Fitness facilities and the treatment of diabetes go together like peas and carrots.
That was the message of the marketing campaign of the YMCA of Greater San Antonio, which sent cans of peas and carrots to local media outlets.
“We partnered with the American Diabetes Association (ADA), which made a lot of sense,” says Amanda Gangawer, spokesperson for the Y. “It's a natural fit.”
Last year, the San Antonio Y began waiving the joining fee for diabetics and pre-diabetics, and, in October, the Y started offering free weekly seminars for diabetics and pre-diabetics as part of its Diabetes360 program.
The program was a must, Gangawer says. While the ADA estimates that almost 21 million children and adults have either type 1 or type 2 diabetes (roughly 7 percent of the U.S. population), San Antonio has almost twice the national average.
San Antonio isn't alone. It's estimated that by 2030, more than 30 million Americans will have diabetes, the most common form of which is type 2 diabetes. That's why some people say the health club industry has an obligation — and a business opportunity — to get diabetics and pre-diabetics moving in the right direction.
“There's such a huge opportunity to reach out and help this market,” says Dave Reiseman, director of communications for Gold's Gym International, which is also partnering with the ADA. “If we can just reach a small portion of these people, it'll make a huge difference.”
In recent years, more studies have been published touting the benefits of cardiovascular exercise in the treatment and prevention of diabetes. In fact, physical activity can help control blood glucose levels, weight and blood pressure, as well as raise HDL cholesterol and lower LDL cholesterol. Regular activity — 30 minutes for five days a week — can also help prevent heart and blood flow problems, reducing the risk of heart disease and nerve damage, which are often problems for people with diabetes, according to the Centers for Disease Control and Prevention.
Getting people with diabetes or those at risk for the disease to get off the couch and exercise can be difficult, often because these people have never exercised and don't know where to begin. However, a growing number of fitness facilities have developed programs targeting this market, many in the industry say. In November, the International Health, Racquet and Sportsclub Association (IHRSA) kicked off an outreach initiative to educate people around the world about how to exercise and help prevent type 2 diabetes. More than 100 people attended IHRSA's Exercise for Prevention Commemorative Eiffel Tower Walk in Paris on Nov. 14, which is World Diabetes Day, in tribute to all those who are living and who have died from the disease. Several fitness facilities in the United States opened their doors for free that day to encourage people to exercise.
As the ADA's national strategic partner, Gold's has raised money through the ADA's Tour de Cure bike ride and has helped create materials for diabetics to get in shape. Gold's “Get Started” guide shows diabetics and pre-diabetics how to start an exercise program with recommendations for strength training, cardiovascular exercise and goal setting.
Earlier this month, Gold's also announced it would reduce its enrollment fee to $59 for anyone afflicted with diabetes, and the club chain will donate 10 percent of diabetics' enrollment fees directly to the ADA, Reiseman says. The company expects all of its locations and franchised facilities to participate.
“Our mission here is to get people in shape,” he says. “We're also working with the ADA to tell people that going to the gym doesn't mean that you have to go and slave away for hours. A little bit makes a huge difference.”
Reducing barriers to exercise and decreasing intimidation is a must when trying to encourage people with diabetes to work out. Although the stereotype is becoming less true, many people still believe health clubs are only for the already buff, says Ann Albright, president of health care and education for the ADA.
“These people really need to get big kudos for coming in and improving their health,” she says. “The tenor and environment is so important. You have to manage the demeanor and nature of people working [at a fitness facility]. They need to be friendly.”
Fitness professionals also need to be realistic about results. Managing diabetes isn't about losing enormous amounts of weight or spending hours in the gym, Albright says. Research shows that just a 5 percent to 7 percent weight loss can prevent type 2 in pre-diabetics, and for every 10 pounds of weight an individual loses, they will experience a 20 percent improvement in insulin sensitivity.
Forming a Team
Providing specialized programs or classes, like the Diabetes360 program at the Y in San Antonio, is another good option for encouraging people with diabetes. Many diabetics are deconditioned and feel more comfortable doing cardio in a group of their own peers, Albright says.
The social element is incredibly important, says Matt Corcoran, a physician who founded and directs Diabetes Training Camp, a week-long camp that brings together diabetics and a team of health professionals. Exercise specialists, sports coaches, diabetes educators, registered dietitians and even an Olympic cyclist are among the professionals who work the camp, which helps diabetics of all fitness abilities learn about the disease and participate in multiple sports.
