Exercise Physiology

Why is Exercise Good for Type 2 Diabetes Mellitus?

We all know that exercise is good for us, we hear it time and time again in the media, but never has it been more important than now. Especially as the rates of obesity are on the rise, and with it other associated lifestyle diseases. One lifestyle related disease, the focus of this blog, is type 2 diabetes mellitus. But what is type 2 diabetes? Why is exercise good? How much, and is there anything I need to consider?

Jackie Chan wondering confused by what to do

Jackie Chan wondering confused by what to do

Well…. I’m glad you asked!

What is Type 2 diabetes?

T2DM is a progressive disease where by the body over time develops a resistance to insulin. 

Insulin is the major cellular mechanism for transport of glucose into skeletal muscle where it is stored as glycogen, or used to produce energy. As the body becomes resistant, more insulin is produced over time to facilitate this process until eventually the cells in the pancreas, responsible for insulin production, become exhausted. Not good! What is required at this point in time is an exogenous (external) source for this process to continue.

Diagram of diabetes

Diagram of diabetes

So my pancreas is exhausted. Now what do I do?

This is where exercise can assist. Muscle contraction also draws glucose into the muscle cell without the reliance on insulin. Using separate signalling pathways, these two processes eventually both lead to the same transporter protein, which transports the glucose into the muscle cell. 

So think of it like this, the more you use your muscles, whether it be walking, riding, jumping, skipping, weights etc. the more you are pumping glucose into the muscle without working the pancreas into overtime. This assists in blood glucose/glycaemic control. A bout of exercise often has a carryover effect on blood sugars of 24hours. 

How exercise is beneficial for those with diabetes

How exercise is beneficial for those with diabetes

How much exercise should I do?

Exercise and Sports Science Australia have released the following position statement when it comes to exercise recommendations for T2DM.

“Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2–4 sets of 8–10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.”

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

Things to consider.

When exercising with diabetes, it is important that you check your blood sugars pre and post exercise, as well as monitor signs and symptoms of hypoglycaemia (a dropping of blood sugars below safe levels presenting in dizziness, confusion, slurred speech and nausea which can lead to a coma or death if unattended). A normal range is 4-8mmol. However, personally I prefer that a diabetic exercising in the movement room, has a post blood sugar reading higher than 6. This accommodates the consideration that the body is still working at a higher metabolic rate for a short time post exercise, and acts as a buffer from dangerously low levels until the body returns to its resting state.

Doctor pun about blood sugar

Doctor pun about blood sugar

Other comorbidities to which the ESSA guidelines refer are heart disease and hypertension to name a few. These also require close monitoring until a safe exercise capacity can be established without risk of causing a serious event. Complications associated with diabetes are things such as peripheral neuropathies, where an individual can experience altered sensation, more commonly in the lower limbs. This can affect balance and sensitivity. So it is important to consult your GP, as well as an exercise physiologist to establish a safe exercise program that will improve your quality of life. 

MIKE

 

Michael Pegg

Exercise Physiologist

B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM

Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.

Stand Up and Be Strong

Just go from sitting to standing and back again…sounds simple right? To get up from a seat. But for some it’s quite difficult. 

This motion is one of the crucial elements in maintaining quality of life as we get older. The less we perform this action, the more we are reliant on aids to get us out of a chair, using our arms to pull ourselves up, changing our living spaces to accommodate (often a costly process), reliant on others to perform actions we once thought of as simple tasks, or worse yet, having to leave your home all together. 

Small daily improvements are the key to staggering long-term results

Small daily improvements are the key to staggering long-term results

The muscles involved in a sit to stand are crucial for maintaining balance while standing and walking. This means having difficulty controlling getting up and down from the couch can be a warning sign for other, more risky difficulties. Reduced muscle mass in the lower extremities equates to less stability which means that an individual’s gait becomes wider and shorter. More simply, the way we walk is not fixed, if we have weak leg muscles, we walk more slowly and have to have our feet further apart to reduce the risk of falling over. Additionally a reduction in muscle mass in the hips and this change in body mechanics commonly contributes to overuse injuries such as hip, knee and lower back pain. 

Over and over I have seen patients drastically improve their quality of life simply by practising ‘sit to stands’ every day. By performing this simple exercise you can improve your strength, reduce the risk of injury and make some simple things easy again. This can seem daunting, especially if this has been an almost impossible feat in the past. Here are some tips to help you start your journey to a better quality of life.

Make the impossible possible

Make the impossible possible

Let’s start with getting the technique right.

Start from the seated position. If you start here you know the seat will be there when you return. Your feet should be parallel to each other (or as close to parallel as possible), the knees should always stay over your heels, chin up, chest out, shoulders back while sticking the backside out to allow the activation of the back muscles to maintain posture. You should always be pushing through the heels. Try wiggling your toes when performing. This will tell you whether you are on the balls of your feet, or on the heels.

Stand to sit avoiding plonking

Stand to sit avoiding plonking

Don’t go too hard too soon!

A phrase that I commonly use is “avoid the plonk”. It’s important to maintain muscle activation through the whole movement and not cheat by letting gravity do all the work. If you ‘plonk’ on the way down, the way back up is likely to be hard work! ‘Plonking’ while lowering down into a seat is a sign that you were not able to (or out of the habit of) controlling your own weight. This will mean that you won’t be working the muscles, which is the whole point. So pick a height that means you are able to dictate the pace of the sit to stand. It may be high at first, and the range small, but you can always progress to a lower seat as the muscles strengthen over time.

Little by little, a little becomes a lot

Little by little, a little becomes a lot

Volume without pain

The more often you are able to perform the sit to stand on a weekly basis the more improvements you will see over a shorter space of time. It’s no use doing 5 sets of 15 on one day then being incapacitated for the rest of the week. This is meant to improve your quality of life not hinder it. Start with a very easy range that produces minimal muscle soreness but is still challenging. Look to increase these repetitions over time. 

A little puppy who got too tired to tired to finish the walk

A little puppy who got too tired to tired to finish the walk

Start in front of the mirror

Perform the sit to stand in front of the mirror. What you are doing here is coupling how good technique looks with how it feels. As a result of giving yourself different forms of immediate feedback, mastery of the technique will be obtained much quicker. You won’t have to do this forever, but it is important in the beginning. 

Kitty thinks he's looking in a mirror!

Kitty thinks he's looking in a mirror!

Get coaching

It’s important to make sure you feel safe when you perform a sit to stand. If you’re unsure of your ability, see an Exercise Physiologist to establish safe ranges of motion, rep ranges and any coaching of techniques that may be required. If practicing this movement causes pain or discomfort, perhaps the first person you need to see is a Physiotherapist. Either way, and whatever your starting point, it is never too late (or too early) to get stronger.

So stand up for yourselves!

MIKE

Michael Pegg

Exercise Physiologist

B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM

Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.

Beautiful sunset

Beautiful sunset

You've decided to exercise more, now what?

You've decided to exercise more, now what?

We are bombarded with so much information on what is the best form of exercise, how often to do it, when to do it, why to do it aaaaand the list goes on….. and on. It can be pretty confusing at the best of times, but especially so if regular exercise is not your forte. So lets simplify things a little.