What is Type 2 Diabetes?
T2DM is a progressive condition where the body becomes resistant to normal effects of insulin from the pancreas. Insulin is responsible for the uptake of glucose to the body to provide and store energy, thus for individuals with Type 2 Diabetes the insulin from the pancreas does not work effectively resulting in high blood glucose levels. Type 2 Diabetes is characterised by 7mmol/L or higher of fasting blood glucose.
According to the Australian Bureau of Statistics, a record of 1 million Australian adults were diagnosed with Type 2 Diabetes in 2017-2018. (6) The main risk factors for Type 2 Diabetes includes obesity, sedentary lifestyle, poor diet and family history.
Evidence has shown that regular exercise helps control blood glucose levels in the body which can prevent or delay type 2 diabetes. The main goal of exercise is to achieve control of blood glucose levels, lipids, control weight and reduce blood pressure to avoid or delay further chronic complications. (2) It is very important to impart a wholistic approach in managing type 2 diabetes focusing on not only physical activity but also a better diet, self-care behaviours and a healthy lifestyle. Our mobile exercise physiology or mobile physiotherapy service can assist in creating a suitable exercise program tailored to your needs.
Whilst exercise is important some of the precautions to consider when exercising in individuals who have diabetes include:
- Hypoglycaemia (Low blood glucose levels)- consume carbohydrate or sugary snack
- Don’t exercise if blood glucose levels are below 4mmol/L or above 14 mmol/L or ketoacidic
- Avoid high impact exercises if you have Retinopathy or Peripheral Neuropathy
- Hyperglycaemia (High blood glucose levels) – wait until blood glucose levels lower below 8mmol/L before exercising
Benefits of Exercise on Type 2 Diabetes
- Control blood glucose levels
The most important benefit of exercise on Type 2 Diabetes is the ability to reduce blood glucose levels. During exercise, insulin sensitivity is increased allowing your muscles cells to use glucose without the need for extra insulin. During strength or aerobic exercises, your muscles are contracting allowing the cells to use glucose for energy and therefore decreasing the glucose levels in your blood.
- Reduce risk of Cardiovascular Disease
Cardiovascular Disease is one of the main complications which may arise in the future for people with T2DM if untreated. Over time, the high blood glucose levels from diabetes can damage blood vessels and nerves controlling the function of the heart and other related organs. This can lead to various types of heart diseases or stroke. There is evidence that at a young age, individuals with diabetes are 1.5 times more likely to have a heart disease or stroke. (1) There has been evidence that both aerobic and resistance training has a significant impact in lowering high blood pressure among individuals with diabetes. (1) Physical activity has proven to strengthen the muscles of the heart, improving its function and the ability to utilise oxygen more efficiently. This is very important in individuals with T2DM to minimize the risk of further cardiovascular complications in the future.
- Weight control
Obesity is one of the biggest risk factors for T2DM and other complications such as cardiovascular disease. For individuals with type T2DM evidence has shown that weight loss has been able to slow the process of symptoms occurring or even reversing the progression of T2DM. A study in the US has shown that men who are obese have 7 times more risk of developing T2DM and women who are obese have a 12 time more risk. (5) In almost all studies, weight loss is recommended as the most important management to control T2DM and reduce its progression. There is significant evidence that the combination of a healthy diet and regular exercise is the most effective way of losing weight.(4) Daily exercise can increase your metabolism levels resulting in more calories being burnt through exercise. Most important thing to know is that losing weight is a long process that will see benefits in the long term through a strict healthy diet and a high intensity exercise program.
What is the best type of Exercise for T2DM?
Evidence has shown that both aerobic and resistance training are both beneficial but a combination of these two forms is the most optimal for people with T2DM.
Resistance training is a form of physical activity which involves focusing on improving muscle mass and strength. It causes muscles to contract against an external resistance such as weight machines, resistance bands or free weights to help increase power, strength, hypertrophy, and endurance. Resistance exercise also significantly impacts on the blood glucose control and insulin action in T2DM individuals. (2) A study which involved a progressive resistance training for 16 weeks by older men who were diagnosed with T2DM showed a 46.% increase in insulin action and a 7.1% reduction in fasting blood glucose levels. (3) Resistance training focuses on increasing muscle mass which contributes to more blood glucose uptake and a reduction in visceral fat levels.
Aerobic exercising involves any training which elicits a cardiovascular response such as an increase in heart rate. It includes the continuous use of large muscle groups which helps increase insulin sensitivity and glucose control. Aerobic exercise involves activities such as running, walking, cycling or even swimming. Regular aerobic exercise has shown to reduce blood glucose levels, blood pressure, and insulin resistance.
Overall, studies have shown that an inclusion of both resistance training and aerobic training is optimal to help increase insulin sensitivity and lower blood glucose levels in individuals with T2DM. (2)
Guidelines for Resistance Training and Aerobic Training
- Resistance Training
- 60-80% 1RM
- Reps: 8-15
- Sets- 1-3
- Sessions- 3-5/week
- Aerobic Training
- Intensity- 50-75% of max HR
- Duration:20-40 min/ day
- All individuals with type 2 diabetes should increase incidental activity and decrease sedentary behaviour
- Focus on a balanced workout which incorporates both resistance and aerobic training
- Include a healthy, balanced diet
- Make sure you measure fasting blood glucose levels before and after exercising
- Target the exercise guidelines of 150min of moderate exercise weekly
- Chudyk, A., & Petrella, R. (2011). Effects of Exercise on Cardiovascular Risk Factors in Type 2 Diabetes: A meta-analysis. Diabetes Care, 34(5), 1228-1237. doi: 10.2337/dc10-1881
- Exercise and Type 2 Diabetes. (2010). Medicine & Science In Sports & Exercise, 42(12), 2282-2303. doi: 10.1249/mss.0b013e3181eeb61c
- Ibanez J, Izquierdo M, Arguelles I, et al. : Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care 2005;28(3):662–7
- Swift, D., Johannsen, N., Lavie, C., Earnest, C., & Church, T. (2014). The Role of Exercise and Physical Activity in Weight Loss and Maintenance. Progress In Cardiovascular Diseases, 56(4), 441-447. doi: 10.1016/j.pcad.2013.09.012
- Wilding, J. (2014). The importance of weight management in type 2 diabetes mellitus. International Journal Of Clinical Practice, 68(6), 682-691. doi: 10.1111/ijcp.12384
- Diabetes, Type 2 diabetes – Australian Institute of Health and Welfare. (2021). Retrieved 23 September 2021, from https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/type-2-diabetes