Learning to exercise can effectively lower blood sugar, and diabetes no longer only depends on taking medicine and injections
Are you saying you need more exercise for diabetes? How should it be moved?
Diabetes is one of the most common metabolic diseases, and its occurrence and development are inseparable from genetic factors, environmental factors and behavioral factors.
We often say that diabetes care consists of five carriages—diabetes education, diet therapy, exercise therapy, medication, and blood sugar monitoring. But in fact, most diabetic patients put more hope in drug and diet therapy in disease management, and often overlook an important link-exercise therapy.
Compared with people who have been exercising for a long time, people who lack exercise are more likely to develop type 2 diabetes (T2DM). According to relevant studies, if people do not exercise for 6 months, a series of factors such as body weight, waist circumference, waist-to-hip ratio, and body fat distribution are related to metabolism. Relevant health indexes will increase to varying degrees, and insulin sensitivity will gradually weaken at this time [1].
What improvements can exercise bring?
How can patients benefit from exercise therapy?
Table 1 Multidimensional improvements in patients with exercise therapy
exercise improvement
1
Increase insulin sensitivity, improve insulin resistance, lower blood sugar and reduce the incidence of T2DM. 2
Improve depression and anxiety in T2DM patients and relieve mental stress. 3
Improve the metabolism of T2DM patients: improve blood glucose metabolism, reduce glycosylated hemoglobin, reduce the level of inflammatory mediators; improve lipid metabolism, etc. 4
Prevent the occurrence of complications in T2DM patients and delay the progress of complications. 5
Improve cardiopulmonary function and increase muscle strength in patients with T2DM, thereby improving the quality of life of patients. 6
Reduce the medical burden of T2DM patients and bring overall medical and economic benefits to the society
Exercise therapy stabilizes the glycemic control of T2DM patients by effectively improving insulin sensitivity, skeletal muscle function, fat and protein metabolism in T2DM patients. Related studies have found that regular exercise for more than 8 weeks can reduce the glycated hemoglobin (HbA1c) of type 2 diabetic patients by 0.66%; adherence to regular exercise for 12 to 14 years can significantly reduce the mortality rate of diabetic patients. At the same time, exercise therapy also has significant benefits in terms of T2DM complications: studies have shown that walking for 2 hours per week reduces all-cause mortality by 39% in diabetic patients [2].
Which patients are suitable for exercise therapy?
The vast majority of patients with impaired glucose tolerance and T2DM patients without significant hyperglycemia and complications are suitable for exercise therapy; however, some T2DM patients with complications such as microalbuminuria, simple retinopathy without fundus hemorrhage, etc. It is recommended to carry out exercise therapy under the guidance of a doctor after diet and drug control of blood sugar.
How does exercise therapy work?
How do T2DM patients benefit from exercise therapy? Next, we will introduce you from the aspects of exercise mode, exercise intensity, exercise time and exercise frequency!
● Movement mode:
For patients with T2DM, especially those with poor blood sugar control [4], it is recommended to choose aerobic exercise combined with resistance training [3] for exercise therapy.
Patients can perform light-to-moderate resistance training twice a week. In terms of aerobic exercise, they can choose moderate-to-low-intensity and rhythmic rhythmic exercise, including walking, cycling, jogging, swimming, and moderate-intensity exercise. Aerobic gymnastics (such as medical gymnastics, Mulan boxing, aerobics, Tai Chi), etc. Of course, recreational ball activities such as table tennis, bowling, badminton, etc. are also good choices [5].
Tips：
Aerobic exercise: Aerobic exercise refers to the form of physical exercise performed by the human body under the condition of sufficient oxygen supply. That is, in the process of exercise, the oxygen inhaled by the human body is equal to the oxygen consumed by the exercise, and a physiological equilibrium state is achieved. In simple terms, aerobic exercise refers to any rhythmic exercise with a longer duration (≥15 minutes) of moderate or above-moderate intensity.
Resistance exercise: The active movement of human skeletal muscles under the condition of overcoming external resistance. The size of the resistance is determined according to the individual muscle strength, to the extent that the resistance can be overcome to complete the movement. Resistance can be generated by others, one's own limbs, or equipment (such as dumbbells, sandbags, springs, rubber bands, elastic bands, etc.). This form of exercise can achieve the effect of restoring and developing muscle strength.
Table 2 Choice of exercise modes
● Exercise intensity:
In the process of exercise therapy, exercise intensity is very important. In order to exercise safely and effectively, the patient's exercise intensity needs to be controlled within a certain range. Excessive exercise or strenuous exercise in a short period of time can easily stimulate the body to produce a stress response, which leads to an increase in the secretion of catecholamines and other hormones that counteract insulin, resulting in increased blood sugar and even diabetic ketoacidosis [8] ], so it is not recommended for patients to choose high-intensity exercise.
