Exercise and Diabetes. Sheri R. Colberg

from the invasive testing done after a false-positive test outweigh the benefits of detection.

      • Symptomatic individuals may benefit from diagnostic cardiac stress testing, both for diagnostic purposes and also to assist in safe and effective exercise.

      • To date, no studies have addressed whether pre-exercise stress testing is necessary or beneficial before participation in resistance training (although likely it is not).

      • Graded exercise testing may be undertaken in low-risk and other individuals to determine fitness levels or to obtain testing results for effective exercise prescription.

      REFERENCES

      American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 36 (Suppl. 1):S11–S66, 2013

      Bax JJ, Young LH, Frye RL, Bonow RO, Steinberg HO, Barrett EJ: Screening for coronary artery disease in patients with diabetes. Diabetes Care 30:2729–2736, 2007

      Bernbaum M, Albert SG, Cohen JD: Exercise training in individuals with diabetic retinopathy and blindness. Arch Phys Med Rehabil 70:605–611, 1989

      Colberg SR, Sigal RJ: Prescribing exercise for individuals with type 2 diabetes: recommendations and precautions. Phys Sportsmed 39:13–26, 2011

      Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B, American College of Sports Medicine, American Diabetes Association: Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 33:e147–e167, 2010

      Curtis JM, Horton ES, Bahnson J, Gregg EW, Jakicic JM, Regensteiner JG, Ribisl PM, Soberman JE, Stewart KJ, Espeland MA, Look Ahead Research Group: Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes: the Look AHEAD (Action for Health in Diabetes) study. Diabetes Care 33:901–907, 2010

      Eddy DM, Schlessinger L, Heikes K: The metabolic syndrome and cardiovascular risk: implications for clinical practice. Int J Obes (Lond) 32 (Suppl. 2):S5–S10, 2008

      Featherstone JF, Holly RG, Amsterdam EA: Physiologic responses to weight lifting in coronary artery disease. Am J Cardiol 71:287–292, 1993

      Fowler-Brown A, Pignone M, Pletcher M, Tice JA, Sutton SF, Lohr KN: Exercise tolerance testing to screen for coronary heart disease: a systematic review for the technical support for the U.S. Preventive Services Task Force. Ann Intern Med 140:W9–W24, 2004

      Ghilarducci LE, Holly RG, Amsterdam EA: Effects of high resistance training in coronary artery disease. Am J Cardiol 64:866–870, 1989

      Gilchrist J, Jones BH, Sleet DA, Kimsey CD, Center for Disease Control: Exercise-related injuries among women: strategies for prevention from civilian and military studies. MMWR Recomm Rep 49:15–33, 2000

      Kothari V, Stevens RJ, Adler AI, Stratton IM, Manley SE, Neil HA, Holman RR: UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine. Stroke 33:1776–1781, 2002

      Morrison S, Colberg SR, Mariano M, Parson HK, Vinik AI: Balance training reduces falls risk in older individuals with type 2 diabetes. Diabetes Care 33:748–750, 2010

      Seeger JP, Thijssen DH, Noordam K, Cranen ME, Hopman MT, Nijhuis-van der Sanden MW: Exercise training improves physical fitness and vascular function in children with type 1 diabetes. Diabetes Obes Metab 13:382–384, 2011

      Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD: Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 29:1433–1438, 2006

      Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C: Physical activity/exercise and type 2 diabetes. Diabetes Care 27:2518–2539, 2004

      Stevens RJ, Kothari V, Adler AI, Stratton IM: The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clin Sci (Lond) 101:671–679, 2001

      U.S. Preventive Services Task Force: Screening for coronary heart disease: recommendation statement. Ann Intern Med 140:569–572, 2004

      Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA, Certo CM, Dattilo AM, Davis D, DeBusk RF, et al.: Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Clin Pract Guidel Quick Ref Guide Clin (17):1–23, 1995

      Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Heller GV, Iskandrian AE, Wittlin SD, Filipchuk N, Ratner RE, Inzucchi SE: Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA 301:1547–1555, 2009

      Chapter 3 Daily Lifestyle Activity

      Individuals with all types of diabetes frequently are deconditioned and live a sedentary lifestyle. Therefore, the first major step in assisting them to exercise more regularly is to focus on incorporating more activities of daily living and other less structured physical activity into their lifestyles (Levine 2005, Johannsen 2008). The U.S. Physical Activity Guidelines (2008) refer to such activities as “baseline activity,” defined as the light-intensity activities of daily life like standing, walking slowly, and lifting lightweight objects. Although individuals vary in how much baseline activity they do, those engaging only in baseline activity are considered to be inactive. For the purposes of this book, daily lifestyle activity includes any unstructured movement done during each day.

      Significant health benefits, such as a reduction in coronary risk factors, can be obtained by incorporating frequent bouts of moderate-intensity activity on most, if not all, days of the week, even if this activity is not a traditional, planned (or structured) one (McBride 2008, Loimaala 2009). A single bout of low-intensity, as opposed to high-intensity, exercise has been shown to substantially reduce the prevalence of hyperglycemia throughout the subsequent 24 h postexercise period in individuals with type 2 diabetes (T2D), demonstrating that activities of daily living also can have a positive effect on blood glucose management (Manders 2010). Although lifestyle physical activity does not entirely take the place of a traditional structured exercise program, in most cases it can be highly effective in helping individuals increase their daily activity level and build a fitness base that will allow them to participate in other, more intense or structured physical activities and exercise programs (Garber 2011).

      Case in Point: Finding Time for Daily Movement

      DC, a 62-year-old woman who has had T2D for 15 years, wants to do more exercise, but cannot find the time or the motivation to do so. Her medications include a daily evening injection of 70 units of long-acting basal insulin (insulin glargine), as well as a daily antidepressant. DC does not test her blood glucose regularly because of the high cost associated with buying strips for her meter (although she does have one). She has never been regularly physically active, and she has been significantly overweight or obese all of her adult life. Although she knows she needs to exercise, she says she has no time or energy left at the end of the day to do any exercise.

      Resting Measurements

      Height: 63 inches

      Weight: 252 lb

      BMI: 44.6 (morbidly obese)

      Heart rate: 95 beats per minute (bpm)

      Blood pressure: 125/80 mmHg

      Fasting Labs

      Plasma glucose: 116 mg/dl

      A1C: 6.7%

      Total cholesterol: 210 mg/dl

      Triglycerides: 85 mg/dl

      High-density lipoprotein cholesterol: 44 mg/dl

      Low-density lipoprotein cholesterol: 149 mg/dl

      Questions to Consider

      1.