Type 2 Diabetes And Golf Fitness
Health & Fitness Director at The Peninsula Club
Bob Forman, MS, GFI, CPT, CFAS
As you incorporate golf-specific strength exercises into your golf fitness program, youre not only helping your golf game, youre lowering the risk of developing or help managing type 2 diabetes.
Resistance exercise training is gaining momentum in the prevention and treatment of type 2 diabetes. A review of the research was presented recently in the Journal Sports Medicine. Fourteen controlled studies using resistance training were studied with over 650 participants who were at high risk for diabetes. For those who stuck with the training program for at least 12 weeks, there was a significantly lowered risk due to improvements in glycemic control, body fat and blood lipids.
This finding is consistent with comparable results reported in the journal Mayo Clinic Proceedings. It supported the lowering of risk of developing type 2 diabetes by 32 percent in those having even a moderate amount of muscle strength.
For those who already have type 2 diabetes, a research review in the journal Nutrition & Metabolism noted that resistance training is so effective in glycemic control and cholesterol metabolism, that it should be prescribed as part of the individual treatment plan.
Effects Of Chronic Exercise On Skeletal Muscle Glut4 Expression
Fig. 3.GLUT4 and mitochondrial markers increased after 2 wk of low-volume high-intensity interval training. AD: 2 wk of high-intensity training increased GLUT4 protein content in skeletal muscle , glycemic control as measured by continuous glucose monitoring , citrate synthase activity , and mitochondrial markers in skeletal muscle . Pre, before training Post, after training NDUFA9, NADH dehydrogenase 1 subcomplex subunit 9. Values are means ± SD n = 7. *P< 0.05.
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- Espeland MA, Glick HA, Bertoni A, Brancati FL, Bray GA, Clark JM, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Hazuda HP, Hill JO, Hire D, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Killean T, Kitabchi AE, Knowler WC, Kriska A, Lewis CE, Miller M, Montez MG, Murillo A, Nathan DM, Nyenwe E, Patricio J, Peters AL, Pi-Sunyer X, Pownall H, Redmon JB, Rushing J, Ryan DH, Safford M, Tsai AG, Wadden TA, Wing RR, Yanovski SZ, Zhang P Look AHEAD Research Group . Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care37: 254856, 2014.
What Kinds Of Exercise Should You Do
doesStrength TrainingFlexibility TrainingCreate a Routine and Stick with It
- American Diabetes Association. Standards of Medical Care in Diabetes2009. Diabetes Care. 2009 32:S13-61.
- Becker G. Type 2 Diabetes: An Essential Guide for the newly Diagnosed. 2nd ed. New York, NY: Marlowe & Company 2007.
- McCulloch D. Patient information: Diabetes type 2: Overview. UpToDate Web site. January 30, 2009. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~n0K0MIfI1iZs.& selectedTitle=5~150& source=search_result. Accessed April 20, 2009.
- McCulloch D. Patient information: Diabetes mellitus type 2: Overview. UpToDate Web site. December 4, 2008. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~X0jjLnBn4._ko& selectedTitle=4~150& source=search_result. Accessed April 20, 2009.
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How Much How Often How Hard
At first, you can aim for about 10 minutes of activity at a time, a couple of times per day. As you get used to the level of activity, you can increase your amount of time or effort. Aim for at least 150 minutes of physical activity per week, over at least three separate days. Ideally, slowly build up your physical activity time until you are active up to four hours per week. This works out to a little over 30 minutes a day, every day.
Try to exercise at a moderate level. When you exercise at this level, you feel warm and breathe a bit faster, but don’t get really sweaty or so out of breath that you can’t talk. Here are some examples of moderate intensity physical activities:
- brisk walking
- water aerobics.
To help you keep active, choose activities that you enjoy and are accessible to you and that you can do with other people.
You may slowly progress to higher intensity activities . Note: High intensity activity can help you to improve your health, but it can also worsen some types of conditions, so check with your healthcare provider if you want to do activities more vigorous than brisk walking.
How Exercise Improves Insulin Health
Exercise helps manage prediabetes and type 2 diabetes by lowering blood glucose levels and improving insulin sensitivity throughout the body. Heres how:
Taking Up Excess Glucose An immediate benefit of exercise is lowering excessively high blood sugar levels, Dr. Kazlauskaite says. Exercise triggers the uptake of glucose from the bloodstream into the working muscles and organs. This is one reason experts agree that people with elevated blood sugar levels can benefit from walks after meals.
Building Muscle When it comes to blood sugar management, muscle is consistently underrated. After you eat, 70 to 80 percent of the glucose in your body goes to your muscles, she says. The lower our muscle mass is, the more we hinder our capacity to clear glucose from the bloodstream. On the flip side, the more muscle we maintain throughout the aging process, the more insulin receptors we have and the greater our glucose sink, Occhipinti says.
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Dont Forget A Dose Of Mindfulness
How It Helps
Mindfulness-based exercises such as yoga and tai chi have been shown to help people with type 2 diabetes.