Table 3 Recommended exercise methods
The patient's exercise intensity should be tailored to the individual patient's specific goals. In general, a reasonable aerobic exercise intensity should be 40% to 70% of its maximum oxygen uptake (VO2 max), and exercise exceeding 80% VO2 max is dangerous for patients.
Table 4 The relationship between exercise and VO2 max and heart rate
Physiological indicators reflecting exercise intensity include: heart rate during exercise, percentage of oxygen uptake during exercise to maximal oxygen uptake, and metabolic rate during exercise as a multiple of metabolic rate at rest (Metre, MET).
Exercise intensity less than 50% VO2 max is an appropriate intensity acceptable to the elderly and heart disease patients. Considering that most middle-aged and elderly diabetic patients have more complications at the same time, the intensity is between 50% and 60% VO2 max. Exercise is relatively suitable [5]. For patients with poor physical condition, the exercise should start from 40% to 50% VO2 max [7].
In addition, in order to ensure the safety of exercise, in principle, the target heart rate (THR) should be determined before exercise for diabetic patients over 40 years old, with a disease course of more than 10 years, and with symptoms and signs of cardiovascular disease [6]. If patients experience large fluctuations in blood sugar during exercise, obvious fatigue and difficulty in recovery, etc., they should immediately reduce the intensity of exercise or suspend exercise.
The specific calculation method of target heart rate is:
(Maximum Heart Rate: MHR, Resting Heart Rate: RHR, Reserve Heart Rate: HRR)
MHR=220-age
HRR=MHR-RHR
THR=（MHR-RHR）*60%~80%+RHR
● Exercise time:
5-10 minutes of preparatory activities should be performed before each exercise, and at least 5 minutes of relaxation and stretching should be ensured after exercise to ensure that the exercise time to reach an effective heart rate lasts 10-30 minutes. In addition, the exercise time should be matched with the exercise intensity to achieve the expected amount of exercise. Therefore, when the exercise intensity is high, the exercise duration can be shortened accordingly; and when the exercise intensity is small, the exercise duration should be appropriately extended.
For patients with younger age, mild illness and better physical strength, short-term high-intensity exercise should be selected, while for older and obese patients, long-term exercise with low intensity should be selected.
● Exercise frequency:
Exercise goals for patients with T2DM include: reducing energy intake (reduced by 300 to 500 kcal/day), regular daily exercise (30 minutes of aerobic exercise), and weight loss greater than 7% [7]. Therefore, the frequency of exercise should be 3 to 7 times per week, depending on the amount of exercise. When the amount of exercise is large, the frequency of once every 2-3 days can be maintained, but the interval should not exceed 3 days; and when the amount of exercise is small, the patient's body should insist on exercising every day.
Table 5 Energy consumption of different sports
How should T2DM patients with complications exercise?
T2DM patients with other complications may have reduced cardiopulmonary function, and there is also a risk of cardiovascular events. Therefore, in the process of exercise therapy, it is necessary to combine personal physical fitness, and choose a method with low exercise intensity and high frequency as much as possible. exercise.
Table 6 Exercise recommendations for T2DM patients with complications
Focus on:
Patients with type 2 diabetes should follow the following principles when exercising [9]:
Exercise therapy should be carried out under the guidance of a physician.
At least 150 minutes of moderate-intensity (50% to 70% of maximum heart rate, with a little exertion during exercise, and rapid but not rapid heartbeat and breathing) for adults with type 2 diabetes per week sports.
Moderate-intensity physical activity includes brisk walking, tai chi, cycling, table tennis, badminton, and golf. High-intensity sports include fast-paced dancing, aerobics, jogging, swimming, cycling uphill, football, basketball, etc.
If there is no obvious contraindication, it is best to perform resistance exercise 2 to 3 times a week (with an interval of ≥ 48 h) to exercise muscle strength and endurance. The training parts should include major muscle groups such as upper limbs, lower limbs, and trunk, and the training intensity should be moderate. Combining resistance and aerobic exercise resulted in greater metabolic improvement.
Exercise programs should be adapted to the patient's age, condition, and physical tolerance, and regular assessments should be made to adjust exercise plans in a timely manner. Keeping an exercise diary can help improve exercise compliance. Blood glucose monitoring should be strengthened before and after exercise, and patients should be advised to temporarily adjust their diet and drug treatment plans to avoid hypoglycemia during heavy or intense exercise.
Develop healthy habits. Develop an active lifestyle, such as increasing daily physical activity, reducing sedentary time, and incorporating beneficial physical activity into your daily routine.
Fasting blood sugar >16.7 mmol/L, repeated hypoglycemia or large blood sugar fluctuation, acute metabolic complications such as DKA, acute infection, proliferative retinopathy, severe renal disease, severe cardiovascular and cerebrovascular diseases (unstable angina, severe heart rhythm) Exercise is contraindicated in cases of abnormal, transient ischemic attack), and exercise can be resumed gradually after the condition is controlled and stabilized.