Diabetes and Exercise Revisited
Perhaps one of the most applicable tidbits from the Scientific Sessions of the American Diabetes Association meetings last week was information I picked up from the first Symposium on Friday afternoon: Pre-Diabetes/Diabetes and Exercise. (As we sat in a darkened lecture hall for the 3-hour session, the thought of doing exercise was actually a pleasant diversion!)
We all know the current recommendations by many professional organizations of at least 30 minutes of exercise 5 to 7 days per week. This is a reasonable goal for many people; however, for some individuals this goal may be unattainable. As such, if a goal is perceived to be impossible, many will simply not even try! Self-efficacy is extremely crucial to achieve behavioral goals. Unfortunately, many of us to do not achieve the recommended goal described above. However, giving up entirely is simply unacceptable. As I sat listening to the different exercise experts, one of the presenters actually acknowledged that many of us do not achieve this recommendation and that is partly due to the fact that many people with and without diabetes have jobs that require an enormous amount of sitting! A significant segment of the audience started paying a bit more attention to the speaker. After discussing the physiology of exercise and the effect on counter-regulatory hormonal regulation in pre-diabetes and diabetes, the presenter linked the increasing incidence of diabetes/metabolic syndrome to evolution (or the lagging thereof).
Interestingly enough, evolution has not prepared us for our sedentary lifestyle. We are still genetically programmed based on our hunter-gatherer ancestors. To survive, the hunter/gatherer had to move and be physically active either by killing future meals or gathering food for storage. As such, there would be bursts of energy when stalking prey and then perhaps several less active days consuming the results of the hunt. Our bodies are programmed such that insulin sensitivity remains stable with this type of “schedule” based on our ancestral hunting patterns. We have not yet evolved to adapt to our current more sedentary lifestyle. Our genes are lagging behind! Perhaps “natural selection” is working to eliminate those of us that cannot adapt to our present environment!
What was the presenter’s “take home message?”
- MOVE- even if it is less than the 30 minutes/day in one session
- 2 minutes walking/20 minutes of sitting will actually improve insulin sensitivity
- Park your car as far away from the mall entrance/workplace environment as is safely possible to increase walking! (It also may help to prevent dings to your car!)
- Get a dog and walk him/her. (It is working for me!)
- Of course, GO to the Gym! (Works for some)
- Walk on the treadmill and watch TV or read at same time. (I wish someone would patent a treadmill where the TV only stays on if you are walking!)
- Play video games that encourage movement: Wi fit, dancing, etc.
- Find like-minded friends to walk with you.
I thought about how I may apply this tidbit of information to my daily lifestyle.
As a practicing pediatric diabetologist, I travel (by car) to the different outpatient sites. The sites range from 10 minutes to 90 minutes by car. I see my children/adolescents with diabetes starting 8:20 am and ending by 5:00-5:30 PM with hopefully a lunch break between sessions. Theoretically, I could be sitting at my desk for nearly 9 hours/day and 3 hours in the car.
During office hours, I have tried to get up between patients and walk to the waiting room to greet them and then walk back to my office. This generally takes only 30 seconds to a minute. Perhaps, we should take a stroll around the office and chat before actually sitting down and getting to business! I am seriously thinking about methods to increase movement during the day and to include my patients and families. Of course, my biggest concern is that the delay between patients is already too long and this will add to it further.
My take-home message is that many of us struggle with different behaviors. Exercise is tough for me personally. Aiming for the recommended 30 minutes/day 5-7 days a week would be ideal. However I know that I will not be as successful as I might like. Despite actually understanding and knowing that exercise will increase insulin sensitivity and help prevent the development of diabetes, this behavior still remains a challenging one for me. My goal therefore has been to increase exercise during the day creatively! The activity may not be sustained; but frequent two-minute jaunts about the office between patients may be just the “ticket.”
I certainly would love to hear from anyone who has creative ideas about exercise when confined to a sedentary lifestyle or work environment.
It does not have to be all or nothing!