DIABETES AND

STRENGTH TRAINING
BY
ARAVIND SREEKUMAR
BPT (INTERN)
Definition:
• Diabetes Mellitus is a clinical syndrome characterized by an abnormal
increase in plasma blood glucose (hyperglycaemia).[1]
What are the Two Main Types of
Diabetes ?
Type 1(T1DM)
• Known as insulin dependent DM.
• Pancreas cannot produce insulin, requiring injections.
• Classified as an autoimmune disease.[1]
“Body attacks and destroys the insulin producing beta cells in the
pancreas”
Type 2 (T2DM)
• Known as non – insulin dependent DM.
“ Either the body does not produce enough insulin or the cells ignore
the insulin.”
• Highly associated to obesity.
• As cells become resistant to insulin, blood glucose levels begins to
soar.[1]
Special Focus: Insulin Resistance
Glucose Tissue/Organs
• Muscles : major consumer, also stores glucose as glycogen.
• Liver: chief organ that stores glucose and distributes between meals.
• Pancreas: responds to glucose levels with secretion of insulin or
glucagon.[1]
Eating Example:
Fasting example:
In T2DM:
Risk Factors
• Family history
• Race (Asian, Hispanic, American and African).
• overweight/obesity
• Age (older much high risk)
• Hypertension
• Heavy alcohol consumption over time
• Cigarette smoking
• h/o gestational DM.[1]
Effects of Exercise on Diabetes
• Exercise helps to increase the insulin sensitivity.
• Therefore , the pancreas doesn’t need to secrete as much insulin.
• Exercise promotes the utilization and breakdown of blood glucose,
thus lowering its circulatory levels.
• During post workout, glycogen depletion prompts glucose uptake(thus
lowering blood glucose).
• Minimal insulin is required for this mechanism.
• Developing muscles (particularly from resistance exercise) store
greater quantities of glycogen, which increases glucose clearance from
blood.[2,3]
Special Focus: Insulin Sensitivity and
Exercise

• Pancreas secretes less insulin during exercise

• Exercise increases ‘sensitivity to insulin’.[2,3]
NEW (ACSM) & American Diabetes
Association (ADA) Exercise
Guidelines for T2DM
(December 2010)
Aerobic training guidelines for diabetes
prevention and management
ACSM & ADA Guidelines
• Perform at least 3 times a week; preferably up to 5 times a week.
• No more than 2 consecutive days between bouts (due to transient
nature of exercise on insulin action)
• 40% - 60% of VO2 max (moderate intensity)
• Greater health benefits at > 60% VO2max.[2]
ACSM & ADA Guidelines
• Duration of >150min per week
• Bouts of > 10 min or more
• Modes : choose modes that use large muscle groups
• Exercise design must progress more gradual for the individuals who
have certain limitations.[2]
Aerobic Exercise recommendations for patients
with impaired sensations
ACSM & ADA Guidelines
AVOID RECOMMENDED
Treadmill Swimming
Jogging Biking
Prolonged walking Rowing
Stepping exercise[2] Chair workouts
Aquatic
Non weight bearing[2]
Resistance training guidelines for diabetes
prevention and management
ACSM & ADA Guidelines
• At least twice weekly on non consecutive days
• Ideally three times a week
• Intensity: Initially 50% of 1RM: 10-15RM
• Gradually increase to 75-80% of 1RM: 8-10 RM[2]
ACSM & ADA Guidelines
• 5-10 exercises of major muscles groups
• “ The majority of the studies with resistance training and diabetic
subjects train the gluteals, thighs, chest, back, core, shoulders and
arms ”
• “ strength training studies with exercise machines and free weights
have shown equivalent benefits for blood glucose control”[2]
ACSM & ADA Guidelines
• Progression recommendations:
1) For GREATER blood glucose control, gradually increase with
heavier weights FIRST vs doing more sets
2) Sets: start with 1 set per exercise progressing to 2-3 sets.
3) If training 2x/week, progress gradually to 3x/week[2]
ACSM & ADA Guidelines
• Optimal Goal:
• May take 6 months to a year or more to attain the following:
1. 3x/wk of resistance training
2. 3 sets of 8-10 reps (75-80% RM) per Ex.
3. Major muscle groups of the body [2]
Resistance exercises for diabetes
ACSM & ADA Guidelines
1. Bench press 9. leg press
2. Chest flies 10. squats
3. Upright row 11. lunge
4. Overhead press 12. calf raises
5. Pull down 13. leg extension
6. Biceps 14. plantar flexion
7. Triceps 15. hip flexion and extension
8. Sit ups
Special Recommendation: supervision
ACSM & ADA Guidelines
• Due to potential complex physical limitations, it is recommended by
ACSM and ADA that diabetic clients doing resistance training always
be properly supervised by a qualified exercise trainer.
• This will help to ensure optimal blood glucose and other health
benefits while minimizing the risk of injury. [2]
RECENT STUDIES
Strength Training and the Risk of Type 2 Diabetes
and Cardiovascular Disease[4]

