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  • Sheri Colberg, PhD

Variety is the Spice of Life--and of Physical Activity


Since most of the physical activity guidelines—for people with and without diabetes—revolve around moderate to vigorous aerobic exercise and resistance training, what about doing other intensities of exercise? I often advocate alternating hard and easy training days, along with varying the pace of training even within a single exercise session, for best results, but fitness gains can also vary in both directions when you change up the intensity of activities. But do alternate or low-intensity ones count for cross-training, or are they not intense enough?


Whether or not an activity should count may depend on your goals. If your primary objective is to get more fit, doing anything that is moderate or higher in intensity is likely better for raising your aerobic or muscular fitness—although how well you respond depends in large part on your initial level of fitness (i.e., the lower it is, the more you gain from doing any activity at any intensity). Also keep in mind that training gains are activity-specific, meaning that you may be in great shape for walking or running and no shape at all for swimming or rowing. If your goal is more health-related, such as managing blood glucose or health issues, many lower-intensity or alternate activities may be even more appropriate to do than more intense ones.


Let’s take a closer look at some of these other activities. In this category, I would include a lot of less traditional ones, such as stretching, yoga, tai chi, qigong, and even table tennis.


· Stretching and flexibility exercise:

Everyone loses flexibility with aging, but having diabetes can speed up those losses. Any exercise done to prevent or reverse this trend will help you in countless ways. Simply stretching your calves appears to be helpful in many ways (2). Years ago, we studied the impact of doing stretching with resistance training in adults with type 2 diabetes and found that it can increase the range of motion around a variety of joints (3). A more recent study looked at how calf-stretching may help prevent and treat diabetes-related foot ulcers (4), and who would not want to prevent those if they can? I personally have found that stretching my feet (the plantar fascia in particular) and ankles has really increased my flexibility when trying to touch my toes. Stretching all of your major muscles group is recommended at least 2 to 3 days per week.


· Yoga:

Yoga has been frequently studied, but only recently have the studies on populations with diabetes had a high enough quality to be definitive. The findings are that yoga helps people with diabetes—when it comes to overall blood glucose levels (5) and fasting glucose and body mass index (6), even when compared to other higher-intensity exercise. It can even improve quality of life in this population (7) -and lower oxidative stress (8), which is associated with many diabetes-related health complications. So feel free to yoga away!


· Tai chi or qigong:

The potential benefits of tai chi, a low-intensity activity that involves strength and stretching moves and only low-intensity aerobic training, are vast and include potential improvements in fasting blood glucose, certain blood lipid levels, and BMI (9). In fact, tai chi may be more effective than aerobic training for certain metabolic measures, such as A1C and HDL-cholesterol. In some instances, qigong may be even better than tai chi, but it differs by outcomes (10); however, many health improvements have been noted with this family of activities (11), including better cognition and balance (12). It may just be time to take up one of these activities in your spare time for added health benefits.


· Table tennis:

Not many studies on this sport/activity have been done in people with diabetes, but we did one a while ago. In that one small study, playing table tennis for 30 minutes (against a ball robot) was as beneficial as walking after dinner when it came to measures like heart rate variability and mood, but self-paced walking (on a treadmill) had a slight edge when it came to lowering the spike in blood glucose after eating (13). As table tennis is a popular activity and competitive sport in many countries around the world, its potential health impacts should not be ignored. It may be time to dust off that table in your garage and grab a paddle after all.


Overall, doing a variety of physical activities in a given week is optimal—both for physical (joint/muscle/fitness level) and emotional health. So, try a new activity at any intensity level today, especially one that you find enjoyable.

References:

1. Bales J, Bales K. Training on a knife's edge: how to balance triathlon training to prevent overuse injuries. Sports Med Arthrosc Rev. 2012;20(4):214-6.

2. Medeiros DM, Martini TF. Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis. Foot. 2018;34:28-35.

3. Herriott MT, Colberg SR, Parson HK, Nunnold T, Vinik AI. Effects of 8 weeks of flexibility and resistance training in older adults with type 2 diabetes. Diab Care. 2004;27(12):2988-9.

4. Maeshige N, Uemura M, Hirasawa Y, Yoshikawa Y, Moriguchi M, Kawabe N, et al. Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus. Int J Low Extrem Wounds. 2021:15347346211031318.

5. Gupta U, Gupta Y, Jose D, Mani K, Jyotsna VP, Sharma G, et al. Effectiveness of Yoga-based Exercise Program Compared to Usual Care, in Improving HbA1c in Individuals with Type 2 Diabetes: A Randomized Control Trial. Int J Yoga. 2020;13(3):233-8.

6. Jayawardena R, Ranasinghe P, Chathuranga T, Atapattu PM, Misra A. The benefits of yoga practice compared to physical exercise in the management of type 2 Diabetes Mellitus: A systematic review and meta-analysis. Diab Metab Syndr. 2018;12(5):795-805.

7. Cui J, Yan JH, Yan LM, Pan L, Le JJ, Guo YZ. Effects of yoga in adults with type 2 diabetes mellitus: A meta-analysis. J Diabetes Investig. 2017;8(2):201-9.

8. Venugopal V, Geethanjali S, Poonguzhali S, Padmavathi R, Mahadevan S, Silambanan S, et al. Effect of Yoga on oxidative stress in type 2 diabetes mellitus: a systematic review and meta-analysis. Curr Diabetes Rev. 2021 Apr 4. doi: 10.2174/1573399817666210405104335.

9. Guo S, Xu Y, Qin J, Chen Y, You Y, Tao J, et al. Effect of tai chi on glycaemic control, lipid metabolism and body composition in adults with type 2 diabetes: A meta-analysis and systematic review. J Rehabil Med. 2021;53(3):jrm00165.

10. Li X, Si H, Chen Y, Li S, Yin N, Wang Z. Effects of fitness qigong and tai chi on middle-aged and elderly patients with type 2 diabetes mellitus. PLoS One. 2020;15(12):e0243989.

11. Zhang YP, Hu RX, Han M, Lai BY, Liang SB, Chen BJ, et al. Evidence Base of Clinical Studies on Qi Gong: A Bibliometric Analysis. Complement Ther Med. 2020;50:102392.

12. Cai H, Li G, Jiang S, Yin H, Liu P, Chen L. Effect of Low-Intensity, Kinect™-Based Kaimai-Style Qigong Exercise in Older Adults With Type 2 Diabetes. J Gerontol Nurs. 2019;45(2):42-52.

13. Colberg SR, Grieco CR, Somma CT. Exercise effects on postprandial glycemia, mood, and sympathovagal balance in type 2 diabetes. J Am Med Dir Assoc. 2014;15(4):261-6.

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