Dr Sheri Colberg: exercise for diabetics Q and A

May 14, 2023Apr 26, 2023 kaitiscotland3 Comments

Diabetes in Control Nov 6, 2021

Author: Sheri R. Colberg, PhD, FACSM

Q: Can you speak to the ability or inability to “cure” T2D? Does it have to do with the loss of the pancreatic beta cells?

A: Yes, it has generally been shown that new-onset type 2 diabetes is easier to “reverse,” meaning that blood glucose levels can be so well managed that it appears diabetes has been cured. Over time, a loss of some insulin-making capacity occurs in people with long-standing T2D, particularly if it has not been well-managed, related both to the impairment of pancreatic β-cell function and the decrease in β-cell mass. (PMID: 27615139)

Q: Isn’t insulin resistance now found to be in T1DM as well?

A: Yes, anyone can develop insulin resistance, and it occurs in at least a third of people with type 1 diabetes as well, although it is not always associated with excess weight gain or overweight. Since people with T1D lack insulin due to the body’s own immune system killing off the pancreatic β-cells, greater resistance increases the total doses of insulin needed (whether injected, pumped, or inhaled). Thus, they have developed characteristics of both types and have “double diabetes.” (PMID: 34530819)

Q: Under lifestyle goals, would you include stress management?

A: Stress management was not assessed in the large multi-center clinical trials on type 2 diabetes prevention, but mental stress can certainly raise blood glucose levels due to the greater release of glucose-raising hormones like cortisol and adrenaline. It certainly would be beneficial to address better ways to manage mental stress as part of lifestyle goals for optimal blood glucose outcomes. (PMID: 29760788)

Q: As each person has their own limitations, how important is it to get a physician clearance and exercise guidelines before working with the client?

A: It really depends on the person’s circumstances. How intense will the planned activities be? Is the person currently sedentary? Has he/she been getting annual checkups to monitor blood glucose management and to check the status of any complications? Does he/she have diabetes-related or other health complications that could be worsened by physical activity? The lower the intensity, the more active an individual has been, and the lower the risk for cardiovascular complications, the less likely medical clearance is absolutely necessary.

The latest ACSM Consensus Statement on activity and T2D will be released in early 2022 in Medicine & Science in Sports & Exercise and states, “For most individuals planning to participate in a low- to moderate-intensity physical activity like brisk walking, no pre-exercise medical evaluation is needed unless symptoms of cardiovascular disease or microvascular complications are present. In adults who are currently sedentary, medical clearance is recommended prior to participation in moderate- to high-intensity physical activity.”

Q: Can flexibility training be used for warmups, or do you recommend it only after the workout?

A: While it is possible to do flexibility training at any point during a workout, joints tend to have a greater range of motion after blood flow to those areas has been increased with a light or short aerobic warmup. It may be prudent to do a quick aerobic warmup, some stretching, the full workout, and then more extensive stretching afterwards for optimal results.

Q: Was there any particular protocol for strength training? sets, reps, periodization? What is considered “intense” resistance work? Would fatigue based off of several sets of moderate intensity be recommended then?

A: That is a tough question, and it depends on who you ask. I have seen a lot of debate over the optimal strength training protocol during the many years I have been in the exercise/fitness world. If people are just starting out with resistance training, they will gain from doing even a minimal amount of training.

Starting out with 1-3 sets of 8 to 10 main exercises that work all of the large muscles groups at a light to moderate intensity is considered appropriate for most older or sedentary adults, many of whom have joint limitations or health issues. Moderate intensity is considered 50%-69% of 1-RM (1 repetition maximum) and vigorous is 70%-85% of 1-RM. Both intensity (fewer reps at a higher intensity) and the number of sets (3-5) or days of training (starting at 2, progressing to 3 nonconsecutive days) can increase over 2 to 3 months. Periodization is usually not undertaken by older adults, but may be appropriate for younger, fitter ones.

Q: Do you have any insight or are aware of any studies that involve high intensity (%1-RM) resistance training and T2DM? Or any studies that compare resistance training volume (Sets x Reps x Load)?

