Diabetes Mellitus & Hypertension

Exercise physiology
Impaired fasting glucose & diabetes
mellitus
 The normal fasting glucose level is less than 100mgdL̄¹.
 Values between 100 and 125mgdL̄¹ confirmed by
measurements on at least two separate occasions are
designated as impaired fasting glucose (IFG) or insulin
resistance (IR).
 The threshold for diagnosis of diabetes is 126mgdL̄¹.
Diabetes mellitus
 It is a complex metabolic disorder characterized by an
inability to use carbohydrates effectively (glucose
intolerance).
 There are four categories of diabetes based on etiology :
type 1, type 2, gestational (onset during pregnancy) and
other ( genetic abnormalities, medication, or other
illnesses).
 Type 1 diabetes begins most commonly in children and
adolescence but is occurring more frequently in older
individuals. In type 1 , an environmentally triggered
autoimmune process destroys the insulin producing beta cells
in the pancreas. Thus, an external source of insulin must be
supplied.
 Type 2 diabetes is a progressive disease whose diagnosis is
often delayed for years. The underlying causes of type 2 are IR
( an inability to achieve normal rates of glucose uptake in
response to insulin) and defective secretion of insulin by
pancreatic beta cells.
 IR, also called as prediabetes, typically precedes the onset of
type 2 diabetes. It is characterized by slight elevations in blood
sugar level ( impaired glucose tolerance) that get
progressively higher until reaching the level of actual diabetes.
 Causes of IR
 Obesity
 Lack of physical activity superimposed on a genetic
predisposition
 Causes of DM
 Early in progression of type 2 diabetes, insulin may be
produced in sufficient or even excessive amounts
 Note: type 2 diabetes are initially not insulin dependent.
 Pathological complications resulting from diabetes –
 Atherosclerosis
 Impaired myocardial contraction
 Poor peripheral perfusion
 Alternation in blood coagulation mechanisms
 Increased fibrinogen levels
 Cardiac death
The influence of exercise and exercise training on
impaired fasting glucose and diabetes

 Exercise training is important in both the prevention and treatment of

type 2 diabetes and IFG.
 One of the acute effects of exercise is an increase in non-insulin-
dependent uptake of glucose into the active skeletal muscle.
 This effect continues after exercise while the depletion stores of glucose
(as glycogen) are restored.
 Studies have shown increased insulin sensitivity and glucose tolerance
as a result of exercise training
 Exercise prescription
– aerobic exercise for single bout effects changes persisting from 12to
72 hours
 Dynamic resistance exercise session effects lasts more than 72 hours
 According to American Diabetic Association recommends ≥ 4 days per week,
30-50 min per day of moderate to vigorous aerobic and/or dynamic resistance
activity for CVD risk reduction in individuals with IFG or diabetes
HYPERTENSION
 High blood pressure, defined as values equal to or greater
than 140/90mmHg.

Category Systolic (mmHg) Diastolic (mmHg)

Adults (>19yrs)
Normal <120 <80
Prehypertension 120-139 80-89
Hypertension
Stage 1 140-159 90-99
Stage 2 ≥160 ≥100

Adolescents
Mild –moderate ≥144 ≥90
Severe ≥160 ≥104
Pathological complication of hypertension
 All stages of hypertension are association with an
increased risk of CVD.
 Hypertension imposes an afterload on the heart, thus
increasing ventricular muscle hypertrophy (thickness) and
reducing early diastolic filling.
 Hypertension is the leading factor in endothelial injury
and calcium deposition in the coronary arteries, as well as
thickening and stiffening of smaller blood vessels
 Atherosclerosis occurs in hypertensive individuals two or
three times more quickly than in normotensive individuals
 Essential hypertension
for blood pressure to reach the levels of hypertension, either
cardiac output or total peripheral resistance or both must be
elevated.

 Resting high blood pressure-

may injure the endothelium and begin the process of
atherosclerosis.
The influence of exercise and exercise
training on hypertension
 Individual at high risk for developing hypertension- because of genetics,
body composition, primary disease status, or an exaggerated blood
pressure response to acute exercise – can reduce their risk through an
endurance training program.
 High levels of both physical activities and physical fitness are
associated with decreased risk of developing hypertension.
 Dynamic aerobic training reduces resting blood pressure in both
individuals with normal or hypertensive values.
 Blood pressure decreases within 3 weeks to 3 months after training
starts, often does not become fully normalized, and does not decrease
further with continued training.
 A single session of submaximal exercise reduces blood pressure for 1-22
hour post exercise
 Post exercise hypotension
 Exercise prescription;
 Type: primarily aerobic endurance exercise supplemented with
dynamic resistance exercise
 Frequency : most, if not all, days of the week
 Intensity : moderate, for adults this should equal 40-60% HRR
or VO₂R
 Duration : 30-60 mins, either performed continuously or
accumulated in 10min bouts