Sports Medicine

, Volume 27, Issue 6, pp 381–391

Exercise and the Treatment of Type 2 Diabetes Mellitus

An Update
Review Article

Abstract

Exercise has long been considered a cornerstone in the treatment regimen for patients with type 2 (non-insulin-dependent) diabetes mellitus. Aerobic endurance exercise has traditionally been advocated as the most suitable exercise mode. Several exercise studies have evaluated the effect of exercise on insulin sensitivity and glycaemic control in patients with type 2 diabetes mellitus. However, the results obtained have been highly heterogeneous regarding the effect of exercise on insulin sensitivity and glycaemic control. Only in certain subgroups (e.g. patients with type 2 diabetes mellitus under 55 years of age, those with diabetes treated through diet and those who have diabetes with fairly good metabolic control), does exercise seem to be beneficial with regard to improvement in glycaemic control.

There has been little research into the effects of resistance training on glucose metabolism in patients with type 2 diabetes mellitus compared with the amount of research involving aerobic endurance exercise. The incidence of type 2 diabetes mellitus increases with increasing age, partly because of the decline in muscle mass associated with aging. This corresponds with a decline in metabolic function, supporting the usefulness of resistance training. Available studies support the usefulness of resistance training in the treatment of type 2 diabetes mellitus.

Therefore, based on the published studies reviewed, this author proposes that an optimal exercise programme for individuals with type 2 diabetes mellitus should include components that improve cardiorespiratory fitness, muscular strength and endurance, i.e. a combination of aerobic endurance training and circuit-type resistance training. Programmes combining various modes of exercise positively influence patient compliance with the exercise programme. The vast majority of patients with type 2 diabetesmellitus can undertake an individualised exercise programme without significantly increased risks of complications.