A: Some older studies have determined that glycemic management is improved by supervised high-intensity resistance training in people with type 2 diabetes (PMID 12351469). Others have also found that home-based (and, therefore, unsupervised) resistance training results in a lesser impact on blood glucose levels, likely due to reductions in adherence and exercise training volume and intensity (PMID 15616225).

Q: I’m still confused about glucose response to acute exercise. Which is better if you want to bring down your BG right now? Can you speak to the possibility of increased blood sugars with intense aerobic exercise?

A: Most light-to moderate-intensity aerobic exercise will lower blood glucose levels, assuming that some insulin is present in the body. (People who are very insulin deficient may have a rise in blood glucose from doing any activity.) Any activity that gets up into the intense/vigorous range, even if only during occasional intervals, has the potential to raise blood glucose due to a greater release of glucose-raising hormones during the activity. This is particularly true if the activity is short and intense. In individuals with any type of diabetes, declines in blood glucose during high-intensity interval exercise are smaller than those observed during aerobic exercise.

That said, if someone wants to lower blood glucose right now with exercise, it also depends on the timing of exercise. Doing something light to moderate for at least 10 to 30 minutes is the best bet, particularly after a meal when insulin levels are generally higher. Avoid doing intense aerobic or heavy resistance training as those may have the opposite effect. For early morning exercise, any intensity can potentially raise blood glucose due to higher levels of insulin resistance then and lower circulating levels of insulin in the body.

Q: I had an endocrinologist say that long runs or walks are better, and another one said to do a bit of weights.

A: Which activities someone chooses to do should depend on the goal of the training. Is it increased fitness, lowering blood glucose levels acutely, or gaining strength and improving overall blood glucose management? Long, slow aerobic training does have the benefit of increasing cardiorespiratory fitness and lowering blood glucose levels (in most cases). Resistance training, on the other hand, increases muscular strength and endurance and helps people gain and preserve muscle mass, which is where most carbohydrates are stored in the body. It may not, however, lower blood glucose levels, at least not acutely.

Both have their place in a weekly training regimen. Insulin resistance is lowered for 2 to 72 hours following a bout of aerobic training. Resistance training has more of a long-term impact on insulin action by enhancing carbohydrate storage capacity. The best advice is to do some aerobic training at least every other day and some resistance training at least 2, and preferably 3, nonconsecutive days per week. These activities can be done on the same days or different ones.

Get up for at least 5 minutes every 30 minutes at work

Mar 3, 2023Feb 27, 2023 kaitiscotland6 Comments

*Photo by Andrea Piacquadio on Pexels.com*

Adapted from Medicine and Science in Sports and Exercise Jan 12 2023

Short, regular breaks from sitting down at work and at home can improve your blood sugar and blood pressure.

Researchers from Columbia University in New York tested middle aged and older adults using various sitting/gentle walking protocols for eight hours a day. Even very short breaks of a minute improved blood pressure but to reduce blood sugars as well, you need a break of five minutes every 30 minutes.

These short activity breaks are helpful to improve your health and should be done in addition to a daily activity/exercise regime.

My comment: You will need to plan how to do this in most work and home situations. You could make a point of taking the stairs, walking around while taking phone calls, getting out for a short walk at lunch time, going to see people in person rather than phoning them, and doing exercises during commercial breaks in front of the television. Every little helps.

BMJ: Group programmes for weight loss are more effective than one to one sessions

Feb 13, 2023Dec 27, 2022 kaitiscotland5 Comments

Adapted from BMJ 26 Feb 2022 NIHR Alert

Around one in four UK adults is living with obesity. Previous research has established that the most effective way to lose weight is through behaviour change with diet and physical activity counselling. It has not been clear whether one to one sessions or group sessions produce the better outcome. Thus a review of 7 studies which included 2,576 participants from the UK, US, Australia, Germany and Spain was done.

The study looked at the outcome of reaching at least a 5% reduction in body weight after a year. This means that a person of 100kg would lose 5kg.

Compared to one to one sessions, people in group sessions:

Lost on average 1.9kg more weight

Were 58% more likely to lose at least 5% of their body weight

Group classes had 12-55 hours treatment time and those in one to one sessions had 2.5 to 11 hours.