• Purpose—To examine the association of strength training with

incident type 2 diabetes and cardiovascular disease risk.

• Methods - Incident type 2 diabetes (N cases = 2120) and

cardiovascular disease (N cases = 1742) were confirmed on medical
record review. Cases of cardiovascular disease were defined as
confirmed cases of myocardial infarction, stroke, coronary artery
bypass graft, angioplasty, or cardiovascular disease death
• Results—Compared to women who reported no strength training,
women engaging in any strength training experienced a reduced rate of
type 2 diabetes when controlling for time spent in other activities and
other confounders. A risk reduction of 17% was observed for
cardiovascular disease among women engaging in strength training.
Participation in both strength training and aerobic activity was
associated with additional risk reductions for both type 2 diabetes and
cardiovascular disease compared to participation in aerobic activity
only.
• Conclusions—These data support the inclusion of muscle-
strengthening exercises in physical activity regimens for reduced risk
of type 2 diabetes and cardiovascular disease, independent of aerobic
exercise. Further research is needed to determine the optimum dose
and intensity of muscle-strengthening exercises.
Effects of passive static stretching on blood
glucose levels in patients with type 2 diabetes
mellitus[5]
• Purpose: This study determined the effects of passive static stretching
on blood glucose levels in patients with type 2 diabetes.
• Subjects: Fifteen patients (8 males and 7 females) with type 2 diabetes
were recruited and randomly assigned to the control group or passive
static stretching group.
• Methods: Glycated haemoglobin was measured before and after the 8-
week training period.
• Results: Glycated haemoglobin levels decreased significantly in the
passive static stretching group, and there were significant differences
in blood glucose levels between the 2 groups.
• Conclusion: Passive static stretching of the skeletal muscles may be an
alternative to exercise to help regulate blood glucose levels in diabetes
patients.
Conclusion :
• Aerobic exercise, resistance training and diet are central to the
management and prevention of T2DM
• Losing weight, if obese is most beneficial
• Self care behaviours such as getting enough sleep, quit smoking and
avoiding too much alcohol intake are decisive.
• Physician supervision of medications.
References
1. Davidson, S., Bouchier, I. and Edwards, C. (1991). Davidson's principles
and practice of medicine. 21st ed. E.L.B.S. and Churchill Livingstone,
London.
2. Page, P. and Rogers, M.(2009). First step to active health for diabetes.
Journal on Active Aging, 8(1), 44-53.
3. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the
American College of Sports Medicine and the American Diabetes
Association: joint position statement. Diabetes Care. 2010;33(12):e147-
67.
4. Shiroma EJ, Cook NR, Manson JE, et al. Strength Training and the Risk of
Type 2 Diabetes and Cardiovascular Disease. Med Sci Sports Exerc.
2017;49(1):40-46.
5. Park SH. Effects of passive static stretching on blood glucose levels in
patients with type 2 diabetes mellitus. J Phys Ther Sci. 2015;27(5):1463-
5.
THANK YOU