Physicians' Academy for Cardiovascular Education

Type 2 diabetic patients significantly benefit from light exercises

Literature - Dempsey PC et al., Diabetes Care 2016

Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities

 
Dempsey PC, Larsen RN, Sethi P, et al.
Diabetes Care 2016;39:964-972
 

Background

Even when using hypoglycaemic agents, lifestyle interventions such as exercise are recommended front-line therapy in the management of type 2 diabetes (T2D). Current guidelines for T2D patients include 150 min/week moderate-vigorous aerobic exercise which should be extended with 2-3 days/week resistance exercises [1]. Despite the known benefits, many T2D patients remain physically inactive and fewer opportunities of daily life exercises exist as a result of economic development [2]. Sitting time with brief interruptions may be associated with a more favourable cardiometabolic risk profile and postprandial metabolism than an equivalent amount of uninterrupted sitting time [3,4]. It has been shown that overweight/obese adults at risk for T2D obtained reduced glucose and insulin responses after interrupting sitting time with 2 minutes walking bouts every 20 minutes, irrespective of intensity [5]. However, it is not known whether these benefits also hold for T2D patients and furthermore, there is limited consensus on how prolonged sitting time should be interrupted.
In this study, the effect of interrupting sitting time by brief bouts of light-intensity walking (LW) or simple resistance activities (SRA) as compared with sitting uninterrupted (SIT) on the postprandial metabolic responses in overweight/obese adults with T2D was determined in a randomised crossover trial. LW/SRA meant 12 rounds of 3 minute walking/exercising every 30 minutes. 24 patients were randomised and completed the trial. Nine patients were included in the uninterrupted sitting condition (SIT), 7 in the light-intensity walking bouts (LW) and 8 in the simple resistance activity bouts (SRA) group.
 

Main results

  • Only preprandial serum C-peptide levels were different between groups at baseline (SIT: 974 pmol/l, LW: 924 pmol/l, SRA: 984 pmol/l).
  • A bout of LW and SRA increased mean energy expenditure (kcal/min) by 73% and 121% respectively.
  • Compared to SIT, a bout of SRA elicited a significantly greater increase in mean VO2 (0.13 L/min), VCO2 (0.08 L/min), and energy expenditure (0.58 kcal/min), all P < 0.001.
  • However, compared to SIT, respiratory exchange ratio VCO2/VO­2 was decreased in SRA patients (-0.02, p < 0.05).
  • Mean postprandial glucose, insulin and C-peptide concentration were significantly attenuated in LW and SRA patients compared to SIT patients. SIT vs LW vs SRA for glucose: 24.2 vs 14.8 vs 14.7 mmol/h/l, insulin: 3.293 vs 2.104 vs 2.066 pmol/h/l, C-peptide: 15.641 vs 11.504 vs 11.012 pmol/h/l.
  • Mean postprandial triglyceride concentration was only attenuated in SRA compared to SIT (2.9 vs 4.8 mmol/h/l, p < 0.001). Only triglyceride concentration was significantly different between SRA and LW patients (p = 0.048).
  • The magnitude of glucose attenuation was greater in women than in men for LW patients, when compared to SIT patients (58% vs 26% reduction, p = 0.045) and this same trend was observed for SRA patients (53% vs 31% reduction, p = 0.17).

Conclusion

This study shows for the first time that inactive overweight/obese men and women with T2D benefit from brief bouts of either LW or SRA exercises as it effectively attenuated postprandial glucose, insulin, and C-peptide levels. SRA patients were also rewarded with a greater increase in energy expenditure compared to LW patients and a greater reduction in triglyceride levels. Both methods may contribute toward reducing the risk of diabetes complications and cardiovascular complications. It should be beneficial if health care professionals consider promoting the message of exercising or providing prescriptive advice to T2D patients.
 
Find this article online at Diabetes Care
 

References

1. Colberg SR, Albright AL, Blissmer BJ, et al.; American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 2010;42:2282–2303
2. Zhao G, Ford ES, Li C, Mokdad AH. Compliance with physical activity recommendations in US adults with diabetes. DiabetMed 2008;25:221–227
3. Healy GN, Dunstan DW, Salmon J, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008;31:661–666
4. Healy GN, Matthews CE, Dunstan DW, Winkler EA, Owen N. Sedentary time and cardiometabolic biomarkers in US adults: NHANES 2003-06. Eur Heart J 2011;32:590–597
5. Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care 2012;35:976–983

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