Physical Exercise, Sports, and Diabetes

  • Pierpaolo de Feo
Part of the Endocrine Updates book series (ENDO, volume 29)


Physical exercise is an appropriate and effective medicine to cure and prevent type 2 diabetes mellitus. It exerts positive effects mainly by increasing insulin sensitivity in the most important insulin-sensitive tissue: skeletal muscle. In muscle, exercise promotes insulin action, mitochondrial biogenesis and activity, and lipid and glucose oxidation. There is evidence in the literature about the efficacy of both aerobic and endurance training in ameliorating glucose control. The combination of both types of exercise has greater beneficial effects. Motivation of the great majority of subjects with type 2 diabetes to long-term practice of exercise is possible if it is conducted with simple and reproducible strategies of counseling.


Physical Activity Mitochondrial Biogenesis Oxidative Capacity Increase Insulin Sensitivity Muscle Oxidative Capacity 
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  1. 1.
    Hossain P, Kawar B et al. Obesity and diabetes in the developing world – a growing challenge. N Engl J Med 2007; 356: 213–215.CrossRefPubMedGoogle Scholar
  2. 2.
    Maffeis C. Physical activity: an effective way to control weight in children? Nutr Metab Cardiovasc Dis 2007; 17: 394–408.CrossRefPubMedGoogle Scholar
  3. 3.
    Hood DA, Salem A. Exercise-induced mitochondrial biogenesis in skeletal muscle. Nutr Metab Cardiovasc Dis 2007; 17: 332–337.CrossRefPubMedGoogle Scholar
  4. 4.
    Baron AD, Brechtel G, Wallace P, Edelman SV. Rates and tissue sites on non-insulin- and insulin-mediated glucose uptake in humans. Am J Physiol 1988; 255: E769–E774.PubMedGoogle Scholar
  5. 5.
    Laaksonen DE et al. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care 2002; 25: 1612–1618.CrossRefPubMedGoogle Scholar
  6. 6.
    Brage S et al. European Youth Heart Study (EYHS). Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care 2004; 27: 2141–2148.CrossRefPubMedGoogle Scholar
  7. 7.
    Wisloff U, Najjar SM et al. Cardiovascular risk factors emerge after artificial selection for low aerobic capacity. Science 2005; 307: 418–420.CrossRefPubMedGoogle Scholar
  8. 8.
    Kelley DE et al. Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes. Diabetes 2002; 51: 2944–2950.CrossRefPubMedGoogle Scholar
  9. 9.
    De Feo P, Stocchi V. Physical activity for the treatment and prevention of metabolic syndrome. Nutr Metab Cardiovasc Dis 2007; 17: 327–331.CrossRefGoogle Scholar
  10. 10.
    Guescini M et al. Fine needle aspiration coupled with real-time PCR: a painless methodology to study adaptive functional changes in skeletal muscle. Nutr Metab Cardiovasc Dis 2007; 17: 383–393.CrossRefPubMedGoogle Scholar
  11. 11.
    Cooper JM, Mann VM, Shapira AH. Analyses of mitochondrial respiratory chain function and mitochondrial DNA deletion in human skeletal muscle: effect of ageing. J Neurol Sci 1992; 98: 113–191.Google Scholar
  12. 12.
    Coggan AR, Spina RJ, Kings DS, Rogers MA, Brown M, Nemeth PM, Holloszy JO. Histochemical and enzymatic comparison of the gastrocnemius muscle of young and ederly men and women. J Gerontol 1992; 47: B71–B76.PubMedGoogle Scholar
  13. 13.
    Short KR, Bigelow ML, Kahl J et al. Decline in skeletal muscle mitochondrial function with aging in humans. Proc Natl Acad Sci USA 2005; 102: 5618–5623.CrossRefPubMedGoogle Scholar
  14. 14.
    Simoneau JA, Colberg SR, Thaete FL, Kelley DE. Skeletal muscle glycolitic and oxidative enzyme capacities are determinants of insulin sensitivity and muscle composition in obese women. FASEB J 1995; 9: 273-278.PubMedGoogle Scholar
  15. 15.
    Mootha V, Lindgren CM, Eriksson KF et al. PGC-1alpha responsive genes involved in oxidative phosphorylation are co-ordinately downregulated in human diabetes. Nat Genet 2003; 34: 267–273.CrossRefPubMedGoogle Scholar
  16. 16.
    Patti M, Butte A, Crunkhorn S et al. Coordinated reduction on genes of oxidative metabolism in humans with insulin resistance and diabetes: potential roles of PGC1 and NRF-1. Proc Natl Acad Sci USA 2003, 100: 8466–8471.CrossRefPubMedGoogle Scholar
  17. 17.
    Rönn T, Poulsen P, Hansson O et al. Age influences DNA methylation and gene expression of COX7A1 in human skeletal muscle. Diabetologia 2008; 51: 1159–1168.CrossRefPubMedGoogle Scholar
  18. 18.
