Module 3: Cardiovascular Exercise for Diabetes

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Questions and Answers

What is the target LDL (bad) cholesterol level for individuals managing diabetes?

Less than 1.5 mmol/L

Less than 2.5 mmol/L

Less than 3.0 mmol/L

Less than 2.0 mmol/L (correct)

Which of the following is NOT a recommended strategy for managing diabetes complications?

Maintaining a healthy body weight

Controlled blood pressure under 130/80 mmHg

Eating any type of food regardless of glycemic index (correct)

Regular screening for kidney and eye health

What is the recommended minimum duration of moderate-to-vigorous intensity activity per week for individuals with diabetes?

120 minutes

90 minutes

75 minutes

150 minutes (correct)

Why does insulin decrease during exercise?

To facilitate glucose uptake by muscles Signup and view all the answers

Which class of medications enhances insulin secretion?

Sulfonylurea Signup and view all the answers

What is a main component of diabetes management related to personal goals?

Self-management and stress control Signup and view all the answers

Which of the following represents the correct recommended blood pressure target for diabetes management?

Less than 130/80 mmHg Signup and view all the answers

Which of the following is a recommended action for smoking cessation?

Seek support to quit smoking Signup and view all the answers

What significantly impacts glucose transport during exercise?

It is influenced by metabolic byproducts and muscle contraction. Signup and view all the answers

How does exercise affect insulin sensitivity in individuals with high intramuscular triglyceride (IMTG) concentrations?

It enhances insulin sensitivity despite high IMTG levels. Signup and view all the answers

What is the role of GLUT-4 during exercise?

It translocates to the plasma membrane to facilitate glucose uptake. Signup and view all the answers

What metabolic environment is necessary for the improvement of insulin sensitivity following a single session of exercise?

A high fatty acid availability. Signup and view all the answers

Which statement about the effects of a single session of exercise is accurate?

It may promote the synthesis of lipogenic enzymes. Signup and view all the answers

What signaling molecule is involved in the transport of glucose during exercise?

AMPK Signup and view all the answers

What happens to fatty acids during exercise when their availability is high?

They are partitioned towards storage as IMTG. Signup and view all the answers

What main effect does exercise have on reactive oxygen species (ROS) concerning glucose metabolism?

They assist in signaling for glucose uptake. Signup and view all the answers

How does acute exercise impact lipid-induced insulin resistance?

It prevents lipid-induced insulin resistance. Signup and view all the answers

Which mechanism allows GLUT-4 translocation to remain effective in diabetes during exercise?

Exercise stimulated movement. Signup and view all the answers

What physiological change is observed in skeletal muscle after acute exercise?

Enhanced IMTG storage. Signup and view all the answers

What was observed regarding hyperglycemia in 'well controlled' diabetics?

It was present for 13 out of 24 hours. Signup and view all the answers

What effect does acute exercise have on reactive lipids?

It reduces the formation of reactive lipids. Signup and view all the answers

What is the significance of AS160 in glucose transport during exercise?

It facilitates the movement of GLUT-4 vesicles. Signup and view all the answers

What is a key benefit of acute exercise for insulin and glucose levels?

It enhances both insulin and glucose transport mechanisms. Signup and view all the answers

Which of the following accurately defines diabetes?

A chronic metabolic disease characterized by hyperglycemia due to insulin-related defects. Signup and view all the answers

What is a major contributing factor to high blood glucose levels in type 2 diabetics?

Insulin resistance in peripheral tissue. Signup and view all the answers

What role does exercise play in the management of diabetes?

It aids in both acute and chronic management of blood glucose levels. Signup and view all the answers

Which of the following complications might arise during exercise for a diabetic individual?

Increased insulin sensitivity leading to hypoglycemia. Signup and view all the answers

Which of the following types of diabetes is characterized by destruction of pancreatic beta cells?

Type 1 diabetes. Signup and view all the answers

Which statement correctly describes glucose transport in skeletal muscle?

