Exercise Prescription For Type 2 Diabetes Patients

Objective: Type 2 diabetes is a major chronic noncommunicable disease that has emerged as a major public health and economic burden.Exercise therapy is a key element in the prevention and management of type 2 diabetes,which can help patients to achieve and maintain optimal concentration of blood glucose,lipid,and delay chronic complication of diabetes.At present,the exercise prescription for patients with type 2 diabetes in many of specific content is undefined,for example,when is the best exercise time point post-meal,and whether the hypoglycemic effects of different exercise intensities and modes are the same.All these questions need further exploration through study.In the present study,through an exercise program performed by type 2 diabetes patients,we aimed at observing the optimal time point,intensity and mode of exercise for blood glucose regulation in type 2 diabetes patients and wish to provide scientific reference and guide for their exercise prescription.Method:This study is divided into three parts,including the effect of different time points,intensities and modes on blood glucose in patients of type 2 diabetes.In part ?,a total of 15 patients of type 2 diabetes were chosen in the present study.All patients performed 2 Km fast walking at 1h,2h and 3h after meal at different days,which was defined as 1h post-meal group,2h post-meal group and 3h post-meal group.Walking speed was set to be 4~4.5km/h,and the average exercise time was about 25 to 30 minutes.In part ?,a total of 15 patients performed 2 Km fast walking or jogging at 2h after meal on two separate days,and did not do any exercise at a third day,which were defined as fast walking group,jogging group and control group.Walking speed was set to be 4~4.5km/h,and the average exercise time was about 25~30 minutes.Jogging speed was set to be 5~6km/h,and the average exercise time was about 20~25 minutes.In part ?,a total of 15 patients performed 2 Km continuous jogging or interval high-intensity running at 2h after breakfast on two separate days and had no any exercise on a third day,which were defined as continuous jogging group,interval high-intensity running group and control group.Jogging speed was set to be 4~6km/h,and the average exercise time was about 20~30 minutes.Running speed was set to be 6~8km/h and patients were required to rest for 3 minutes after every 4-minute running.The average time of running was about 15~20 minutes and the rest time was about 9~12 minutes.The total time of interval high-intensity running was about 24~32min.All patients were asked to keep their usual diet,medications,and daily activities unchanged during the experimental days.Different experimental days were separated by three days to avoid the effects of the previous exercise.All patients were randomly assigned to three experimental days.In all parts of the experiment,fasting blood glucose,glucose at pre and post exercise,and glucose levels at 11am(pre-lunch)and 4pm(pre-supper)were measured,as well as heart rate before and after exercise.Meanwhile,blood pressure,rate of perceived exertion(RPE)and physical activity enjoyment scale(PACES)were monitored in part ? and part ?.Data were analyzed through ANOVA and paired-t test.Results:Part ? All patients completed the experiments without unexpected withdrawal from intolerance or other adverse events.The main results are listed as follows.1.Results of fast walking: The time to finish 2 Km fast walking was 26~27 min with a speed of 4~5 Km/h.Patient's heart rate after exercise were 65~66% of their maximal heart rate without significant difference among three groups.2.Blood glucose levels at each time point tested:1)Fasting blood glucose levels were similar among three groups.2)Post-exercise blood glucose levels were lower than pre-exercise in both 2h and 3h post-meal groups and it was lower in 3h post meal group than in 1h and 2h post meal groups.3)Blood glucose levels at 11 am were 3h post-meal group < 2h post-meal group < 1h post-meal group.4)Blood glucose levels at 4pm in 2h and 3h post-meal groups were lower than 1h post-meal group,but there was no difference between the former two groups.3.Hypoglycemia: Hypoglycemia happened in a few type 2 diabetes patients after 2 Km fast walking exercise.Among them,3 patients were from 3h post-meal group and 1 from 2h post-meal group.Part ? All patients completed the experiments without unexpected withdrawal from intolerance or other adverse events.The main results are listed as follows.1.Results of fast walking: The time to finish 2 Km fast walking was 27.80�1.66 min with a speed of 4.33�0.24 Km/h.Patients' heart rate after exercise were 72.7�4.4% of their maximal heart rate.Results of jogging: The time to finish 2 Km jogging was 20.33�1.72 min with a speed of 5.80�0.51 Km/h.Patients' heart rate after exercise were 85.5�3.9% of their maximal heart rate.2.Blood glucose levels at each time point tested:1)Fasting blood glucose levels were similar among three groups.Pre-exercise blood glucose levels were similar among three groups.2)Post-exercise blood glucose levels were lower than pre-exercise in both