Physical Activity (or lack there of) and its implications for Diabetes

[Anil]

We all know that when it comes to containing the complications arising
out of diabetics if staying active as much as we possibly can. While
doing some research on this topic I came across a few good references I
thought may be of benefit to newbies and old times alike. Old Al has
been hammering us with this view point for a while. Here is more
ammunition right from the ammunition factory! What came through very
clearly is that a simple routine of 30 min or more of walk EVERY DAY
can get you 80 to 90 percent benefit. No weights, no gyms just walk.
Its free. And I know the weather factor very well. I live in Boston
:-).


Reference 1:
ref: http://tinyurl.com/ygkxcf

Physical Activity and Life Expectancy With and Without Diabetes
Jacqueline T. Jonker, MSC1, Chris De Laet, PHD1, Oscar H. Franco, MD,
DSC1, Anna Peeters, PHD2, Johan Mackenbach, MD, PHD1 and Wilma J.
Nusselder, PHD


CONCLUSIONS-Moderately and highly active people have a longer total
life expectancy and live more years free of diabetes than their
sedentary counterparts but do not spend more years with diabetes.

Moderately and highly active people live longer and spend more years
without diabetes than subjects with low physical activity levels. At
age 50 years, life expectancy free of diabetes is 2.3 years longer for
moderately active men and women and at least 4 years longer for highly
active men and women. The effect of physical activity on life
expectancy without diabetes reflects both the lower incidence of
diabetes and the lower mortality of nondiabetic individuals associated
with increasing physical activity levels. Life expectancy with diabetes
is at least 0.5 and 0.1 years less for moderate and highly active
people, respectively, compared with those with low physical activity.
This reflects two opposing effects: 1) lower incidence of diabetes in
the active group reducing the time spent with diabetes and 2) lower
mortality in diabetic subjects, increasing the time spent with
diabetes. The net result is that while moderate and highly active
people live longer, they do not spend more years with diabetes.

The reported hazard ratios found in our study fall well within the
range of the published measures of the effect of physical activity on
incident diabetes (4-6,8,9,31-33) and mortality of diabetic
subjects (15,16,19,20). However, comparison with prior studies is
difficult because the measurement scales and definitions of physical
activity used differ.

Most studies published on the subject (4,6,8,9,31,32) have found
dose-response relations between physical activity and the incidence of
diabetes. We similarly found a dose-response relation between physical
activity and the mortality rates among nondiabetic and diabetic
subjects. However, similar to a few other studies (5,33,34), we found
that the degree of protection against diabetes was virtually the same
in those with either vigorous or moderate physical activity levels.

Additional analyses (data not shown) suggest that, in particular, the
oldest subjects are responsible for this lack of a clear dose-response
relation. Our data suggested that the effect of physical activity could
be different in those aged >80 years. A possible explanation is that at
this age, the lower physical activity group still at risk for diabetes
is more selected due to higher risks of diabetes and mortality earlier
in their life than those with higher levels of physical activity.
However, the study was underpowered to detect any true difference in
effect, and it is unlikely that such a difference would have affected
our conclusions. Similar to Gregg et al. (20), the effect of moderate
physical activity on the transition of diabetes to death did not reach
statistical significance after full adjustment. Additional analyses
showed that using a hazard ratio of 1.00 for this transition in the
moderate active group would only strengthen our results.

A strength of this study is the use of data from a prospective,
well-organized study, with long-term follow-up. Another advantage is
that the glucose levels as well as other risk factors are measured at
regular, biannual intervals. In our study, diagnosis of diabetes was
based on glucose tests or the use of hypoglycaemic agents instead of
self-report. In studies based on self-reported diabetes, many subjects
with diabetes remain undiagnosed. In this study, there could be
underdiagnosis only if subjects were not present at one or more exams
(or had a false-negative test). As most subjects only missed one or a
few subsequent exams, it becomes more a matter of delayed diagnosis
than underdiagnosis.

Some limitations should be mentioned. The present study is an
observational study and not a randomized trial. Consequently, bias may
occur if diseases at baseline are responsible for inactivity (reverse
causation) and if other factors confound the association between
physical activity and the transition rates. There are two approaches to
avoid reverse causation: exclusion of subjects with known diseases at
baseline or adjustment for baseline diseases in the analysis. We used
the second option, since we considered that by excluding subjects with
diseases at baseline, there would be a selection of healthy people, and
therefore the results would not be applicable to the whole population.

Residual confounding cannot entirely be ruled out, but as we examined
the potential effect of a large set of confounders (age, sex,
education, presence of diseases, marital status, smoking, exam of start
follow-up, cholesterol, and family history of diabetes) and included
those that affected the association between physical activity and the
transitions, we do not expect that this would have biased our results.

Another limitation of our study is that in the Framingham Heart Study,
physical activity levels were evaluated by self-report, which may
introduce misclassification of exposure. However, this
misclassification is likely to be nondifferential, which can only
attenuate our results and fade a stronger association. We maximized the
power of our study by using 12 years of follow-up. As a long period of
follow-up reduces the effect of selection, but increases the risk of
misclassification of exposure, the optimal follow-up time is unknown.
Since it has been reported that levels and effects of physical activity
change with time (35), we evaluated the effect of length of follow-up
on the relation between physical activity and the transitions. These
sensitivity analyses showed that with a follow-up period of 8 or 10
years instead of 12 years, our main conclusions did not change (data
not shown).

The added value of this study is the combination of the observed
effects of physical activity on incidence of diabetes and mortality in
a large prospective study and the translation into the population
health measures (life expectancy with and without diabetes).

This study shows that physically inactive people have shorter lives,
and, moreover, they live fewer years without diabetes and more or an
equivalent number of years with diabetes compared with people with
higher levels of physical activity.

These results underline the public health importance of increasing
physical activity levels in the population. Moreover, as Reunanen et
al. (2) found that total costs of medications for people with diabetes
were 3.5 times greater than those for nondiabetic control subjects, our
findings are also important for the health care sector. When people
live longer, but do not spend more years with diabetes, they do not put
an extra demand on diabetes-related health care.

As far as the associations reflect causal relationships, our study
suggests that if sedentary people could be stimulated to be at least
moderately active, they could extend their lives and increase their
lifetime spent without diabetes without spending more years with
diabetes.


Reference 2:

NEJM Volume 345:790-797 September 13, 2001

Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women

Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D.,
Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and
Walter C. Willett, M.D

ABSTRACT
Background Previous studies have examined individual dietary and
lifestyle factors in relation to type 2 diabetes, but the combined
effects of these factors are largely unknown.
Methods We followed 84,941 female nurses from 1980 to 1996; these women
were free of diagnosed cardiovascular disease, diabetes, and cancer at
base line. Information about their diet and lifestyle was updated
periodically.

A low-risk group was defined according to a combination of five
variables: a body-mass index (the weight in kilograms divided by the
square of the height in meters) of less than 25; a diet high in cereal
fiber and polyunsaturated fat and low in trans fat and glycemic load
(which reflects the effect of diet on the blood glucose level);
engagement in moderate-to-vigorous physical activity for at least half
an hour per day; no current smoking; and the consumption of an average
of at least half a drink of an alcoholic beverage per day.

Results During 16 years of follow-up, we documented 3300 new cases of
type 2 diabetes. Overweight or obesity was the single most important
predictor of diabetes. Lack of exercise, a poor diet, current smoking,
and abstinence from alcohol use were all associated with a
significantly increased risk of diabetes, even after adjustment for the
body-mass index. As compared with the rest of the cohort, women in the
low-risk group (3.4 percent of the women) had a relative risk of
diabetes of 0.09 (95 percent confidence interval, 0.05 to 0.17). A
total of 91 percent of the cases of diabetes in this cohort (95 percent
confidence interval, 83 to 95 percent) could be attributed to habits
and forms of behavior that did not conform to the low-risk pattern.

Conclusions Our findings support the hypothesis that the majority of
cases of type 2 diabetes could be prevented by the adoption of a
healthier lifestyle.

Discussion
In this large cohort of middle-aged women, a combination of several
lifestyle factors, including maintaining a body-mass index of 25 or
lower, eating a diet high in cereal fiber and polyunsaturated fat and
low in saturated and trans fats and glycemic load, exercising
regularly, abstaining from smoking, and consuming alcohol moderately,
was associated with an incidence of type 2 diabetes that was
approximately 90 percent lower than that found among women without
these factors. These results suggest that in this population the
majority of cases of type 2 diabetes could be avoided by behavior
modification.

Excess body fat is the single most important determinant of type 2
diabetes.

Weight control would be the most effective way to reduce the risk of
type 2 diabetes, but current strategies have not been very successful
on a population basis,35 and the prevalence of obesity continues to
increase.(36) The public generally does not recognize the connection
between overweight or obesity and diabetes.(37) Thus, greater efforts
at education are needed.

Our data suggest that the percentage of cases of diabetes that are
preventable by diet and exercise independently of body weight is
greater among women of normal weight than among obese women. However,
even among overweight and obese persons, the combination of an
appropriate diet, a moderate amount of exercise, and abstinence from
smoking could substantially lower the risk of type 2 diabetes. Although
the percentage of cases that could be avoided by means of these
lifestyle changes is lower among obese persons, the absolute number of
cases avoided among such persons would be greater because of their
higher risk.

Moreover, diet and exercise are the primary factors in determining
weight loss.

Our present results are in agreement with our previous study of
coronary disease,21 which found that adherence to similar guidelines
was associated with an 83 percent reduction in risk. These analyses
underscore the common lifestyle-related origins of diabetes and
coronary disease and provide further evidence that modifications of
diet and lifestyle have large and multiple benefits.

Clinical trials in China and Finland have demonstrated the feasibility
and efficacy of lifestyle-intervention programs in the prevention of
diabetes in high-risk populations. Among 577 patients with impaired
glucose tolerance in Da Qing, China,38 exercise interventions, dietary
interventions, or both resulted in a decrease of 42 to 46 percent in
the rate of progression from impaired glucose tolerance to diabetes
during six years of follow-up.

Recently, the Finnish Diabetes Prevention Program reported that the
modification of lifestyle reduced the incidence of type 2 diabetes by
58 percent during 3.2 years of follow-up among 522 middle-aged,
overweight participants with impaired glucose tolerance.39 The program
included a relatively small reduction in weight (less than 4.5 kg [10
lb]), combined with a diet low in saturated and trans fat and high in
fiber and regular moderate exercise.

Results from the first three years of the Diabetes Prevention Program
in the United States also show that regular exercise and the
modification of diet reduced the incidence of type 2 diabetes by 58
percent among patients with impaired glucose tolerance.40 Our results
suggest that closer adherence to behavioral guidelines could reduce the
risk further in both low-risk and high-risk populations.

Because all the women in our study were health care professionals, our
findings may not apply directly to the general population. However,
since risk factors for diabetes tend to be more prevalent in the
general population, the magnitude of the reduction in risk that would
be achievable with adherence to the behavioral guidelines we outline
would probably be even greater than the magnitude of the reduction we
found. Although some factors we considered - for example, alcohol use
and smoking - have not been (and will probably never be) tested in
randomized trials with clinical end points, ample observational data
support their associations with diabetes.

Nevertheless, physicians must exercise caution in recommending alcohol
use, since it may lead to overuse. Finally, we did not consider
pharmacologic means of preventing diabetes, some of which are being
tested in ongoing clinical trials in high-risk populations.

