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The definition of diabetes health and social care essay

Transient hyperglycemia can follow intense PA. Combined weight loss and PA may be more effective than aerobic exercise training alone on lipids. ECG exercise stress testing for asymptomatic individuals at low risk of CAD is not recommended but may be indicated for higher risk.

Persons with type 2 diabetes are encouraged to increase their total daily unstructured PA. Flexibility training may be included but should not be undertaken in place of other recommended types of PA. Users of insulin and insulin secretagogues are advised to supplement with carbohydrate as needed to prevent hypoglycemia during and after exercise.

Individuals with angina classified as moderate or high risk should likely begin exercise in a supervised cardiac rehabilitation program. PA is advised for anyone with PAD.

Exercise and Type 2 Diabetes

Comprehensive foot care including daily inspection of feet and use of proper footwear is recommended for prevention and early detection of sores or ulcers. Moderate walking likely does not increase risk of foot ulcers or reulceration with peripheral neuropathy.

Exercise intensity is best prescribed using the HR reserve method with direct measurement of maximal HR. The presence of microalbuminuria per se does not necessitate exercise restrictions.

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Encouraging mild or moderate PA may be most beneficial to adoption and maintenance of regular PA participation. Lifestyle interventions may have some efficacy in promoting PA behavior. Insulin-independent and insulin-dependent muscle glucose uptake during exercise.

There are two well-defined pathways that stimulate glucose uptake by muscle 96.

  1. PA seems to play a role in preventing type 2 diabetes across ethnic groups and in both sexes 154 , 224. Individuals with angina classified as moderate or high risk should likely begin exercise in a supervised cardiac rehabilitation program.
  2. In individuals with type 2 diabetes performing moderate exercise, BG utilization by muscles usually rises more than hepatic glucose production, and BG levels tend to decline 191. Acute changes in liver's ability to process glucose.
  3. In 2006, a meta-analysis reviewed four RCTs on GDM in which pregnant women in their third trimester exercised on a cycle or arm ergometer or performed resistance training three times a week for 20—45 min compared with doing no specific program 36. A meta-analysis of 10 cohort studies 125 that assessed the preventive effects of moderate-intensity PA found that risk reduction for type 2 diabetes was 0.
  4. As the two pathways are distinct, BG uptake into working muscle is normal even when insulin-mediated uptake is impaired in type 2 diabetes 28 , 47 , 293. ECG exercise stress testing for asymptomatic individuals at low risk of CAD is not recommended but may be indicated for higher risk.

At rest and postprandially, its uptake by muscle is insulin dependent and serves primarily to replenish muscle glycogen stores.

During exercise, contractions increase BG uptake to supplement intramuscular glycogenolysis 220227. As the two pathways are distinct, BG uptake into working muscle is normal even when insulin-mediated uptake is impaired in type 2 diabetes 2847293. Muscular BG uptake remains elevated postexercise, with the contraction-mediated pathway persisting for several hours 86119 and insulin-mediated uptake for longer 933141226. Glucose transport into skeletal muscle is accomplished via GLUT proteins, with GLUT4 being the main isoform in muscle modulated by both insulin and contractions 110138.

Insulin activates GLUT4 translocation through a complex signaling cascade 256293. Insulin-stimulated GLUT4 translocation is generally impaired in type 2 diabetes 96. Both aerobic and resistance exercises increase GLUT4 abundance and BG uptake, even in the presence of type 2 diabetes 3951204270. Insulin-stimulated BG uptake into skeletal muscle predominates at rest and is impaired in type 2 diabetes, while muscular contractions stimulate BG transport via a separate additive mechanism not impaired by insulin resistance or type 2 diabetes.

ACSM evidence category A. During moderate-intensity exercise in nondiabetic persons, the rise in peripheral glucose uptake is matched by an equal rise in hepatic glucose production, the result being that BG does not change except during prolonged, glycogen-depleting exercise. In individuals with type 2 diabetes performing moderate exercise, BG utilization by muscles usually rises more than hepatic glucose production, and BG levels tend to decline 191.

Plasma insulin levels normally fall, however, making the risk of exercise-induced hypoglycemia in anyone not taking insulin or insulin secretagogues very minimal, even with prolonged PA 152. The effects of a single bout of aerobic exercise on insulin action vary with duration, intensity, and subsequent diet; a single session increases insulin action and glucose tolerance for more than 24 h but less than 72 h 263385141. The effects of moderate aerobic exercise are similar whether the PA is performed in a single session or multiple bouts with the same total duration 14.

