Rehabilitation

Type 2 Diabetes & Rehab Explained

mountain climber exercise for aerobic and weight training against type 2 diabtes

Diabetes mellitus (DM), simply put, is a group of metabolic diseases associated with hyperglycaemia – high blood sugar, as a result of either insufficient secretion or inefficient processing of insulin (Kokil, Veedu, Ramm, Prins & Parekh, 2015). In this article we will focus on Type 2 Diabetes, signs and symptoms of the disease, and how to manage this chronic condition.

Introduction to Type 2 Diabetes

“Insulin is a regulating hormone produced by the pancreas and is responsible for transporting glucose from the blood to the cells where it is used an energy source or stored as glycogen in the liver for later use.  DM can be classified according to the degrees of deficiency of insulin action, the most well-known being Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM)” (Seino et al., 2010). Type 1 diabetes, formally knowns as ‘insulin-dependent diabetes’ is characterized by hyperglycaemia as a result of inadequate insulin production by the pancreas. People with this type of diabetes are dependent on exogenous insulin to maintain healthy blood glucose levels. Type 2 diabetes however is known as ‘non-insulin dependent diabetes’ and refers to the reduced ability of insulin to stimulate glucose uptake by the cells, i.e. insulin resistance.

In other words, if there is too little insulin or resistance to insulin, blood glucose levels will continue to rise, as glucose is unable to be removed from the blood stream into the cells (Steenkamp, 2015). Individuals struggling with Type 2 Diabetes can improve and regulated their condition through special attention to diet and lifestyle changes as well as regular monitoring of blood glucose levels.

You can read more about the types of DM in our in-depth article Diabetes | Types & Risk Factors.

Lifestyle Changes

While genetic factors may influence ones susceptibility to developing Type 2 diabetes, the main risk factors include obesity and physical inactivity.  The most effective means to managing DM is through glycaemic control using diet in combination with exercise, as well as the use of medication such as insulin or oral hypoglycaemic agents.  Exercise not only improves glycaemic control but also has positive effects on cardiorespiratory fitness, physical functioning, and wellbeing. But which exercises and how often?

Managing Diabetes through exercise

Exercise guidelines suggest that 150 minutes of moderate to vigorous intensity exercise, 3 days a week, consisting of a combination of both aerobic and resistance training is the gold standard for treating type 2 diabetes. Sound confusing? That’s where we come in. Biokineticists are primarily concerned with health promotion and the maintenance of physical abilities by means of individualised, scientifically based physical activity programme prescription. Our goal is to improve physical functioning and health care through exercise.

Mountain Climber Exercise
Example of “aerobic and resistance training”

Exercise Recommendations and Prescriptions

We know that finding the motivation to exercise on your own is a challenge, especially when you don’t have a plan to follow. We pride ourselves in caring for each patient as an individual, creating an exercise program that is suitable to your strengths and capabilities. Not everyone has the stamina of an elite athlete, in fact very few of us do. An initial consultation allows us to facilitate a series of tests to gather information about your current levels of fitness and functional abilities, following which, we take the time to create an exercise program exclusively designed for you to achieve your goals.

The exercises prescribed may sound simple at first, but upon trying them, you may not feel the desired effect. Something as simple as a weight shift or posture change may result in a completely different outcome. This is why, we as Biokineticists, encourage our patients to attend one-on-one sessions to begin, allowing us the opportunity to ensure you understand and can perform the exercises correctly without any pain, discomfort or adverse effects. It also gives you, the patient, the opportunity to ask any questions you might have regarding your programme prescription and understand the benefit these exercises will provide.

A study conducted by Delevatti et al. (2016) included an alternative exercise modality involving aquatic exercises which provides lower impact on the joints, favouring physical activity with less risk of injury. While this study compared the effectiveness of aquatic training to dry-land training, the results showed that both methods were equally as effective in lowering glycated haemoglobin levels and demonstrated that the effeteness of aerobic training on glucose control in patients with T2DM was similar whether done on land or in water.

How long should you continue with a biokinetic programme?

The answer differs from person to person. Type 2 Diabetes is a lifelong condition which requires continuous monitoring and intervention to keep under control. Many individuals struggle to adhere to an exercise program when they are responsible for making the time to do it on their own. One-on-one or group class sessions are therefore the preferred option, allowing accountability to act as your motivation and encouragement.  However, some people do prefer to exercise alone. We then offer our patients a home exercise programme as a guide, which can be performed at home or in the gym. A home program option should only be considered once the Biokineticist and patient are equally comfortable that exercises can be executed correctly, and that the patient has the discipline to adhere to their home program as often as is recommended.

For Type 2 diabetes specifically, it is recommended, that there should be no more than two consecutive days between bouts of exercise. The reason for this is that increased insulin sensitivity decreases substantially after 48hours post-exercise. Planning training sessions within this time interval is therefore important and will promote increased insulin sensitivity over time.

While Diabetes is a chronic disease with many adverse side effects and possible comorbidities, exercise should be an essential part of any treatment plan for all individuals at risk. Exercise has proven effective in minimizing the effects of hyperglycaemia and possibly even preventing the onset of Diabetes altogether.

If you are struggling to control your diabetes, why not talk to us for an evaluation and find out how we as Biokineticists can help you?

References

Delevatti, R., Kanitz, A., Alberton, C., Marson, E., Lisboa, S., & Pinho, C. et al. (2016). Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial. Journal Of Science And Medicine In Sport, 19(8), 688-693. http://dx.doi.org/10.1016/j.jsams.2015.10.008

Forouhi, N., & Wareham, N. (2014). Epidemiology of diabetes. Medicine, 42(12), 698-702.

Hordern, M., Dunstan, D., Prins, J., Baker, M., Singh, M., & Coombes, J. (2012). Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia. Journal Of Science And Medicine In Sport, 15(1), 25-31. http://dx.doi.org/10.1016/j.jsams.2011.04.005

Kokil, G., Veedu, R., Ramm, G., Prins, J., & Parekh, H. (2015). Type 2 Diabetes Mellitus: Limitations of Conventional Therapies and Intervention with Nucleic Acid-Based Therapeutics. Chemical Reviews, 115(11), 4719-4743. http://dx.doi.org/10.1021/cr5002832

O’Hagan, C., De Vito, G., & Boreham, C. (2012). Exercise Prescription in the Treatment of Type 2 Diabetes Mellitus. Sports Medicine, 43(1), 39-49. http://dx.doi.org/10.1007/s40279-012-0004-y

Pescatello, L. (2014). ACSM’s guidelines for exercise testing and prescription (9th ed., pp. 278-284). ‎Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Ramachandran, A. (2014). Know the signs and symptoms of diabetes. Indian Journal Of Medical Research, 140, 579-581.

Seino, Y., Nanjo, K., Tajima, N., Kadowaki, T., Kashiwagi, A., & Araki, E. et al. (2010). Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. Diabetology International, 1(1), 2-20. http://dx.doi.org/10.1007/s13340-010-0006-7

Shah, M., & Vella, A. (2014). What is type 2 diabetes?. Medicine, 42(12), 687-691. http://dx.doi.org/10.1016/j.mpmed.2014.09.013

Steenkamp, T. (2015). Diabetes Mellitus | Biokinetics Association. Biokinetics.org.za. Retrieved 26 July 2017, from http://www.biokinetics.org.za/blog/2015/06/diabetes-mellitus/

Thrower, S., & Bingley, P. (2014). What is type 1 diabetes?. Medicine, 42(12), 682-686. http://dx.doi.org/10.1016/j.mpmed.2014.09.003

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