    De Feo P, Di Loreto C, Ranchelli A et al. Physical inactivity is the main cause of the metabolic syndrome. In: Stocchi V, de Feo P, Hood DA (eds) Role of physical exercise in preventing disease and improving the quality of life. Milan: Springer 2007; 23–33.CrossRefGoogle Scholar
  19. 19.
    Dohm GL, Huston RL, Askew EW, Fleshood HL. Effects of exercise, training, and diet on muscle citric acid cycle enzyme activity. Can J Biochem 1973; 51: 849–854.CrossRefPubMedGoogle Scholar
  20. 20.
    Holloszy JO, Oscai LB, Dohn IJ, Molé PA. Mitochondrial citric acid cycle and related enzymes: adaptive response to exercise. Biochem Biophys Res Commun 1970; 40: 1368–1373.CrossRefPubMedGoogle Scholar
  21. 21.
    Hoppeler H, Luthi P, Claassen H, Weibel ER, Howald H. The ultrastructure of the normal human skeletal muscle. A morphometric analysis on untrained men, women and well trained orienteers. Pfuegers Arch 1973; 344: 217–232.CrossRefGoogle Scholar
  22. 22.
    Coggan AR, Spina RJ, Kings DS, Rogers MA, Brown M, Nemeth PM, Holloszy JO. Skeletal muscle adaptations to endurance training in 60- to 70-yr-old men and women. J Appl Physiol 1992; 72: 1780–1786.PubMedGoogle Scholar
  23. 23.
    Jubrias SA, Esselman PC, Price LB, Cress ME, Conley KE. Large energetic adaptations of ederly muscle to resistance and endurance training. J Appl Physiol 2001; 90: 1663–1670.CrossRefGoogle Scholar
  24. 24.
    Menshikova EV, Ritov VB, Fairfull L, Ferrell RE, Kelley DE, Goodpaster BH. Effects of exercise on mitochondrial content and function in aging human skeletal muscle. J Gerontol A Biol Sci Med Sci 2006; 61: 534–540.PubMedGoogle Scholar
  25. 25.
    Toledo FGS, Menshikova EV, Ritov VB, Azuma K, Radikova Z, DeLany J, Kelley DE. Effects of physical activity and weight loss on skeletal muscle mitochondria and relationship with glucose control in type 2 diabetes. Diabetes 2007; 56: 2142–2147.CrossRefPubMedGoogle Scholar
  26. 26.
    Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218–1227.CrossRefPubMedGoogle Scholar
  27. 27.
    Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006; (3): CD002968.PubMedGoogle Scholar
  28. 28.
    Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care 2002; 25: 1729–1736.CrossRefPubMedGoogle Scholar
  29. 29.
    Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002; 25: 2335–2341.CrossRefPubMedGoogle Scholar
  30. 30.
    Balducci S, Leonetti F, Di Mario U, Fallucca F. Is a long-term aerobic plus resistance training program feasible for and effective on metabolic profiles in type 2 diabetic patients? Diabetes Care 2004; 27: 841–842.CrossRefPubMedGoogle Scholar
  31. 31.
    Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud’homme D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jennings A, Jaffey J. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007; 147: 357–369.PubMedGoogle Scholar
  32. 32.
    Kraus WE, Levine BD. Exercise training for diabetes: the “strength” of the evidence. Ann Intern Med 2007; 147: 423–424.PubMedGoogle Scholar
  33. 33.
    Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1433–1438.CrossRefPubMedGoogle Scholar
  34. 34.
    Di Loreto C, Fanelli C, Lucidi P, et al. Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care 2005; 28: 1295–1302.CrossRefPubMedGoogle Scholar
  35. 35.
    Di Loreto C, Fanelli C, Lucidi P et al. Validation of a counseling strategy to promote the ­adoption and the maintenance of physical activity by type 2 diabetic subjects. Diabetes Care 2003; 26: 404–408.CrossRefPubMedGoogle Scholar
  36. 36.
    De Feo P, Di Loreto C, Lucidi P, Murdolo G, Parlanti N, De Cicco A, Piccioni F, Santeusanio F. Metabolic response to exercise. J Endocrinol Invest 2003; 26: 851–854.PubMedGoogle Scholar
  37. 37.
    Bajpeyi S, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Hickner RC, Kraus WE, Houmard JA. Effect of exercise intensity and volume on the persistence of insulin sensitivity during training cessation. J Appl Physiol 2009; 106: 1079–1085.CrossRefPubMedGoogle Scholar
  38. 38.
    Kirk A, De Feo P. Strategies to enhance compliance to physical activity for patients with insulin resistance. Appl Physiol Nutr Metab 2007; 32: 549–556.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Internal Medicine, C.U.R.I.A.MO (Centro Universitario Ricerca Interdipartimentale Attività Motoria)University of PerugiaPerugiaItaly

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