Exercise: A Key Component of Diabetes Management

Abstract

Exercise has long been recognized as an essential component of diabetes management. Elliot Joslin once referred to exercise as “the second steed in the diabetic's three-horse chariot,” sharing equal billing with diet and insulin.1 Subsequent generations of diabetes practitioners have established exercise as one of the four cornerstones of care (along with diet, medication, and monitoring) and have come to learn a great deal more about the mechanisms by which exercise is able to provide such profound benefits for physical health. Atherosclerotic vascular disease remains the number one killer of people with diabetes, and research has shown exercise to be of tremendous utility in its treatment. It is known that exercise ameliorates many of the known vascular disease risk factors, favorably influencing levels of blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and glycemia.2 More recent research suggests that exercise may exert similarly favorable effects on emerging vascular disease risk factors as well, including thrombosis, endothelial function, and levels of C-reactive protein.2,3 Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise appears to aid in the loss of visceral fat, quite literally getting to the core of the metabolic syndrome. Results of the Diabetes Prevention Program4 demonstrated that as little as 150 minutes per week of moderate exercise as part of a lifestyle intervention significantly decreased the progression of type 2 diabetes in patients with preexisting impaired glucose tolerance. These findings were comparable to those of the Finnish Diabetes Prevention Study.5 The magic bullet–like ability of exercise to counter much of the metabolic disruption and ensuing pathology occurring in diabetes is beyond remarkable and has understandably led to greater emphasis being placed on the physiological benefits of exercise. Lesser known, and far less celebrated, …