Conquering Type 2 Diabetes with Exercise: A Guide to the Best Workouts

While exercise benefits type 2 diabetes by improving blood sugar control, the best training program remains a mystery. This review, published in the journal Diabetologia, explores how tweaking factors like exercise type, intensity, and diet affect these benefits. Mixing aerobic and resistance training seems to trump solo workouts, though the increased frequency might explain the edge. High-intensity interval training appears to further boost the blood sugar benefits of aerobic exercise. Training with limited carbs also shows promise for improving fitness and muscle function in healthy individuals.

Key Findings

Exercise and Type 2 Diabetes:

• Exercise improves blood sugar control in individuals with type 2 diabetes, but the optimal training regimen remains unclear.

• This review examines how exercise type, intensity, and nutritional strategies might influence these benefits.

Combined Training:

• Combining aerobic and resistance training may offer greater improvements in blood sugar control compared to either modality alone.

• However, the increased training frequency in combined programs might be the main factor contributing to this benefit.

Aerobic Exercise Intensity:

• Evidence suggests that the benefits of aerobic exercise on blood sugar control increase with exercise intensity.

• High-intensity interval training (HIIT) appears to be particularly effective.

Training with Low Carbohydrate Availability:

• Training while maintaining low carbohydrate availability ("training low") improves cardiorespiratory function and muscle function in healthy individuals.

• Research is needed to determine the safety and effectiveness of this strategy for individuals with type 2 diabetes.

Optimizing Training for Individuals with Type 2 Diabetes:

• Similar to athletes, individuals with type 2 diabetes should personalize their training to improve their fitness and metabolism.

• Further research is needed to explore various training regimens, considering safety, efficacy, feasibility, and specific benefits for this population.

While exercise benefits blood sugar control in type 2 diabetes, the ideal training plan is still being explored. This review highlights that combining aerobic and resistance training might be more effective than each alone, but this could be due to the increased training frequency. Additionally, high-intensity interval training shows promise for improved blood sugar control compared to moderate-intensity workouts. Training with low carbohydrate availability, while beneficial for healthy individuals, needs further investigation for safety and effectiveness in type 2 diabetes. Ultimately, similar to athletes, individuals with this condition should personalize their training programs to optimize fitness and metabolism, and researchers need to explore various training options considering safety, effectiveness, and feasibility.

Tailoring Exercise for Type 2 Diabetes

Exercise Modalities and Intensities

Distinct exercise modalities and intensities present specific physiological challenges, driving unique adaptations in training. For individuals with type 2 diabetes, the challenge lies in identifying the optimal regimen for metabolic benefits. Evidence suggests that combining aerobic and resistance training yields superior improvements in glycaemic control compared to singular training types.

The Power of Combined Training

Greater advancements in glycaemic control are observed in combined aerobic and resistance training regimens. The synergy between these two modalities appears to outperform singular approaches. However, it's crucial to note that the increased frequency and number of exercise bouts may contribute to the apparent advantages seen in combined programs.

Aerobic Exercise Intensity Matters

While all forms of aerobic exercise contribute to improved glycaemic control, the intensity at which they're performed plays a pivotal role. High-intensity interval training (HIT) emerges as a standout, showcasing superior adaptations in glycaemic control. For individuals with type 2 diabetes, incorporating HIT into their exercise routine may be a game-changer for optimizing metabolic outcomes.

Training Low: A Unique Approach

In addition to exercise type and intensity, nutritional status during training plays a significant role. Training with low carbohydrate availability, commonly referred to as 'training low,' emerges as a strategy that enhances cardiorespiratory function and skeletal muscle oxidative capacity more than conventional training in healthy, untrained individuals. The implications of this approach for those with type 2 diabetes warrant further exploration.

Encouraging Fitness and Metabolism

Individuals with type 2 diabetes are not exempt from the benefits of tailored exercise regimens. Encouraging them to adopt training routines that boost both fitness and metabolism is paramount. As we continue to unlock the potential of exercise for glycaemic control, it becomes clear that a personalized approach, considering exercise type, intensity, modality, and nutritional conditions, is the key to optimal outcomes.

Skeletal Muscle Glucose Uptake and Insulin-Independent Mechanism

Exercise acts as a catalyst for skeletal muscle glucose uptake, operating through an insulin-independent mechanism. This revelation opens a door to understanding how exercise training can contribute to metabolic improvements, even in individuals with insulin resistance.

