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Individualized exercise to battle diabetes Ola Hansson ([email protected])
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
Type 1 diabetes Type 2 diabetes Gestational diabetes
• Lack of insulin • Autoimmune • Usually children
• Defect insulin secretion
• Insulin resistance • Lifestyle factors • Usually adults
• Insulin resistance • During pregnancy • Risks to mother
and child
Main “types” of diabetes
The risk of complications is reduced by good glycaemic control
25 times higher risk of
eye problems
6 times higher risk for stroke
5 times higher risk of kidney
disease
20 times higher risk of
lower limb amputation
2-4 times higher risk for heart attack
High blood glucose leads to long term
complications
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
Seshasai et al. N Engl J Med 2011;364:829-41
.
0
7
6
5
4
3
2
1
0
40 50 60 70 80 90Age (years)
Year
s of
life
lost
Men7
6
5
4
3
2
1
0
40 50 60 70 80 900Age (years)
WomenNon-vascular deaths
Vascular deaths
On average, a 50-year-old individual with diabetes and no history of vascular disease will die 6 years earlier compared to someone
without diabetes
Diabetes is associated with significant loss
of life years
• Not curable • But can be controlled with
Education Healthy Diet Proper Medications
Regular Check ups
Regular Exercise
Diabetes management
Diabetes: A global
emergency
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
2014 2040
WORLD
415
million
WORLD
642 million people living with diabetes
Middle East and North Africa 85%
South East Asia 64%
South and Central America 55%
Western Pacific 46%
North America and Caribbean 30%Europe 33%
Africa 93%
55%
Diabetes: A global
emergency
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
Diabetes is a human and economic burden
4.9 million deaths per year
50% of deaths under 60 years of age
Intersects with all dimensions of development
US$612 billion 11% of worldwide healthcare
expenditure
… and the costs to society are high and
escalating
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
Lifestyle (diet and exercise) is better than drugs in preventing diabetes…
Knowler W.C. et al., N Engl J Med. , 2002
…but we don´t respond to exercise in the same way
Bouchard, C., et al., J Appl Physiol (1985), 1999
The Malmö exercise intervention study (50 ♂)
FH - FH +Age (years) 37,8 ± 4,7 38,4 ± 3,9weight (kg) 94,8 ± 10,2 92,4 ± 12,8BMI (kg/m2) 29,0 ± 2,9 28,4 ± 2,8Waist (cm) 101,0 ± 7,8 98,1 ± 8,2VO2max (ml/kg/min)
30,5 ± 4,7 32,5 ± 4,6
HbA1c (%) 4,3 ± 0,3 4,3 ± 0,4Glucose, 2h (mM) 5,8 ± 1,4 5,8 ± 1,2
Do individuals with a genetic predisposition for diabetes respond in the same way to
exercise?
Elgzyri et al., JCEM, 2012
Exercise at “Friskis och Svettis”
Screening •Health declaration
•Physical examination
•Blood tests
•Submax bike ergometer test
•OGTT
Pre-training •Anthropometric measurements
•Blood tests
•Max exercise test
•Muscle & fat biopsies
•BIA
•Actiheart recording
Mid-training •Anthropometric measurements
•Submax bike ergometer test
•Actiheart recording
Post-training •Anthropometric measurements
•Blood tests
•Max exercise test
•Muscle & fat biopsies
•BIA
•OGTT •Actiheart recording
6 months
Ekman et al., JAP, 2015
FH+ individuals exercised more
Ekman et al., JAP, 2015
What happened after 6 months of exercise?
FH - FH +Before After Before After
Weight (kg) 94,8 ± 10,2
94,3 ± 10,5
92,4 ± 12,8
90,4 ± 12,6
BMI (kg/m2) 29,0 ± 2,9 28,8 ± 3,0 28,4 ± 2,8 27,8 ± 2,9Waist (cm) 101,0 ±
7,899,2 ± 7,8 98,1 ± 8,2 94,3 ± 7,3
VO2max (ml/kg/min)
30,5 ± 4,7 34,6 ± 5,5 32,5 ± 4,6 36,9 ± 5,7
HbA1c (%) 4,3 ± 0,3 4,3 ± 0,3 4,3 ± 0,4 4,3 ± 0,4Glucose, 2h (mM) 5,8 ± 1,4 5,7 ± 1,7 5,8 ± 1,2 5,4 ± 1,3
? ? Ekman et al., JAP, 2015
How much did the fitness improve?
FH- FH+
Ekman et al., JAP, 2015
… and the same for weight and waist!
Ekman et al., JAP, 2015
Conclusions
• Even a relatively modest increase in physical activity during 6 months improves physical fitness and thereby some cardiometabolic risk factors
• The FH+ group took part in ~45% more exercise sessions and spent ~60% more energy compared to the FH-
• However, individuals with FH did not benefit from the exercise intervention to the same extent as those without a FH
? Should individuals at risk of diabetes exercise in a specific way to reduce the risk.
? How can we tailor exercise for the individual for the most effective health improvement
? Biomarkers
Albert Szent-Györgyi(Nobel prize, 1937)
”Biological structures and living systems are worn out by inactivity and developed by use”
By the courtesy of Bengt Saltin
Thank you to all participants in the study!