Diagnoses of diabetes in our study were reported by the women but were
confirmed by a supplementary questionnaire regarding symptoms,
diagnostic tests, and treatment. Our previous study found this
confirmation to be highly accurate as compared with a review of the
medical records.5 Because the women in our cohort who did not have
diabetes were not uniformly screened for glucose intolerance, some
cases of diabetes may not have been diagnosed. However, when the
analyses were restricted to symptomatic cases of diabetes, the findings
were not altered substantially, suggesting that surveillance bias is
unlikely.

In conclusion, our findings suggest that the majority of cases of type
2 diabetes could be prevented by weight loss, regular exercise,
modification of diet, abstinence from smoking, and the consumption of
limited amounts of alcohol. Weight control would appear to offer the
greatest benefit.

===============

Anil
T2DM
Walking 100 miles/month

[ray]

On Sat, 28 Oct 2006 08:40:43 -0700, Anil wrote:

> We all know that when it comes to containing the complications arising
> out of diabetics if staying active as much as we possibly can. While
> doing some research on this topic I came across a few good references I
> thought may be of benefit to newbies and old times alike. Old Al has
> been hammering us with this view point for a while. Here is more
> ammunition right from the ammunition factory! What came through very
> clearly is that a simple routine of 30 min or more of walk EVERY DAY
> can get you 80 to 90 percent benefit. No weights, no gyms just walk.
> Its free. And I know the weather factor very well. I live in Boston
> :-).


I find walking to be very tedious. I'd much rather bicycle or (weather
permitting) snowshoe. BTW snowshoeing burns about twice the calories of
walking or hiking.

[Alan S]

On Sat, 28 Oct 2006 20:22:52 -0600, ray <[email protected]>
wrote:

>On Sat, 28 Oct 2006 08:40:43 -0700, Anil wrote:
>
>> We all know that when it comes to containing the complications arising
>> out of diabetics if staying active as much as we possibly can. While
>> doing some research on this topic I came across a few good references I
>> thought may be of benefit to newbies and old times alike. Old Al has
>> been hammering us with this view point for a while. Here is more
>> ammunition right from the ammunition factory! What came through very
>> clearly is that a simple routine of 30 min or more of walk EVERY DAY
>> can get you 80 to 90 percent benefit. No weights, no gyms just walk.
>> Its free. And I know the weather factor very well. I live in Boston
>> :-).
>
>
>I find walking to be very tedious. I'd much rather bicycle or (weather
>permitting) snowshoe. BTW snowshoeing burns about twice the calories of
>walking or hiking.

Do whatever you can - as long as you do it long enough and
often enough.

Cheers, Alan, T2, Australia.
d&e, metformin 1000mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com/
http://loraltravel.blogspot.com/
latest: Florence

[Chris Malcolm]

ray <[email protected]> wrote:
> On Sat, 28 Oct 2006 08:40:43 -0700, Anil wrote:

>> We all know that when it comes to containing the complications arising
>> out of diabetics if staying active as much as we possibly can. While
>> doing some research on this topic I came across a few good references I
>> thought may be of benefit to newbies and old times alike. Old Al has
>> been hammering us with this view point for a while. Here is more
>> ammunition right from the ammunition factory! What came through very
>> clearly is that a simple routine of 30 min or more of walk EVERY DAY
>> can get you 80 to 90 percent benefit. No weights, no gyms just walk.
>> Its free. And I know the weather factor very well. I live in Boston
>> :-).

> I find walking to be very tedious. I'd much rather bicycle or (weather
> permitting) snowshoe. BTW snowshoeing burns about twice the calories of
> walking or hiking.

My grandfather, a country doctor, lived into his 90s. All his life he
refused to drive a car. He claimed that cars killed their drivers
through lack of exercise. He visited his patients by bicycle. He
outlived all three of his wives. He reluctantly bought them cars,
because they said cars were essential for shopping, children, and so
on. Despite the fact that all his wives were younger than him, they
all died on him.

His daughter, my mother, took his advice seriously. During my
childhood my sister and I were taken everywhere too far for us to walk
in the bicycle seats of our carless parents. My mother continued to
use a bicycle for local shopping until one day in her sixties when she
had her first bicycle accident. She knocked over a policeman who was
directing traffic at a cross roads. "How nice of all these cars to
stop for an old lady on a bicycle!" was her last thought before she
knocked over the policeman.

He chased her down the High St shouting and blowing his whistle while
she pedalled furiously away. She hid her bicycle in the coal cellar
and refused to leave the house for days in case the police were
searching for her. She decided then that she was too old to go on
cycling and gave it up for walking.

I took my grandfather's advice about cars seriously. It's one of the
reasons I've avoided ever having a car. Apart from in my energetic
teens and early twenties everyday utility cycling is the only regular
exercise I've ever taken.

Many years ago now I was referred to a cardiologist because of
suspicions about the condition of my heart. I cycled to the
hospital. He looked at my notes. He looked at my bicycle clips. He
looked at my notes again.

"Did you cycle here?" he asked.

"Yes."

"From your home address?"

"Yes."

"Up that bloody great hill?"

"Yes."

"Do you feel ok?"

"I'm fine. I'm used to that hill. I cycle up it most days to get to my
office round the corner."

"Ah well, in that case I think we can safely dispense with any further
examination. If even half of what was suggested in this letter of
referral was true then that hill would have killed you. Keep cycling!"

--
Chris Malcolm [email protected] DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

[Roger Zoul]

Anil wrote:
:: We all know that when it comes to containing the complications
:: arising out of diabetics if staying active as much as we possibly
:: can. While doing some research on this topic I came across a few
:: good references I thought may be of benefit to newbies and old times
:: alike. Old Al has been hammering us with this view point for a
:: while. Here is more ammunition right from the ammunition factory!
:: What came through very clearly is that a simple routine of 30 min or
:: more of walk EVERY DAY can get you 80 to 90 percent benefit. No
:: weights, no gyms just walk. Its free. And I know the weather factor
:: very well. I live in Boston :-).

I'm a little confused. The two cites you give below talk about prevention,
not about living with diabetes and avoiding complications. Frankly, 30 mins
of walking is minimal for exercise, IMO. I think weights should be
considered mandatory for those can than manage it and a second (or more) fun
activity should be adopted for those who live with type 2 diabetes as a
means to avoid complications. These should be considered serious, regular
parts of a T2D life and significant time, IMO, be spent in the second (or
more) fun activity. Achievement of as close to normal A1c as possible (which
will be different for everyone due to genetic factors and time of diagonsis
relative to when the line was crossed - and we have zero control over either
of these, it seems) should be the goal. While 30 min of daily walking is
something that most can achieve, I think it is a goal that should be
considered minimal for optimal lifestyle for the type 2 diabetic who wishes
to avoid complications.

The first study below considered diabetes to be present after a random BG
level of >= 200 mg/dl !

Also, I don't get how they define moderate and high physical activity. If
this is not made clear in a tangible way that anyone can duplicate, I don't
see how this info can be useful.

I fear setting the bar too low will not help. People have a bad habit of
missing the mark. Set the mark low and when the miss, it will be because
they did nothing at all.

Frankly, I'd rather see people spending 30 mins 3X/week on weights (full
body workout) followed by 30 mins 3X/week on cardio than just walking 30 min
every day. One doesn't need to go to a gym or buy expensive equipment to do
weights, either.

