Zusammenfassung
Hintergrund
Körperliches Training ist eine zentrale Interventionsstrategie bei metabolischem Syndrom, eingeschränkter Glukosetoleranz und manifestem Diabetes mellitus Typ 2. Ursache dieser Erkrankungen ist eine vermehrte Insulinresistenz, die durch repetitive Belastung der Muskulatur und Verbesserung des transmembranösen Glukosetransports über eine gesteigerte Anzahl von GLUT4-Molukülen (GLUT4: Glukosetransporter 4) an der Muskelmembran verbessert werden kann.
Ergebnisse
Große randomisierte Studien zur Primär- und Sekundärprävention des Typ-2-Diabetes ergaben, dass die Inzidenz in der Prävention um 60 % reduziert werden kann. Bei der Manifestation des Typ-2-Diabetes hat körperliches Training keinen Einfluss auf makrovaskuläre Ereignisse, allerdings nachweislich auf mikrovaskuläre Komplikationen. Dies beinhaltet neben der Verbesserung der Progression der Nephropathie auch eine Besserung der diastolischen Funktion des Myokards, eine Entität, die häufig bei diesen Patienten zu beobachten ist und die körperliche Belastbarkeit einschränkt.
Schlussfolgerung
Trainingsprinzipien für Patienten sind 1. Regelmäßigkeit, 2. „start low, go slow“, 3. Integration von Intervalleinheiten und 4. regelmäßige Kontrollen eines individuellen Trainingsprogramms und Motivation durch den behandelnden Arzt. Wenn diese Maßnahmen berücksichtigt werden, ist die Aussicht auf eine erfolgreiche Therapie nachweislich gegeben. Dies führte dazu, dass Krankenkassen entsprechende Programme wie „Sport als Therapie“ gerade auch in der Prävention und Therapie des Diabetes mellitus Typ 2 fördern.
Abstract
Background
Physical activity and exercise training is a core interventional strategy for metabolic syndrome, impaired glucose tolerance and type 2 diabetes mellitus. Pathophysiologically, this is due to increased insulin resistance which can be improved by repetitive physical strain on muscle fibers and improved transmembranous glucose transport by which glucose transporter 4 (GLUT4) is translocated from the endoplasmic reticulum to the membrane and facilitates glucose transport into the cells.
Results
Large randomized trials for primary and secondary prevention of type 2 diabetes mellitus have shown a 60 % reduction of the conversion of prediabetes into clinical diabetes. Recent trials have revealed that macrovascular complications cannot be influenced by life-style interventions but that microvascular complications can be influenced. This includes an improvement in the progression of nephropathy and also improvement in the diastolic function of the myocardium, an entity that is often observed in these patients and limits the physical capacity.
Conclusion
In order to achieve sufficient results the following training principles have to be followed: 1) regular and daily exercise, 2) start low go slow, 3) integration of training intervals and 4) regular control of the individualized training program and motivation by the treating physician. When these measures are taken into consideration, the prospect of successful therapy has been proven. This results in healthcare insurance companies including appropriate programs, such as “sport as therapy” even for the prevention and therapy of type 2 diabetes mellitus.
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K. Esefeld und M. Halle geben an, dass kein Interessenkonflikt besteht.
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Esefeld, K., Halle, M. Körperliche Aktivität und Sport bei Typ-2-Diabetes. Diabetologe 11, 618–628 (2015). https://doi.org/10.1007/s11428-015-0040-y
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DOI: https://doi.org/10.1007/s11428-015-0040-y