Canonical Acute Responses and Mitochondrial Function

Canonical acute responses to exercise, such as increased AMP-activated protein kinase activity and the expression of PGC-1α, are conserved in insulin-resistant skeletal muscle. Additionally, exercise training restores skeletal muscle mitochondrial function in individuals with type 2 diabetes, paralleling gains in strength and endurance observed in healthy counterparts.

Modulating Exercise Type, Intensity, and Volume

While insulin sensitivity improves with exercise training, its levels remain lower than in healthy individuals. Fine-tuning the training modality becomes crucial, acknowledging the influence of factors like the participant's age and the duration of type 2 diabetes. Nevertheless, adjustments in exercise type, intensity, volume, and duration offer avenues for achieving glycemic improvements.

The Traditional Prescriptions: Aerobic Training

Aerobic training has long been the traditional prescription for managing type 2 diabetes. Rigorous studies have shown consistent decreases in HbA1c levels after moderate- to high-intensity aerobic training. The glycaemic benefits stem from the ability of aerobic exercise to bypass insulin resistance, increase skeletal muscle glucose uptake, and potentiate insulin sensitivity post-exercise.

The Strength of Resistance Training

Resistance training, on the other hand, presents a different yet impactful avenue for glycaemic control. A single bout of resistance exercise leads to acute improvements, with longer training periods resulting in lower HbA1c levels compared to standard care. Skeletal muscle adaptations play a pivotal role, highlighting the potential of resistance training in managing type 2 diabetes.

The Synergy of Combined Training

Recent studies have delved into the efficacy of combined training regimens—blending aerobic and resistance exercises. Results indicate a greater reduction in HbA1c levels compared to singular approaches, showcasing the potential synergistic effects of diverse exercise types.

Diving into Training Intensity

Exercise intensity emerges as a crucial factor in achieving glycaemic control. High-intensity interval Training (HIT) stands out, offering superior glycaemic improvement compared to continuous moderate-intensity training. Notably, HIT achieves these results with a lower time commitment, making it an attractive option for those with a busy lifestyle.

Volume Matters: Exploring Training Duration

Research examining the effects of aerobic training at different intensities and volumes underscores the importance of exercise volume in achieving sustained metabolic improvements. While both moderate and vigorous intensities contribute to insulin sensitivity, longer training sessions and higher volumes may lead to more lasting benefits.

The Efficiency of HIT

High-Intensity Interval Training (HIT) deserves a spotlight for its efficiency in improving glycaemic control. Studies indicate that HIT induces similar athletic performance adaptations as continuous moderate-intensity training but with significantly lower time commitment and exercise volume. The allure of HIT lies in its ability to lower blood glucose levels and enhance insulin sensitivity, making it a compelling alternative for individuals with type 2 diabetes.

High Carbohydrate Availability: A Performance Booster

Fuel preference during an activity bout significantly influences performance outcomes. High carbohydrate availability emerges as the go-to strategy for athletes seeking optimal performance during exercise. Consumption of carbohydrate-rich beverages stands out as a key practice, not only enhancing performance but also mitigating symptoms of overtraining.

Fueling Superior Endurance

Traditional approaches often advocate for exercising after an overnight fast or incorporating twice-daily sessions to deplete glycogen stores. This sets the stage for improved endurance, as high carbohydrate availability remains a driving force behind enhanced performance.

Embracing 'Training Low': A Paradigm Shift

Forcing Utilization of Lipids

Contrary to the high carbohydrate paradigm, 'training low' takes a different route, compelling the utilization of lipids as a primary fuel source. This strategic approach promotes mitochondrial biogenesis and superior adaptations in skeletal muscle oxidative capacity, unlocking a realm of metabolic benefits.

A Novel Approach: The Power of HIT

A groundbreaking variation of 'training low' involves performing High-Intensity Interval Training (HIT) in the evening, followed by an overnight fast. This dual-depletion strategy, targeting both skeletal muscle and liver glycogen stores, proves to be a game-changer. The result? Superior increases in fatty acid oxidation, enhanced endurance, and heightened expressions of key metabolic markers like PGC-1α mRNA.