Geez.
::
::
:: Reference 1:
:: ref: http://tinyurl.com/ygkxcf
::
:: Physical Activity and Life Expectancy With and Without Diabetes
:: Jacqueline T. Jonker, MSC1, Chris De Laet, PHD1, Oscar H. Franco, MD,
:: DSC1, Anna Peeters, PHD2, Johan Mackenbach, MD, PHD1 and Wilma J.
:: Nusselder, PHD
::
::
:: CONCLUSIONS-Moderately and highly active people have a longer total
:: life expectancy and live more years free of diabetes than their
:: sedentary counterparts but do not spend more years with diabetes.
::
:: Moderately and highly active people live longer and spend more years
:: without diabetes than subjects with low physical activity levels. At
:: age 50 years, life expectancy free of diabetes is 2.3 years longer
:: for moderately active men and women and at least 4 years longer for
:: highly active men and women. The effect of physical activity on life
:: expectancy without diabetes reflects both the lower incidence of
:: diabetes and the lower mortality of nondiabetic individuals
:: associated with increasing physical activity levels. Life expectancy
:: with diabetes is at least 0.5 and 0.1 years less for moderate and
:: highly active people, respectively, compared with those with low
:: physical activity. This reflects two opposing effects: 1) lower
:: incidence of diabetes in the active group reducing the time spent
:: with diabetes and 2) lower mortality in diabetic subjects,
:: increasing the time spent with diabetes. The net result is that
:: while moderate and highly active people live longer, they do not
:: spend more years with diabetes.
::
:: The reported hazard ratios found in our study fall well within the
:: range of the published measures of the effect of physical activity on
:: incident diabetes (4-6,8,9,31-33) and mortality of diabetic
:: subjects (15,16,19,20). However, comparison with prior studies is
:: difficult because the measurement scales and definitions of physical
:: activity used differ.
::
:: Most studies published on the subject (4,6,8,9,31,32) have found
:: dose-response relations between physical activity and the incidence
:: of diabetes. We similarly found a dose-response relation between
:: physical activity and the mortality rates among nondiabetic and
:: diabetic subjects. However, similar to a few other studies
:: (5,33,34), we found that the degree of protection against diabetes
:: was virtually the same in those with either vigorous or moderate
:: physical activity levels.
::
:: Additional analyses (data not shown) suggest that, in particular, the
:: oldest subjects are responsible for this lack of a clear
:: dose-response relation. Our data suggested that the effect of
:: physical activity could be different in those aged >80 years. A
:: possible explanation is that at this age, the lower physical
:: activity group still at risk for diabetes is more selected due to
:: higher risks of diabetes and mortality earlier in their life than
:: those with higher levels of physical activity. However, the study
:: was underpowered to detect any true difference in effect, and it is
:: unlikely that such a difference would have affected our conclusions.
:: Similar to Gregg et al. (20), the effect of moderate physical
:: activity on the transition of diabetes to death did not reach
:: statistical significance after full adjustment. Additional analyses
:: showed that using a hazard ratio of 1.00 for this transition in the
:: moderate active group would only strengthen our results.
::
:: A strength of this study is the use of data from a prospective,
:: well-organized study, with long-term follow-up. Another advantage is
:: that the glucose levels as well as other risk factors are measured at
:: regular, biannual intervals. In our study, diagnosis of diabetes was
:: based on glucose tests or the use of hypoglycaemic agents instead of
:: self-report. In studies based on self-reported diabetes, many
:: subjects with diabetes remain undiagnosed. In this study, there
:: could be underdiagnosis only if subjects were not present at one or
:: more exams (or had a false-negative test). As most subjects only
:: missed one or a few subsequent exams, it becomes more a matter of
:: delayed diagnosis than underdiagnosis.
::
:: Some limitations should be mentioned. The present study is an
:: observational study and not a randomized trial. Consequently, bias
:: may occur if diseases at baseline are responsible for inactivity
:: (reverse causation) and if other factors confound the association
:: between physical activity and the transition rates. There are two
:: approaches to avoid reverse causation: exclusion of subjects with
:: known diseases at baseline or adjustment for baseline diseases in
:: the analysis. We used the second option, since we considered that by
:: excluding subjects with diseases at baseline, there would be a
:: selection of healthy people, and therefore the results would not be
:: applicable to the whole population.
::
:: Residual confounding cannot entirely be ruled out, but as we examined
:: the potential effect of a large set of confounders (age, sex,
:: education, presence of diseases, marital status, smoking, exam of
:: start follow-up, cholesterol, and family history of diabetes) and
:: included those that affected the association between physical
:: activity and the transitions, we do not expect that this would have
:: biased our results.
::
:: Another limitation of our study is that in the Framingham Heart
:: Study, physical activity levels were evaluated by self-report, which
:: may introduce misclassification of exposure. However, this
:: misclassification is likely to be nondifferential, which can only
:: attenuate our results and fade a stronger association. We maximized
:: the power of our study by using 12 years of follow-up. As a long
:: period of follow-up reduces the effect of selection, but increases
:: the risk of misclassification of exposure, the optimal follow-up
:: time is unknown. Since it has been reported that levels and effects
:: of physical activity change with time (35), we evaluated the effect
:: of length of follow-up on the relation between physical activity and
:: the transitions. These sensitivity analyses showed that with a
:: follow-up period of 8 or 10 years instead of 12 years, our main
:: conclusions did not change (data not shown).
::
:: The added value of this study is the combination of the observed
:: effects of physical activity on incidence of diabetes and mortality
:: in a large prospective study and the translation into the population
:: health measures (life expectancy with and without diabetes).
::
:: This study shows that physically inactive people have shorter lives,
:: and, moreover, they live fewer years without diabetes and more or an
:: equivalent number of years with diabetes compared with people with
:: higher levels of physical activity.
::
:: These results underline the public health importance of increasing
:: physical activity levels in the population. Moreover, as Reunanen et
:: al. (2) found that total costs of medications for people with
:: diabetes were 3.5 times greater than those for nondiabetic control
:: subjects, our findings are also important for the health care
:: sector. When people live longer, but do not spend more years with
:: diabetes, they do not put an extra demand on diabetes-related health
:: care.
::
:: As far as the associations reflect causal relationships, our study
:: suggests that if sedentary people could be stimulated to be at least
:: moderately active, they could extend their lives and increase their
:: lifetime spent without diabetes without spending more years with
:: diabetes.
::
::
:: Reference 2:
::
:: NEJM Volume 345:790-797 September 13, 2001
::
:: Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women
::
:: Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D.,
:: Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and
:: Walter C. Willett, M.D
::
:: ABSTRACT
:: Background Previous studies have examined individual dietary and
:: lifestyle factors in relation to type 2 diabetes, but the combined
:: effects of these factors are largely unknown.
:: Methods We followed 84,941 female nurses from 1980 to 1996; these
:: women were free of diagnosed cardiovascular disease, diabetes, and
:: cancer at base line. Information about their diet and lifestyle was
:: updated periodically.
::
:: A low-risk group was defined according to a combination of five
:: variables: a body-mass index (the weight in kilograms divided by the
:: square of the height in meters) of less than 25; a diet high in
:: cereal fiber and polyunsaturated fat and low in trans fat and
:: glycemic load (which reflects the effect of diet on the blood
:: glucose level); engagement in moderate-to-vigorous physical activity
:: for at least half an hour per day; no current smoking; and the
:: consumption of an average of at least half a drink of an alcoholic
:: beverage per day.
::
:: Results During 16 years of follow-up, we documented 3300 new cases of
:: type 2 diabetes. Overweight or obesity was the single most important
:: predictor of diabetes. Lack of exercise, a poor diet, current
:: smoking, and abstinence from alcohol use were all associated with a
:: significantly increased risk of diabetes, even after adjustment for
:: the body-mass index. As compared with the rest of the cohort, women
:: in the low-risk group (3.4 percent of the women) had a relative risk
:: of diabetes of 0.09 (95 percent confidence interval, 0.05 to 0.17). A
:: total of 91 percent of the cases of diabetes in this cohort (95
:: percent confidence interval, 83 to 95 percent) could be attributed
:: to habits and forms of behavior that did not conform to the low-risk
:: pattern.
::
:: Conclusions Our findings support the hypothesis that the majority of
:: cases of type 2 diabetes could be prevented by the adoption of a
:: healthier lifestyle.
::
:: Discussion
:: In this large cohort of middle-aged women, a combination of several
:: lifestyle factors, including maintaining a body-mass index of 25 or
:: lower, eating a diet high in cereal fiber and polyunsaturated fat and
:: low in saturated and trans fats and glycemic load, exercising
:: regularly, abstaining from smoking, and consuming alcohol moderately,
:: was associated with an incidence of type 2 diabetes that was
:: approximately 90 percent lower than that found among women without
:: these factors. These results suggest that in this population the
:: majority of cases of type 2 diabetes could be avoided by behavior
:: modification.
::
:: Excess body fat is the single most important determinant of type 2
:: diabetes.
::
:: Weight control would be the most effective way to reduce the risk of
:: type 2 diabetes, but current strategies have not been very successful
:: on a population basis,35 and the prevalence of obesity continues to
:: increase.(36) The public generally does not recognize the connection
:: between overweight or obesity and diabetes.(37) Thus, greater efforts
:: at education are needed.
::
:: Our data suggest that the percentage of cases of diabetes that are
:: preventable by diet and exercise independently of body weight is
:: greater among women of normal weight than among obese women. However,
:: even among overweight and obese persons, the combination of an
:: appropriate diet, a moderate amount of exercise, and abstinence from
:: smoking could substantially lower the risk of type 2 diabetes.
:: Although the percentage of cases that could be avoided by means of
:: these lifestyle changes is lower among obese persons, the absolute
:: number of cases avoided among such persons would be greater because
:: of their higher risk.
::
:: Moreover, diet and exercise are the primary factors in determining
:: weight loss.
::
:: Our present results are in agreement with our previous study of
:: coronary disease,21 which found that adherence to similar guidelines
:: was associated with an 83 percent reduction in risk. These analyses
:: underscore the common lifestyle-related origins of diabetes and
:: coronary disease and provide further evidence that modifications of
:: diet and lifestyle have large and multiple benefits.
::
:: Clinical trials in China and Finland have demonstrated the
:: feasibility and efficacy of lifestyle-intervention programs in the
:: prevention of diabetes in high-risk populations. Among 577 patients
:: with impaired glucose tolerance in Da Qing, China,38 exercise
:: interventions, dietary interventions, or both resulted in a decrease
:: of 42 to 46 percent in the rate of progression from impaired glucose
:: tolerance to diabetes during six years of follow-up.
::
:: Recently, the Finnish Diabetes Prevention Program reported that the
:: modification of lifestyle reduced the incidence of type 2 diabetes by
:: 58 percent during 3.2 years of follow-up among 522 middle-aged,
:: overweight participants with impaired glucose tolerance.39 The
:: program included a relatively small reduction in weight (less than
:: 4.5 kg [10 lb]), combined with a diet low in saturated and trans fat
:: and high in fiber and regular moderate exercise.
::
:: Results from the first three years of the Diabetes Prevention Program
:: in the United States also show that regular exercise and the
:: modification of diet reduced the incidence of type 2 diabetes by 58
:: percent among patients with impaired glucose tolerance.40 Our results
:: suggest that closer adherence to behavioral guidelines could reduce
:: the risk further in both low-risk and high-risk populations.
::
:: Because all the women in our study were health care professionals,
:: our findings may not apply directly to the general population.
:: However, since risk factors for diabetes tend to be more prevalent
:: in the general population, the magnitude of the reduction in risk
:: that would be achievable with adherence to the behavioral guidelines
:: we outline would probably be even greater than the magnitude of the
:: reduction we found. Although some factors we considered - for
:: example, alcohol use and smoking - have not been (and will probably
:: never be) tested in randomized trials with clinical end points,
:: ample observational data support their associations with diabetes.
::
:: Nevertheless, physicians must exercise caution in recommending
:: alcohol use, since it may lead to overuse. Finally, we did not
:: consider pharmacologic means of preventing diabetes, some of which
:: are being tested in ongoing clinical trials in high-risk populations.
::
:: Diagnoses of diabetes in our study were reported by the women but
:: were confirmed by a supplementary questionnaire regarding symptoms,
:: diagnostic tests, and treatment. Our previous study found this
:: confirmation to be highly accurate as compared with a review of the
:: medical records.5 Because the women in our cohort who did not have
:: diabetes were not uniformly screened for glucose intolerance, some
:: cases of diabetes may not have been diagnosed. However, when the
:: analyses were restricted to symptomatic cases of diabetes, the
:: findings were not altered substantially, suggesting that
:: surveillance bias is unlikely.
::
:: In conclusion, our findings suggest that the majority of cases of
:: type 2 diabetes could be prevented by weight loss, regular exercise,
:: modification of diet, abstinence from smoking, and the consumption of
:: limited amounts of alcohol. Weight control would appear to offer the
:: greatest benefit.
::
:: ===============
::
:: Anil
:: T2DM
:: Walking 100 miles/month

[Anil]

Roger Zoul wrote:
>
>
> The first study below considered diabetes to be present after a random BG
> level of >= 200 mg/dl !

>From what I understood they did the test them selves in the cohort to
find if any one was developing Diabetes. They did not want to depend on
individual's ability to have that discovered via their own medical
access.

Here is the actual quote:

"A strength of this study is the use of data from a prospective,
well-organized study, with long-term follow-up. Another advantage is
that the glucose levels as well as other risk factors are measured at
regular, biannual intervals.

In our study, diagnosis of diabetes was based on glucose tests or the
use of hypoglycaemic agents instead of self-report. In studies based on
self-reported diabetes, many subjects with diabetes remain undiagnosed.
In this study, there could be underdiagnosis only if subjects were not
present at one or more exams (or had a false-negative test). As most
subjects only missed one or a few subsequent exams, it becomes more a
matter of delayed diagnosis than underdiagnosis."

>
> Also, I don't get how they define moderate and high physical activity. If
> this is not made clear in a tangible way that anyone can duplicate, I don't
> see how this info can be useful.
>

Under the heading of Assessment of physical activity, the report does
document what they mean by "moderate" or "high" physical activity.
Again here is the direct quote:

"
Assessment of physical activity

Participants were asked about their time spent resting or engaged in
light, moderate, or heavy physical activity on an average day.

Time spent at each activity in hours per week was multiplied by its
metabolic cost (based on the oxygen consumption required for that
activity) as described before by Kannel et al. (26). A weight of 1.0
was used for an activity with oxygen consumption of 0.25 l/min, for
example sleep. Other weights were 1.1 for being sedentary, 1.5 for
light activity, 2.4 for moderate activity, and 5 for heavy activity.
The weight factor corresponds to a metabolic equivalent task. These
weighted hours were added up to get a total daily physical activity
score. The minimum physical activity score is 24, which is equivalent
to 24 h of rest/sleep. Based on tertiles of the daily physical activity
scores, we grouped the participants in three levels: low (<30),
moderate (30-33), and high (>33) physical activity level."

As you can see its not that hard to be in high activity range if you
are not living a sedentary life style AND are doing at least a 30 min a
day brisk walk or similar activity. You may do different math than that
I have done. But the the article at least has documented very clearly
the methodology used.

> I fear setting the bar too low will not help. People have a bad habit of
> missing the mark. Set the mark low and when the miss, it will be because
> they did nothing at all.
>

I am with you. I personally have 90-100 minutes (6 miles a day, 100
miles a week) of brisk walking in my routine along with push ups (jack
knife kind) and squats (Deep Knee Bends) in my exerciser regiment. I
did say at least 30 min for 80 to 90% benefit. You are welcome to
disagree and do a lot more, but at least don't do less!

