TYPE 2 DIABETES The exercise approach
LIFESTYLE INTERVENTIONS, TYPICALLY a combination of diet and exercise, are a universally acknowledged mainstay of type 2 diabetes treatments. These two stalwarts are often portrayed as equally beneficial, and why not?
Exercise improves weight loss efforts, although its effects are much more modest than most assume. Nevertheless, physical inactivity is an independent risk factor for more than twenty-five chronic diseases, including type 2 diabetes and cardiovascular disease. Low levels of physical activity in obese subjects are a better predictor of death than cholesterol levels, smoking status, or blood pressure.
And the benefits of exercise extend far beyond simple weight loss. Exercise programs improve strength and balance, blood pressure, cholesterol, blood glucose, and insulin sensitivity, without involving medications and their potential side effects. Trained athletes have consistently lower insulin levels, and these benefits can be maintained for life, as demonstrated by many studies on older athletes. These seem like good returns for a low-cost investment.
Yet results of both aerobic and resistance exercise studies in type 2 diabetes are varied. Meta-analyses show that exercise may significantly reduce A1C, without a change in body mass. This finding suggests that exercise does not need to reduce body weight to have benefits, which echoes clinical experience with patients. However, the corollary is that exercise programs have minimal effect on weight loss.
With all the proven benefits of exercise, it may surprise you to learn that I think this is not useful information. Why not? Because everybody already knows this. The benefits of exercise have been extolled relentlessly for the past 40 years. I have yet to meet a single person who has not already understood that exercise might help type 2 diabetes and heart disease. If people already know its importance, what is the point of telling them again?
The main problem has always been non-compliance. Many real issues may deter someone from embarking on an exercise program: obesity itself, joint pain, neuropathy, peripheral vascular disease, back pain, and heart disease may all combine to make exercise difficult or even unsafe.
Overall, however, I suspect the biggest issue is lack of visible results. The benefits are greatly over-hyped and exercise doesn’t work nearly as well as advertised. Weight loss is often minimal.