Diabetes: A Wake-Up Call! We Can Do Better! Part II

By Dr. John Mishock, PT, DPT, DC

Irrefutable evidence supports the importance of physical activity, exercise, and cardiorespiratory fitness in preventing and treating chronic diseases, such as cardiovascular disease, obesity, type 2 diabetes Mellitus, cognitive decline, and many cancers while enhancing the immune system, health span (years healthy free of disease), longevity, and resilience. Eighty percent of heart disease, stroke, and type II diabetes are preventable, and 40 to 60% of cancers could be prevented with a healthy diet, exercise, and other lifestyle changes. Americans could save 75% of health care dollars by implementing healthy lifestyle changes. (Saphier, Make Am Heathy, 2020; NIH, 2016, Health line.com; Blue Zones of Health, 2019) This article reviews essential aspects of aerobic and resistance exercises, and the impact on changing the course of type II diabetes and other chronic disease.

What is the difference between physical activity and exercise?
Physical activity is any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure. Exercise is a physical activity that is planned, structured, and repetitive, such as aerobic training, resistance training, or high-intensity interval training. (Caspersen et al, 1985)

How much exercise is recommended to prevent disease and optimize function and quality of life?
The World Health Organization (WHO), the Centers for Disease Control (CDC), and other health legislative bodies recommend that a healthy adolescent and adult spend at least 150 to 300 minutes performing moderate-intensity exercise or at least 75 to 150 minutes of vigorous-intensity aerobic exercises per week. Exercise sessions could be broken down into 20-30 min of daily exercise or 45-60 minutes three times per week. It is also recommended to do resistance exercises a minimum of two days a week as part of the 150-300 minutes.

What is moderate-intensity exercise?
Moderate-intensity exercise means the heart rate increases to 50-70% of the maximum heart rate for at least 20-30 minutes. The maximum heart rate is 220 minus your age times 50-70%. For example, a 52-year-old’s maximum heart rate would be 168 beats per minute (220-52=168). Multiplying that by 70% (.70 x 168= 118) would be 118 beats per minute. At 70%, you would want an average of 118 beats per minute of exercise for 20-30 minutes daily. Examples include brisk walking, pickleball, golf, vacuuming, bicycling, hiking, and gardening.

What is vigorous-intensity exercise?
Vigorous-intensity exercise means the heart rate increases to 70-85% of the maximum heart rate for at least 20-30 minutes. Examples include running, aerobic dancing, basketball, tennis, jumping rope, swimming laps, biking, vigorous yard work, or gardening.

What is the difference between anaerobic (resistance-exercise) and aerobic exercise?
Aerobic exercise: According to the American College of Sports Medicine (ACSM), aerobic exercise is any activity that uses large muscle groups, can be maintained continuously, and is rhythmic (ASCM, 2017). Examples of aerobic exercises include swimming, cycling, walking, hiking, dancing, rowing, running, jumping ropes, Etc. Aerobic capacity is the peak oxygen consumption (VO2), or how much you breathe and use oxygen.

Anaerobic or Resistance Exercise: According to the American College of Sports Medicine (ACSM), Resistance exercise is the intense physical activity of a very 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). This exercise increases muscle strength, endurance, and motor control by making muscles work against a weight or force. Examples of resistance exercise includes strength training, interval training, isometric exercise, and plyometrics.

When doing aerobic exercise, how is intensity of the workout measured?
Using a fitness tracker on a phone or watch can easily monitor heart rate and intensity. If you do not have a fitness tracker (app on my watch or phone, you can take the carotid (neck) or radial (wrist) pulse. Find the heartbeat, count the beats for 15 seconds, and multiply by 4 (60 seconds total). Another alternative to measure intensity if the “talk test.” During moderate exercise, talking should be challenging, but there would not be the ability to sing. In vigorous exercise, only a few words could be spoken during the activity due to labored breathing.

In Part III, I will review why resistance exercise is essential to prevent chronic disease and improve function and quality of life.

Before beginning any exercise program, it is essential to consult with your physician to determine your readiness and health safety to begin a program. In Part III, I will review the exercise evidence and how to implement a chronic disease prevention exercise program to improve function and quality of life.


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