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References

  1. 1.
    DeFronzo RA, Bonadonna RC, Ferrannini E. Pathogenesis of NIDDM: a balanced overview. Diabetes Care 1992; 15: 318–68PubMedCrossRefGoogle Scholar
  2. 2.
    Groop L, Eriksson J. The etiology and pathogenesis of noninsulin-dependent diabetes. Ann Med 1992; 24: 483–9PubMedCrossRefGoogle Scholar
  3. 3.
    Valle T, Tuomilehto J, Eriksson J. Epidemiology of NIDDM in Europids. In: Alberti KGMM, Zimmet P, DeFronzo RA, et al., editors. International textbook of diabetes mellitus. Chichester: John Wiley & Sons Ltd, 1997: 125–42Google Scholar
  4. 4.
    McCarthy D, Zimmett P. Diabetes 1994 to 2010: global estimates and projections. Melbourne: International Diabetes Institute, 1994Google Scholar
  5. 5.
    Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM: the need for early emphasis. Diabetes Care 1994; 12: 1469–72CrossRefGoogle Scholar
  6. 6.
    Rogers MA, Yamamoto C, King D, et al. Improvement in glucose tolerance after 1 week of exercise in patients with mild NIDDM. Diabetes Care 1988; 11: 613–8PubMedCrossRefGoogle Scholar
  7. 7.
    Schneider SH, Khachadurian AK, Amorosa LF, et al. Abnormal glucoregulation during exercise in Type II (non-insulindependent) diabetes. Metabolism 1987; 6: 1161–6CrossRefGoogle Scholar
  8. 8.
    Koivisto VA, DeFronzo RA. Exercise in the treatment of type II diabetes. Acta Endocrinol Suppl 1984; 262: 107–11Google Scholar
  9. 9.
    Koivisto VA, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1986; 1: 445–81PubMedCrossRefGoogle Scholar
  10. 10.
    Koivisto VA, Yki-Järvinen H, DeFronzo RA. Physical training and insulin sensitivity. Diabetes Metab Rev 1986; 4: 445–81CrossRefGoogle Scholar
  11. 11.
    Devlin JT. Effects of exercise on insulin sensitivity in humans. Diabetes Care 1992; 15 Suppl. 4: 1690–3PubMedCrossRefGoogle Scholar
  12. 12.
    Campaigne BN, Lampman RM, editors. Exercise in the clinical management of diabetes. Champaign (IL): Human Kinetics, 1994Google Scholar
  13. 13.
    Ligtenberg PC, Hoekstra JBL, Zonderland ML, et al. Physical activity and diabetes mellitus. Eur J Intern Med 1995; 6: 95–108Google Scholar
  14. 14.
    Ruderman N, Devlin JT, editors. The health professional’s guide to diabetes and exercise. Alexandria (VA): American Diabetes Association, 1995Google Scholar
  15. 15.
    Kemmer FW, Gudat U, Berger M. Exercise. In: Alberti KGMM, Zimmet P, DeFronzo RA, et al., editors. International textbook of diabetes mellitus. 2nd ed. Chichester: John Wiley & Sons Ltd, 1997: 799–815Google Scholar
  16. 16.
    Ekoe JM. Overview of diabetes mellitus and exercise. Med Sci Sports Exerc 1989; 21: 353–5PubMedGoogle Scholar
  17. 17.
    Young JC. Exercise prescription for individuals with metabolic disorders: practical considerations. Sports Med 1995; 19: 43–54PubMedCrossRefGoogle Scholar
  18. 18.
    American Diabetes Association: clinical practice recommendations 1998. Diabetes Care 1999; 22 Suppl. 1: S49-53Google Scholar
  19. 19.
    Wahren I, Felig P, Ahlborg G, et al. Glucose metabolism during leg exercise in men. J Clin Invest 1971; 50: 2715–25PubMedCrossRefGoogle Scholar
  20. 20.
    Ahlborg G, Felig P, Hagenfeldt L, et al. Substrate turnover during prolonged exercise in man: splanchnic and leg metabolism of glucose, free fatty acids and amino acids. J Clin Invest 1974; 53: 1080–90PubMedCrossRefGoogle Scholar
  21. 21.
    Lohmann D, Liebold F, Heilmann W, et al. Diminished insulin response in highly trained athletes. Metabolism 1987; 27: 521–4CrossRefGoogle Scholar
  22. 22.
    Seals DR, Hagberg JM, Allen WK, et al. Glucose tolerance in young and older athletes and sedentary men. J Appl Physiol 1984; 56: 1521–5PubMedGoogle Scholar
  23. 23.
    Holloszy JO. Glucose tolerance in young and older athletes and sedentary men. J Appl Physiol 1984; 56: 1521–5PubMedGoogle Scholar
  24. 24.
    Rogers MA, King DS, Hagberg JM, et al. Effect of 10 days of physical inactivity on glucose tolerance in master athletes. J Appl Physiol 1990; 68 (5): 1833–7PubMedGoogle Scholar
  25. 25.
    Kahn SE, Larson VG, Beard JC, et al. Effect of exercise on insulin action, glucose tolerance, and insulin secretion in aging. Am J Physiol 1990; 258: E937–43PubMedGoogle Scholar