> Frankly, I'd rather see people spending 30 mins 3X/week on weights (full
> body workout) followed by 30 mins 3X/week on cardio than just walking 30 min
> every day. One doesn't need to go to a gym or buy expensive equipment to do
> weights, either.

Hey that works for you great. I am glad to see you share your angle.

>
> Geez.

??? Not clear if I get the subtle nuance! Care to elaborate?

Anil
T2DM

[Roger Zoul]

Anil wrote:
:: Roger Zoul wrote:
:::
:::
::: The first study below considered diabetes to be present after a
::: random BG level of >= 200 mg/dl !
::
::: From what I understood they did the test them selves in the cohort
::: to
:: find if any one was developing Diabetes. They did not want to depend
:: on individual's ability to have that discovered via their own
:: medical access.
::

My point is that a random 200 mg/dl is very high to be diagnosed, not just
that they didn't depend on individuals. A person with a random 170 mg/dl
didn't get counted.

:: Here is the actual quote:
::
:: "A strength of this study is the use of data from a prospective,
:: well-organized study, with long-term follow-up. Another advantage is
:: that the glucose levels as well as other risk factors are measured at
:: regular, biannual intervals.
::
:: In our study, diagnosis of diabetes was based on glucose tests or the
:: use of hypoglycaemic agents instead of self-report. In studies based
:: on self-reported diabetes, many subjects with diabetes remain
:: undiagnosed. In this study, there could be underdiagnosis only if
:: subjects were not present at one or more exams (or had a
:: false-negative test). As most subjects only missed one or a few
:: subsequent exams, it becomes more a matter of delayed diagnosis than
:: underdiagnosis."

Seems that if they used 200 mg/dl, then they missed the mark on this.

::
:::
::: Also, I don't get how they define moderate and high physical
::: activity. If this is not made clear in a tangible way that anyone
::: can duplicate, I don't see how this info can be useful.
:::
::
:: Under the heading of Assessment of physical activity, the report
:: does document what they mean by "moderate" or "high" physical
:: activity. Again here is the direct quote:
::
:: "
:: Assessment of physical activity
::
:: Participants were asked about their time spent resting or engaged in
:: light, moderate, or heavy physical activity on an average day.
::

And this is gauged by the individuals, whose notions of what's moderate may
be very skewed. What some call light may be moderate to others and what
some call heavy made be light to others. This seems meaningless to me.

:: Time spent at each activity in hours per week was multiplied by its
:: metabolic cost (based on the oxygen consumption required for that
:: activity) as described before by Kannel et al. (26). A weight of 1.0
:: was used for an activity with oxygen consumption of 0.25 l/min, for
:: example sleep. Other weights were 1.1 for being sedentary, 1.5 for
:: light activity, 2.4 for moderate activity, and 5 for heavy activity.
:: The weight factor corresponds to a metabolic equivalent task. These
:: weighted hours were added up to get a total daily physical activity
:: score. The minimum physical activity score is 24, which is equivalent
:: to 24 h of rest/sleep. Based on tertiles of the daily physical
:: activity scores, we grouped the participants in three levels: low
:: (<30), moderate (30-33), and high (>33) physical activity level."
::
:: As you can see its not that hard to be in high activity range if you
:: are not living a sedentary life style AND are doing at least a 30
:: min a day brisk walk or similar activity. You may do different math
:: than that I have done. But the the article at least has documented
:: very clearly the methodology used.

Yeah, and it doesn't make sense to me. It's not hard to be in the
high-activity range? Like I said before, this doesn't seem tangible to me.
Is 30 min/day really going to be good enough for prevention? And what about
those who already have T2D?

Also, where is your math for 30min/day mininum? It seems to me that you'd
need 2.5 hours of moderate activity per day get to 30 on their scale. Since
rest/sleep all day is 24, a 30 on their scale rates a difference of 6.
6/2.4 (for moderate activity) = 2.5 h. You must have some other math to
whittle that down. Perhaps 2 hours of normal moving around? As a
guideline, one has to know what "moderate" really means.

::
::: I fear setting the bar too low will not help. People have a bad
::: habit of missing the mark. Set the mark low and when the miss, it
::: will be because they did nothing at all.
:::
::
:: I am with you. I personally have 90-100 minutes (6 miles a day, 100
:: miles a week) of brisk walking in my routine along with push ups
:: (jack knife kind) and squats (Deep Knee Bends) in my exerciser
:: regiment. I did say at least 30 min for 80 to 90% benefit. You are
:: welcome to disagree and do a lot more, but at least don't do less!

It's the less that I'm worried about, not the more.

::
::: Frankly, I'd rather see people spending 30 mins 3X/week on weights
::: (full body workout) followed by 30 mins 3X/week on cardio than just
::: walking 30 min every day. One doesn't need to go to a gym or buy
::: expensive equipment to do weights, either.
::
:: Hey that works for you great. I am glad to see you share your angle.
::
:::
::: Geez.
::
:: ??? Not clear if I get the subtle nuance! Care to elaborate?

Yeah, the article seems to be talking about prevention moreso than living
with it. Also, what do you make of this statement:

"Life expectancy with diabetes is at least 0.5 and 0.1 years less for
moderate and highly active
people, respectively, compared with those with low physical activity."

So, if we're moderately or highly active, we have shorter lives compared to
those low-physical activity people? If they had said "compared with those
without diabetes" then that would be very meaningful to me.


Maybe I just need this broken down a bit more.

[bj]

"Roger Zoul" <[email protected]> wrote in message
news:[email protected]..
> My point is that a random 200 mg/dl is very high to be diagnosed, not just
> that they didn't depend on individuals. A person with a random 170 mg/dl
> didn't get counted.
>
> :: Here is the actual quote:
> ::
> :: "A strength of this study is the use of data from a prospective,
> :: well-organized study, with long-term follow-up. Another advantage is
> :: that the glucose levels as well as other risk factors are measured at
> :: regular, biannual intervals.
> ::
> :: In our study, diagnosis of diabetes was based on glucose tests or the
> :: use of hypoglycaemic agents instead of self-report. In studies based
> :: on self-reported diabetes, many subjects with diabetes remain
> :: undiagnosed. In this study, there could be underdiagnosis only if
> :: subjects were not present at one or more exams (or had a
> :: false-negative test). As most subjects only missed one or a few
> :: subsequent exams, it becomes more a matter of delayed diagnosis than
> :: underdiagnosis."
>
> Seems that if they used 200 mg/dl, then they missed the mark on this.
>

This is the current diagnostic standard -- and should be confirmed by a
separate test on a different day to diagnose diabetes.

If you don't like the standards, take it up with the various committees
making them. The standards changed (downward) a few years ago (about 10?) so
they're not set in stone.
bj

[Roger Zoul]

bj wrote:
:: "Roger Zoul" <[email protected]> wrote in message
:: news:[email protected]..
::: My point is that a random 200 mg/dl is very high to be diagnosed,
::: not just that they didn't depend on individuals. A person with a
::: random 170 mg/dl didn't get counted.
:::
::::: Here is the actual quote:
:::::
::::: "A strength of this study is the use of data from a prospective,
::::: well-organized study, with long-term follow-up. Another advantage
::::: is that the glucose levels as well as other risk factors are
::::: measured at regular, biannual intervals.
:::::
::::: In our study, diagnosis of diabetes was based on glucose tests or
::::: the use of hypoglycaemic agents instead of self-report. In
::::: studies based on self-reported diabetes, many subjects with
::::: diabetes remain undiagnosed. In this study, there could be
::::: underdiagnosis only if subjects were not present at one or more
::::: exams (or had a false-negative test). As most subjects only
::::: missed one or a few subsequent exams, it becomes more a matter of
::::: delayed diagnosis than underdiagnosis."
:::
::: Seems that if they used 200 mg/dl, then they missed the mark on
::: this.
:::
::
:: This is the current diagnostic standard -- and should be confirmed
:: by a separate test on a different day to diagnose diabetes.
::
:: If you don't like the standards, take it up with the various
:: committees making them. The standards changed (downward) a few years
:: ago (about 10?) so they're not set in stone.

I don't need to take anything up with anyone....I can simply discount the
study.

[Anil]

Roger Zoul wrote:

> "Life expectancy with diabetes is at least 0.5 and 0.1 years less for
> moderate and highly active
> people, respectively, compared with those with low physical activity."
>
I am perplexed by that specific statement myself. Recently a study came
out suggesting that a typical diabetes lives 15 yrs less than if s/he
did not have diabetes. I am sure that staying physically active makes
the life we do get relatively complication free. Does it give us those
15 yrs? I have no clue. But I for sure would not sweat too much if I
conk out at say 80! The last 10-15 yrs of one's life after a certain
stage may not always be pleasant, especially if you are a diabetes.


>
> Maybe I just need this broken down a bit more.

Here is what I got from the cited article broken down in snippets:

o Moderately and highly active people live longer and
spend more years without diabetes than subjects
with low physical activity levels.

o The net result is that while moderate and
highly active people live longer, they do
not spend more years with diabetes.

o Most studies published on the subject
have found dose-response relations between
physical activity and the incidence of diabetes.

o We similarly found a dose-response relation
between physical activity and the mortality
rates among nondiabetic and diabetic subjects.

o However, similar to a few other studies we
found that the degree of protection against
diabetes was virtually the same in those with
either vigorous or moderate physical activity levels.

-- This was some what of a surprise finding for me. Seems like there is
an optimum point for intensity of activity level. This is my
justification for brisk walk for 30 min. If you feel that is too short
go for 1 hr or 45 min. But point is you will get most of the benefits
at some optimum point with moderate level. Doing more could be
enjoyable and not discouraged! As I said I do it twice as long myself
plus have in-door exercise to boot.

o This study shows that physically inactive people
have shorter lives, and, moreover, they live fewer
years without diabetes and more or an equivalent
number of years with diabetes compared with people
with higher levels of physical activity.

[Roger Zoul]

Anil wrote:
:: Roger Zoul wrote:
::
::: "Life expectancy with diabetes is at least 0.5 and 0.1 years less
::: for moderate and highly active
::: people, respectively, compared with those with low physical
::: activity."
:::
:: I am perplexed by that specific statement myself. Recently a study
:: came out suggesting that a typical diabetes lives 15 yrs less than
:: if s/he did not have diabetes. I am sure that staying physically
:: active makes the life we do get relatively complication free. Does
:: it give us those 15 yrs? I have no clue. But I for sure would not
:: sweat too much if I conk out at say 80! The last 10-15 yrs of one's
:: life after a certain stage may not always be pleasant, especially if
:: you are a diabetes.
::
::
:::
::: Maybe I just need this broken down a bit more.
::
:: Here is what I got from the cited article broken down in snippets:
::
:: o Moderately and highly active people live longer and
:: spend more years without diabetes than subjects
:: with low physical activity levels.
::
:: o The net result is that while moderate and
:: highly active people live longer, they do
:: not spend more years with diabetes.
::
:: o Most studies published on the subject
:: have found dose-response relations between
:: physical activity and the incidence of diabetes.
::
:: o We similarly found a dose-response relation
:: between physical activity and the mortality
:: rates among nondiabetic and diabetic subjects.
::
:: o However, similar to a few other studies we
:: found that the degree of protection against
:: diabetes was virtually the same in those with
:: either vigorous or moderate physical activity levels.
::
:: -- This was some what of a surprise finding for me. Seems like there
:: is an optimum point for intensity of activity level. This is my
:: justification for brisk walk for 30 min. If you feel that is too
:: short go for 1 hr or 45 min. But point is you will get most of the
:: benefits at some optimum point with moderate level. Doing more could
:: be enjoyable and not discouraged! As I said I do it twice as long
:: myself plus have in-door exercise to boot.
::
:: o This study shows that physically inactive people
:: have shorter lives, and, moreover, they live fewer
:: years without diabetes and more or an equivalent
:: number of years with diabetes compared with people
:: with higher levels of physical activity.

