THE ROLE OF EXERCISE IN THE MANAGEMENT

OF T2DM

Luthfan Budi Purnomo

pErkeni Cabang Jogjakarta
DEFINITION

Physical activity: bodily movement

produced by the contraction of skeletal
muscle that requires energy expenditure
in excess of resting energy expenditure
Exercise: subset of physical activity,
planned, structured, and repetitive
bodily movement performed to improve or
maintain one or more component of
physical fitness
ADA, 2007
DEFINITION

 Aerobic exercise: rhythmic, repeated, and

continuous movement of the same large muscle
group for at least 10 min at a time (walking,
swimming, bicycling, jogging).
 Resistance exercise: activities that use muscular
strength to move a weight or work against a
resistive load (weight lifting).

ADA, 2007
Type of Physical Activity
ADVENTAGES OF EXERCISE

 Improve insulin sensitivity

 Assist with reduction and maintenance of body
weight
 Improve lipid abnormalities
 Lower blood pressure

Steppel & Horton, 2005

Misra et al. Diabetes Care 31: 1282-1287; 2008

Progressive resistance training improves

(3 months)

insulin sensitivity, glycemic control, lipids,

truncal & peripheral subcutaneous
adipose
tissue
Cuff et al. Diabetes Care, 26:2977-2982; 2003

Adding resistance training to aerobic training

Enhances glucose disposal

improved insulin sensitivity related to loss of
abdominal subcutaneous & visceral adipose
tissue and increased muscle density
Bloem & Chang J Clin Endocrinol Metab
39:387-392, 2008

Short-term exercise ( 7 days)

Increases insulin sensitivity

Enhances ß-cell function

EVALUATION BEFORE RECOMMENDING EXERCISE
PROGRAM

 Sedentary individual whose 10-year risk of a

coronary events is likely to be ≥10%
 Conditions increase likelihood of CVD
 Contraindications to certain types of exercise
 Predispose to injury
(uncontrolled hypertension, severe autonomic
neuropathy, severe peripheral neuropathy,
preproliferative or proliferative retinopathy or
macular edema)
ADA, 2007
HAZARDS OF EXERCISE

 Hypoglycemia can occur up to 24 hours after

exercise
 Ketosis
 Injury
 Exacerbation of cardiac disease

Steppel & Horton, 2005

 EXERCISE IN THE PRESENCE OF NONOPTIMAL
GLYCEMIC CONTROL

 Hyperglycemia: if well condition and urine

and/or blood ketones are negative, it is not
necessary to postpone exercise based simply on
hyperglycemia
 Hypoglycemia: it is rare in diabetic patient who is
not treated with insulin or insulin secretagogues.
If taking insulin or insulin secretagogues and
blood glucose before exercise <100 mg/dl, add
carbohydrate

ADA, 2007
PROLONG PHYSICAL ACTIVITY/EXERC

Phys.Activ Adr/N-adr Pancreas

GH & Cort↑ Muscle cell A Cell B Cell

Glicogen ↓↓ Glucag ↑ Ins ↓

Gluconeogenesis↑ Gluc ↑
HEAVY ACTIVITY/EXERCISE

Phys.Act FFA ↑

GH Cortisol

Numb Res.Ins ↓ Aff Res.Ins ↓

Glukosa darah

Gluconeogenesis

LIVER GLUCOSE OUTPUT ↑

 INTENSITY

Maximum Heart Rate

(MHR) Load

220 - age

Target Heart Rate (THR)

60% - 70% MHR (80%)

Exercise: calculating intensity of exercise

E.H.R = (D.I x H.R.R) + R.H.R

E.H.R = Exercise heart rate
D.I = Desired intensity 40-80% VO2 max
H.R.R.= Heart rate range (maximal H.R. – R.H.R)
Max H.R. = 200 – (0.5 x age)

Severe obese, sedentary/not trained D.I. 40-60%,

40 year old, R.H.R 80 x/min
H.R.R = ([0.4-0.6] x 100) + 80
= 120 – 140 x/min
(Miller & Wadden, 2004)
 Definitions
 Metabolic Equivalent (MET)
The amount of energy expended during
exercise relative to the energy expenditure
during rest.

 Energy expenditure during rest = 1 MET

= 3.5 ml of O2 / kg. min
= 1 kcal / kg BW. hr
GLUCOSE UPTAKE AND EXERCISE
DURATION OF EXERCISE

20 - 60 MINUTES
< 20 MIN: No Effect
> 60 MIN: Prone to Injuries
(Musculoskeletal
problems) &
disease attack
TYPES of EXERCISE
1. ENDURANCE (AEROBIC)
Walking, Cycling, Jogging etc
2. ANAEROBIC EXERCISE?
tennis, badminton
3. STRENGTH (R.TRAINING)?
Dumble, Circuit
Classification of Exercise

 Aerobic Exercise
Endurance type exercise, rhythmic, sustained for
sometimes.
 Ex: Walking, jogging, running, cycling, swimming, etc

 Strength (Resistance) Exercise

Weight training with: free weight, machine, elastic
rope, calisthenics, etc

 Flexibility Exercise
Stretching exercise.
Exercise Program

F I D T
* FREQUENCY
* INTENSITY
* DURATION
* TYPE

Also: Warm-up, Conditioning, Cooling-

down and Stretching
 Exercise Program
Others:
C = continues
R = rhytmic
I = interval
P = progressive
E = endurance/aerobic

Safe for any complications

Continues
Start with low intensity, go slowly
Enjoy
 Exercise procedures at RSCM-Dep. of Physiology FMUI

1. Check blood glucose

2. Measure blood pressure
3. Aerobic class
- check heart rate (HR)
- warming up and light stretching, check HR
- conditioning, check HR
- cooling down, check HR
- stretching
4. Check blood glucose
5. Measure blood pressure
6. Snack and drink are needed
Exercise procedures at RSCM-Dep. of Physiology FMUI

 Test Glucose result

- < 70mg/dl ……. not allowed to exercise
- < 100mg/dl …… exercise but should
consume light snack
- 100mg/dl-250mg/dl … safe to exercise
> 1 hr need snacks
- > 250-300mg/dl …. dangerous
Exercise procedures at RSCM-Dep. of Physiology FMUI

 Blood pressure
Before exercise
- BP > 140/90 mmHg, exercise under supervise
- BP ≥ 160/100 mmHg … not exercise
- BP > 180/100 mmHg … dangerous

Notice:
- headache, dizziness, etc during exercise
 Not allowed to exercise
 Blood glucose > 250-300 mg/dl
 Drug and insulin in peak action
 < 2-3 hours after meal
 There is a part of the body with numbness or pain
 Dehydration
 Dyspnoe
 Ill: influenza and fever
 Dizziness
 Pain in the chest, neck, shoulder and mandibula
 Eyes problem
 FREQUENCY OF EXERCISE
 Diabetic patient should accumulate ≥30 min of moderate-
intensity activity on most, ideally all, days of the week
 To improve glycemic control, assist with weight
maintenance, reduce risk of CVD, at least 150 min/week
of moderate-intensity aerobic exercise (50-70% of
maximum heart rate) and/or at least 90 min/week of
vigorous aerobic exercise (>70% of maximum heart rate)
 In the absence of contraindications, encourage resistance
exercise 3 times/week, targeting all major muscle groups,
progressing to three sets of 8-10 repetitions at a weight
that cannot be lifted more than 8-10 times

ADA, 2007