exercise groups,and it was lower in jogging group than fast walking groups.3)Blood glucose levels at 11 am in three groups were jogging group < fast walking group < contrast group.4)Blood glucose levels at 4pm were similar among three groups.3.Blood pressure and heart rate tested:1)Systematic blood pressure(SBP): SBP were similar between fast walking group and jogging group before exercise.The change of SBP from pre-exercise to 30 min post-exercise was larger in jogging group than that in fast walking groups.2)Diastolic blood pressure(DBP): DBP were similar between fast walking group and jogging group before exercise.The changes of SBP from pre-exercise to 30 min post-exercise in fasting walking group and jogging group were similar.3)Heart rate(HR): HR pre-exercise were similar between fasting walking group and jogging group.HR at each time point during exercise in fasting walking group was lower than that in jogging group.4.RPE: RPE in fasting walking group was lower than that in jogging group.5.PACES: PACES in fasting walking group was higher than that in jogging group.Part ? All patients completed the experiments without unexpected withdrawal from intolerance or other adverse events.The main results are listed as follows.1.Results of continuous jogging: The time to finish 2 Km continuous jogging was 19.53�1.81 min with a speed of 6.06�0.50 Km/h.Patient's heart rate after exercise was 74.4�4.4% of their maximal heart rate.Results of interval high-intensity running: The time to finish 2 Km interval high-intensity running was 26.80�2.78 min and the time of running was16.40�1.35 min with a speed of 7.25�0.67 Km/h.The time of rest was 10.4�1.55 min and the average speed within the whole period was 4.51�0.47Km/h.Patient's heart rates after exercise were 85.5�3.9% of their maximal heart rate.2.Blood glucose levels at each time point tested:1)Fasting blood glucose levels and pre-exercise blood glucose levels were similar among three groups.2)Post-exercise blood glucose levels were lower than pre-exercise,and there was no difference between continuous jogging group and interval high-intensity running group.3)Blood glucose levels at 11 am of the two exercise groups were lower than that in control group.And there was no difference between the two exercise groups.4)Blood glucose levels at 4pm were similar among three groups.3.Blood pressure and heart rate tested:1)SBP: SBP were similar between continuous jogging group and interval high-intensity running group before exercise.The change of SBP from pre-exercise to 30 min post-exercise was larger in interval high-intensity running group than in continuous jogging groups.2)DBP: DBP were similar between continuous jogging group and interval high-intensity running group before exercise.The change of DBP from pre-exercise to 30 min post-exercise was larger in continuous jogging group than that in interval high-intensity running group.3)HR: HR pre-exercise was similar between continuous jogging group and interval high-intensity running group.HR at each time point during exercise in continuous jogging group was lower than interval high-intensity running group.4.RPE: RPE were similar between interval high-intensity running group and continuous jogging groups.5.PACES: PACES in interval high-intensity running group was higher than that in continuous jogging group.Conclusions:1.Among the 2 Km fast walking at different time points,the 3h post-meal exercise has the most significant effect in lowering glucose level,followed by 2h post-meal exercise.There are risks of hypoglycemia after 2 Km fast walking in type 2 diabetes patients and the risk is the highest in 3h post-meal group.2.Jogging exercise has stronger effect in lowering blood glucose than fast walking group.The change of SBP from pre-exercise to 30 min post-exercise was larger in jogging group than that in fast walking groups.3.The effects on blood glucose were similar between interval high-intensity running group and continuous jogging groups.The change of SBP from pre-exercise to 30 min post-exercise was larger in interval high-intensity running group than that in continuous groups.The change of DBP from pre-exercise to 30 min post-exercise was larger in continuous jogging group than that in interval high-intensity running group.General speaking,in the 1 to 3h post-meal exercise,2h post-meal exercise has a good effect in lowering blood glucose,meanwhile has low risk of hypoglycemia,thereby worth to be recommended to type 2 diabetes patients.As for the more intensive jogging and less intensive fast walking,jogging has stronger effect in lowering blood glucose and blood pressure,thereby worth to be recommended to type 2 diabetes patients.However,fast walking is preferred by the patients due to less effort.We recommend type 2 diabetes patients start exercise from fast walking and gradually increase intensity and transfer to jogging.The different modes of exercise,continuous jogging and interval high-intensity running,have the similar effects in regulating blood glucose.But interval high-intensity running exercise is preferred by subjects,thereby worth to be recommended to type 2 diabetes patients.