During brief, intense aerobic exercise, plasma catecholamine levels rise markedly, driving a major increase in glucose production 184. Hyperglycemia can result from such activity and persist for up to 1—2 h, likely because plasma catecholamine levels and glucose production do not return to normal immediately with cessation of the activity 184.

Although moderate aerobic exercise improves BG and insulin action acutely, the risk of exercise-induced hypoglycemia is minimal without use of exogenous insulin or insulin secretagogues. ACSM evidence category C. The acute effects of resistance exercise in type 2 diabetes have not been reported, but result in lower fasting BG levels for at least 24 h after exercise in individuals with IFG. Combined aerobic and resistance and other types of training.

A combination of aerobic and resistance training may be more effective for BG management than either type of exercise alone 51238. Any increase in muscle mass that may result from resistance training the definition of diabetes health and social care essay contribute to BG uptake without altering the muscle's intrinsic capacity to respond to insulin, whereas aerobic exercise enhances its uptake via a greater insulin action, independent of changes in muscle mass or aerobic capacity 51.

However, all reported combination training had a greater total duration of exercise and caloric use than when each type of training was undertaken alone 51183238. Mild-intensity exercises such as tai chi and yoga have also been investigated for their potential to improve BG management, with mixed results 98117159257 the definition of diabetes health and social care essay, 269286291. Although tai chi may lead to short-term improvements in BG levels, effects from long-term training i.

Some studies have shown lower overall BG levels with extended participation in such activities 286291although others have not 159257. One study suggested that yoga's benefits on fasting BG, lipids, oxidative stress markers, and antioxidant status are at least equivalent to more conventional forms of PA 98. However, a meta-analysis of yoga studies stated that the limitations characterizing most studies, such as small sample size and varying forms of yoga, preclude drawing firm conclusions about benefits to diabetes management 117.

A combination of aerobic and resistance exercise training may be more effective in improving BG control than either alone; however, more studies are needed to determine if total caloric expenditure, exercise duration, or exercise mode is responsible. ACSM evidence category B. Milder forms of exercise e. Insulin resistance Acute changes in muscular insulin resistance. Most benefits of PA on type 2 diabetes management and prevention are realized through acute and chronic improvements in insulin action 2946116118282.

The acute effects of a recent bout of exercise account for most of the improvements in insulin action, with most individuals experiencing a decrease in their BG levels during mild- and moderate-intensity exercise and for 2—72 h afterward 2483204.

BG reductions are related to the duration and intensity of the exercise, preexercise control, and state of physical training 242647238. Although previous PA of any intensity generally exerts its effects by enhancing uptake of BG for glycogen synthesis 4083 and by stimulating fat oxidation and storage in muscle 216495more prolonged or intense PA acutely enhances insulin action for longer periods 92975111160238.

Acute improvements in insulin sensitivity in women with type 2 diabetes have been found for equivalent energy expenditures whether engaging in low-intensity or high-intensity walking 29 but may be affected by age and training status 2475100101228. For example, moderate- to heavy-intensity aerobic training undertaken three times a week for 6 months improved insulin action in both younger and older women but persisted only in the younger group for 72—120 h.

Acute changes in liver's ability to process glucose. Increases in liver fat content common in obesity and type 2 diabetes are strongly associated with reduced hepatic and peripheral insulin action.

Enhanced whole-body insulin action after aerobic training seems to be related to gains in peripheral, not hepatic, insulin action 146282. Such training not resulting in overall weight loss may still reduce hepatic lipid content and alter fat partitioning and use in the liver 128.

PA can result in acute improvements in systemic insulin action lasting from 2 to 72 h. BG levels and insulin resistance.

Aerobic exercise has been the mode traditionally prescribed for diabetes prevention and management. Even 1 week of aerobic training can improve whole-body insulin sensitivity in individuals with type 2 diabetes 282. Moderate and vigorous aerobic training improve insulin sensitivity 97583111albeit for only a period of hours to days 141but a lesser intensity may also improve insulin action to some degree 111. Moderate training may increase glycogen synthase activity and GLUT4 protein expression but not insulin signaling 39.

Fat oxidation is also a key aspect of improved insulin action, and training increases lipid storage in muscle and fat oxidation capacity 6495136223. An individual's training status will affect the use of carbohydrate during an aerobic activity.