The costs of treating people in groups is also lower than one to one sessions. The quality of life of people who are obese would be more likely to improve and their would be fewer cases of diabetes, heart disease, stroke, and cancer that all require medical treatment.

NICE are intending to publish revised guidelines on the treatment of obesity in 2023.

Healthcare professionals can now confidently say that group educational programmes are at least if not more effective than one to one sessions when referring or advising patients. Social support in groups and more intensive interventions may account for greater success but for some people eg who are anxious in groups or who need translators, or even just patient preference, will mean that one to one sessions will still need to be offered. Further research into what specific factors improve results would be helpful.

Nutrients and exercise can reduce cancer risk

Dec 13, 2022Nov 5, 2022 kaitiscotland3 Comments

Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and

Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape

In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.

Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.

A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.

Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.

Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.

Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.

Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.

Marinate mean in an acid solution for more than one hour.

Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.

Cook at a low temperature eg boiling.

Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.

Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.

Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.

The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.

Daily rituals determine our health, so think about how you can optimise your routines.

The influence of exercise on cancer has only been studied in the last ten years.

Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.

In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.

The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.

Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.

A forensic pathologist tells us how to live to a good old age

Sep 9, 2022 kaitiscotland2 Comments

Adapted from Medscape August 31 2022 Would you like to live to a ripe old age? George D Lundberg MD

Choose ancestors who did not die of natural causes in young adulthood or middle age (oophs…too late!)

Maintain a body mass index within the healthy range using a variety of tools

Maintain blood pressure within a normal range with or without medications

Maintain a low resting heart rate

Do eat whole grains including bran

Consume above ground leafy vegetables, some root vegetables, tree nuts, peanuts and berries

Ingest supplemental fibre such as psyllium husks

Ingest supplemental magnesium and possibly vitamins K2, C and D

Enjoy eating animal and vegetable fats including milk, cheese, meat, poultry, seafood, and eggs in moderation.

Eat two full meals a day

Do drink alcohol after 5pm

Sleep 6-8 hours a night

Walk up and downstairs and use handrails if necessary

Continue to be active physically, mentally, socially and sexually

Study and enjoy birds, bees, trees, plants, flowers and wildlife

Value your family life and participate actively while encouraging individuals to live their own lives

Read great books, fiction or non fiction a little every day

Actively engage in person or electronically with younger people

Stay informed about current world affairs and care about what you can change

Be passionate about culture such as performing and visual arts and sport

Recognise the value of spirituality and religion and feel free to live otherwise if you choose

Do your best to earn and retain as much money as needed to control your environment into old age

Take charge of your own health

Listen to your body

Maintain a long term relationship with a reliable and conservative primary care physician and certain specialists that fit the needs of older people.

Promote good vision in any way you can

Use hearing aids if you need them to retain brain function

See your dentist every 6 to 12 months and practice good oral hygiene. There is a strong correlation between the number of original teeth and length of life

Keep up to date with vaccinations

Maintain a safe distance and use mask if you may be around infective people

Take as few medications as necessary

Have as few diagnostic tests and surgical procedures as possible especially on the back and the knees

Use acupuncture and massage appropriately

Apply moisturising skin lotion especially after sun exposure

Use saline mist often to prevent nosebleeds

Walk at least 2 miles every day

If you can, swim every day

Practice yoga particularly the standing side bend, prone baby cobra, forward plank and windshield-wiper

Eat a protein rich diet and deliberately weight train or lift heavy objects to reduce sarcopenia

stand on one foot to improve balance

Use wearable exercise monitors if you find them useful

If you retire from work do some part time or volunteer jobs

Have something productive and fulfilling to do each day

Don’t

Inhale tobacco smoke

Consume sugar or sugar in anything in home cooked or restaurant meals, in soft drinks, fruit juices, pastries, desserts or processed foods

Use street drugs

Use natural or synthetic opioids except for short term relief of severe pain or the relief of pain from advanced cancer: then use all you need

Use sleep medication

Drink more than moderately or binge drink

Drive a vehicle after drinking or taking certain psychoactive drugs

Keep firearms in your home or workplace

Fret about things in your personal life or world affairs that you cannot change

Completely retire and have nothing useful to do

My comments: Dr Lundberg has a pretty long list of sensible suggestions. To these I would add, get some daily sunshine if you can and enjoy your pets. Have things to look forward to. Keep in touch with your friends and make contact with old ones who you value but don’t see often. Learn new things. What other suggestions do you have?