I'm very doubtful of the study. Too much double talk. I believe that we
should shoot for normal BG levels 24/7 and since exercise & diet helps many
of us do that, that's what we should do. Even 30 min is definitely better
than nothing.

[Anil]

Roger Zoul wrote:
> I believe that we
> should shoot for normal BG levels 24/7 and since exercise & diet helps many
> of us do that, that's what we should do. Even 30 min is definitely better
> than nothing.

Cool. That is the message worth taking to ones heart! How one arrives
at this message is not as much important as staying with it for rest of
our life!

Anil

[Gantlet]

how many of the complications diabetics get are a result of the life before
diabetes?
just because I am doing better now does that give me a free pass for what i
have done in the past?
will becoming more active add years to our lives? i dont know the answer to
that question.
but i do know that if the body is fueled correctly and the exercises are
done right.
even if for some reason exercise does not add years to your life - it will
no doubt add life
to the years we do have left.
a body at rest wants to stay at rest and its not that easy or always
possible to undue
the conditions that a static life will bring. its not that the body wants
to stay at rest
it seems to insist that you stay at rest. i spent way to much time at my
computer over the last year
trying to learn things about computers that will help my business. i
believe the pain in my shoulder is a result
of that static state not to mention my hard as nails mattress.
i say the best reason to exercise is to help enjoy the time we have left.

Studies dont really prove much when you are aware of many variables there
could be.

Tom

[Chris Malcolm]

Anil <[email protected]> wrote:

> Roger Zoul wrote:

>> "Life expectancy with diabetes is at least 0.5 and 0.1 years less for
>> moderate and highly active
>> people, respectively, compared with those with low physical activity."
>>
> I am perplexed by that specific statement myself. Recently a study came
> out suggesting that a typical diabetes lives 15 yrs less than if s/he
> did not have diabetes. I am sure that staying physically active makes
> the life we do get relatively complication free. Does it give us those
> 15 yrs? I have no clue. But I for sure would not sweat too much if I
> conk out at say 80! The last 10-15 yrs of one's life after a certain
> stage may not always be pleasant, especially if you are a diabetes.

It often looks different when you actually get there. I know plenty of
70 year olds who would have preferred to die rather than be 60 when
they were 20.

>> Maybe I just need this broken down a bit more.

> Here is what I got from the cited article broken down in snippets:

> o Moderately and highly active people live longer and
> spend more years without diabetes than subjects
> with low physical activity levels.

> o The net result is that while moderate and
> highly active people live longer, they do
> not spend more years with diabetes.

> o Most studies published on the subject
> have found dose-response relations between
> physical activity and the incidence of diabetes.

> o We similarly found a dose-response relation
> between physical activity and the mortality
> rates among nondiabetic and diabetic subjects.

> o However, similar to a few other studies we
> found that the degree of protection against
> diabetes was virtually the same in those with
> either vigorous or moderate physical activity levels.

As they point out, they're not the first study to have noticed this
effect. As is often the case with statistical studies, they're trying
to study an elephant through a few pinholes. My suspicion is that the
dose-benefit curve for exercise at first rises steeply, giving a lot
of benefit from the intitial small increments of exercise, then curves
off into requiring a lot more exercise for extra benefit, and then
begins to tail off as increasing benefit begins to fight against
increased damage.

> -- This was some what of a surprise finding for me. Seems like there is
> an optimum point for intensity of activity level. This is my
> justification for brisk walk for 30 min. If you feel that is too short
> go for 1 hr or 45 min. But point is you will get most of the benefits
> at some optimum point with moderate level. Doing more could be
> enjoyable and not discouraged! As I said I do it twice as long myself
> plus have in-door exercise to boot.

I suspect it's less of an optimum point than a long plateau at the top
of the curve, where adding a lot of exercise doesn't either add much
or reduce much the benefit.

The important point with respect to public health is that you get so
much benefit from so little exercise in the early stages that it's
very worthwhile encouraging people to take a little, rather than
risking discouraging them by advocating longer and more strenuous
exercise schedules.

There's also the business of building up exercise schedules slowly,
especially as you get older. If you already run three miles a day,
then running four might well benefit you, whereas if you only walk
three miles a month, trying to walk three miles a day might exhaust
and injure you.

> o This study shows that physically inactive people
> have shorter lives, and, moreover, they live fewer
> years without diabetes and more or an equivalent
> number of years with diabetes compared with people
> with higher levels of physical activity.

It's not just diabetes. It's IMHO a general feature that folk who
exercise moderately as opposed to those who sit around spend a larger
proportion of their lives on their feet and able to get around, a
better quality of life in the final decade or two. A point that's
often missed in length of life statistics, for example, is that the US
gains it's superior longevity compared to other nations largely by
extending the length of time doctors are struggling to keep you going
at the end. Length of active life is longer in many nations who aren't
as good as the US at keeping people alive in hospital beds.

--
Chris Malcolm [email protected] DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

[Chris Malcolm]

Roger Zoul <[email protected]> wrote:
> Anil wrote:
> :: Roger Zoul wrote:
> ::
> ::: "Life expectancy with diabetes is at least 0.5 and 0.1 years less
> ::: for moderate and highly active
> ::: people, respectively, compared with those with low physical
> ::: activity."

> :: I am perplexed by that specific statement myself. Recently a study
> :: came out suggesting that a typical diabetes lives 15 yrs less than
> :: if s/he did not have diabetes. I am sure that staying physically
> :: active makes the life we do get relatively complication free. Does
> :: it give us those 15 yrs? I have no clue. But I for sure would not
> :: sweat too much if I conk out at say 80! The last 10-15 yrs of one's
> :: life after a certain stage may not always be pleasant, especially if
> :: you are a diabetes.
> ::
> :::
> ::: Maybe I just need this broken down a bit more.

> :: o However, similar to a few other studies we
> :: found that the degree of protection against
> :: diabetes was virtually the same in those with
> :: either vigorous or moderate physical activity levels.
> ::
> :: -- This was some what of a surprise finding for me. Seems like there
> :: is an optimum point for intensity of activity level. This is my
> :: justification for brisk walk for 30 min. If you feel that is too
> :: short go for 1 hr or 45 min. But point is you will get most of the
> :: benefits at some optimum point with moderate level. Doing more could
> :: be enjoyable and not discouraged! As I said I do it twice as long
> :: myself plus have in-door exercise to boot.
> ::
> :: o This study shows that physically inactive people
> :: have shorter lives, and, moreover, they live fewer
> :: years without diabetes and more or an equivalent
> :: number of years with diabetes compared with people
> :: with higher levels of physical activity.

> I'm very doubtful of the study. Too much double talk. I believe that we
> should shoot for normal BG levels 24/7 and since exercise & diet helps many
> of us do that, that's what we should do. Even 30 min is definitely better
> than nothing.

The study wasn't aimed at telling folk who already exercise how much
they should aim for to get maximum benefit. People who already
exercise are a very small minority. I recall a TV programme which
wandered through a housing estate knocking on doors and asking if
people had any exercise kit to sell. Lots of people had exercise kit
they'd only used once or twice. Some had had exercise kit for years in
the garage still in its boxes unopened. Some were reluctant to discuss
selling because they thought they might get round to using it next
year. They didn't actually find anyone who had exercise kit which they
currently used.

The conclusion of the programme was that you didn't need to buy
exercise kit, because it was easy to find people who would let you
take it away for free because it was cluttering up their house or
garage.

With respect to the problem of getting the majority of non-exercisers
off their butts, there's a lot of dispute in scientific circles (as
opposed to gym-trainer circles) about how much you need to do to get a
a worthwhile benefit.

Of course 30 mins walking a day is better than nothing. The
interesting fact seems to be that generally statistically speaking,
when of course we're speaking about the non-exercising majority, 30
minutes walking isn't just better than noting, it's a *lot* better
than nothing.

I do agree with you that the finding of relative lack of
dose-dependent increase of benefit with increased exercise begs lots
of questions which the study is far too crude to answer. There is also
the problem that some doctors are unsophisticated enough to read such
a study and then tell a patient that there's no point in doing more
than 30 mins walking a day.

--
Chris Malcolm [email protected] DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

[Roger Zoul]

Chris Malcolm wrote:
:: Roger Zoul <[email protected]> wrote:
::: Anil wrote:
::::: Roger Zoul wrote:
:::::
:::::: "Life expectancy with diabetes is at least 0.5 and 0.1 years less
:::::: for moderate and highly active
:::::: people, respectively, compared with those with low physical
:::::: activity."
::
::::: I am perplexed by that specific statement myself. Recently a study
::::: came out suggesting that a typical diabetes lives 15 yrs less
::::: than if s/he did not have diabetes. I am sure that staying
::::: physically active makes the life we do get relatively
::::: complication free. Does it give us those 15 yrs? I have no clue.
::::: But I for sure would not sweat too much if I conk out at say 80!
::::: The last 10-15 yrs of one's life after a certain stage may not
::::: always be pleasant, especially if you are a diabetes.
:::::
::::::
:::::: Maybe I just need this broken down a bit more.
::
::::: o However, similar to a few other studies we
::::: found that the degree of protection against
::::: diabetes was virtually the same in those with
::::: either vigorous or moderate physical activity levels.
:::::
::::: -- This was some what of a surprise finding for me. Seems like
::::: there is an optimum point for intensity of activity level. This
::::: is my justification for brisk walk for 30 min. If you feel that
::::: is too short go for 1 hr or 45 min. But point is you will get
::::: most of the benefits at some optimum point with moderate level.
::::: Doing more could be enjoyable and not discouraged! As I said I do
::::: it twice as long myself plus have in-door exercise to boot.
:::::
::::: o This study shows that physically inactive people
::::: have shorter lives, and, moreover, they live fewer
::::: years without diabetes and more or an equivalent
::::: number of years with diabetes compared with people
::::: with higher levels of physical activity.
::
::: I'm very doubtful of the study. Too much double talk. I believe
::: that we should shoot for normal BG levels 24/7 and since exercise &
::: diet helps many of us do that, that's what we should do. Even 30
::: min is definitely better than nothing.
::
:: The study wasn't aimed at telling folk who already exercise how much
:: they should aim for to get maximum benefit. People who already
:: exercise are a very small minority. I recall a TV programme which
:: wandered through a housing estate knocking on doors and asking if
:: people had any exercise kit to sell. Lots of people had exercise kit
:: they'd only used once or twice. Some had had exercise kit for years
:: in the garage still in its boxes unopened. Some were reluctant to
:: discuss selling because they thought they might get round to using
:: it next year. They didn't actually find anyone who had exercise kit
:: which they currently used.
::
:: The conclusion of the programme was that you didn't need to buy
:: exercise kit, because it was easy to find people who would let you
:: take it away for free because it was cluttering up their house or
:: garage.
::
:: With respect to the problem of getting the majority of non-exercisers
:: off their butts, there's a lot of dispute in scientific circles (as
:: opposed to gym-trainer circles) about how much you need to do to get
:: a a worthwhile benefit.
::
:: Of course 30 mins walking a day is better than nothing. The
:: interesting fact seems to be that generally statistically speaking,
:: when of course we're speaking about the non-exercising majority, 30
:: minutes walking isn't just better than noting, it's a *lot* better
:: than nothing.

