Exercise and Diabetes - Sheri R. Colberg

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of being sedentary by taking frequent breaks.

      • Pedometers are step counters that can be used to track unstructured physical movement throughout the day; go for simplicity, but accuracy, in a pedometer.

      • Walking-based activities are the best use for pedometers as they cannot detect changes in type, intensity, or pattern of activity; however, accelerometers and GPS devices can.

      • For most adults, 2,000 steps is the equivalent of ~1 mile of walking, but step equivalents of other activities (like swimming) can be estimated based on MET levels.

      REFERENCES

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      Bankoski A, Harris TB, McClain JJ, Brychta RJ, Caserotti P, Chen KY, Berrigan D, Troiano RP, Koster A: Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes Care 34:497–503, 2011

      Bell GJ, Harber V, Murray T, Courneya KS, Rodgers W: A comparison of fitness training to a pedometer-based walking program matched for total energy cost. J Phys Act Health 7:203–213, 2010

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      Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR: Using pedometers to increase physical activity and improve health: a systematic review. JAMA 298:2296–2304, 2007

      Cooper AR, Sebire S, Montgomery AA, Peters TJ, Sharp DJ, Jackson N, Fitzsimons K, Dayan CM, Andrews RC: Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia 55:589–599, 2012

      Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, Shaw JE, Bertovic DA, Zimmet PZ, Salmon J, Owen N: Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care 35:976–983, 2012

      Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of Sports Medicine: American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359, 2011

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      Levine JA, McCrady SK, Lanningham-Foster LM, Kane PH, Foster RC, Manohar CU: The role of free-living daily walking in human weight gain and obesity. Diabetes 57:548–554, 2008

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      Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, Vuori I: Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol 103:972–977, 2009

      Manders RJ, Van Dijk JW, van Loon LJ: Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc 42:219–225, 2010

      McBride PE, Einerson JA, Grant H, Sargent C, Underbakke G, Vitcenda M, Zeller L, Stein JH: Putting the Diabetes Prevention Program into practice: a program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus. J Nutr Health Aging 12:745s–749s, 2008

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      Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC, U.S. Department of Health and Human Services, p. 1–683, 2008

      Swartz AM, Squires L, Strath SJ: Energy expenditure of interruptions to sedentary behavior. Int J Behav Nutr Phys Act 8:69, 2011

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      Chapter 4 General Principles of Aerobic Exercise Prescription

      Aerobic activities involve rhythmic, repeated, and continuous movements of the same large muscle groups for at least 5 min. Anaerobic or resistance activities use muscular strength to move a weight or work against a resistant load and are fully discussed in chapter 8. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults (Physical Activity Guidelines Advisory Committee 2008, Garber 2011)

      All exercise programs need to be designed to address mode (type of activity), intensity (how difficult), frequency (how often), duration (how long), and appropriate progression. Rates of progression depend on an individual’s functional capacity, medical and health status, age, individual activity preferences and goals, and tolerance to the current level of activity (Colberg 2011). Empowering individuals to set their own specific goals is the ultimate aim of such programming.

      Case in Point: Aerobic Exercise Rx for Uncomplicated T2D

      KK is a 50-year-old woman who was recently diagnosed with type 2 diabetes (T2D) during a routine annual checkup with her primary care physician. She has already met with a dietitian to improve her dietary plan, but she wants to get started doing more exercise to manage her blood glucose levels without the need for medications. In the past decade or two, she has gone through phases of being more active—walking daily—and periods of more inactivity, and she was in one of the latter when diagnosed; she does do a lot of standing and walking, though, in her full-time job. Since being diagnosed a month ago, she has lost ~10 lb thanks to dietary improvements, but she has another ~40 lb that she still desires to lose. Her goal with her physical activity is to lose more weight, get more fit, and keep her diabetes in check (without medications).

      Resting Measurements

      Height: 64 inches

      Weight: 170 lb (180 lb at diagnosis)

      BMI: 29.2 (high end of “overweight” category)

      Heart rate: 80 beats per minute (bpm)

      Blood pressure: 135/75 mmHg

      Fasting Labs (1 Month after Diagnosis)

      Plasma glucose: 105 mg/dl (controlled with lifestyle intervention only)

      A1C: 6.2%

      Total cholesterol: 180 mg/dl

      Triglycerides: 125 mg/dl

      High-density lipoprotein cholesterol: 50 mg/dl

      Low-density lipoprotein cholesterol: 105 mg/dl

      Questions to Consider

      1. What type of aerobic exercise should KK start doing?

      2. What would be the best exercise Rx for her in terms of exercise frequency, intensity, and duration?

      3. How should her exercise training progress over time?

      4. Are any precautions needed for KK when she exercises?

      (Continued)

      GENERAL AEROBIC EXERCISE RECOMMENDATIONS

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