Sheri Colberg: exercise for living your best life as you age

Jul 28, 2022May 3, 2022 kaitiscotland1 Comment

Adapted from BMJ 30 Oct 21: A study from the Mayo Clinic indicates that cardiorespiratory fitness tests were a better predictor of of survival in older people than blood lipids, diabetes, smoking and hypertension.

6,500 people aged 70 or over were tested on treadmills. The fittest showed the lowest mortality rates ten years on, and the burden of other risk factors made no difference at all.

Adapted from Diabetes in Control 10 August 21: Sheri Colberg says: Aging successfully takes a lot of work, If you don’t use it, you lose it. Physical fitness peaks around the age of 25 and then declines. Balance gets worse after the age of 40, bones get thinner, muscle bulk diminishes, and even with training maximal aerobic capacity declines. Your reflexes get slower and recovery from workouts takes longer.

The good news is that you can’t stop the aging process but you can slow it down to some extent. This means paying attention to regular physical training, nutrition, sleep and stress management.

Her advice is:

In addition to regular activities like walking, cycling, and swimming, add in some faster intervals to any workout such as walking faster for ten to sixty seconds at a time during your normal walk or doing a hill profile on a cardio training machine. This will improve your cardio respiratory fitness and improve insulin sensitivity for longer. It is fine to to high intensity interval training once a week, but if you don’t already do this you need to work up to it slowly. You should vary the intensity of your workouts to allow recovery and reduce the risk of injury.

Pick at least eight to ten resistance exercises that cover the major muscle groups in the upper, core and lower body and do them two or three days a week. You can use your own body weight, weights, kettlebells, resistance bands or water bottles. Improving muscle mass and strength is critical to being able to live independently through your lifespan.

Improve your balance by standing on one leg for a minute at a time. Make sure you can grab something if you feel unsteady. Once you can do this, make it harder by moving the raised leg in different directions. My comment: Wii Fit has a lot of balance exercises included. Ballet and Yoga also include balance exercises and Tai Chi is a good starting point.

High blood sugars take a particular toll on the flexibility of joints and tendons. Stretch two or three times a week. The worse your flexibility and the older you are the longer you should hold the stretch. Up to a minute with each stretch may be necessary. My comment: There are lots of You Tube videos on stretching. You may like to use rubber bands and yoga blocks or use props such as chairs.

Weight bearing exercises to reduce bone loss can be achieved by weight training, carrying shopping in both hands, and hopping up and down on one leg at a time, and by doing body weight exercises such as press ups.

It is very important that you can get off of a chair as you get older. Practice standing up from the sitting position without using your hands. You can enhance your strength by sitting against a wall with your knees at 90 degrees. My comment: I used to do this for two minutes at a time. I would suggest 30 seconds to start with.

Last, but not least, pelvic floor exercises. You pull in all the muscles around your urethra and anus and practice a combination of long holds and pulses. This improves continence.

Physical activity can improve cognitive function if you have type two diabetes

Jun 10, 2022Feb 28, 2022 kaitiscotland1 Comment

*Photo by Polina Tankilevitch on Pexels.com*

Adapted from Diabetes in Control Aug 10 2021 by Macrina Ghali, Pharm D candidate, Florida.

Hyperglycaemia has been linked to reduced cognitive function and can impair life through impairing memory and language. Mistakes with medication are more likely. Some studies have shown that exercise can reduce the risk of dementia on the long term.

The meta-analysis sought to answer the question, does cognitive ability change from baseline, while on the exercise programme compared to the non-exercising controls? Just over 2,500 patients with diabetes were analysed, almost evenly split to control groups and exercise groups.

The exercise group did aerobic exercise, resistance exercise and non aerobic exercise. The control groups did monthly telephone calls, stretching, gentle movement and education. The interventions ranged in time from 12 months to 9.8 years and sample sizes ranged from 47 to over a thousand.

Standard tests such as the mini-mental state examination, mental state examination and global cognitive score were undertaken.

