Diabetes Self-Management Blog

The first session I attended at last month’s ADA Scientific Sessions featured three experts on the effects of exercise. The room was packed with interested doctors. The moderator assured us that all three researchers were "well-funded," which I guess is high praise in research circles.

William Haskell, M.D., of Stanford University’s Center on Longevity answered the questions: “How much exercise do we need?” and “How much is too much?” He is on the National Institutes of Health (NIH) committee creating the national exercise guidelines that will be released in October.

One startling conclusion is that the first step is the most valuable. Even minimal exercise is significantly better than none. Just 70 minutes a week (10 minutes a day) of moderate-intensity exercise (such as a very brisk walk) probably gets you half the benefit you can get. Doing 150 minutes a week gets you most of the rest. (Dr. Haskell reported that 90 minutes a week of moderate exercise reduces death rates by 20%.) There is apparently very little additional health benefit from going over 240 minutes a week.

But that 10 to 30 minutes a day is super-important, Dr. Haskell said. Even three days of bed rest causes insulin resistance, even among athletes! So you can imagine what no exercise might do to someone who is already insulin resistant. Even light activity reverses most of this insulin resistance.

Fit vs. Fat
Timothy Church, M.D., M.P.H., Ph.D., of the Pennington Biomedical Research Center at Louisiana State University answered the question, “Which is more important, getting physically fit or losing weight?” He had explored this “fatness vs. fitness” issue for years at The Cooper Institute in Houston, a leading exercise research center.

The short answer was that when it comes to developing Type 2 diabetes, “obesity is somewhat more important than physical activity.” But when it comes to death from cardiovascular disease (heart disease and strokes), fitness is much more important than weight. And since most people with diabetes die from cardiovascular disease, exercise is the most important medicine when it comes to survival for people with diabetes, especially Type 2.

Dr. Church agreed that 10 minutes a day was very valuable and that 150 minutes a week was enough for most people when it comes to fitness. But he cited the DREW (Dose Response to Exercise in Women) study to explain that sustained weight loss requires more work. To lose weight, 150 minutes a week is enough. But to keep it off, you probably will need more like 45 to 60 minutes a day of moderate to vigorous exercise.

Does Weight Training Help?
Gary Hunter, Ph.D., of the University of Alabama showed that there is much more to exercise than walking and running. He cited studies that show that resistance training (usually with weights) increases strength and muscle mass, and decreases fat and inflammation. All of this is good news for people with diabetes. Weight training might be better than aerobics for many people, although combining aerobics and resistance training is best.

Resistance training also tends to make bones stronger and denser. So if you have concerns about osteoporosis, strength training is great medicine.

So the bottom line is that even small amounts of physical activity are extremely helpful. Being a complete couch potato is extremely bad. And you can try almost any kind of activity. It doesn’t have to be all walking.

Does this match up with your experience? I personally think that 150 minutes a week is doable, and most people can feel the benefits quickly, especially in improved mood, but also in things like blood glucose readings. Has it worked like that for you?

If you’re interested in what else went on at ADA, you can see abstracts of all the presentations at scientificsessions.diabetes.org.

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Comments
  1. These recommendations are consistent with most of what I’ve read over the last 10 year. A panel of experts 5 years ago came out with recommendations that were so rigorous - 60 minutes most days per week - that I’m afraid some people used the guidelines as an excuse to give up.

    -Steve Parker, M.D.

    Advanced Mediterranean Diet Blog

    Posted by Steve Parker, M.D. |
  2. Dear David.

    Everything sounds reasonable.

    And it is probably true that 60 minutes a day of intensive exercise may be needed for sustained weight loss. When I lost 85 lb, 10 miles or more of bicycling per day was essential and so was eating 1500 calories or less. Unfortunately specially since starting insulin I have regained 60 of these pounds. It would be interesting to hear stories from people that have lost weight and are on insulin.

