Exercise and Physical Activity for All Ages: 2012 Research and ACSM/ADA Prediabetes and Diabetes Guidelines Ralph La Forge, MSc Duke University - Endocrine Division Durham NC [email protected] Four-part Agenda • Overview & Key Concepts • Recent Important Clinical Exercise Trials • ACSM/ADA Physical Activity Guidelines • Practical Physical Activity Strategies IHS Division of Diabetes 2 Overview & Key Concepts Objective • Just get your patients to move and move often ! You too !! IHS Division of Diabetes 4 A large amount of evidence shows REFERENCES • Goodpaster 2003 that exercise provides the best • Hawley 2004 prevention and treatment for • Hooumard 2004 insulin resistance and type 2 • Helmrich 1991 diabetes • Kraus 2004 • Ross 2004 • Laakosen 2005 • Schulze 2005 • LaForge 2006 • Short 2003 • Thyfault 2009 • Slentz 2011 • Chae 2012 • Sluik 2012 IHS Division of Diabetes 5 Weekly Physical Activity and Cardiometabolic Benefits Walking ~5 miles ~10 miles ~15 miles ~20 miles 25+ miles kcal per 500 1000 1500 2000 2500+ week Benefit Functional and Measurable body fat Weight Loss metabolic benefits alterations, weight loss, Maintenance (glucose transport, lowered LDL-C, … AMPK, PPAR insulin gamma, sensitization) IHS Division of Diabetes 6 Sequence of Metabolic Events During One Muscle Contraction IHS Division of Diabetes 7 Bioenergetics of Moderate and High Intensity Exercise High Intensity Exercise Low-Moderate Intensity Exercise ATP Hydrolysis Rate Very High Low (>60% V02max) (30 to 50% V02max) Exercise 15 minutes 30 to 35 minutes 300 kcal 300 kcal 43 moles ATP 43 moles ATP IHS Division of Diabetes 8 Cardiometabolic Risk and Exercise Training • From a reduction in cardiometabolic risk perspective - total energy expenditure is the key prescriptive parameter: • Fundamentally a product of exercise intensity x exercise duration. • There are added benefits of higher intensity exercise but with added risks. IHS Division of Diabetes 9 Comparative Outcome Indicators Body Weight Changes vs. Muscle Contractions BODY WEIGHT MUSCLE CONTRACTIONS • (fat, water, muscle protein) • Each intentional loosely tied to adipokine, contraction/step: AMPK - A1C, lipocentric changes PPARδγ activation, insulin sensitization IHS Division of Diabetes 10