OVERVIEW OF NIDDM
• incidence of 4-6% of Canadian population; incidence increases with age
• primarily linked to upper body or truncal obesity
• decreased glucose uptake due to abnormal insulin receptors, causing increased insulin resistance and decreased insulin responsiveness, due to impaired B cells of the pancreas
• problems with enzyme activation of GLUT-4 (Ackerman, 1992)
• life style modification including diet and aerobic exercise effective for controlling NIDDM and reducing risk factors
• exercise is more effective in patients not taking meds (Barnard et al, 1994)

• proper footwear (neuropathy), running or any sport requiring it b/c of jarring of the brain, extreme heat/cold, dehydration, prevent hypoglycemia
• exercise is not recommended in periods of poor metabolic control

EXERCISE PRESCRIPTION FOR NIDDM
? A TXT should be performed before commencement of exercise
• TYPE: -a dynamic aerobic exercise that is the patients personal preference eg. swim, walk -circuit resistive training (Eriksson et al, 1997)
• WARM UP: 5-10 min low intensity exercise

• INTENSITY: 50-70% VO2 max or 70-85% max HR, higher exercise intensities
result in decreased progression of NIDDM, don’t exceed BP of 180 mmHg
• DURATION: 20-60 min
• FREQUENCY: 3-5 days/week, if goal weight loss >5 days/week
• COOL DOWN: 5-10 min at 10-15 BPM above resting
• COMPLIANCE: enjoyable, convenient time & location, reinforced by family, quantify progress, don’t set goals too high, education regarding benefits of exercise and disease process

BENEFITS OF EXERCISE FOR NIDDM
1. Improved Glycemic Control
• occurs with proper diet, exercise, and having a normal BW
• increased insulin sensitivity b/c: muscle mass enlarged, increased type I insulin sensitive muscle fibers, higher density of capillaries (Ackerman, 1992)
• greater affect when large muscle mass is exercised
• repeated muscle contraction enhances glucose uptake by increasing the membranes permeability due to an increase in GLUT 4
• decreased fasting glucose levels from 10.0 to 8.45 mmol/L (Barnard et al, 1994)
• 71% of patients taking oral hypoglycemic meds and 39% taking insulin had their meds discontinued (Barnard et al, 1994)
• effects of physical activity have a limited duration (2 days), therefore exercise must be performed regularly
• individuals most regularly followed their prescribed meds and least regularly followed recommendations for lifestyle changes of diet and exercise (Ruggiero et al, 1997)

2. Decrease C/V Risk Factors
• decreased BP, 34% taken off antihypertensive drugs (Barnard et al, 1994)
• most effective for patients with borderline hypertension
• serum total and LDL cholesterol decreased by 22%, TG by 33% and the ratio of total serum to HDL cholesterol was decreased by 13% (Barnard et al, 1994)

3. Weight Loss
• decreased BMI & obesity (Ackerman, 1992)
• decreased total fat and distribution
• enhanced glucose tolerance, and insulin sensitivity
• diet and exercise most effective in decreasing body fat than either alone (Yamanouchi et al, 1995)

4. Psychological
• decreased anxiety, improved mood and self esteem, increased sense of well being, enhanced quality of life

PREVENTION OF NIDDM
• exercise delays or prevents onset
• development of NIDDM decreases by 6% with each 500 kcal increase in energy expended in leisure time activity (Ackerman, 1992)
• maintaining a healthy body weight
• protective effect of exercise greatest in individuals at the highest risk (Helmrich, 1994)

INSULIN LEVELS DURING EXERCISE
Reasons why insulin decreases during exercise:
1. exercise increases blood glucose uptake by increasing GLUT-4 activation therefore increasing insulin’s sensitivity and thus decreasing the amount secreted
2. with intense exercise there is acidosis, increased lactate and IGF-I which all inhibit the release of insulin