  26. 26.
    DeFronzo RR, Sherwin RS, Kraemer N. Effect of physical training on insulin action in obesity. Diabetes 1987; 36: 1379–85PubMedCrossRefGoogle Scholar
  27. 27.
    Pedersen O, Beck-Nielsen H, Heding L. Increased insulin receptors after exercise in patients with insulin-dependent diabetes mellitus. N Engl J Med 1980; 302: 886–92PubMedCrossRefGoogle Scholar
  28. 28.
    Reitman J, Vasquez B, Klimes l, et al. Improvement of glucose homeostasis after exercise training in non-insulin dependent diabetes mellitus. Diabetes Care 1984; 7: 434–41PubMedCrossRefGoogle Scholar
  29. 29.
    Trovati M, Carta Q, Cavalot F, et al. Influence of physical training on blood glucose control, glucose tolerance, insulin secretion, and insulin action in non-insulin dependent diabetic patients. Diabetes Care 1984; 7: 416–20PubMedCrossRefGoogle Scholar
  30. 30.
    Lampman RM, Schteingart DE, Santinga JT, et al. The influence of physical training on glucose tolerance, insulin sensitivity, and lipid and lipoprotein concentrations in middle-aged hypertriglyceridemic, carbohydrate intolerant men. Diabetologia 1987: 30; 380–5PubMedCrossRefGoogle Scholar
  31. 31.
    Holloszy JO, Schultz J, Kusnierkiewicz J, et al. Effects of exercise on glucose tolerance and insulin resistance. Acta Med Scand Suppl 1986; 711: 55–65PubMedGoogle Scholar
  32. 32.
    Burstein R, Polychronakos C, Toews CJ, et al. Acute reversal of the enhanced insulin action in trained athletes: association with insulin receptor changes. Diabetes 1985; 34: 756–60PubMedCrossRefGoogle Scholar
  33. 33.
    King DS, Dalsky GP, Clutter WE, et al. Effects of exercise and lack of exercise on insulin sensitivity and responsiveness. J Appl Physiol 1988; 64: 1942–6PubMedGoogle Scholar
  34. 34.
    Perseghin GP, Price TB, Petersen KF, et al. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med 1996; 335: 1357–62PubMedCrossRefGoogle Scholar
  35. 35.
    Segal KR, Edano A, Abolos A, et al. Effect of exercise training on insulin sensitivity and glucose metabolism in lean, obese, and diabetic men. J Appl Physiol 1991; 71: 2402–11PubMedGoogle Scholar
  36. 36.
    Rönnemaa T, Mattila K, Lehtonen A, et al. Acontrolled randomized study on the effect of long-term physical exercise on the metabolic control in Type 2 diabetic patients. Acta Med Scand 1986; 220: 219–24PubMedCrossRefGoogle Scholar
  37. 37.
    Heath GW, Wilson RH, Smith J, et al. Community-based exercise and weight control: diabetes risk reduction and glycemic control in Zuni Indians. Am J Clin Nutr 1991; 53 (6 Suppl.): 1642S–6SPubMedGoogle Scholar
  38. 38.
    Schneider SH, Khachadurian AV, Amorosa LF, et al. Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus. Diabetes Care 1992; 15 Suppl. 4: 1800–10CrossRefGoogle Scholar
  39. 39.
    Vanninen E, Uusitupa M, Siitonen O, et al. Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention. Diabetologia 1992; 35: 340–6PubMedCrossRefGoogle Scholar
  40. 40.
    Di D-X, Teng W-P, Zhang J, et al. Exercise therapy of noninsulin dependent diabetes mellitus. A report of 10 year studies: the efficacy of exercise therapy. Chin Med J 1993; 106: 757–9PubMedGoogle Scholar
  41. 41.
    Bourn DM, Mann JI, McSkimming BJ, et al. Impaired glucose tolerance and NIDDM: does a lifestyle intervention program have an effect? Diabetes Care 1994; 17: 1311–9PubMedCrossRefGoogle Scholar
  42. 42.
    Lehmann R, Vokac A, Niedermann K, et al. Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM. Diabetologia 1995; 38: 1313–9PubMedCrossRefGoogle Scholar
  43. 43.
    Dunstan DW, Mori TA, Puddey IB, et al. The independent and combined effects of aerobic exercise and dietary fish intake on serum lipids and glycemic control in NIDDM. Diabetes Care 1997; 20: 913–21PubMedCrossRefGoogle Scholar
  44. 44.
    Eriksson J, Taimela S, Eriksson K, et al. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. Int J Sport Med 1997; 18: 242–6CrossRefGoogle Scholar
  45. 45.
    Honkola A, Forsén T, Eriksson J. Resistance training improves the metabolic profile in individuals with non-insulin-dependent diabetes mellitus. Acta Diabetol 1997; 34: 245–8PubMedCrossRefGoogle Scholar
  46. 46.