A September 2018 review published in Endocrinology and Metabolism concluded that yoga can be an effective tool when it comes to blood glucose control, and it also can help treat other, related conditions such as high blood pressure.
Another meta-analysis, published July 2018 in the Journal of Diabetes Research, looked at 14 studies and found that regular tai chi yielded very similar effects.
There are a couple reasons why these types of workouts may be helpful: Besides promoting physical activity, they also help reduce stress, which has been shown to worsen type 2 diabetes, Dr. Iafrate says. They also emphasize flexibility, strength, and balance at the same time, all three of which are recommended types of training for anyone with diabetes, adds Colberg-Ochs.
How to Do It
While there are no official guidelines on mindfulness-based activities, the ADA recommends flexibility and balance training which includes yoga and tai chi two to three times a week. It doesn’t matter which type of yoga, either, since there’s no specific research showing one is more effective than another, says Colberg-Ochs.
Workouts to Try
Dr Michael Mosley Finds Exercise Snacking May Be Best Exercise For Type 2 Diabetes
On his BBC Radio 4 podcast Just One Thing the former doctor investigated the benefits of exercise snacking, particularly how it can help with type 2 diabetes. Exercise snacking, a fairly new concept, is a method of structuring exercise into short bouts up to 30 minutes a day.
Little and often might even be better.
In a small study of people with type 2 diabetes, researchers compared the effects of half an hour of moderately intense walking before dinner with just six minutes of intense walking, broken up into one minute chunks.
Mosley explained: The exercise snackers reduced their blood sugar levels after eating not only on that day but also for the 24 hours following.
The half hour walkers did neither.
Dr Marie Murphy, Professor of Sport and Exercise Science at Ulster University, explained to Mosley why this type of exercise may benefit type 2 diabetes.
Exercise uses fuel and that fuel can often be glucose, she said. By contracting your muscles you activate some of the enzymes on the muscle membrane that allows the glucose to move the blood across into the muscle and to get used up.
Getting some of our big muscles, particularly our quads and our glutes, so things like squats and brisk walks, climbing the stairs, those are getting the big muscles active and that puts a demand on our glucose, our blood glucose and it brings down our blood glucose and helps us to regulate it.
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Effects Of Acute Exercise On Skeletal Muscle Glucose Uptake
It is well established that insulin is a potent simulator of glucose transport in skeletal muscle. In people with type 2 diabetes, insulin-stimulated glucose uptake in skeletal muscle is impaired. However, exercise-stimulated glucose uptake in people with type 2 diabetes is normal or at near normal levels . Because exercise-stimulated glucose uptake is normal in people with type 2 diabetes, defining insulin-independent mechanisms in the control of exercise-stimulated skeletal muscle glucose uptake is of critical importance as a potential means to treat diabetes. During the last several years, researchers have learned much about the signaling mechanisms that regulate exercise-induced glucose transport. There are many lines of evidence that show that exercise activates molecular signals that bypass defects in insulin action in skeletal muscle.
Acute exercise activates multiple signaling pathways, but the activated signaling pathways necessary for increased glucose uptake and GLUT4 translocation are not well understood. Muscle contraction involves changes in energy status , increases in intracellular Ca2+ concentration, increased ROS, and PKC. These changes activate various signaling cascades, some of which likely work to phosphorylate Tre-2/USP6, BUB2, cdc16 domain family member 1 and Akt substrate of 160 kDa and activate GLUT4 translocation. Here, we will discuss some of the various signaling cascades that have been implicated in exercise-stimulated glucose uptake .
Will It Hurt Your Joints
Long-term diabetes can affect them. Over time, blood sugar starts to build up in them, a process called âglycation.â Good control over your disease can help delay it, but the longer you have the diabetes, the more likely it will happen.
Glycation can make your joints stiff and brittle. Pounding away with HIIT or making a lot of fast moves might be risky — one wrong move could lead to an injury. Routines that have you do the same moves over and over can cause problems. Stiff joints can also take a toll on your balance, setting you up for a fall.
Many people with type 2 diabetes take cholesterol medications called statins. They can cause muscle or joint pain, making it tough for you to do high-impact moves correctly or quickly. These drugs also make muscle or joint injuries more likely.
On the other hand, workouts like yoga, Pilates, and tai chi are good choices. Theyâll help you build your strength, balance, and flexibility.
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How Long Should I Exercise
The U.S. Surgeon Generals report recommends that most people accumulate at least 30 min of moderate-intensity activity on most, ideally all, days of the week. However, many people find it easier to schedule fewer longer sessions rather than five or more weekly shorter sessions. Ideally, there should not be more than two consecutive days without aerobic physical activity.
The Importance Of Exercise When You Have Diabetes
For people who have diabetesor almost any other disease, for that matterthe benefits of exercise can’t be overstated. Exercise helps control weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being. There are added benefits for people with diabetes: exercise lowers blood glucose levels and boosts your body’s sensitivity to insulin, countering insulin resistance.