Well, there's another rub. It's a *lot* better than nothing for what? Do
live complication free or to maximize quality of life. It would seem that
as far as diabetics are concerned, we simply shoot for the minimum. There
doesn't seem to be any focus on being the best you can be, but merely not
becoming a burden on the medical system. That's quite disappointing. The
constant notion that normalacy is unattainable is depressing. Forget any
notions about being above normal. Does diabetes really have to mean that we
are doomed to only a fight for survival as opposed to a robust, active,
fruitful life? That certainly seems to be the message.

::
:: I do agree with you that the finding of relative lack of
:: dose-dependent increase of benefit with increased exercise begs lots
:: of questions which the study is far too crude to answer. There is
:: also the problem that some doctors are unsophisticated enough to
:: read such a study and then tell a patient that there's no point in
:: doing more than 30 mins walking a day.

If you put the bar at minimum then you'll mostly get nothing.

[Larry]

Chris/Anil: Just thinking that this paper supports the notion that the
more sedentary/overweight people are perhaps "luckier" to have the
chance to observe there T2 diabetes symptoms earlier. They are the ones
who respond best to weight reduction and exercise. Whereas the
physically more active people, their T2 diabetes has been lurking
undetected for a longer period of time. Unfortunately these individuals
need to go on meds sooner due to diminished beta cell function. This
may help with the suggestion that higher activity T2 diabetics live
with diabetes for a shorter period of time.

Larry
Chris Malcolm wrote:
> Anil <[email protected]> wrote:
>
> > Roger Zoul wrote:
>
> >> "Life expectancy with diabetes is at least 0.5 and 0.1 years less for
> >> moderate and highly active
> >> people, respectively, compared with those with low physical activity."
> >>
> > I am perplexed by that specific statement myself. Recently a study came
> > out suggesting that a typical diabetes lives 15 yrs less than if s/he
> > did not have diabetes. I am sure that staying physically active makes
> > the life we do get relatively complication free. Does it give us those
> > 15 yrs? I have no clue. But I for sure would not sweat too much if I
> > conk out at say 80! The last 10-15 yrs of one's life after a certain
> > stage may not always be pleasant, especially if you are a diabetes.
>
> It often looks different when you actually get there. I know plenty of
> 70 year olds who would have preferred to die rather than be 60 when
> they were 20.
>
> >> Maybe I just need this broken down a bit more.
>
> > Here is what I got from the cited article broken down in snippets:
>
> > o Moderately and highly active people live longer and
> > spend more years without diabetes than subjects
> > with low physical activity levels.
>
> > o The net result is that while moderate and
> > highly active people live longer, they do
> > not spend more years with diabetes.
>
> > o Most studies published on the subject
> > have found dose-response relations between
> > physical activity and the incidence of diabetes.
>
> > o We similarly found a dose-response relation
> > between physical activity and the mortality
> > rates among nondiabetic and diabetic subjects.
>
> > o However, similar to a few other studies we
> > found that the degree of protection against
> > diabetes was virtually the same in those with
> > either vigorous or moderate physical activity levels.
>
> As they point out, they're not the first study to have noticed this
> effect. As is often the case with statistical studies, they're trying
> to study an elephant through a few pinholes. My suspicion is that the
> dose-benefit curve for exercise at first rises steeply, giving a lot
> of benefit from the intitial small increments of exercise, then curves
> off into requiring a lot more exercise for extra benefit, and then
> begins to tail off as increasing benefit begins to fight against
> increased damage.
>
> > -- This was some what of a surprise finding for me. Seems like there is
> > an optimum point for intensity of activity level. This is my
> > justification for brisk walk for 30 min. If you feel that is too short
> > go for 1 hr or 45 min. But point is you will get most of the benefits
> > at some optimum point with moderate level. Doing more could be
> > enjoyable and not discouraged! As I said I do it twice as long myself
> > plus have in-door exercise to boot.
>
> I suspect it's less of an optimum point than a long plateau at the top
> of the curve, where adding a lot of exercise doesn't either add much
> or reduce much the benefit.
>
> The important point with respect to public health is that you get so
> much benefit from so little exercise in the early stages that it's
> very worthwhile encouraging people to take a little, rather than
> risking discouraging them by advocating longer and more strenuous
> exercise schedules.
>
> There's also the business of building up exercise schedules slowly,
> especially as you get older. If you already run three miles a day,
> then running four might well benefit you, whereas if you only walk
> three miles a month, trying to walk three miles a day might exhaust
> and injure you.
>
> > o This study shows that physically inactive people
> > have shorter lives, and, moreover, they live fewer
> > years without diabetes and more or an equivalent
> > number of years with diabetes compared with people
> > with higher levels of physical activity.
>
> It's not just diabetes. It's IMHO a general feature that folk who
> exercise moderately as opposed to those who sit around spend a larger
> proportion of their lives on their feet and able to get around, a
> better quality of life in the final decade or two. A point that's
> often missed in length of life statistics, for example, is that the US
> gains it's superior longevity compared to other nations largely by
> extending the length of time doctors are struggling to keep you going
> at the end. Length of active life is longer in many nations who aren't
> as good as the US at keeping people alive in hospital beds.
>
> --
> Chris Malcolm [email protected] DoD #205
> IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
> [http://www.dai.ed.ac.uk/homes/cam/]

[Anil]

Larry wrote:
> Chris/Anil:
<Snipped>
> Whereas the physically more active people, their T2 diabetes
> has been lurking undetected for a longer period of time.
> Unfortunately these individuals need to go on meds sooner
> due to diminished beta cell function. This may help with
> the suggestion that higher activity T2 diabetics live
> with diabetes for a shorter period of time.
>
> Larry

Let me restate what you have said so that before I disagree I make
clear what I am in disagreement.
Your reading of the article that active live style along with
regular exercise keeps the diabetic tendencies suppressed
for most of the life time.

--Yes I agree with this part. It may very well keep a whole lifetime
-- free of any metabolic syndrome related complications.

If these folks do get Diabetes they get it at relatively
advance stage
so their life expectancy is shorter after diabetes is
discovered.

No I do not agree with this. A concrete example (not backed by the
cited report) will help illustrate the point. Say due to active life
style you are healthy till 80. At this age due to inherited genes or
any other factor one does get diabetes, chances are that the person
will not have to worry above the severity of this slow progressing
disability before death which (the reason for the death) may very well
be natural. The only reason for short life time after diabetics
discovery for such a person is that the count down timer rang the final
bell.

So there is nothing unfortunate about it in some ways! Ideal result
would have been not getting the numbers high enough to push him in T2DM
range.

=*=
Here is another related article that addresses needs expressed by Roger
Zoul (What's there for T2DM in this study any way?)

Ref: http://tinyurl.com/vjnzl

Effects of Exercise on Glycemic Control and Body Mass in Type 2
Diabetes Mellitus

Sampling of what I got out it(quoted directly from the cited article)

o Postintervention HbA1c values were significantly reduced in
the exercise groups compared with control groups while body
mass was not.
o The postintervention HbA1c values were 0.66% lower in the
exercise
groups when compared with nonexercise control groups.
o A reduction in HbA1c of this magnitude is clinically
significant and
close to the difference between conventional and intensive
glucose-lowering therapy in the United Kingdom Prospective
Diabetes Study (UKPDS). In the UKPDS, subjects receiving
intensive treatment with insulin or sulfonylureas had HbA1c
averaging 0.9% below the conventional treatment
(7.0% vs 7.9%; P<.001) and had significant reduction
in diabetes-related clinical end points (40.9 vs 46 events per

1000 patient-years; P = .03).

- I like the last point as it obviously supports taking
- exercise approach seriously and says it alone is
capable of producing great results obviating the need for
further medication.

Additional findings:
<\begin quote>
The meta-regression results suggest that the differences in HbA1c found
between the exercise groups and control groups after the intervention
were not mediated by differences in weight loss, exercise intensity, or
exercise volume. The finding that exercise does not need to reduce body
weight to have a beneficial impact on glycemic control is clinically
important. Exercise training decreases hepatic and muscle insulin
resistance and increases glucose disposal through a number of
mechanisms that would not necessarily be associated with body weight
changes. The mechanisms were extensively reviewed recently by Ivy et
al,55 and include increased postreceptor insulin signaling,56 increased
glucose transporter protein and messenger RNA,57 increased activity of
glycogen synthase58 and hexokinase,59 decreased release and increased
clearance of free fatty acids,55 increased muscle glucose delivery due
to increased muscle capillary density,59-61 and changes in muscle
composition favoring increased glucose disposal.

The effect of exercise on HbA1c and body mass was estimated from data
obtained across different ethnicities (Northern Europeans, Southern
Europeans, blacks, Asian, Middle-Easterners), medication status (no
medication, oral hypoglycemic agents, insulin therapy), age groups, and
dietary interventions. The results are therefore widely generalizable
to middle-aged patients with type 2 diabetes. Because only 1 study20
included many participants who were older than 65 years, we cannot be
certain that the overall results are generalizable to people older than
65 years. Adherence rates to the exercise programs were relatively high
in most studies (mean >80%, where reported). Adherence rates lower than
these would presumably result in a lesser impact on HbA1c.

<\end quote>

And finally here is one about resistance training:

<\begin quote>
There is little research on the effects of resistance training (such as
weight lifting) in patients with type 2 diabetes; only 2 resistance
exercise studies met inclusion criteria for this analysis. Several
relevant resistance training studies were excluded from the present
analysis because of the absence of an appropriate control group66 or
the inclusion of nondiabetic participants.67-75

In the present meta-analysis, the postintervention WMD for HbA1c in the
resistance training groups vs nonexercise control groups was similar to
aerobic training groups vs nonexercise control groups (-0.64% [95% CI,
-1.29% to 0.01%] and -0.67% [95% CI, -1.04% to -0.30%], respectively).

Well-designed studies on the effects of resistance training and aerobic
training are needed to better understand the impact of increasing
muscle mass and reducing fat mass (especially visceral fat) on glycemic
control and other metabolic abnormalities.
<\end quote>

Anil
T2DM

[Roger Zoul]

Anil wrote:
:: Here is another related article that addresses needs expressed by
:: Roger Zoul (What's there for T2DM in this study any way?)
::
:: Ref: http://tinyurl.com/vjnzl

Thanks. I recall reading this some time ago, IIRC.

::
:: Effects of Exercise on Glycemic Control and Body Mass in Type 2
:: Diabetes Mellitus
::
:: Sampling of what I got out it(quoted directly from the cited article)
::
:: o Postintervention HbA1c values were significantly reduced in
:: the exercise groups compared with control groups while body
:: mass was not.
:: o The postintervention HbA1c values were 0.66% lower in the
:: exercise
:: groups when compared with nonexercise control groups.

These two together seem to be saying that 0.66% lower HbA1c is significant.
Why?

:: o A reduction in HbA1c of this magnitude is clinically
:: significant and
:: close to the difference between conventional and intensive
:: glucose-lowering therapy in the United Kingdom Prospective
:: Diabetes Study (UKPDS). In the UKPDS, subjects receiving
:: intensive treatment with insulin or sulfonylureas had HbA1c
:: averaging 0.9% below the conventional treatment
:: (7.0% vs 7.9%; P<.001) and had significant reduction
:: in diabetes-related clinical end points (40.9 vs 46 events
:: per
::
:: 1000 patient-years; P = .03).