    Weight lifting( bench press and inclined bench press)is very useful in my case even though growing more muscle mass is unlikely without ordering some testosterone from the net. Some people do, as I saw a girl with very rippling muscles at the gym. But not loosing the remaining muscle mass is achievable. And the huge bonus is no more back pain even when lugging our backpacks around France.

    And of course you must do at least enough aerobic exercise to warm up prior to weight lifting and the more the better.

    Thanks for the first class report.

    Posted by CalgaryDiabetic |
  3. Hi CD,
    The insulin/weight-gain pattern is super common. It’s one reason a lot of people don’t want to take insulin. What have other readers done about this problem?
    Enjoy France!
    David

    Posted by David Spero RN |
  4. Dear David. If someone somehow could develop a stategy to contreact the massive weight gain of insulin intensive therapy this would be a gift from the God’s. Please do some blogs that would stimulate discusion so that we could get many comments and therby at least develop some ideas that could be tried if only to give some hope temporalily. Otherwise insulin is a very good tool to control blood sugar but a disastrous weight gain is the price many people pay. I can look in all my extensive battles and maybe offer some ideas why weight gain occurs. Some could be psychological like the fear of hypoglyceamia makes yoy eat preventitively and continiusely and hence too much.

    Posted by CalgaryDiabetic |
  5. I have been an insulin-dependent diabetic for almost 20 years. My experience (being overweight, having diabetes, and taking insulin) is that there is a very direct correlation between carbohydrates and insulin. The more carbs I eat, the more insulin I require to keep my blood sugar levels down and I gain weight. When I limit the carbs I eat, I require less insulin and I am able to shed weight. It is also easier to keep blood sugar readings from swinging very high and very low, when carbohydrate intake is minimal. When someone goes on insulin to pull his/her blood surgar readings back down to a normal level, and they are not careful of the types of foods they are eating, weight gain is probably to be expected… especially if that someone is older, not so active and has a slower metabolism than he/she might have had at a younger age.

    Posted by Pepper |
  6. I have been diabetic for 20 years and on insulin the past 3 years plus the oral meds. I have joined a gym and was persistent to shed pounds and get in shape but I have already had one knee replaced and the other want is not in very good shape either. I am on injections of that knee and it makes it possible to bare the pain but regular exercise (walking, bike riding) causes pain that even when trying to sleep is difficult. After watching my diet and exercising 5 times weekly for 30 to 45 minutes each time I was able to shed about 3 pounds. I went in for a visit with the doctor and voiced my frustration and she said that I had done very well and she knew I was my job to get weight off because she had started me on ACTOS and most people gain ten pounds just from the medication. I had not been told that. Is there something I can take that will not cause weight gain? The other medication I take is METOFORMAN(two 1000 mg. tablets per day). I need the other knee operation but when I had the previous one done my blood sugar was out of sight.

    Posted by pat knipper |
  7. Hi Pat,
    I’m going to write about the problems of diabetes meds causing weight gain soon. It sounds like you are working really hard to keep active, but the knee problems are getting in the way. Have you considered water exercise? Especially in deep water, it takes all the strain off the knees. Even shallow water exercise is easier on the knees than dry land.
    David

    Posted by David Spero RN |
  8. Dear Pepper you are right on the money, the more insulin the more weight gain cutting carbs to the bone specially any grain products, and to hell with whole wheat, is a must.

    Pat you are also right 11 years ago when I first got diabetes and was not on insulin eating only 1500 calories per day and bicycling a minimum of 10 miles per day was no sweat. Now at 57 I find if I go to the gym more than once a week everything hurts and of course even if you don’t go it still hurts. Maybe our GPs could prescribe morphine so that we could exercise more.

    Dear David. We need more info on how to loose weight when on insulin which may be equivalent to breaking a crack addiction. I am trying Metformin and Lantus (50 units per day) with minimal( less than 10 u/day) or no Novorapid. And of course no bread, pasta , rice, patatos, pancakes, pirogies or any such toxicity. Hunger is a lot less but Metformin really makes me feel quite sick.

    Posted by CalgaryDiabetic |

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