TYPE II DIABETES AND EXERCISE
how do i incorporate exercise?
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how do i incorporate exercise? 〰️
What exercise is best for diabetes management and how long should we exercise for?
These are frequently asked questions I get from my patients. My answer is always the same; The best exercise for your health is the one that you will do consistently. For example, people may think running is better than walking because it is objectively a more intense exercise, but what good is it if you can only keep it up for a month? The length of exercise bouts follows a similar train: If you enjoy exercising for 20 minutes, but 40 minutes feels insurmountable at the moment, then stick with 20 minutes.
Now let’s go through how and why exercise is so valuable for our health, and the specific recommendations in the scientific literature.
Exercise goes hand in hand with positive health outcomes, especially when we increase our activity levels from minimal levels to a more substantial amount. I have always found that how physically active I am greatly impacts my glucose regulation/insulin sensitivity in a positive manner, which is also a common finding among my patients.
Exercise can be a contentious issue when it comes to dosage, duration, and form. However, my argument is that any form of physical activity can be beneficial for our health, no matter how easy or short-acting it is. The purpose of this blog is to reinforce the idea that physical activity is incredibly valuable to manage diabetes, but also that even non-strenuous and short-duration physical activity can have impressive effects on glucose management, HbA1C levels, and overall health.
A meta-analysis study from 2019 showed that there were significant improvements in fasting insulin and insulin resistance when a structured exercise approach was applied to people living with type II diabetes. Some of the studies within this meta-analysis also confirmed that structured physical activity can improve body composition by decreasing body mass index score, which subsequently can improve insulin sensitivity. Importantly, you may notice the use of the term “structured physical activity” which appears to be greater than 150 minutes of exercise weekly in duration and includes mainly aerobic exercise such as walking, running, and cycling; when looking at the studies.
I however would suggest that my clinical findings support the idea that even lesser amounts of exercise will have a relevant impact on glucose management in both the short and long term. This is because, from a physiological level, we see that physical activity can give glucose an alternative avenue of transport out of the bloodstream and into cells. This is done by a glucose transporter protein called GLUT-4; which you can read more about here. Even low levels of physical activity will cause the GLUT-4 protein to become activated to some capacity, but as the intensity of exercise increases, so will the GLUT-4 activity, as was demonstrated in this study.
Incorporating any physical activity can also improve type II diabetes-associated comorbidities such as cardiovascular disease risk, hyperlipidemia, hypertension, obesity, mental health conditions, and even sleep disorders. Something interesting to consider is that diabetes and its comorbidities affect each other in a bidirectional fashion. For example: Diabetes can cause somebody to gain weight because increasing insulin resistance leads to greater blood insulin levels, which has been correlated to an increased risk of weight gain, as was seen in this study. On the flip side, weight gain, specifically adiposity (the state of being obese) increases insulin resistance, which leads to a worsened state of diabetes.
Typically when it comes to diabetes management exercise is near the top of the list, along with nutritional habits and medication, as is suggested by reputable sources such as Diabetes Canada and The MAYO Clinic. Unfortunately, the guidelines are non-specific and can leave people without a real plan on what to do and how to get started with exercise. Bridging this gap is part of my mission, as I can see there is a missing link in the healthcare system when it comes to lifestyle medicine.
If you or someone you know would benefit from talking to a healthcare practitioner about their current lifestyle and what changes can be implemented to obtain an improved understanding and practice of managing their diabetes, then please follow the link below to book an initial assessment or a free 15-minute consult to see if I am the right naturopathic doctor for you.
In health,
Dr. Matas Nakrosius, ND
References:
Kumar AS, Maiya AG, Shastry BA, Vaishali K, Ravishankar N, Hazari A, Gundmi S, Jadhav R. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of physical and rehabilitation medicine. 2019 Mar 1;62(2):98-103.
Vargas E, Podder V, Sepulveda C. Physiology, glucose transporter type 4.
Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiological reviews. 2013 Jul 1.
Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC medicine. 2019 Dec;17(1):1-0.
Pennings N, Jaber J, Ahiawodzi P. Ten-year weight gain is associated with elevated fasting insulin levels and precedes glucose elevation. Diabetes/metabolism research and reviews. 2018 May;34(4):e2986.
https://www.diabetes.ca/en-CA/about-diabetes/type-2/treatment
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199