ola hansson

Individualized exercise to battle diabetes Ola Hansson (Ola.Hansson@med.lu.se)

International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

Type 1 diabetes Type 2 diabetes Gestational diabetes

• Lack of insulin • Autoimmune • Usually children

• Defect insulin secretion

• Insulin resistance • Lifestyle factors • Usually adults

• Insulin resistance • During pregnancy • Risks to mother

and child

Main “types” of diabetes

The risk of complications is reduced by good glycaemic control

25 times higher risk of

eye problems

6 times higher risk for stroke

5 times higher risk of kidney

disease

20 times higher risk of

lower limb amputation

2-4 times higher risk for heart attack

High blood glucose leads to long term

complications

International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

Seshasai et al. N Engl J Med 2011;364:829-41

.

0

7

6

5

4

3

2

1

0

40 50 60 70 80 90Age (years)

Year

s of

life

lost

Men7

6

5

4

3

2

1

0

40 50 60 70 80 900Age (years)

WomenNon-vascular deaths

Vascular deaths

On average, a 50-year-old individual with diabetes and no history of vascular disease will die 6 years earlier compared to someone

without diabetes

Diabetes is associated with significant loss

of life years

• Not curable • But can be controlled with

Education Healthy Diet Proper Medications

Regular Check ups

Regular Exercise

Diabetes management

Diabetes: A global

emergency

International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

2014 2040

WORLD

415

million

WORLD

642 million people living with diabetes

Middle East and North Africa 85%

South East Asia 64%

South and Central America 55%

Western Pacific 46%

North America and Caribbean 30%Europe 33%

Africa 93%

55%

Diabetes: A global

emergency

International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

Diabetes is a human and economic burden

4.9 million deaths per year

50% of deaths under 60 years of age

Intersects with all dimensions of development

US$612 billion 11% of worldwide healthcare

expenditure

… and the costs to society are high and

escalating

International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

Lifestyle (diet and exercise) is better than drugs in preventing diabetes…

Knowler W.C. et al., N Engl J Med. , 2002

…but we don´t respond to exercise in the same way

Bouchard, C., et al., J Appl Physiol (1985), 1999

The Malmö exercise intervention study (50 ♂)

FH - FH +Age (years) 37,8 ± 4,7 38,4 ± 3,9weight (kg) 94,8 ± 10,2 92,4 ± 12,8BMI (kg/m2) 29,0 ± 2,9 28,4 ± 2,8Waist (cm) 101,0 ± 7,8 98,1 ± 8,2VO2max (ml/kg/min)

30,5 ± 4,7 32,5 ± 4,6

HbA1c (%) 4,3 ± 0,3 4,3 ± 0,4Glucose, 2h (mM) 5,8 ± 1,4 5,8 ± 1,2

Do individuals with a genetic predisposition for diabetes respond in the same way to

exercise?

Elgzyri et al., JCEM, 2012

Exercise at “Friskis och Svettis”

Screening •Health declaration

•Physical examination

•Blood tests

•Submax bike ergometer test

•OGTT

Pre-training •Anthropometric measurements

•Blood tests

•Max exercise test

•Muscle & fat biopsies

•BIA

•Actiheart recording

Mid-training •Anthropometric measurements

•Submax bike ergometer test

•Actiheart recording

Post-training •Anthropometric measurements

•Blood tests

•Max exercise test

•Muscle & fat biopsies

•BIA

•OGTT •Actiheart recording

6 months

Ekman et al., JAP, 2015

FH+ individuals exercised more

Ekman et al., JAP, 2015

What happened after 6 months of exercise?

FH - FH +Before After Before After

Weight (kg) 94,8 ± 10,2

94,3 ± 10,5

92,4 ± 12,8

90,4 ± 12,6

BMI (kg/m2) 29,0 ± 2,9 28,8 ± 3,0 28,4 ± 2,8 27,8 ± 2,9Waist (cm) 101,0 ±

7,899,2 ± 7,8 98,1 ± 8,2 94,3 ± 7,3

VO2max (ml/kg/min)

30,5 ± 4,7 34,6 ± 5,5 32,5 ± 4,6 36,9 ± 5,7

HbA1c (%) 4,3 ± 0,3 4,3 ± 0,3 4,3 ± 0,4 4,3 ± 0,4Glucose, 2h (mM) 5,8 ± 1,4 5,7 ± 1,7 5,8 ± 1,2 5,4 ± 1,3

? ? Ekman et al., JAP, 2015

How much did the fitness improve?

FH- FH+

Ekman et al., JAP, 2015

… and the same for weight and waist!

Ekman et al., JAP, 2015

Conclusions

• Even a relatively modest increase in physical activity during 6 months improves physical fitness and thereby some cardiometabolic risk factors

• The FH+ group took part in ~45% more exercise sessions and spent ~60% more energy compared to the FH-

• However, individuals with FH did not benefit from the exercise intervention to the same extent as those without a FH

? Should individuals at risk of diabetes exercise in a specific way to reduce the risk.

? How can we tailor exercise for the individual for the most effective health improvement

? Biomarkers

Albert Szent-Györgyi(Nobel prize, 1937)

”Biological structures and living systems are worn out by inactivity and developed by use”

By the courtesy of Bengt Saltin

Thank you to all participants in the study!