  1. PA is advised for anyone with PAD.
  2. Data show that moderate exercise such as brisk walking reduces risk of type 2 diabetes 108 , 113 , 114 , 154 , 224 , and all studies support the current recommendation of 2. ACSM evidence category C.
  3. Exercise likely has psychological benefits for persons with type 2 diabetes, although evidence for acute and chronic psychological benefits is limited. PA can result in acute improvements in systemic insulin action lasting from 2 to 72 h.
  4. Individuals with type 2 diabetes engaged in supervised training exhibit greater compliance and BG control than those undertaking exercise training without supervision. Both moderate walking and vigorous activity have been associated with a decreased risk, and greater volumes of PA may provide the most prevention 113.

Aerobic training increases fat utilization during a similar duration bout of low- or moderate-intensity activity done after training, which spares muscle glycogen and BG and results in a lesser acute decrease in BG 2883223. Type 2 diabetes may be associated with a decrease in lipid oxidation and shift toward greater carbohydrate oxidation at all exercise intensities 87.

Resistance exercise training also benefits BG control and insulin action in type 2 diabetes 4665115116118246. In a randomized controlled trial RCTtwice-weekly progressive resistance training for 16 weeks by older men with newly diagnosed type 2 diabetes resulted in a 46.

An increase in muscle mass from resistance training may contribute to BG uptake from a the definition of diabetes health and social care essay effect, and heavy weight training in particular may reverse or prevent further loss of skeletal muscle due to disuse and aging 34276. In another RCT, all 20 men with type 2 diabetes who participated in either resistance or aerobic exercise thrice weekly for 10 weeks improved their overall BG control, but those doing resistance training had significantly lower A1C values 32.

Diabetic women undergoing 12 weeks of low-intensity training with resistance bands had gains in strength and muscle mass and loss of fat mass but had no change in insulin sensitivity 157. Both aerobic and resistance training improve insulin action, BG control, and fat oxidation and storage in muscle.

Resistance exercise enhances skeletal muscle mass. One larger RCT found decreases in total cholesterol with both aerobic and yoga training but no changes in HDL cholesterol or LDL cholesterol 98although most have found no effect of any form of exercise training on lipids 6175178238258267.

RCTs designed to increase PA also had no effect on the cholesterol profile in type 2 diabetes, with most also finding no change in triglycerides 6175238258267. Lipid profiles may benefit more from concomitant exercise training and weight reduction. Some studies using intensive diet and aerobic exercise interventions reported large reductions in total cholesterol and triglycerides but failed to include controls 1213. In the Look AHEAD Action for Health in Diabetes study, intensive lifestyle participants exhibited greater decreases in triglycerides and increases in HDL cholesterol than the control group, while both the intensive lifestyle and usual care groups decreased LDL cholesterol 218.

Most lifestyle interventions have been accompanied by an approximate 5-kg weight loss. Blood lipid responses to training are mixed but may result in a small reduction in LDL cholesterol with no change in HDL cholesterol or triglycerides.

Both aerobic and resistance training can lower BP in nondiabetic individuals, with slightly greater effects observed with the former 49134135137. Most observational studies show that both exercises lower BP in diabetic individuals 354678208267.

The Look AHEAD trial found reductions in both systolic and diastolic BP with exercise and weight loss 218but several studies have reported no changes in BP with training in type 2 diabetes 175238283. Aerobic training may slightly reduce systolic BP, but reductions in diastolic BP are less common, in individuals with type 2 diabetes.

Mortality and CV risk. Higher levels of physical fitness and PA are associated with lower CV risk and mortality in both healthy and clinical populations 19153164207. Increases in PA and physical fitness are also associated with reduced early mortality in both populations as well 1942153163164186272. All-cause and CV mortality risk was 1. No RCT data on the effects of changes in physical fitness on mortality in diabetes exist.

Observational studies suggest that greater PA and fitness are associated with a lower risk of all-cause and CV mortality. The most successful programs for long-term weight control have involved combinations of diet, exercise, and behavior modification 281.

Exercise interventions undertaken with volumes typically recommended to improve BG control and reduce CVD risk e. However, in RCTs, about 1 h of daily moderate aerobic exercise produces at least as much fat loss as equivalent caloric restriction, with resultant greater insulin action 231232. The optimal volume of exercise to achieve sustained major weight loss is probably much larger than the amount required to achieve improved BG control and CV health 24217.

Recommended levels of PA may help produce weight loss. Exercise intervention studies showing the greatest effect on BG control have all involved supervision of exercise sessions by qualified exercise trainers 3465196238.