Obesity is a major risk factor for the development of diabetes and the numbers of people that are becoming obese is increasing rapidly. It is the major cause of premature mortality and morbidity due to cardiovascular, renal, ophthalmic and neurological disease. It is widely accepted that control of the lifestyle situation including diet and exercise decrease the risk of complications and control the Hg1c (Porth & Matfin, 2007). This paper will discuss recent studies affecting the overall Hg1c with combined strength and aerobic exercise programs.
Self management of diabetes includes diet, exercise, medication, and blood sugar control. Exercise, however has been shown to be highly important. Lean muscle mass improves Hg1c (Sigal, Kenny, Boule et.al. 2007). There has been some controversy in determining whether that exercise should be aerobic or strength or both. In researching this, studies relating to diet and other controls were eliminated and a search was conducted for supporting evidence that both types of exercise included in routines for these patients improved overall blood glucose control and limited complications from the disease. Five peer reviewed studies were retained from many found as they included both exercise routines against controls.
Historically, aerobic exercise has been used to attempt to improve glucose levels in diabetic patients. However, there is a great deal of literature available now that shows a great deal of merit for adding resistance exercise to this routine for control. It appears that glucose control is only one of the benefits of this kind of routine for diabetic patients. Strength, endurance, and power are benefits received (Marcus, Smith, Morrell, 2008). There is also an increase in lean tissue mass which creates an increase in metabolic rate. The importance of physical activity in these patients cannot be denied. It is considered not only preventative but also therapeutic (Tokmakidis, Zois, Votaklis, et.al. 2004). The change that occurs in muscle mass coupled with effects on glucose uptake are the reasons for better control. This occurs even in people with insulin resistance.
In operationalizing this data, education is the key. Over the past years, diabetics have been taught that walking is the perfect exercise to control their HgA1c and to some point that is true, it is the perfect exercise. However, there is a gap in the education as far as adding the needed strength training. It may be clearly important, due to the large numbers of diabetics now, to design and implement diabetic exercise programs that are couple with regular education programs. Certainly controlling blood sugar and preventing complications of this disease proves to be financially needed for both the patients and the healthcare system.
Sigal, Kenny, & Boule et.al. (2007) published a study in the Annuls of Internal Medicine on this very issue. Previous studies evaluated by them determined that the effects of aerobic exercise alone provided for better glucose control. They felt that there was likelihood that a combination of aerobic and strength exercises would lead to better control. They performed a randomized control trial set in 8 community based facilities. Included in this study were 251 adults age 39 to 70 with type 2 diabete (Sigal, et.al., 2007). Patients were