Health

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.

Do standing desks stack up?

It is well researched and well known that prolonged sitting, as a form of inactivity, can be detrimental to both musculoskeletal and general health. Even if you go to the gym for an hour in the mornings, you can undo all of that hard work by sitting on your butt for eight hours of the working day. 

It is estimated that 60-70% of our waking hours are spent in a sedentary position. That’s a whopping three quarters! Sitting for 8 hours at work, the commute from home, screen time .. it all adds up quickly! 

Thanks to google images for this one...

Thanks to google images for this one...

So if sitting is bad… lets just stand!

One of many strategies that many workplaces have been implementing to help their employees be more active are standing desks. 

You may have heard about them, or perhaps even used them at work, but for those of us not in the know they’re just a desk that is higher than normal so you can stand rather than sit. Ideally, the height of the tabletop should be roughly at elbow level. So they constitute more of a workplace culture change rather than a technological advancement! 

Standing desks have been shown to have great outcomes for employers because they improve productivity, reduce time away from work due to illness or injury and tend to lead to happier, healthier workers. 

Surely it’s not that simple…

The implementation of standing desks in workplaces has not always been a story of happiness and productivity though! Some employers have completely turfed seated desks in favour of standing desks. So instead of eight hours of sitting and a sore neck, employees now stood for eight hours and had sore lower backs and feet instead*! It really shows that too much of anything can have a negative effect. 

The middle ground is a variable height desk, or a sit-stand desk. They allow the user to alternate between sitting and standing as they feel the need. There are various models of these desks, which begin at about $300 for a manually variable desk that sits on top of your current desk, right the way up to fully automated electronic and programmable versions for several thousands of dollars. Experts recommend doing your research before buying in to anything to make sure it suits your needs, your body frame and the work you need to do. 

Image of man working with an adjustable desk

Image of man working with an adjustable desk

Stand, Sit, Sit-Stand… whats the best for your body?!

If you are thinking about switching from a sitting desk to a standing or variable height desk, there are some things you can do to smooth the transition. If you are normally an 8 hour a day sitter… you should begin by trying to incorporate no more than two hours in a day of standing and light walking (like to the printer and back again). There might be some initial tiredness or discomfort as your body adjusts, but you should not just accept pain. If you are experiencing discomfort or prolonged fatigue don't just put up with it! Review your posture, change your timing, move more and consider having your standing position reviewed or assessed. 

Once comfortable with this, then aim for four hours in the day where you are active or standing, which should equate to roughly half your time at work. This is a gradual process. Be patient and stick to it! Remember that there are more options than just sitting or standing also… perhaps different types of chairs, kneeling, squatting, or lying are options for you and your workplace. 

Trust your body!

"Trust yourself, no matter what anyone else thinks"

"Trust yourself, no matter what anyone else thinks"

When you move your body more, it will thank you! Just by taking the scenic route to the water cooler or a stroll during lunch you’ve dropped your risk of developing heart disease, diabetes and some cancers. Congratulations! 

Isabelle.

TMT Physiotherapist

 

The facts in this article are drawn from a consensus statement published in 2015 from experts in England and Australia. You can find it here. http://getaustraliastanding.org/pdfs/BJSM_Expert%20Statement%202015_06.pdf


For more palatable reading of those facts and more information on the topic, head to getaustraliastanding.org 

Fitness Trackers - Do they make us more healthy?

Fitness Trackers - Do they make us more healthy?

So, I took the dive and invested in a Fitness Tracker. My weapon of choice is a popular one, apparently: a FitBit Charge HR. I like it because it challenges me to compete against my past self. And so far, it’s working for me! (Also it’s great for letting my know someone is ringing me when my phone is on vibrate and hiding in the bottom of my handbag, but that’s another story.) 

Weighing In On The 'Obesity Epidemic'

If like 2/3 of the Australian population you're either overweight or obese, are you doomed to a lifetime of poor health unless you lose those extra 10, 20 or 30kg? The short answer, NO! 

BMI charts aren't always accurate

BMI charts aren't always accurate

As a society we've come to associate the increasing number on the scales with declining health and higher mortality rates. The weight of recent evidence suggests that perhaps we don't fully understand the big picture in terms of the relationship between weight and health. For example, almost all population based studies show that overweight or moderately obese persons live at least as long as people in the normal weight category! Many people then argue that if this group lives as long as their leaner counterparts surely overweight and obese people are comparatively less healthy, right? Wrong. When we take a closer look at the specific effects of fitness, physical activity, diet quality and weight cycling we see that these factors are more relevant than weight. 

Fit & fat

Fit & fat

So what does this mean in practical terms? In essence this means you can make significant health improvements WITHOUT focusing on weight. 

In terms of nutrition, it's about getting back to basics. Choose a varied diet, eat regularly and include plenty of wholegrain breads and cereals, vegetables, fruit, dairy and meat. Recognise that it's normal to enjoy cake, chocolate and wine. Eat mindfully, tap into your hunger and fullness levels, and avoid restrictive diets. These behaviour changes will allow you to settle at your most comfortable healthy weight. For some people, this will translate to weight loss, for others it may mean a change in body composition without weight changes, and for many it will require acceptance that your healthiest most comfortable weight will not be the 'goal weight' you had in mind (and that's perfectly okay). 

Health at every size

Health at every size

While some of these concepts may sound simple, they are certainly not easy to fully embrace. I can only recommend that you seek help from your personal support team (health professionals, family and friends included), make gradual changes, and be kind to yourself. We are given only one body, so it seems absolutely absurd that many people spend the better part of their lives dissatisfied with their unique shape and size. Let go of the idea that weight loss equals health, and remember that your best weight is the one at which you are living the healthiest life you actually enjoy. 

You can find some great information here from Linda Bacon- one of the pioneer's of the "health at every size" movement.

Megan on a hike in New Zealand

Megan on a hike in New Zealand

Megan one of the Dietitians at the Movement Team and is passionate about challenging the way society approaches dieting. She has clinical interests in weight management, chronic disease, and eating behaviour. Megan also has experience in research and aged care.

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.