Surprisingly the study found that the greatest change in cognitive scores between both groups was in the studies done for 12 months rather than longer periods. They were not sure if this was due to patient drop out or the development of dementia. They think that more studies would need to be done to clarify the issue.

Meanwhile they think that physical activity programmes should be started soon after diagnosis of type two diabetes to prevent a worsening of cognitive functioning as time goes on.

Physical activity monitors have some role in increasing activity by 10 minutes a day

May 29, 2022Feb 26, 2022 kaitiscotland2 Comments

Adapted from BMJ 29 Jan 2022

Like many other people I eventually bought a smart watch. I was a late adopter of this but after visiting my son in London, and seeing what a benefit it would be to scan in and out of the tube with a device, I got one just over a year ago. Many people had already been tracking their steps, heart rate and sleep schedules with these. So, are they of any use?

This was a systematic review which looked at 121 RCTs (so many!) covering 16,743 participants.

They found that there was a small but definite improvement in physical activity when people wore the trackers.

Physical activity increased by ten minutes a day. This was equivalent to 1,235 daily steps and works out at an additional 48.5 minutes a week.

To put this into context, I work out in different modalities for about this time every day, so it is like the equivalent of working out 8 days a week instead of 7.

Although this level of increased activity is unlikely to make much difference to your weight, what may do is a broadening of referral sources to the UK NHS online weight management programme. Community Pharmacists are now allowed to refer patients to the programme, instead of just GPs.

The course is 12 weeks long. You can join if you are in the obese category (BMI 30 or over), or if you are overweight (BMI 25 and over) and have hypertension, or type 2 diabetes. If you are of ethnic minority you can join if your BMI is 27.5 or over because you are more likely to develop type 2 diabetes.

Entrants to the scheme are currently 5 pounds heavier on average compared to pre-covid pandemic weights.

Oldies need to exercise more to improve their sleep

Jun 9, 2021Mar 22, 2021 kaitiscotland8 Comments

A randomised controlled trial in older adults with insomnia found that 12 weeks training in Tai Chi improved both subjective and objective measures of sleep quality. Although the effect size was modest it persisted for over two years.

Sleep quality also improved in groups that took part in brisk walking programmes and muscle strengthening exercises.

My comments: With consideration to my last post, about the importance of sociability in brain health, I do wonder if it is the exercise or the social factors that improve sleep.

Free You Tube sites to help you look and feel your best

May 16, 2021Feb 15, 2021 kaitiscotland2 Comments

The Times recently published a long list of exercise sites that you can get for free or pay for. Being a home exercise enthusiast I read this carefully and decided to try out the sites they listed as being FREE. These were my favourite ones. All had a variety of exercises eg low and high impact aerobics, walking, weights, rubber bands, stretching, relaxation and even dressing, hair and make up tips.

Top of the pops was Fabulous 50s. There are over a hundred workouts on this site. All are one to one, and set in beautiful Australia. This lady’s house is so clean, tidy, uncluttered that I was immediately pea green with envy. Of course, if I moved into her house, it wouldn’t stay that way for long. There is a fantastic range of exercises and from the ones I have tried, they were well produced and constructed, and even if you are a complete beginner, are pretty easily done. They range in time from 5 minutes to 30 minutes really giving you plenty of options no matter how hard pressed you are for time.

Mad fit, Lucy Wyndam-Read and Fitness Blender also are free and have multiple workouts in terms of types and durations. They seemed more tuned to the younger or fitter age group than Fabulous 50s and I have only done a few of them being 61 with some unfortunate back issues right now. They are not quite as beautifully produced as Fab 50s but they are free!

You will get adverts popping up during all these workouts. Now this is where you have to be careful because the marketing folks know who they are aiming at here and the top products seem to be wrinkle cream, make up and chocolate. It doesn’t matter how lucious it looks. Do not buy it. Because you will eat it.

Adriene is purely a yoga site. This is free too, and she sometimes has her dog with her. Again, there are a lot of different length and types of workout.

Now, if you have a smart phone, a tablet, a pc or a smart television, whatever your favourite form of home exercise is, and even if you only have five or ten minutes, you can workout for free at home.