Researchers recommend different plans and programs to the level of exercise for those with diabetes and cardiovascular risk.
Diabetes and cardiovascular disease are associated with an increased risk of mortality. Exercise and diabetes are linked; previous studies have shown that there are added benefits to exercising for those diagnosed with diabetes. If there are no additional complications in those with diabetes, they may engage in exercise on their own, but those with cardiovascular complications in addition to diabetes, may require some supervision.
Evidence suggests that it is unlikely for people to have an exercise plan and follow it for a longer duration of time, and this is due to many factors. One is a lack of motivation, despite the benefits of exercise. Benefits include blood pressure control. An exercise plan needs to be made, keeping in mind how the participant’s level of exercise and diabetes diagnosis and other potential cardiovascular risks may interact.
Kemps and colleagues outline some recommendations for exercise plans for those with diabetes in their recent paper published in The European Journal of Preventative Cardiology. Specifically, they looked at those with type 2 diabetes and cardiovascular disease.
1. Measure fitness not fat loss
The authors stated that fat loss may not be the best end goal for those engaged in exercise and with a diabetes diagnosis. Participants may lose motivation if they do not lose the weight in a perceived period of time. It may be best to set specific goals related to levels of certain cellular processes. This may be a better indicator of how the level of exercise and diabetes prognosis interact. It was suggested that cardiorespiratory fitness could be measured instead. There is evidence that better levels of certain factors, like high-density lipoprotein cholesterol (HDL-C), can occur with improvements in cardiovascular fitness. Interval exercise may be especially beneficial to diabetics who are obese.
2. Consider blood sugar control
Blood sugar (glycaemic) control is limited in certain tissues – like liver tissue – in those diagnosed with type 2 diabetes. Studies have shown some improvement in glycaemic control when a physical activity regimen is involved. Therefore, glycaemic control is recommended to be also one of the main factors to be included in the assessment of possible participant exercise programs. There may also be benefits in lifestyle changes.
3. Improve vascular function
It has also been suggested that a training regimen should consider vascular function improvement as an important factor. This is because many studies have shown that a decline in some cardiovascular-related events may be, in part, associated with some early interventions done to better one’s own vascular health.
4. Monitoring inflammation is not recommended in clinical practice
Inflammation factors are associated with many pathways in the human body and are associated with exercise. For example, anti-inflammatory myokines are just one of these factors that are released in training. There are also inflammatory factors associated with chronic inflammation.
Inflammation factors are not recommended to be monitored because they are likely not the best option for tests that are done frequently when there exist other, more easily implementable alternatives.
5. Exercise should support—not replace—medications that control lipid levels and blood pressure
Use of medications that lower lipid levels, like statins, are still considered to be useful, even if diabetic patients have a regular exercise schedule. The same can be said for blood pressure control with medication. Exercise and medication can be beneficial, but more research needs to be done on the duration, type and intensity of the exercise.
6. Motivational feedback is important to motivate patients to continue exercise regimens
Though there are instances of complications with an exercise plan, most patients do improve based on measurable cardiovascular factors. What needs to be done is a longer-term follow-up study, as most long-term follow-up studies looking at the level of exercise and diabetes and cardiovascular complications have suggested that a lack of adherence to exercise programs may mask the ability to see any long-term effects.
It is recommended to have motivational feedback for these patients to continue along their exercise regimen. It is also recommended that aerobic exercise training be used in exercise plans, and some evidence shows that a combination of aerobic exercise training and high-volume resistance training may also be helpful.
Shift the focus from general weight loss to individual needs
Overall, this paper addresses the shift from weight loss to different parameters of fitness in order to treat people with diabetes. It is important to consider the target population being examined, as weight loss may not necessarily be the most important or only parameter to examine in trying to improve the quality of living in someone with diabetes. The researchers stress the importance of tailoring the program to the patients’ needs and situation. For example, there is a benefit to moderate-intensity exercise in those with cardiovascular complications and diabetes.
There may even be disadvantages seen in the level of exercise and diabetes risk. The lack of benefit of exercise in diabetics in a small number of cases could be due to loss of motivation to follow the exercise program or certain genetic factors. Long-term improvements can really only be assessed once compliance can be assured. Future studies and protocol will have to take this into consideration in order to look at the long-term effects of exercise on diabetic patients.
Kemps H et al. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A position paper of the European Association of Preventive Cardiology (EAPC). European Journal of Preventative Cardiology. 2019; 0(00) 1–19. doi:https://doi.org/10.1177/2047487318820420