    Ligtenberg PC, Hoekstra JBL, Bol E, et al. Effect of physical training on metabolic control in elderly type 2 diabetes mellitus patients. Clin Sci 1997: 93: 127–35PubMedGoogle Scholar
  47. 47.
    Mourier A, Gautier J-F, DeKerviler E, et al. Mobilization of visceral adipose tissue related to the improvement in insulin sensitivity in response to physical training in NIDDM. Diabetes Care 1997; 20: 385–91PubMedCrossRefGoogle Scholar
  48. 48.
    Soukup JT, Kovaleski JE. A review of the effects of resistance training for individuals with diabetes mellitus. Diabetes Educ 1993; 19: 307–12PubMedCrossRefGoogle Scholar
  49. 49.
    Harris K, Holly R. Physiological response to circuit weight training in borderline hypertensive subjects. Med Sci Sports Exerc 1987; 19: 246–52PubMedGoogle Scholar
  50. 50.
    Hurley BF, Seals DR, Ehsani AA, et al. Effects of high-intensity strength training on cardiovascular function. Med Sci Sports Exerc 1984; 16: 483–8PubMedCrossRefGoogle Scholar
  51. 51.
    Hurley BF, Hagberg JM, Goldberg AP, et al. Resistive training can reduce coronary risk factors without altering VO2max or percent body fat. Med Sci Sports Exerc 1988; 20: 150–4PubMedCrossRefGoogle Scholar
  52. 52.
    Smutok MA, Reece C, Kokkinos PF, et al. Effects of exercise training modality on glucose tolerance in men with abnormal glucose regulation. Int J Sports Med 1994; 6: 283–9CrossRefGoogle Scholar
  53. 53.
    Eriksson J, Tuominen J, Valle T, et al. Aerobic endurance exercise or circuit-type resistance training for individuals with impaired glucose tolerance? Horm Metab Res 1998; 30: 37–41PubMedCrossRefGoogle Scholar
  54. 54.
    Gudat U, Berger M, Lefèbvre PJ. Physical activity, fitness, and non-insulin-dependent (type II) diabetes mellitus. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health. International proceedings and concensus statement. Champaign (IL): Human Kinetics, 1994: 669–83Google Scholar
  55. 55.
    Fleck S. Cardiovascular adaptations to resistance training. Med Sci Sports Exerc 1988; 20 (5 Suppl.): S146–S51PubMedGoogle Scholar
  56. 56.
    Effron MB. Effects of resistive training on left ventricular function. Med Sci Sports Exerc 1989; 21 (6): 694–7PubMedGoogle Scholar
  57. 57.
    Ghilarducci LE, Holly RG, Amsterdam EA. Effects of high resistance training in coronary artery disease. Am J Cardiol 1989; 64: 866–70PubMedCrossRefGoogle Scholar
  58. 58.
    Tzankoff SP, Norris AH. Effect of muscle mass decrease on age-related BMR changes. J Appl Physiol 1977; 43: 1001–6PubMedGoogle Scholar
  59. 59.
    Fluckey JD, Hickey MS, Brambrink JK, et al. Effects of resistance exercise on glucose tolerance in normal and glucose intolerant subjects. J Appl Physiol 1994; 77: 1087–92PubMedGoogle Scholar
  60. 60.
    Miller JP, Pratley RE, Goldberg AP, et al. Strength training increases insulin action in healthy 50- to 65-yr-old men. J Appl Physiol 1994; 77: 1122–7PubMedGoogle Scholar
  61. 61.
    Pratley R, Nicklas B, Rubin M, et al. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50-to 65-yr-old men. J Appl Physiol 1994; 76: 133–7PubMedCrossRefGoogle Scholar
  62. 62.
    US Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta (GA): US Department of Health and Human Services, Centres for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996Google Scholar
  63. 63.
    Eriksson J, Taimela S, Koivisto VA. Exercise and the metabolic syndrome. Diabetologia 1997; 40: 125–35PubMedCrossRefGoogle Scholar
  64. 64.
    Helmrich SP, Ragland DR, Leung RW et al. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991; 325: 147–52PubMedCrossRefGoogle Scholar
  65. 65.
    Manson JE, Rimm EB, Stampfer MJ et al. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991; 338: 774–8PubMedCrossRefGoogle Scholar
  66. 66.
    Manson JE, Nathan DM, Krolewski AS, et al. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992; 268: 63–7PubMedCrossRefGoogle Scholar
  67. 67.
    Manson JE, Spelsberg A. Primary prevention of non-insulindependent diabetes mellitus. Am J Prev Med 1994; 10: 172–84PubMedGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.Department of Epidemiology and Health PromotionNational Public Health InstituteHelsinkiFinland

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