Working Wonders: Physical Activity for Diabetes Prevention and Management
Maintaining perfect health in today’s world is to some degree, a dream. Our wellbeing is affected by multiple factors, some of which may inevitably be overlooked. Presently diabetes mellitus, a chronic metabolic disease, has emerged to be strikingly common – affecting around 347 million people worldwide .
Diabetes is associated significant morbidity and mortality; in the year 2012, 1.5 million casualties were estimated to result from diabetes. The WHO predicts that by 2030, diabetes would rank as the seventh major cause of death. [2, 3] The global incidence of diabetes is on the rise, from 171 million patients in the year 2000 to an expected 366 million by 2030. 
Diabetes mellitus is a condition due to either insufficient insulin production by the pancreas, or inability of the body to utilize insulin. Insulin is an essential hormone that regulates blood glucose levels. Uncontrolled diabetes brings about hyperglycemia (elevated glucose level) which can severely damage organ systems of the body, predominantly veins and nerves. Diabetes is classified into three types: type I, type II and gestational diabetes.
Type I diabetes is characterized by impaired insulin production, hence also called insulin-dependent diabetes. Type II diabetes results from the body’s resistance to insulin. It is additionally known as non-insulin-dependent or adult-onset diabetes. It is the predominant type (around 90% of all cases) and its risk is associated with obesity and physical inactivity.
Gestational diabetes refers to hyperglycemia occurring during pregnancy. Here, the blood glucose level is above normal but below values that are diagnostic of diabetes. Such females are at higher risk of developing type II diabetes in future. 
The complications of diabetes are myriad, and not only restricted to stroke and other cardiovascular diseases but also include peripheral neuropathy arising from diminished blood flow to extremities. Consequently, diabetic patients may have reduced ability to sense pain and so might neglect ongoing infections until much advanced. This condition may lead to foot ulcers, cellulitis and infections eventually necessitating limb amputation. Diabetic retinopathy involves damage to retinal blood vessels, producing visual disturbances. 1% of cases of visual impairment world over are attributable to diabetes.  .
Regular exercise holds benefits for every individual; however it has been demonstrated to be of remarkable value to diabetics as it slows down the evolution of impaired glucose tolerance (IGT) to type II diabetes. Several studies have shed light on the metabolic impact of activity, and it has been established that physical training and workout enhances consumption of glucose and free fatty acids in muscles and lowers blood glucose levels in diabetic patients.  There is unequivocal evidence that diabetes and its complications can, to a great extent, be forestalled by following a healthy diet, adhering to a consistent physical activity regimen, maintaining normal body weight and avoiding tobacco consumption. 
Medical literature holds strong evidence that advancement of physical activity assumes an imperative role in essential counteractive action of type II diabetes. Primary prevention of diabetes involves interventions that fundamentally delay or halt the succession of diabetes in ‘prediabetic’ individuals (i.e. who are asymptomatic but have impaired glucose tolerance). Recent research supports a causal link between regular physical activity and deterrence of diabetes. Additionally, there are multiple trails of evidence that prioritize lifestyle modifications over pharmaceutical approaches such as metformin. 
In keeping with the above, some observational studies have regarded physical inactivity as an independent risk factor for diabetes. [9, 10] Also evidence suggests that as frequency and intensity of physical activity increases, the risk of incident diabetes declines.  According to a survey, individuals with an active lifestyle have around 30% lower risk of developing diabetes than those having a sedentary lifestyle.  There is growing evidence that it is not solely a lack of physical exercise that carries increased risk for diabetes; sedentary behavior like excessive television watching and prolonged computer use by itself is a contributing factor. Some studies even indicate that an increment in the number of hours of inactivity directly correlates with the rise in the risk of diabetes. [13, 14]
Thus, as an adjunct to pharmaceutical approaches, and other preventive measures against diabetes, mild exercise, for instance regular jogging plays a beneficial role in managing metabolic activities and enhancing insulin action. Exercise therapy is useful in both preventing and treating diabetes by limiting the perils of hyperglycemia, hypertension and insulin resistance. Following a standard exercise routine improves vascularity and brings about gradual weight reduction, resulting in better glycemic and lipemic control in diabetics. Studies suggest that insulin sensitivity is positively influenced by the average number of steps taken per day. 
The recommended activity regimen for diabetics incorporates mild to moderate aerobic exercises for approximately 10–30 minutes per day, at least 3–5 days a week – which may simply comprise of walking and jogging. Mildly intense exercises that include lifting of light-weight dumbbells, free weights or stretch cords may improve endurance and muscular strength in the elderly population.
Physical therapists endeavor to support and assist patients in adopting an active lifestyle, which is crucial in effective management of diabetes. This may consist of walking, occupational, household and recreational or yard activities. A physical therapist thereby makes sure that the patient maintains a sound body weight, remains physically active, performs no less than 30 minutes of standard moderate-intensity activities, eats a healthy diet, and cuts down on sugar and saturated fats intake. [5, 6, 7]
Although the importance of physical activity has been discussed here with chief regard to diabetes mellitus, it must be underscored that the advantages of workout sessions extend far beyond those mentioned here; normal people of any age group or class can benefit their health from appropriate physical training. Physical activity is not only of essence in risk reduction in prediabetic individuals, but is also a significant method of secondary intervention, i.e. in treating and preventing further complications of diabetes. Light, moderate or high-impact activities can be performed by the patients. The duration, intensity, frequency and mode of exercise may be adjusted according to patient needs.
Generally, 30 minutes of aerobic activity are considered sufficient to yield substantial benefits. These may incorporate walking, jogging, swimming or using a treadmill. The exercise program can be stepped up by increasing loads in resistance exercises that make use of free-weights, or by introduction of resisted recumbent or upright bikes. Advancement in the exercise regime can be made by making resisted activities such as using free-weights or resisted recumbent or upright bikes a part of the program.
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2. Health statistics and information systems. Cause-specific mortality. Estimates for 2000-2012.
3. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.
4. Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27(5):1047-1053.
5. Who.int. WHO | Diabetes [Internet]. 2015 [cited 3 November 2015]. Available from: http://www.who.int/mediacentre/factsheets/fs312/en/
6. Cade W. Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. Physical Therapy. 2008; 88(11):1322-1335.
7. Sato Y, Nagasaki M, Kubota M, Uno T, Nakai N. Clinical aspects of physical exercise for diabetes/metabolic syndrome. Diabetes Research and Clinical Practice. 2007; 77(3):S87-S91.
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9. Manson J, Stampfer M, Colditz G, Willett W, Rosner B, Hennekens C et al. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. The Lancet. 1991; 338(8770):774-778.
10. Helmrich S, Ragland D, Leung R, Paffenbarger R. Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus. New England Journal of Medicine. 1991; 325(3):147-152.
11. Perry I, Wannamethee S, Walker M, Thomson A, Whincup P, Shaper A. Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men. BMJ. 1995; 310(6979):560-564.
12. Jeon C, Lokken R, Hu F, van Dam R. Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: A systematic review. Diabetes Care. 2007; 30(3):744-752.
13. Hu F, Leitzmann M, Stampfer M, Colditz G, Willett W, Rimm E. Physical Activity and Television Watching in Relation to Risk for Type 2 Diabetes Mellitus in Men. Arch Intern Med. 2001; 161(12):1542.
14. Hu F. Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women. JAMA. 2003; 289(14):1785.
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