Many studies underscore these and other benefits from exercise. Following are some highlights of those results:
In general, the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher. If you use insulin, it’s important to test your blood sugar before exercising. If the level before exercise is below 100 mg/dL, eating a piece of fruit or having a small snack will boost it and help you avoid hypoglycemia. Testing again 30 minutes later will show whether your blood sugar level is stable. It’s also a good idea to check your blood sugar after any particularly grueling workout or activity. If you’re taking insulin, your risk of developing hypoglycemia may be highest six to 12 hours after exercising. Experts also caution against exercising if your blood sugar is too high , because exercise can sometimes raise blood sugar even higher.
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Physical Exercise And Glycaemia And Insulinaemia Control
The first aim of T2DM treatment is hyperglycaemia control, as a way of reducing chronic diabetic complications, namely of cardiovascular nature. The American Diabetes Association recommends a value of HbA1c above 7%. Our group demonstrated, using the training protocol above described in ZDF rats, that hyperglycaemia was prevented by exercise, together with a significantly lower value of HbA1c , when compared to sedentary counterpart, reinforcing the idea of a effect maintained over time . This results were corroborated by Kyraly et al. in ZDF rats submitted to forced swim training . Additionally, in our study the hiperinsulinaemia was partially, but significantly, corrected in the trained rats, which was accompanied by reduction of insulin resistance, given by the lower HOMA , and index of insulin resistance. Thu, we hypothesize that swimming training was able to improve peripheral insulin resistance, although the less action on hepatic resistance, suggesting that hyperinsulinaemia could be a reflex of insulin resistance in the liver, not improved by exercise .
The amelioration on glucose metabolism by exercise training may occur primarily through three distinct mechanisms: i) stimulation of glucose transport to muscle ii) increased in insulin action on cells of the organs involved in the exercise iii) positive regulation of signaling pathway stimulated by insulin as a result of regular exercise.
How Exercise Helps Prevent And Manage Type 2 Diabetes
Improve blood sugar levels and insulin health and mediate complications from type 2 diabetes with these tips from endocrinologists and exercise physiologists.
Strength training improves insulin health, so don’t forget to include it in your exercise routine.
If youre working to manage type 2 diabetes or trying to prevent the condition altogether exercise is a crucial step in making your goal a reality.
The long-term benefits of exercise on blood sugar and insulin health are unquestionable, says Rasa Kazlauskaite, MD, associate professor of endocrinology, diabetes, and metabolism at Rush University Medical Center in Chicago.
For example, a review published in March 2020 in Mayo Clinic Proceedings found that in people with type 2 diabetes, regular exercise can reduce dependence on glucose-lowering oral medications and insulin. And according to a study published in November 2015 in TheLancet, increased physical activity can help reverse prediabetes, which the Centers for Disease Control and Prevention notes affects more than 1 in 3 adults in the United States.
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Physical Activity Obesity And Body Fat Distribution
Our studies showed that exercised diabetic rats presented, when sacrificed 48 h after the last bout training session, a trend to increase body weight, which might be due to an increase in muscle mass . Despite the lack of measurement of the animal body fat amount, a reduction in total visceral or subcutaneous fat in exercised animals cannot be excluded. Similar effect was observed by other studies in humans, confirming that after the training there was an increase in muscle mass with decrease in fat mass .
In the same work, Teixeira de Lemos et al. showed that the weight of some organs or tissues were heavier in the exercised diabetic rats when compared with the sedentary animals, thus confirming that training leads to important morphological and physiological adaptations to maintain body homeostasis, as previously suggested by others . In addition, the results suggest that the maintenance in time of training is an important factor for the appearance of those adaptations.
Effects Of Activity Type And Timing On Glycemic Balance
Blood glucose responses to physical activity in type 1 diabetes are highly variable . In general, aerobic exercise decreases blood glucose levels if performed during postprandial periods with the usual insulin dose administered at the meal before exercise , and prolonged activity done then may cause exaggerated decreases . Exercise while fasting may produce a lesser decrease or a small increase in blood glucose . Very intense activities may provide better glucose stability or a rise in blood glucose if the relative intensity is high and done for a brief duration . Mixed activities, such as interval training or team/individual field sports, are associated with better glucose stability than those that are predominantly aerobic , although variable results have been reported for intermittent, high-intensity exercise .
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Improvement Of Insulin Sensitivity
Muscle tissue is the main target tissue for insulin action. Previous studies found that resistance exercise can significantly increase the strength of skeletal muscles and enlarge the cross-sectional area of the quadriceps muscles , which result in an increased number of insulin receptor and the improvement of insulin sensitivity. In addition, the beneficial effects of exercise are also studied by amplifying insulin signaling and enhancing the transduction of intracellular signaling pathways. Thus, exercise is likely to facilitate the physiological effects of insulin. In T2DM patients, glucose is taken up by skeletal muscles through 2 major pathways: insulin-dependent and non-insulin-dependent. T2DM is mostly associated with varying degrees of insulin resistance and hypoinsulinism, which causes impairment of insulin-dependent glucose uptake in skeletal muscles. Because normal uptake of glucose can be obtained through the non-insulin-dependent pathway activated by acute exercise, this pathway is becoming another important way of glucose regulation in insulin resistance state .