It is facilitated by the GLUT-4 vesicle upon insulin or exercise stimulation. Signup and view all the answers

What defines gestational diabetes?

Glucose intolerance recognized during pregnancy due to pregnancy-related hormonal changes. Signup and view all the answers

What is the primary difference between type 1 and type 2 diabetes?

Type 1 is due to the destruction of beta cells, whereas type 2 involves insulin resistance and defective secretion. Signup and view all the answers

What is the recommended exercise frequency for maximizing cardiovascular benefits in diabetes management?

Greater than 3 days per week Signup and view all the answers

What should be taken into account for individuals on hypoglycemic medication during exercise?

Food intake and carbohydrate requirements Signup and view all the answers

Which combination of exercise types is suggested to improve blood glucose control for individuals with T2DM?

A combination of aerobic and resistance exercise Signup and view all the answers

What is a significant health concern for individuals with T2DM and prediabetes related to exercise?

Healthy weight loss and maintenance Signup and view all the answers

What blood glucose condition indicates a risk of hypoglycemia during moderate exercise?

Glucose utilization exceeds glucose production Signup and view all the answers

How much additional carbohydrate is recommended for each hour of vigorous or long-duration exercise?

15-30 g CHO Signup and view all the answers

What reflects a normal response to exercise regarding glucose homeostasis in individuals without diabetes?

A precise coordination of hormonal and metabolic events Signup and view all the answers

What is a common problem for diabetics when they engage in exercise?

Insufficient insulin response to exercise Signup and view all the answers

What are the direct benefits of chronic aerobic and resistance training in diabetics?

Improves insulin action and blood glucose control Signup and view all the answers

Which of the following factors is NOT recognized as a risk factor for the development and progression of type 2 diabetes that can be reduced by exercise?

Physical inactivity Signup and view all the answers

How does exercise influence glucose transport independent of insulin resistance?

By stimulating glucose transport pathways Signup and view all the answers

What effect does a high lipid environment have on glucose metabolism in diabetics?

It results in insulin resistance and hyperglycemia Signup and view all the answers

According to the documented outcomes, what is a significant long-term effect of both acute and chronic exercise on glucose levels in diabetics?

Reduces glucose levels for an extended timeframe Signup and view all the answers

What is the primary goal of exercise training in diabetes management?

Prevention of diabetes-related complications Signup and view all the answers

What important health assessment should be conducted annually for individuals with diabetes?

CVD risk factor assessments Signup and view all the answers

Which mechanism of exercise is highlighted as potentially bypassing lipid-induced insulin resistance?

Promoting GLUT-4 transport to muscle membranes Signup and view all the answers

Study Notes

Module 3: Cardiovascular Exercise Principles - Week 3

Module is about cardiovascular exercise principles, specifically focusing on exercise prescription for diabetes.
The module is taught by Dr. Tanya Holloway, PhD, ACSM-RCEP.

Learning Objectives

Define diabetes.
Identify the physiological processes involved in regulating blood glucose, and explain factors contributing to high blood glucose levels in type 2 diabetes.
Identify the treatment goals for diabetes, and justify the role of exercise in acute and chronic management.
Describe complications that can arise with exercise in diabetics.
Design effective exercise strategies for managing type 2 diabetes.

Diabetes

A chronic metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion or an inability to utilize insulin.
Types:
- Type 1: An autoimmune disease caused by the destruction of beta cells in the pancreas, stopping insulin production.
- Type 2: A metabolic disease caused by insulin resistance in peripheral tissues and defective insulin secretion.
- Gestational Diabetes: Glucose intolerance with onset or first recognition during pregnancy due to contra-insulin effects of pregnancy.

Blood Glucose Control in Type 2 Diabetes

Blood glucose control is impaired in Type 2 Diabetes.

24-hour Blood Glucose Control

Van Dijk et al. (2015) Diabetes Journal 28(24-30) studied 24-hour blood glucose control.

