Diabetes: A Wake-Up Call! We Can Do Better! Part III
By Dr. John Mishock, PT, DPT, DC
Approximately 35 million adults in the US have Type 2 Diabetes, 12.6 million of whom are undiagnosed. In addition, nearly 166 million adults are also categorized as having prediabetes. Exercise therapy is the first-line recommended treatment for prediabetes and diabetes. Only 2.4% of adults achieve aerobic and resistance exercise recommended by numerous US and worldwide legislative bodies (CDC, WHO). Adults should spend at least 150 to 300 minutes of exercise per week with two days of resistance exercises. (Troiano et al. 2008) If Americans followed the exercise mandate, it would save $1.5 billion in healthcare expenditure while preventing 60-80% of chronic diseases (type II diabetes, cardiovascular disease, hypertension, and cancer). (Bilandzic & Rosella, 2017) Studies demonstrate that up to 50% of prediabetes and type II diabetes could be prevented with resistance training alone. (Mcleod et al., 2019) This is outside of other interventions, such as optimizing nutrition and aerobic exercise.
What is resistance exercise?
According to the American College of Sports Medicine (ACSM), Resistance exercise is an intense physical activity of short duration, fueled by the energy sources within the contracting muscles and independent of the use of inhaled oxygen as an energy source. Resistance exercise includes using weight machines, exercise bands, hand-held weights, or one’s body weight (e.g., push-ups or sit-ups).
Why is muscle vital as we age?
At age > 50 years, we lose 1-2% of muscle and 1.5-5% strength body per year. By age 80, most adults have lost 40% of their muscle mass. (Saini et al., 2009) This progressive decline of skeletal muscle mass and strength (sarcopenia) becomes a leading predictor of mobility disability, falls, and chronic disease risk, especially type II diabetes. (Persen et al. 2015)
I am too old; how will resistance exercise help me?
You are never too old for resistance exercise and the health benefits it will bring. In 33 studies of older (>70 years of age), pre-frail and frail older adults showed significant enhancements in muscular strength, gait speed, and physical performance and function following an 8-12 weeks training program. (Jadczak et al. 2018; Liu and Latham 2009)
I am too old; can I gain muscle mass?
Senior individuals can gain strength and muscle mass with appropriate resistance exercise and good nutrition (appropriate protein, carbohydrates, and fats). In 49 randomized controlled resistance exercise trials, it was concluded that older adults could gain 2.5 lbs of lean body mass with 20.5 weeks of resistance exercise. (Peterson et al., 2011)
Is resistance exercise risky to my heart as I age?
Five studies evaluating adverse events during low-to-moderate intensity resistance exercise (30–69% of 1RM) in older adults with cardiovascular disease found that resistance exercise was actually associated with a lower rate of adverse cardiovascular complications, even beating out aerobic exercise. (Hollings et al. 2017). Before starting any exercise program, getting approval from your medical provider is essential.
Why does losing muscle mass lead to diabetes?
Muscle is metabolically active tissue, with 80% of blood sugar (glucose) deposited in skeletal muscle after eating. The loss of muscle mass is the primary driving force of insulin resistance and type II diabetes development in older adults. (DeFronzo et al. 2009)
What are myokines, and how do they impact diabetes?
During resistance exercise, skeletal muscle works as an organ that can produce and secrete hundreds of myokines (communicating peptides) that affect and communicate with many body organs (pancreas, brain, fat tissue, bone, liver, gut, skin). Myokines (IL-6, GLUT4) increase (sugar) glucose uptake, improve pancreas release of insulin, and increase mitochondrial function (improved efficiency and growth). Together this helps to reduce the impact of insulin sensitivity and diabetes. Beyond this, these myokines reduce inflammation, making exercise an anti-inflammatory modality.
Are there studies that demonstrate the effects of resistance exercise on diabetes?
In a study of 32,000 adults (40–75 years), those engaging in at least 150 min/week of resistance exercise had a 34% lower risk of developing diabetes over 18 years (Grontved et al., 2012)
Another study of overweight/obese older adults showed that in only 3 months (2×/week) of resistance exercise, 40% achieved normal glucose levels. (Davy et al., 2017)
In a study of 360 older patients with type II diabetes, resistance exercise for at least 8 weeks was associated with clinically relevant improvements in glycated hemoglobin (HbA1c) and muscle strength. (Lee et al., 2017)
As I get older, I feel like I have no energy. How does resistance exercise give more energy?
As we age, we have reduced and inefficient mitochondria (powerhouse or cell energy source). Resistance exercise can counteract this by increasing the development and number of mitochondria by releasing myokines. The more mitochondria that are added to our body cells, the more energy we can create through glucose utilization. A study showed that there could be an increase in mitochondria with 57% greater oxidative capacity (energy production) with resistance exercise training. (Judrias et al., 2001)
What are the resistance exercise recommendations to prevent and treat insulin resistance and Type II Diabetes?
Exercise type: Whole body exercise progressive resistance
Frequency: 2-3 times per week, 24 hours rest before the next workout.
Duration: 8-12 weeks, then change the program.
Contraction type: Concentric (muscle contraction closing the joint angle), Isometric (muscle contraction without movement), and Eccentric “negative” (muscle contraction opening the joint angle)
Intensity (effort): 30-69% of 1 repetition maximum performed to muscle contraction fatigue. Keeping the intensity in this range will prevent excessive elevation of blood pressure. (MacDougall et al. 2008)
The evidence presented in this review demonstrates the beneficial effects of resistance exercise on reducing chronic disease risk (mobility, disability, type II diabetes, cardiovascular disease, and cancer) in both younger and older adults. Regular performance of resistance exercise improves muscle mass, strength, and function and can directly affect the primary prevention of several chronic diseases.
We can help!
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Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and train2playsports.com.