1. Chapter 11 Resistance-Training Strategies for Individuals with Type 2 Diabetes

2. Overview of T2D • Development of insulin resistance over time • Comprises 90 to 95 percent of all new diabetes cases • More common in individuals over age 40 • Also affects children and young adults

3. Overview of T2D • Gestational diabetes • Transient diabetic state experienced during latter stages of pregnancy • Leads to risk of permanent diabetes

4. Prevalence of T2D • Affects 20.8 million individuals • 7 percent of all Americans • One in three 3 individuals will develop during lifetime • Even higher risks in some minority groups • African-American, Hispanic, American-Indian, and Alaska-Native adults two to three times more likely than whites

5. Prevalence of T2D • Affects one in five adults over age 65 • 41 million Americans age 40 to 74 have prediabetes • Causes 3.2 million deaths per year globally • Six deaths per minute

6. Major Precursor to Other Medical Conditions • Elevated glucose and fat levels in blood damage vital organs • Premature heart disease • Leading cause of death • Stroke • Blindness • Kidney failure

7. Major Precursor to Other Medical Conditions • Pregnancy complications • Loss of central nerve function • Loss of feeling in feet or hands • Lower-extremity amputations • Premature death

8. Economic Impact of T2D • Estimated annual cost = $132 billion • Direct medical costs = $92 billion • Indirect costs = $40 billion • Estimated annual individual health care costs = $13,243

9. Etiology of T2D • Begins as prediabetes • Insulin-resistant state • Progresses to overt hyperglycemia • Lifestyle and other environmental factors lead to state of relative insulin deficiency

10. Etiology of T2D • Prevention of diabetes-related health complications requires controlling hyperglycemia and keeping blood glucose levels in normal/near-normal ranges

11. Optimal Control Over Blood Glucose • Most individuals rarely achieve or maintain optimal levels • Only 37 percent in US • Many undiagnosed individuals likely unaware of damage being done to bodies • Some individuals unwilling or unable to control

12. Benefits of Resistance Training • Increased muscle mass: • Heightens skeletal muscle sensitivity to available insulin • Improves blood glucose control • Potentially improves coexisting conditions • E.g., hypertension, elevated blood cholesterol, excess body fat

13. Research Supports Resistance Training • Enhances action of insulin • Promoting more normal blood glucose levels and avoiding diabetic complications • Increases levels of GLUT4 in trained muscle • Increases insulin receptors, protein kinase B, glycogen synthase, and glycogen synthase total activity following acute training

14. Research Supports Resistance Training • Helps control systemic inflammation • Increases adiponectin levels to improve metabolic control • Improves overall glycemic control when combined with weight loss • Contributes to preservation of lean body mass during moderate weight loss

15. Research Supports Resistance Training • Exercise intensity appears less important than total duration and caloric expenditure • Maintenance of regular exercise training program critical to increased muscle mass and insulin sensitivity • May be aerobic, resistance training, or both

16. Program Design Considerations • Current activity level of individual • Primary goal(s) of training program • Individual’s medications that can affect/be affected by physical activity • Existence of any related health comorbidities

17. Current Activity Level • Dictates extent of overall muscular fitness and strength gains that can be attained • Sedentary individual likely to achieve greater gains than physically active individual • Sedentary individual must begin with low-intensity exercise program to protect against injuries

18. Current Activity Level • Currently active individuals better able to perform moderate- to high-intensity work safely • Higher intensity training = greater gains in muscle strength

19. Training Goals • Determine prior to program development • Remember that training benefits are specific to types of exercises and related muscle groups

20. Medications • Can affect risk for hypoglycemia and alter exercise performance • Certain heart medications can artificially lower resting and exercise heart rates • Making intensity measurement difficult

21. Medications • Discuss exercise-related side effects with health care professional in advance • Consider co-morbidities • E.g., hypertension, elevated blood cholesterol

22. Exercise Testing Considerations • Use repetition maximum testing to avoid elevated blood pressure • 3 RM, 10 RM • Use maximal exercise stress test to determine existence of upper limit to safe exercise • Silent ischemia

23. Exercise Testing Considerations • Obtain physician approval if known cardiovascular disease exists • ACSM recommends screening all individuals with T2D for cardiovascular disease

24. Conditions Requiring Physician Consultation • Proliferative retinopathy or current retinal hemorrhage • Neuropathy • Nerve damage • Either peripheral or autonomic

25. Conditions Requiring Physician Consultation • Foot injuries • Including ulcers • High blood pressure • Serious illness or infection

26. Exercise Precautions • Have blood glucose meter accessible to monitor glycemia before, during, and/or after exercise • Immediately treat hypoglycemia with glucose tablets or regular soft drinks • Stay properly hydrated with frequent intake of small amounts of cool water

27. Exercise Precautions • Seek immediate medical attention for chest pain or pain that radiates down arm, jaw, or neck • With hypertension or unstable proliferative retinopathy, avoid activities that cause excessive increases in blood pressure

28. Exercise Precautions • Never exercise with active retinal hemorrhages • Stop exercise if visual changes occur • Wear proper footwear and check feet daily for signs of trauma • E.g., blisters, redness, signs of irritation

29. Program Considerations • Older individuals benefit as much as younger individuals • Individuals with cardiovascular disease should use onset of angina as guide to limit exercise intensity/duration

30. Program Considerations • Modify training for those with peripheral vascular disease (PVD) • E.g., use seated exercises • Avoid high-intensity or heavy-resistance exercises for individuals with hypertension • Individuals with peripheral neuropathy should pay special attention to foot care

31. Program Considerations • Individuals with autonomic neuropathy require special care to avoid fainting or dehydration • Follow exercise precautions related to diabetic retinopathy

32. Program Considerations • Prevent joint-related injuries through good glycemic control and integration of flexibility exercises • Individuals with arthritis may benefit from ice applications or non-steroidal anti-inflammatory drugs (NSAIDs) post-workout

33. Program Components • Follow ACSM recommendations for progressive resistance training at least two to three times per week • Minimum of eight to 10 exercises involving all major muscle groups • Minimum of 1 set of 10 to 15 repetitions to near fatigue

34. Program Components • Progress to 3 or more sets of 8 to 10 repetitions • Precede and follow each session with five-minute warm-up/cooldown • Provide initial supervision and periodic reassessment • Review sample 24-Week Program