves around one factor and only one… CALORIES
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