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Exercise For Diabetes

The Best Way to Prevent Diabetes

If you have prediabetes, the standard advice to avoid getting diabetes is to do three things at once: cut calories, eat a low-fat diet, and get exercise. But a recent study shows that it makes more sense to focus on just the last one of these.

Ever since 2002, when researchers published the results of the Diabetes Prevention Program, we have known that intensive lifestyle changes are the best way to avoid diabetes. That program aimed at reducing your weight by 7 percent, eating a low-fat diet, and increasing your physical activity to at least 150 minutes per week of moderate exercise, such as walking or biking.

This program, a large landmark trial, concluded that when you follow this strategy, the chance that you will get diabetes decreases by 58 percent. The next best choice, taking the diabetes drug called metformin, reduces your chance of getting this chronic condition by 31 percent.

Prediabetes is still increasing

On the whole, the three-pronged strategy isn’t working well. The proportion of adult Americans who had prediabetes increased from 32 percent of us in 2002 to 38 percent in 2010, according to National Health and Nutrition Examination Surveys.

Now, a recent study suggests a better approach for many people who have prediabetes. The peer-reviewed medical journal Diabetologia, which is the official journal of the European Association for the Study of Diabetes, published the study by researchers at the Duke University Medical Center in Durham, North Carolina.

The findings, published online in July, are the result of a randomized, six-month study of 150 participants with prediabetes. The researchers randomized them into four groups. The first group followed an intervention modeled after the Diabetes Prevention Program. The other three groups received exercise only, using different amounts and intensities: a low amount at a moderate intensity, equivalent to walking briskly for 71⁄2 miles per week, a high amount at a moderate intensity, equivalent to walking briskly for 111⁄2 miles per week, and a high amount at a vigorous intensity, equivalent to jogging for 111⁄2 miles per week.

How the four groups fared

Not surprisingly, the people who were able to follow the intervention modeled after the Diabetes Prevention Program got the greatest benefit. They averaged a 9 percent improvement in their oral glucose tolerance.

But the people in the group that followed a moderate intensity program of walking briskly for 111⁄2 miles each week came in a close second. They had an average 7 percent improvement in oral glucose tolerance.

The group that walked 71⁄2 miles averaged a 5 percent improvement. Surprisingly, the vigorous intensity group — the joggers — had the least success. They averaged only a 2 percent improvement.

Why moderate exercise works better

A likely key to the superiority of moderate intensity exercise to that of high intensity exercise is that moderation tends to burn more fat than glucose, while the more intense exercise has the opposite effect, William Kraus, MD, the study’s lead author, says. He believes that one benefit of moderate intensity exercise is that it burns off fat in the muscles, which is important because the muscles are the major place where we store glucose after a meal.

“Our study found that with high intensity exercise compared to moderate intensity exercise — the equivalent of jogging versus brisk walking — the brisk walking was superior to the jogging in improving metabolic health in individuals at risk for diabetes, Dr. Kraus says. “The gold standard of lifestyle counseling is diet, weight loss, and exercise. The patient is overwhelmed by three activities at one time. They can focus just on exercise. This can really help them to get on the right path to improving their health.”

You may have heard that the best exercise is the one that you will do. Likewise, the best strategy for you to conquer prediabetes is the one that you will follow. Instead of trying to juggle multiple demands, this strategy is to focus on getting the exercise that you need.

This article is based on an earlier version of my article published by HealthCentral.

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