Overview of Glucose Transport in Skeletal Muscle

Glucose
Blood
Insulin
Exercise
Cytosol
GLUT-4 vesicle
Key point: Glucose transport into skeletal muscle can be insulin-stimulated or exercise-stimulated.

Insulin-Stimulated Glucose Transport

Elevated circulating glucose stimulates insulin release from the pancreas.
Insulin acts by binding to its receptor on the membranes of target tissues.
Skeletal muscle accounts for 50-80% of insulin-stimulated glucose uptake
Accounts for 40% of body mass.
Key Point: Insulin stimulates the movement of GLUT-4 to the skeletal muscle membrane to enhance glucose transport.

Pathophysiology of Insulin Resistance

Adipose tissue (AT) becomes insulin-resistant before skeletal muscle.
Healthy adipose tissue (AT)
Adipocyte hypertrophy
Inflammation
ROS emission
Lipolysis
Caloric surplus
FFA-Alb
Resulting in increased release of fatty acids from adipose tissue and accumulation in skeletal muscle.
Frangos SM et al. (2021) Biochem J.

The Effect of Excess Lipids on Insulin Signaling

Adipose tissue insulin resistance increases circulating lipids.
Lipid transporters accumulate on the skeletal muscle membrane.
Increased transport of lipids into skeletal muscle results in reactive lipids (DAGs, ceramides).
Accumulation of reactive lipids impairs insulin signaling.

Diabetic Complications

Acute Complications
- Hyperglycemia:
  - Manifestations:
    - Headache
    - Weakness
    - Fatigue
- Hypoglycemia:
  - Potential causes:
    - Diabetes out of control
    - Diabetic ketoacidosis
    - Hyperglycemic hyperosmolar nonketotic syndrome
Chronic Complications
- Peripheral neuropathies
- Somatic neuropathy
- Autonomic neuropathy
- Nephropathies
- Retinopathies
- Macro/microvascular complications
- Diabetic foot ulcers
- Infections

Exercise Prescription in Diabetes

Follow the ABCDEs:
- A1C (Blood Sugar)
- Blood Pressure
- Cholesterol
- Drugs (Medications)
- Exercise and Meal Planning
- Screening for Complications
- Smoking Cessation
- Self Management
Exercise Strategies:
- Regular exercise (150 minutes or more moderate-to-vigorous intensity activity weekly, spread over at least 3 days/week) is crucial for diabetes management.
Treatment Goals for Diabetes:
- Diet (when and what to eat)
- Medication (insulin, oral glucose-lowering agents, antihypertensives, lipid lowering agents)
- Regular exercise.
Exercise Duration: 150 minutes or more of moderate to vigorous intensity activity weekly. Shorter duration of vigorous intensity or interval training is also sufficient for younger and more physically fit individuals.
Key point: Acute exercise reduces glucose levels for an extended period in diabetics. Acute exercise induces GLUT-4 translocation. Exercise can bypass lipid-induced insulin resistance.
Contraindications: - Blood glucose levels over 14mmol/L and presence of ketones - Blood glucose levels under 4mmol/L - Specific exercise types may be unsuitable for individuals with peripheral neuropathy, retinopathy and nephropathy.

General Exercise Prescription for Diabetes

Individualized
Include endurance and resistance exercises
Food intake must be considered for individuals on hypoglycemic medication
Acute exercise prevents lipid-induced insulin resistance in diabetes, improves insulin and exercise-stimulated glucose transport

Glucose Control Goals in Diabetes

Glucose control
Prevention of diabetes-related complications.
CVD risk factor reduction.

Additional Notes:

Exercise testing is important for individuals with diabetes.
Diabetes mellitus requires exercise and medication management in conjunction.
Exercise prescription for diabetes should be individualized, considering medication, complications and the goals of the exercise program.

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Description

This module focuses on the principles of cardiovascular exercise, specifically tailored for individuals with diabetes. It covers the physiological processes involved in blood glucose regulation, exercise treatment goals, and effective strategies for managing type 2 diabetes. Learn how to safely incorporate exercise into diabetes management.