What is conventional treatment? I guess I need to go read something to
figure that out. But the slight reduction of HbA1c of 0.66% is close to
0.9% using this intensive therapy. Not surprising at all.

::
:: - I like the last point as it obviously supports taking
:: - exercise approach seriously and says it alone is
:: capable of producing great results obviating the need for
:: further medication.

Well, I'm not sure it said that at all.


::
:: Additional findings:
:: <\begin quote>
:: The meta-regression results suggest that the differences in HbA1c
:: found between the exercise groups and control groups after the
:: intervention were not mediated by differences in weight loss,
:: exercise intensity, or exercise volume. The finding that exercise
:: does not need to reduce body weight to have a beneficial impact on
:: glycemic control is clinically important.

that last statement is very important, especially when combined with the
once right before it. Even eight loss isn't always necessary. One can gain
improved glycemic control with proper diet and exercise. That is a very
important point that seems to be totally ignored by the medical
establishment.

Exercise training
:: decreases hepatic and muscle insulin resistance and increases
:: glucose disposal through a number of mechanisms that would not
:: necessarily be associated with body weight changes. The mechanisms
:: were extensively reviewed recently by Ivy et al,55 and include
:: increased postreceptor insulin signaling,56 increased glucose
:: transporter protein and messenger RNA,57 increased activity of
:: glycogen synthase58 and hexokinase,59 decreased release and
:: increased clearance of free fatty acids,55 increased muscle glucose
:: delivery due to increased muscle capillary density,59-61 and changes
:: in muscle composition favoring increased glucose disposal.
::
:: The effect of exercise on HbA1c and body mass was estimated from data
:: obtained across different ethnicities (Northern Europeans, Southern
:: Europeans, blacks, Asian, Middle-Easterners), medication status (no
:: medication, oral hypoglycemic agents, insulin therapy), age groups,
:: and dietary interventions. The results are therefore widely
:: generalizable to middle-aged patients with type 2 diabetes. Because
:: only 1 study20 included many participants who were older than 65
:: years, we cannot be certain that the overall results are
:: generalizable to people older than 65 years. Adherence rates to the
:: exercise programs were relatively high in most studies (mean >80%,
:: where reported). Adherence rates lower than these would presumably
:: result in a lesser impact on HbA1c.
::
:: <\end quote>
::
:: And finally here is one about resistance training:
::
:: <\begin quote>
:: There is little research on the effects of resistance training (such
:: as weight lifting) in patients with type 2 diabetes; only 2
:: resistance exercise studies met inclusion criteria for this
:: analysis. Several relevant resistance training studies were excluded
:: from the present analysis because of the absence of an appropriate
:: control group66 or the inclusion of nondiabetic participants.67-75
::
:: In the present meta-analysis, the postintervention WMD for HbA1c in
:: the resistance training groups vs nonexercise control groups was
:: similar to aerobic training groups vs nonexercise control groups
:: (-0.64% [95% CI, -1.29% to 0.01%] and -0.67% [95% CI, -1.04% to
:: -0.30%], respectively).
::
:: Well-designed studies on the effects of resistance training and
:: aerobic training are needed to better understand the impact of
:: increasing muscle mass and reducing fat mass (especially visceral
:: fat) on glycemic control and other metabolic abnormalities.
:: <\end quote>
::
:: Anil
:: T2DM

Too bad that studies on the benefits of proper resistance training for T2s
are so long coming, especially when I and many others already know the
answers!

[Larry]

Anil: Well I agree with your assessment too. But I'm thinking about the
say physically active 57 yr old who had suppressed/masked full blown
diabetes for say 10 yrs prior to a diagnosis. I say a lot of hidden
damage could have be done to beta cell function during this period of
time hardly detected even by A1c tests. Yes this individual only has so
many more years to live anyway and independent of diabetes but could be
shortened a bit more as a direct effect of diabetes complications
particularly if activity level declines for various reasons including
arthritis etc. We know that 50% of beta cell population could be
damaged at the time of diagnosis. I don't believe we know too much
about "normal" beta cell death rate in non-diabetics humans who
eventually are diagnosed with diabetes.

Larry
Anil wrote:
> Larry wrote:
> > Chris/Anil:
> <Snipped>
> > Whereas the physically more active people, their T2 diabetes
> > has been lurking undetected for a longer period of time.
> > Unfortunately these individuals need to go on meds sooner
> > due to diminished beta cell function. This may help with
> > the suggestion that higher activity T2 diabetics live
> > with diabetes for a shorter period of time.
> >
> > Larry
>
> Let me restate what you have said so that before I disagree I make
> clear what I am in disagreement.
> Your reading of the article that active live style along with
> regular exercise keeps the diabetic tendencies suppressed
> for most of the life time.
>
> --Yes I agree with this part. It may very well keep a whole lifetime
> -- free of any metabolic syndrome related complications.
>
> If these folks do get Diabetes they get it at relatively
> advance stage
> so their life expectancy is shorter after diabetes is
> discovered.
>
> No I do not agree with this. A concrete example (not backed by the
> cited report) will help illustrate the point. Say due to active life
> style you are healthy till 80. At this age due to inherited genes or
> any other factor one does get diabetes, chances are that the person
> will not have to worry above the severity of this slow progressing
> disability before death which (the reason for the death) may very well
> be natural. The only reason for short life time after diabetics
> discovery for such a person is that the count down timer rang the final
> bell.
>
> So there is nothing unfortunate about it in some ways! Ideal result
> would have been not getting the numbers high enough to push him in T2DM
> range.
>
> =*=
> Here is another related article that addresses needs expressed by Roger
> Zoul (What's there for T2DM in this study any way?)
>
> Ref: http://tinyurl.com/vjnzl
>
> Effects of Exercise on Glycemic Control and Body Mass in Type 2
> Diabetes Mellitus
>
> Sampling of what I got out it(quoted directly from the cited article)
>
> o Postintervention HbA1c values were significantly reduced in
> the exercise groups compared with control groups while body
> mass was not.
> o The postintervention HbA1c values were 0.66% lower in the
> exercise
> groups when compared with nonexercise control groups.
> o A reduction in HbA1c of this magnitude is clinically
> significant and
> close to the difference between conventional and intensive
> glucose-lowering therapy in the United Kingdom Prospective
> Diabetes Study (UKPDS). In the UKPDS, subjects receiving
> intensive treatment with insulin or sulfonylureas had HbA1c
> averaging 0.9% below the conventional treatment
> (7.0% vs 7.9%; P<.001) and had significant reduction
> in diabetes-related clinical end points (40.9 vs 46 events per
>
> 1000 patient-years; P = .03).
>
> - I like the last point as it obviously supports taking
> - exercise approach seriously and says it alone is
> capable of producing great results obviating the need for
> further medication.
>
> Additional findings:
> <\begin quote>
> The meta-regression results suggest that the differences in HbA1c found
> between the exercise groups and control groups after the intervention
> were not mediated by differences in weight loss, exercise intensity, or
> exercise volume. The finding that exercise does not need to reduce body
> weight to have a beneficial impact on glycemic control is clinically
> important. Exercise training decreases hepatic and muscle insulin
> resistance and increases glucose disposal through a number of
> mechanisms that would not necessarily be associated with body weight
> changes. The mechanisms were extensively reviewed recently by Ivy et
> al,55 and include increased postreceptor insulin signaling,56 increased
> glucose transporter protein and messenger RNA,57 increased activity of
> glycogen synthase58 and hexokinase,59 decreased release and increased
> clearance of free fatty acids,55 increased muscle glucose delivery due
> to increased muscle capillary density,59-61 and changes in muscle
> composition favoring increased glucose disposal.
>
> The effect of exercise on HbA1c and body mass was estimated from data
> obtained across different ethnicities (Northern Europeans, Southern
> Europeans, blacks, Asian, Middle-Easterners), medication status (no
> medication, oral hypoglycemic agents, insulin therapy), age groups, and
> dietary interventions. The results are therefore widely generalizable
> to middle-aged patients with type 2 diabetes. Because only 1 study20
> included many participants who were older than 65 years, we cannot be
> certain that the overall results are generalizable to people older than
> 65 years. Adherence rates to the exercise programs were relatively high
> in most studies (mean >80%, where reported). Adherence rates lower than
> these would presumably result in a lesser impact on HbA1c.
>
> <\end quote>
>
> And finally here is one about resistance training:
>
> <\begin quote>
> There is little research on the effects of resistance training (such as
> weight lifting) in patients with type 2 diabetes; only 2 resistance
> exercise studies met inclusion criteria for this analysis. Several
> relevant resistance training studies were excluded from the present
> analysis because of the absence of an appropriate control group66 or
> the inclusion of nondiabetic participants.67-75
>
> In the present meta-analysis, the postintervention WMD for HbA1c in the
> resistance training groups vs nonexercise control groups was similar to
> aerobic training groups vs nonexercise control groups (-0.64% [95% CI,
> -1.29% to 0.01%] and -0.67% [95% CI, -1.04% to -0.30%], respectively).
>
> Well-designed studies on the effects of resistance training and aerobic
> training are needed to better understand the impact of increasing
> muscle mass and reducing fat mass (especially visceral fat) on glycemic
> control and other metabolic abnormalities.
> <\end quote>
>
> Anil
> T2DM

[[email protected]]

Gantlet wrote:
> even if for some reason exercise does not add years to your life - it will
> no doubt add life
> to the years we do have left.

I like this.

Eating well and exercising don't have to add years to my life, they
make me feel better *now*.

I doubt anyone can accurately quantify what they add in the long run,
but I'm quite happy with the increased quality of life today.

[Trinkwasser]

On Tue, 31 Oct 2006 08:04:24 -0500, "Roger Zoul"
<[email protected]> wrote:

>Well, there's another rub. It's a *lot* better than nothing for what? Do
>live complication free or to maximize quality of life. It would seem that
>as far as diabetics are concerned, we simply shoot for the minimum. There
>doesn't seem to be any focus on being the best you can be, but merely not
>becoming a burden on the medical system. That's quite disappointing. The
>constant notion that normalacy is unattainable is depressing. Forget any
>notions about being above normal. Does diabetes really have to mean that we
>are doomed to only a fight for survival as opposed to a robust, active,
>fruitful life? That certainly seems to be the message.

Yes that level of proactivity is a major difference between the
posters here and the advice they promote vs. the likes of DUK.

I read a horror story in a local mag at the doctor's, a fairly well
known author was diagnosed with diabetes seven years ago.

Now she is blind and in a wheelchair.

Wow, now this is interesting, I just googled Sue Townsend (Adrian
Mole, for it is she) and look what I turned up

http://www.tellparliament.net/diabetes/node/view/7

[Nicky]

"Trinkwasser" <[email protected]> wrote in message
news:[email protected]..
> I read a horror story in a local mag at the doctor's, a fairly well
> known author was diagnosed with diabetes seven years ago.
>
> Now she is blind and in a wheelchair.
>
> Wow, now this is interesting, I just googled Sue Townsend (Adrian
> Mole, for it is she) and look what I turned up
>
> http://www.tellparliament.net/diabetes/node/view/7
>

I didn't spot Sue Townsend in that thread (although it's interesting knowing
she's visually disabled and diabetic, I enjoyed her interview on Breakfast
News the other day, and might get her new book) but I did spot lots of
familiar names in that thread - anyone heard from Maggie or VbHol recently?
And I'd love to be in Dr Morrison's practice! Shame it's in Aberdeen or
similar...

