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576 Exercise and Physical Activity in Diabetes Mellitus

WITH DIABETES specific reference to change in body weight and fat
stores. Compared with the control group, supervised
 Lower blood glucose  Improvement in mild exercise produced significant improvements in cardio
concentrationsDuring to moderate hyperten- respiratory fitness, upper and lower body strength,
and after exercise sion HbA C, systolic and diastolic blood pressure, total
1
 Lower basal and post  Increased energy ex- serum cholesterol, HDL-C and LDL-C, body mass
prandial insulin concen- penditure index (BMI), waist circumference, insulin resistance,
trations inflammation (C reactive protein), leptin and CHD risk
 Adjunct to diet for scores, independent of body weight loss. It is also
weight reduction
said that aerobic training increased mitochondrial
 Increased fat loss density, oxidative enzymes, pulmonary function, im-
mune function and cardiac output.
 Preservation of lean
body mass Two meta analysis have shown that regular exercise
undertaken, can decrease the overall risk of cardio-
vascular events up to 50%, from various mechanisms
 Improved insulin  Cardiovascular condi- including anti atherosclerotic, antiishemic, antiar-
sensitivity tioning rhythmic, antithrombotic and psychological effects.
 Lower HbA1C levels  Increased strength As already noted, aerobic exercise with or without
and flexibilit resistance training, has favorable effects on the di-
 Improved lipid profile  Improved sense of abetic patients cardio vascular risk factors profile as
well being and quality well as on coagulability, fibrinolysis and coronary en-
 Increased triglycerides dothelial function. It is also said that 40% of the risk
of life
 Slightly decreased reduction presumably not explained by changes in
LDL cholesterol conventional risk factors, a cardio protective vascular
condition effect of the exercise including enhanced
 Increased HDL2 cho- nitric oxide vasodilator function, improved vascular
lesterol reactivity, altered vascular structure or combination

Cardio Vascular Benefits of Regular Exercise: thereof has been proposed. Increased threshold to
life threatening arrhythmias and increased resistance
Several recent randomized controlled trails in pa- to ventricular fibrillation have also been postulated,
tients with T DM have investigated the effects of reflect exercise-related autonomic system adapta-
2
moderate to vigorous aerobic exercise and resistance tion. Endurance training produces reduction in rest-
training on cardio respiratory fitness, modifiable car- ing sympathetic drive. Vagal tone and heart rate vari-
dio vascular risk factors and arterial stiffness, with ability are increased (fig 1)

Fig 1: Cardio Protective Effects of Regular Exercise

ANTIATHERO- ANTITHROMBOTIC ANTIISHEMIC AUTIARHYTHMIC PSYCHOLOGIC
SCLEROTIC
Improved lipid Decreased platelet Decreased Myocardial Increased Vagal tone Decreased Depres-
profile aggregability O2 demand sion
Lower blood Increased Fibrino- Increased coronary Decreased adrenergic Decreased Stress
pressure lysis blood flow activity
Reduced adi- Decreased Fibrino- Decreased Endothelial Increased heart rate Increased social fit-
posity gen dysfunction variability ness
Increased insu- Decreased blood Increased endo- thelial
lin sensitivity viscosity progenitor cells & cul-
tured angiogenic cells
Decreased in- Increased Nitric oxide
flammation

GCDC 2017