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?

<p>To facilitate glucose uptake by muscles (A)</p> Signup and view all the answers

Which class of medications enhances insulin secretion?

<p>Sulfonylurea (B)</p> Signup and view all the answers

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

<p>Self-management and stress control (C)</p> Signup and view all the answers

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

<p>Less than 130/80 mmHg (D)</p> Signup and view all the answers

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

<p>Seek support to quit smoking (C)</p> Signup and view all the answers

What significantly impacts glucose transport during exercise?

<p>It is influenced by metabolic byproducts and muscle contraction. (B)</p> Signup and view all the answers

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

<p>It enhances insulin sensitivity despite high IMTG levels. (C)</p> Signup and view all the answers

What is the role of GLUT-4 during exercise?

<p>It translocates to the plasma membrane to facilitate glucose uptake. (D)</p> Signup and view all the answers

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

<p>A high fatty acid availability. (A)</p> Signup and view all the answers

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

<p>It may promote the synthesis of lipogenic enzymes. (B)</p> Signup and view all the answers

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

<p>AMPK (C)</p> Signup and view all the answers

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

<p>They are partitioned towards storage as IMTG. (B)</p> Signup and view all the answers

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

<p>They assist in signaling for glucose uptake. (A)</p> Signup and view all the answers

How does acute exercise impact lipid-induced insulin resistance?

<p>It prevents lipid-induced insulin resistance. (C)</p> Signup and view all the answers

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

<p>Exercise stimulated movement. (A)</p> Signup and view all the answers

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

<p>Enhanced IMTG storage. (D)</p> Signup and view all the answers

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

<p>It was present for 13 out of 24 hours. (A)</p> Signup and view all the answers

What effect does acute exercise have on reactive lipids?

<p>It reduces the formation of reactive lipids. (C)</p> Signup and view all the answers

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

<p>It facilitates the movement of GLUT-4 vesicles. (A)</p> Signup and view all the answers

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

<p>It enhances both insulin and glucose transport mechanisms. (A)</p> Signup and view all the answers

Which of the following accurately defines diabetes?

<p>A chronic metabolic disease characterized by hyperglycemia due to insulin-related defects. (A)</p> Signup and view all the answers

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

<p>Insulin resistance in peripheral tissue. (B)</p> Signup and view all the answers

What role does exercise play in the management of diabetes?

<p>It aids in both acute and chronic management of blood glucose levels. (B)</p> Signup and view all the answers

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

<p>Increased insulin sensitivity leading to hypoglycemia. (D)</p> Signup and view all the answers

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

<p>Type 1 diabetes. (D)</p> Signup and view all the answers

Which statement correctly describes glucose transport in skeletal muscle?

<p>It is facilitated by the GLUT-4 vesicle upon insulin or exercise stimulation. (A)</p> Signup and view all the answers

What defines gestational diabetes?

<p>Glucose intolerance recognized during pregnancy due to pregnancy-related hormonal changes. (B)</p> Signup and view all the answers

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

<p>Type 1 is due to the destruction of beta cells, whereas type 2 involves insulin resistance and defective secretion. (A)</p> Signup and view all the answers

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

<p>Greater than 3 days per week (D)</p> Signup and view all the answers

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

<p>Food intake and carbohydrate requirements (D)</p> Signup and view all the answers

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

<p>A combination of aerobic and resistance exercise (D)</p> Signup and view all the answers

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

<p>Healthy weight loss and maintenance (C)</p> Signup and view all the answers

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

<p>Glucose utilization exceeds glucose production (C)</p> Signup and view all the answers

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

<p>15-30 g CHO (B)</p> Signup and view all the answers

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

<p>A precise coordination of hormonal and metabolic events (C)</p> Signup and view all the answers

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

<p>Insufficient insulin response to exercise (C)</p> Signup and view all the answers

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

<p>Improves insulin action and blood glucose control (C)</p> 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?

<p>Physical inactivity (C)</p> Signup and view all the answers

How does exercise influence glucose transport independent of insulin resistance?

<p>By stimulating glucose transport pathways (B)</p> Signup and view all the answers

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

<p>It results in insulin resistance and hyperglycemia (D)</p> 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?

<p>Reduces glucose levels for an extended timeframe (A)</p> Signup and view all the answers

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

<p>Prevention of diabetes-related complications (D)</p> Signup and view all the answers

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

<p>CVD risk factor assessments (D)</p> Signup and view all the answers

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

<p>Promoting GLUT-4 transport to muscle membranes (A)</p> Signup and view all the answers

Flashcards

Type 2 Diabetes

A metabolic disorder where the body's cells don't respond properly to insulin, leading to high blood sugar.

Insulin Resistance

Cells in the body do not respond effectively to the hormone insulin, hindering glucose uptake.

High Blood Glucose

Elevated levels of glucose in the blood, a hallmark of diabetes.

Blood Glucose Control

Maintaining a balanced level of glucose in the bloodstream.

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GLUT-4

A type of glucose transporter facilitating glucose uptake into cells, including skeletal muscles.

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Exercise-stimulated glucose transport

Body's ability to draw glucose from the bloodstream during exercise, regardless of insulin.

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Type 1 Diabetes

An autoimmune disease causing the destruction of insulin-producing pancreatic cells.

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Diabetes Treatment Goal

Maintaining healthy blood sugar levels to prevent complications.

