Exercise prescription for type 2 diabetes patients
Exercise recommendationsThe following recommendations have been set for individuals with type 2 diabetes (Colberg et al 2010):
- Aerobic exercise: A minimum of 150 minutes/week of moderate intensity or, in moderately fit people, 60 minutes/week of vigorous exercise
- Resistance exercise: At least 2-3 days/week of moderate (50% of one-repetition maximum) to vigorous resistance training (75-80% of one-repetition maximum)
- Unstructured physical activity: Increase total daily unstructured (commuting, occupational, home and leisure time) physical activity
- Combining aerobic and resistance exercise: Combined aerobic and resistance exercise is recommended as it is more effective than either one alone
- Exercise counseling: Structured exercise counseling is recommended, but it is more effective in combination with supervised exercise training (Balducci et al, 2010, 2012).
- Flexibility: This may be included as part of a physical activity programme, although it should not be a substitute for other training.
Adjunct modality: Low-volume high-intensity interval training (HIT)Many individuals with T2D cite ‘lack of time’ as a barrier to regular participation in exercise programmes. High-intensity interval training (HIT) is physical exercise characterized by brief, intermittent bursts of vigorous activity. Low-volume HIT is emerging as a time-efficient exercise strategy for improving health and fitness in people with or at risk for cardiometabolic disorders.
A practical model of low-volume HIT consists of 10 × 60 seconds work bouts at a constant-load intensity that elicits ∼90% of maximal heart rate, interspersed with 60 seconds of recovery. This means that only 10 minutes of exercise is performed over a 20 minutes training session (Gibala et al, 2012).
- Accelerate the kinetic response of VO2 during submaximal exercise
- Reduce blood glucose, lipid and blood pressure levels
- Increase physical activity (outside the supervised sessions)
- Increase exercise tolerance
The big challenge: long-term exercise adherence
- We did a study where people with T2D initially trained for 12 weeks, exercising 3 times per week under the supervision of a qualified trainer, followed by 12 weeks exercising 3 times per week without supervision. However, for the unsupervised phase study participants were encouraged to train in the same health centre previously used in the supervised exercise phase.
An effective strategy to educate and motivate participants to exercise on their own and ensure long-term exercise adherence could be to perform the unsupervised exercise phase in the same leisure centre used during the initial supervised phase as long as it is ensured that participants are familiar with the training routines and equipment used.We demonstrated that the unsupervised training was effective in maintaining benefits in exercise tolerance, VO2 max, VO2 kinetics and physical activity levels, while exercise adherence rates remained high (MacAnaney et al, 2012).
- As a healthcare professional, how do you prescribe and monitor exercise therapy in people with T2D?
- Has lack of time been a barrier to exercise for your patients? How have you addressed this?
Exercise Prescription for the Prevention and Treatment of Disease
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