Glycemic Responses to Exercise in Different States

While direct examinations of these training strategies in individuals with type 2 diabetes are scarce, insights from crossover randomized control trials (RCTs) shed light on acute glycaemic responses. The modality and intensity of exercise play a pivotal role, with a stronger impact of moderate exercise achieved in the postprandial state and vigorous exercise showing superior effects under fasted conditions.

Navigating Adaptations and Safety

Current research points to the combined efficacy of resistance and aerobic training regimens and HIT in conveying superior improvements in glycaemic control. Concerns about the acute side effects of HIT in the diabetes population are addressed, highlighting its application in cardiovascular disease rehabilitation without increased risk.

A Complex Equation

Selecting the most efficacious training regimen for type 2 diabetes management involves a careful consideration of exercise type, intensity, volume, and nutritional status. Current evidence leans towards the superiority of combined resistance and aerobic training regimens, coupled with the efficiency of HIT.

Addressing Concerns and Risks

Concerns about the potential risk of hypoglycemia with 'training low' are acknowledged, especially in individuals with uncontrolled or insulin-treated type 2 diabetes. While many exercise regimens are generally safe, consultation with a physician is advisable for untrained individuals, ensuring a holistic evaluation of any underlying health issues.

Unlocking the Full Potential

Despite substantial evidence supporting the positive impact of exercise training on glycaemic control, gaps in knowledge persist. Further studies are imperative to examine the relative advantages of distinct training types and intensities, nutritional status, and their intricate interactions. These investigations will provide crucial insights into tailoring exercise regimens for individuals with type 2 diabetes to confer the most advantageous metabolic adaptations.

To Summarize

• 1. Exercise training improves glycaemic control in individuals with type 2 diabetes; however, the precise training regimen that confers the most beneficial metabolic adaptations in this population is unknown. This review discusses how modifying exercise type, intensity, modality, and nutritional status affects the beneficial effects of exercise on glycaemic control in individuals with type 2 diabetes.

• 2. The findings suggest that greater improvements in glycaemic control can be achieved through combined aerobic and resistance training regimens compared with either training type alone. However, the increased frequency of training and a greater number of exercise bouts during combined programmes could be responsible for the apparent advantages over a single training modality.

• 3. The beneficial effects of aerobic exercise on glycaemic control seem to rise with training intensity, with superior adaptations achieved by high-intensity interval training (HIT). In addition, training with low carbohydrate availability (‘training low’) improves cardiorespiratory function and skeletal muscle oxidative capacity more than conventional training in healthy, untrained individuals.

• 4. Examinations of various training regimens are warranted to assess their safety, efficacy, feasibility, and beneficial effects in the type 2 diabetes population. Just like competitive athletes, individuals with type 2 diabetes should be encouraged to adopt training regimens that improve fitness and metabolism.

• Here is a summary of the main findings of the review:

  • Combined aerobic and resistance training regimens are more effective than either training type alone for improving glycaemic control in individuals with type 2 diabetes.

  • The beneficial effects of aerobic exercise on glycaemic control seem to rise with training intensity, with superior adaptations achieved by high-intensity interval training (HIT).

  • Training with low carbohydrate availability (‘training low’) improves cardiorespiratory function and skeletal muscle oxidative capacity more than conventional training in healthy, untrained individuals.

• These findings suggest that exercise training can be an effective tool for improving glycemic control in individuals with type 2 diabetes. However, more research is needed to determine the optimal training regimen for this population.

In Conclusion

In the intricate landscape of exercise, nutrition, and metabolic health, the journey towards optimal glycaemic control is multifaceted. Whether it's the strategic utilization of carbohydrate availability, the paradigm-shifting 'training low' approaches, or the dynamic interplay of exercise modalities, the key lies in a personalized approach. As we navigate the complexities, the promise of improved health outcomes for individuals with type 2 diabetes emerges, beckoning towards a future where exercise becomes a precision tool in combating metabolic disease.

Reference articles

Savikj, M., Zierath, J.R. Train like an athlete: applying exercise interventions to manage type 2 diabetes. Diabetologia 63, 1491–1499 (2020). https://doi.org/10.1007/s00125-020-05166-9

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https://healthnewstrend.com/exercise-and-fat-metabolism-a-muscle-centric-perspective

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