Exercise and Physical Activity for All Ages: 2012 Research and

85 Pages·2012·1.04 MB·English

by  Indian Health Service

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 !!

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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)

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Sequence of Metabolic Events During One
Muscle Contraction
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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
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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.
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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

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