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A1C Test

Measures your average blood sugar level over the past 120 days. It's a good indicator of long-term blood sugar control.

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Blood Pressure Goal

Aim for a blood pressure reading of less than 130/80 mmHg.

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LDL Cholesterol Goal

Keep your LDL (bad) cholesterol below 2.0 mmol/L.

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Diabetes Medications

Medications help manage blood sugar levels. Speak to your doctor about options.

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Exercise & Diet for Diabetes

Regular physical activity and a healthy diet are crucial for managing diabetes.

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Diabetes Complications Screening

Regular checks for heart, feet, kidneys, and eyes are essential.

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Smoking and Diabetes

Quitting smoking is vital for people with diabetes. Seek support if needed.

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Self-Management for Diabetes

Working towards goals, managing stress, and addressing barriers are all part of self-management.

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Acute Exercise & Glucose

Short bursts of physical activity can lower blood sugar levels for a prolonged period in people with diabetes.

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GLUT-4 Translocation

Exercise triggers the movement of glucose transporter (GLUT-4) to the cell surface, allowing glucose to enter cells even when insulin resistance is present.

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Exercise Bypasses Lipid Resistance

Exercise can overcome the negative effects of lipids (fats) on insulin sensitivity, allowing glucose to enter cells more effectively.

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Exercise Prevents Lipid Resistance

Regular physical activity can reduce the build-up of harmful lipids and promote proper lipid storage, preventing insulin resistance.

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Exercise Enhances Glucose Transport

Acute exercise improves both insulin-mediated and independent glucose uptake by enhancing GLUT-4 translocation and other mechanisms.

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Improved Insulin Sensitivity

A single session of moderate-to-high intensity exercise can lead to significant improvements in insulin sensitivity within a short timeframe.

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Hyperglycemia in Type 2 Diabetes

Even in individuals considered 'well-controlled', high blood sugar levels are common in Type 2 diabetes, occurring for a significant portion of the day.

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Glycemic Instability

Type 2 Diabetes often involves frequent fluctuations in blood glucose levels, highlighting the challenge of managing the condition.

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Exercise & Glucose Transport

Muscles take in glucose during exercise, even if cells are resistant to insulin.

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Muscle Contraction & Signaling

When muscles contract, changes in the cell environment trigger a chain of events that brings glucose transporters to the cell surface.

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What triggers signaling?

During muscle contraction, Ca2+, ADP, and reactive oxygen species (ROS) accumulate, initiating the signaling cascade.

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GLUT-4's Role

GLUT-4 is a protein that helps glucose enter muscle cells. Exercise moves GLUT-4 from inside the cell to the cell membrane.

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Athlete's Paradox

Even though athletes may have high levels of intramuscular triglycerides (IMTG), they are still insulin sensitive.

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Exercise & IMTG

A single exercise session can increase IMTG synthesis and storage, helping to reduce the formation of metabolic byproducts.

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Benefits of exercise in diabetes

Chronic exercise improves insulin action, blood sugar control, cardiovascular health, and reduces risk factors for diabetes complications (like obesity, hypertension, high cholesterol).

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Effect of Exercise on Insulin Sensitivity

A single exercise session can significantly improve insulin sensitivity, even in obese individuals.

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How does exercise help with insulin resistance?

Exercise 'bypasses' the mechanisms causing insulin resistance by promoting proper lipid storage and reducing the formation of reactive lipids.

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IMTG and Fat Availability

The benefit of IMTG storage during exercise may be more significant when fatty acid availability is high, like in obese individuals.

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Glucose transport in skeletal muscle

Glucose can enter skeletal muscle cells through two pathways - either stimulated by insulin or stimulated by exercise.

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Exercise and diabetes complications

Regular exercise helps prevent diabetes-related complications by improving blood sugar control, cardiovascular health, and reducing risk factors like obesity.

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Acute vs. Chronic Exercise

Both acute (single session) and chronic (regular) exercise have positive effects on glucose control in diabetics.

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Exercise and GLUT-4

Exercise stimulates the movement of GLUT-4 to the muscle membrane, increasing glucose transport into the muscle.

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Exercise Prescription for Diabetes

Tailoring exercise routines for individuals with diabetes, considering their type of diabetes, medication schedule, complications, and goals.

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Exercise Frequency in Diabetes

Aiming for at least three exercise sessions per week to maximize cardiovascular benefits for individuals with both types of diabetes.

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Resistance Exercise for Diabetes

Strength training, besides aerobic exercise, offers similar metabolic benefits for individuals with type 2 diabetes.

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Combined Exercise for Diabetes

Combining aerobic and resistance exercise may lead to better blood glucose control compared to either modality alone in individuals with type 2 diabetes.

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Carbohydrate Adjustment for Exercise

Adjusting carbohydrate intake based on exercise duration and intensity, especially important for people on hypoglycemic medication.

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Normal Glucose Homeostasis during Exercise

In individuals without diabetes, hormones and metabolic processes work seamlessly to maintain balanced blood sugar during exercise.

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Hypoglycemia Risk During Exercise

Diabetic individuals may experience low blood sugar due to an imbalance between glucose utilization and production during exercise.

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Common Exercise Problem for Diabetics

Hypoglycemia, or low blood sugar, is the most frequent issue encountered by individuals with diabetes who exercise.

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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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Exercise Prescription for Diabetes PDF

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.

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