Exercise as Diabetes Medicine

Physical activity linked to lowering risk of developing type 2 diabetes.

Sheri Colberg-Ochs By Sheri Colberg-Ochs, PhD

Maybe you know that following a "diabetes diet" and taking your diabetes medications as prescribed are both important to controlling your condition, but are you aware that there is an equally important third cornerstone in diabetes management and prevention? Regular exercise! Exercise enhances your body's sensitivity to insulin, usually resulting in better blood sugar control. Unfortunately, physical activity is generally the most overlooked diabetes management tool of all even though it's the easiest to prescribe, and it's very likely the best "medicine" to control your condition.

Over the past decade, many studies have assessed people's exercise habits and concluded that regular physical activity is associated with a lower risk for developing type 2 diabetes. Much of this research retrospectively examined large groups using recall questionnaires or brief physical exams to assess people's current health status, lifestyle habits, and risk, and they heavily relied on often unreliable, self-reported exercise habits. Regardless, in these studies, self-reported "active" individuals were still generally leaner, with lower levels of abdominal fat, better glucose levels and insulin action, and a lower risk of developing diabetes than their sedentary peers.

Only recently have landmark research studies directly assessed the impact of regular physical activity on the prevention of type 2 diabetes. In particular, the Diabetes Prevention Program (DPP) studied 3,234 overweight American adults with impaired glucose tolerance at high risk for diabetes, at least 45% minorities (African-Americans or Hispanics), known for having the highest risk of developing it. The adults in the "lifestyle arm" of the study were asked to follow a lower fat diet and increase their exercise to include 150 minutes (2.5 hours) per week of a moderate-intensity activity like brisk walking, spread out over at least three days and done for a minimum of ten minutes at a time. After three years, participants had reduced their average risk of developing diabetes by a whopping 58% despite their high-risk status. Moreover, this reduced risk was evident regardless of their ethnicity, age, or sex – in fact, the effect was even greater among older individuals! A similar Finnish lifestyle study resulted in the same exact 58% decrease in diabetes risk.

Since the DPP study utilized combined lifestyle changes, it did not directly test how much physical activity contributed by itself without simultaneous changes in diet and body weight. However, the active DPP participants lost an average of only 7% of their body weight (equivalent to a loss of 14 pounds in a 200-pound person). Subjects in the Finnish study lost similar amounts of body weight, lowered their fat intake, ate less saturated fat and more fiber, and added 30 minutes of daily walking and occasional resistance training. Thus, extensive loss of body weight is apparently not essential for diabetes prevention, and other recent research has confirmed that it's better to be "fat and fit" than lean and sedentary when it comes to staying healthy.

Since exercise appears to be so effective, why aren't people convinced yet that being active is essential? Like with most things, maybe it simply takes a while for a new idea to sink it. To prove the point yet again, another recent study, the Diabetes In Control 10,000 Step Study, recruited people who already had type 2 diabetes and asked them to increase their physical activity without changing in their diets. They had to be willing and committed to taking at least 10,000 steps throughout each day (equal to roughly five miles of walking), monitored with pedometers. Forty-four diabetic adults completed the study, clocking in over three million steps, or 15,000 collective miles over three months. The conclusion was that diabetic adults, wearing pedometers and with a daily goal to become more active all day (increasing from 3,000 steps up to 10,000), improve their physical fitness levels, blood sugars, cholesterol levels, blood pressure, and body weight; moreover, many of these improvements occur in the first four weeks. By the end of the study, over 15 participants had reduced dosages of their various medications (including diabetes-related ones), six had completely eliminated some, and three had gone off all medications completely, with only a minimal weight loss of four pounds.

In addition, if you exercise regularly, a bad diet will not have the same negative impact on your insulin action; the relative glycemic effect of foods is lower because your insulin works better to lower any glycemic spikes. In other words, an overweight, but fit individual will better utilize carbohydrate just by having more insulin-responsive muscles. Thus, lack of exercise is also a potentially more potent contributor to ineffective diabetes management than misguided dietary choices! Regular exercise done without any attention to eating, though, will have less of an influence on the prevention or control of diabetes. For that reason, a quality diet is also an important component in treating diabetes, and the two are best done together – that is, daily activity plus a healthier diet.

Finally, even regular walking can keep you from dying sooner. In a recent study, diabetic adults of all ages who walk at least two hours per week have a 39% lower risk of dying from any cause and a 34% reduction in their risk of dying from heart disease. People with diabetes also have a higher risk of joint-related injuries, so adoption of a moderate program of walking may be more suitable for most of them than a more vigorous exercise like running. Exercise can likely prevent many of the complications related to poor glycemic control. Diabetes alone is an extremely strong risk factor for heart disease, and physical inactivity is also associated with a higher risk of dying from heart disease. With regular exercise, you can improve blood sugars and reduce both heart disease risks at once! It also lessens the potential impact of elevated blood lipids (cholesterol and other blood fats), insulin resistance, and hypertension.

So, stop thinking of exercise as being any less important in both the prevention and treatment of type 2 diabetes than a better diet and prescribed medicines. Exercise truly is one of the best diabetic "medicines" you will ever have!

For more information on all of the mental benefits of physical activity, please consult my new book, The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight. Check my Web site (www.shericolberg.com) for more details or to order a copy today.

Read Sheri's bio here.

Read more of Sheri Colberg-Och's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.


Last Modified Date: December 06, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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