Nicky.

--
A1c 10.5/5.5/<6 T2 DX 05/2004
100ug Thyroxine
95/72/72Kg

[Anil]

Ok here is a great (at least I think so!) review paper on every thing
we need to know about exercise and its wonderful effects on T2DM's over
all health. It covers both resistance exercise and aerobic one. Its
big but well worth the read. There is plenty to digest and more
important to follow. Yes 30 min/day of walking is the minimum you need
to do! Any thing more is very much in line with what the doctors
recommend! And yes Roger your hunch was right on.

Physical Activity/Exercise and Type 2 Diabetes
R e v i e w s / C o m m e n t a r i e s / A D A S t a t e m e n t s
DIABETES CARE, VOLUME 27, NUMBER 10, OCTOBER 2004

http://care.diabetesjournals.org/cgi/reprint/27/10/2518

Anil
T2DM
walking 6 miles a day/100 miles a month
Eating plant based whole food
A1c 5.8 (10/06)
Metformin 2x500 mg
No other medication

[Roger Zoul]

Good find, Anil.

"Recommendations: resistance
exercise
In the absence of contraindications, people
with type 2 diabetes should be encouraged
to perform resistance exercise
three times a week, including all major
muscle groups, progressing to three sets
of 8-10 repetitions at a weight that cannot
be lifted 8-10 times (8-10 RM).
Level of evidence. A. In order to ensure
resistance exercises are performed correctly,
maximize health benefits, and
minimize the risk of injury, we recommend
initial supervision and periodic reassessments
by a qualified exercise
specialist, as was done in the clinical trials
(159,160)."

Now there's something I can agree with fully!

There much more great stuff in the paper Anil found.




Anil wrote:
:: Ok here is a great (at least I think so!) review paper on every thing
:: we need to know about exercise and its wonderful effects on T2DM's
:: over all health. It covers both resistance exercise and aerobic
:: one. Its big but well worth the read. There is plenty to digest and
:: more important to follow. Yes 30 min/day of walking is the minimum
:: you need to do! Any thing more is very much in line with what the
:: doctors recommend! And yes Roger your hunch was right on.
::
:: Physical Activity/Exercise and Type 2 Diabetes
:: R e v i e w s / C o m m e n t a r i e s / A D A S t a t e m e n t s
:: DIABETES CARE, VOLUME 27, NUMBER 10, OCTOBER 2004
::
:: http://care.diabetesjournals.org/cgi/reprint/27/10/2518
::
:: Anil
:: T2DM
:: walking 6 miles a day/100 miles a month
:: Eating plant based whole food
:: A1c 5.8 (10/06)
:: Metformin 2x500 mg
:: No other medication

[Kurt]

Anil wrote:
> Ok here is a great (at least I think so!) review paper on every thing
> we need to know about exercise and its wonderful effects on T2DM's over
> all health. It covers both resistance exercise and aerobic one. Its
> big but well worth the read. There is plenty to digest and more
> important to follow. Yes 30 min/day of walking is the minimum you need
> to do! Any thing more is very much in line with what the doctors
> recommend! And yes Roger your hunch was right on.
>
> Physical Activity/Exercise and Type 2 Diabetes
> R e v i e w s / C o m m e n t a r i e s / A D A S t a t e m e n t s
> DIABETES CARE, VOLUME 27, NUMBER 10, OCTOBER 2004
>
> http://care.diabetesjournals.org/cgi/reprint/27/10/2518

Great link, Anil. Thanks for posting it. I'm passing it on to a few
of my friends.

Best,
Kurt

[Anil]

Roger Zoul wrote:
<snipped>
>
> There much more great stuff in the paper Anil found.
>

Yes that is why I did not want to extract parts of it here other than
give you a hint that you may like what you read.

I think if we collectively spend more time on helping folks with what
we all violently agree on, we would do a great community service.
Exercise , significantly large proportion of colorful vegetables in
every meal, plenty of fibrous food and a assortment of nuts (unsalted)
as part of his/her diet plan, is a no-brainer approach for newbies and
not so newbies alike. Same is true with eating in such a way that
loosing weight remains the goal for folks with BMI > 24.5 (unless of
course you are wicked muscular). There is so much we can agree on and
blurry the differences based on individual dietary preferences. There
always will be individual exceptions but most can use a significantly
overlapped path for handling this unfortunate handicap.

Anyway I sure would like to keep working on things that make sense for
all of us. I am glad you found the article useful.

Anil
T2DM

[Anil]

Kurt wrote:

> Great link, Anil. Thanks for posting it. I'm passing it on to a few
> of my friends.
>
> Best,
> Kurt

Thanks Kurt.

Here is another one that kind of addresses all chronic diseases and
role of exercise. I am surprised it is free! There is a whole section
on Diabetes. Plenty to like for people like you and me who prefer high
fiber whole foods!

Effects of exercise and diet on chronic disease
J Appl Physiol 98: 3-30, 2005; doi:10.1152/japplphysiol.00852.2004
http://jap.physiology.org/cgi/content/full/98/1/3

Happy reading.

Anil

[Chris Malcolm]

Nicky <[email protected]> wrote:

> "Trinkwasser" <[email protected]> wrote in message
> news:[email protected]..
>> I read a horror story in a local mag at the doctor's, a fairly well
>> known author was diagnosed with diabetes seven years ago.
>>
>> Now she is blind and in a wheelchair.
>>
>> Wow, now this is interesting, I just googled Sue Townsend (Adrian
>> Mole, for it is she) and look what I turned up
>>
>> http://www.tellparliament.net/diabetes/node/view/7
>>

> I didn't spot Sue Townsend in that thread (although it's interesting knowing
> she's visually disabled and diabetic,

That's the problem with pages which get updated after google has
indexed the contents. But you can find it via google "cached".

Seems Sue Townsend was diagnosed in roughly 1985, started noticing
serious vision problems in about 1997, became officially blind in
about 2001. Is now also in a wheelchair. In an interview in "Balance"
in 2002, a magazine put out by Diabetes UK, Sue Townsend said she'd
always been too busy to give her diabetes high priority. Asked if she
regretted what that had now cost her, she pondered on whether or not
letting her BGs get so high might have prevented her going blind due
to diabetic retinopathy. "Who knows?" she said.

Who knows indeed...

Some people have known for decades. It's hardly a revolutionary and
paradoxical idea that the complications of diabetes might be due to
high blood sugars. It's hardly surprising and counter-intuitive that
early diagnosis and tight BG control might halt the progression of
complications. It seems like a rather natural suspicion, something
definitely worth trying even if you weren't quite sure. Strange the
resistance against making the facts more widely known.

As Dr Katherine Morrison points out in her submissions to

http://www.tellparliament.net/diabetes/node/view/7

the problem seems to be having to compete with the advertising budgets
of the carby snack advertisers.

It took a hell of a long time before the tobacco industry could be
dragged, kicking and screaming and emitting huge smokescreens of
misinformation, to put health warnings on its packets. I wonder if
we'll ever see health warnings on chocolate biscuits?

--
Chris Malcolm [email protected] DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

[Trinkwasser]

On Thu, 2 Nov 2006 21:31:45 -0000, "Nicky"
<[email protected]> wrote:

>
>"Trinkwasser" <[email protected]> wrote in message
>news:[email protected]. .
>> I read a horror story in a local mag at the doctor's, a fairly well
>> known author was diagnosed with diabetes seven years ago.
>>
>> Now she is blind and in a wheelchair.
>>
>> Wow, now this is interesting, I just googled Sue Townsend (Adrian
>> Mole, for it is she) and look what I turned up
>>
>> http://www.tellparliament.net/diabetes/node/view/7
>>
>
>I didn't spot Sue Townsend in that thread (although it's interesting knowing
>she's visually disabled and diabetic, I enjoyed her interview on Breakfast
>News the other day, and might get her new book) but I did spot lots of
>familiar names in that thread - anyone heard from Maggie or VbHol recently?
>And I'd love to be in Dr Morrison's practice! Shame it's in Aberdeen or
>similar...

Actually in the thread (or a thread) she was supposed to have been
diagnosed sevenTEEN years ago (never trust a journo, when there was
someone in a local paper I knew, the journo got his age wrong. Twice.
I mean two different wrong ages in the same article.)

Yes there don't seem to be many posters to asduk at all much and many
names missing

Time to repost Maggie's advice, it's still up

http://www.sequin.pwp.blueyonder.co....ds/openlet.htm

also available as pdf or word .doc

http://www.sequin.pwp.blueyonder.co..../diabetes.html

[Larry]

Anil: Thanks for the article. The authors refer to "prevention of T2
diabetes" for a period of time. When in fact if one has the genes for
diabetes including abnormal IGT, then exercise may at best delay the
onset of full blown T2 diabetes for perhaps a period of years. I
believe weight loss was a key parameter in their analysis as well.

Larry
Anil wrote:
> Kurt wrote:
>
> > Great link, Anil. Thanks for posting it. I'm passing it on to a few
> > of my friends.
> >
> > Best,
> > Kurt
>
> Thanks Kurt.
>
> Here is another one that kind of addresses all chronic diseases and
> role of exercise. I am surprised it is free! There is a whole section
> on Diabetes. Plenty to like for people like you and me who prefer high
> fiber whole foods!
>
> Effects of exercise and diet on chronic disease
> J Appl Physiol 98: 3-30, 2005; doi:10.1152/japplphysiol.00852.2004
> http://jap.physiology.org/cgi/content/full/98/1/3
>
> Happy reading.
>
> Anil

[Anil]

Larry wrote:
> Anil: Thanks for the article. The authors refer to "prevention of T2
> diabetes" for a period of time. When in fact if one has the genes for
> diabetes including abnormal IGT, then exercise may at best delay the
> onset of full blown T2 diabetes for perhaps a period of years. I
> believe weight loss was a key parameter in their analysis as well.
>
> Larry

Yes Larry, weight combined with life style changes aka plenty of
regular exercise (resistance as well as aerobic) and high fiber diet
seem to hold of ugly effects of organ sickness for extended period of
time. They also indicate that some participants reacted so well that
they no longer needed insulin or BP or LDL lowering drugs.

<\begin quote>
In a separate study (30), 70 hypertensive, diabetic patients had
reductions in blood pressure of 141 ± 2/81 ± 2 to 127 ± 2/75 ± 1
mmHg, with 37 of the 61 patients taking antihypertensive medications
having discounted their medications.

Glucose decreased from 198 ± 9 to 152 ± 5 with 20 of 28 discontinuing
oral hypoglycemics and 12 of 27 discontinuing insulin therapy after the
intervention.

O2max increased, and blood pressure at the same relative work rate
decreased from 183 ± 3/84 ± 2 to 161 ± 3/76 ± 1 mmHg.

Of the 4,587 individuals previously discussed (21), 652 patients were
identified with diabetes; 71% of 197 subjects taking oral hypoglycemic
agents and 39% of 212 taking insulin were able to discontinue their
medication.

Overall, the combined effect of lifestyle modification on diabetes over
five studies (38, 39, 40, 41, 43) and 864 subjects is shown in Fig. 3.

These data suggest the need to emphasize lifestyle modification early
in the treatment of diabetes. It should be noted that these studies
were performed when diabetes was defined as fasting glucose >140 mg/dl.
<\end quote>

Anil
T2DM