“My purpose was to create a resource that didn't exist for people who have diabetes and get the whole health team together in one place,” Corcoran says. “I'm a diabetes specialist by trade, and in traditional medicine it's hard to get everyone on the same page and in the same place to offer the education that people with diabetes need.”
Working with the medical community is key when it comes to training diabetics, Reiseman says. Before any Gold's trainer works with a diabetic client, they must have clearance from the client's doctor.
Many people with diabetes have other health complications such as high cholesterol and high blood pressure, and they may be at an increased risk for heart disease and stroke. Cardiovascular exercise can also greatly affect blood sugar levels, Albright says.
“Fitness professionals need to understand these complications and how to recognize and treat low blood sugar,” she says. “I encourage them to learn all they can about the disease. A lot of people have diabetes, and a lot more will in the future.”
Certifying and education organizations are helping to educate fitness professionals about diabetes by creating specialized courses and revamping current certifications.
“The good news is that there are so many options available [to learn about diabetes] from distance learning online to conferences at the regional and national level to subscribing to various newsletters and journals,” says Cedric Bryant, chief science officer for the American Council on Exercise.
Club owners and operators who are unwilling to invest in diabetes education for their staff members are shortsighted, he says.
“If your staff is more confident and they have developed themselves professionally, then they're less likely to put your members at risk,” Bryant says. “It's going to help you provide a higher and more effective level of service to your members, and participants will receive better results, which enhances retention.”
However, one thing fitness professionals shouldn't do is overstep their boundaries or go beyond their scope of practice. Albright says fitness professionals should never adjust medications or give out detailed dietary plans and should be very careful about suggesting nutritional supplements.
If fitness professionals can work with diabetics properly and improve their symptoms, fitness professionals can also better secure their place on the health care continuum, Bryant says.
Reiseman agrees, saying, “It all goes back to the doctor. We're facilitating that marriage between fitness and medicine.”
The role of fitness professionals in improving the care and symptoms of people with diabetes is paramount, experts say.
“It's important to be a reliable source of information and not a huckster selling the latest product,” Albright says. “You're not a medical professional, but you still can promote health and fitness for people with diabetes. Let's try to do this right.”
The Latest Diabetes and Fitness-Related Research
A number of published articles have examined fitness's role in diabetes treatment and prevention. Here are two of the most recent and notable published studies:
Dramatic health benefits are evident after just one exercise session. Research from the University of Michigan showed that just one session of exercise can prevent a primary symptom of type 2 diabetes by altering fat metabolism in muscle.
Researchers discovered that a session of aerobic exercise increases storage of fat in muscle, which actually improves insulin sensitivity. Low insulin sensitivity, or insulin resistance, is an impaired ability of the body to take up sugar from the blood, which can lead to high blood sugar and diabetes.
Jeffrey Horowitz, associate professor in the University of Michigan division of kinesiology, and his former doctoral student, Simon Schenk, now a post-doctoral fellow at the University of California, San Diego, conducted the study, which was published last May in the Journal of Clinical Investigation.
In muscle cells, fatty acids can be burned for energy, and they also can be stored as intramuscular triglyceride (IMTG). IMTG is a reservoir for fat storage, and high IMTG levels correlate with insulin resistance in obese people and those with type 2 diabetes. Partly because of this correlation, many researchers assumed IMTG is somehow involved in the development of insulin resistance. However, people who exercise regularly also have high IMTG levels, even though they are actually very sensitive to insulin.
With that in mind, researchers set out to test their hypothesis that increasing the capacity for fat storage in muscle after one session of exercise can actually increase insulin sensitivity. They suspected that for several hours after exercise, more fatty acids entering the muscle will be stored as IMTG, thus keeping them from turning into more harmful metabolites that are known to cause insulin resistance. Essentially, this means that exercise may cause you to store more fat in your muscles, but, in doing so, your insulin sensitivity improves.
Researchers studied eight lean female subjects and infused fat into their bloodstream to increase fatty acid to levels commonly found in obesity. The subjects were admitted to the hospital for the two-day procedure on two separate occasions. On the first day of one hospital stay, they exercised for 90 minutes at 75 percent of maximum heart rate. On the other visit, they remained inactive.
With all other conditions being equal, researchers found that during the non-exercise visit, the fat infusion reduced insulin sensitivity to levels commonly found in obese people. However, they found that during the exercise visit, not only did the exercise prevent the impairment in insulin sensitivity, but it also increased insulin sensitivity by about 25 percent over their base levels. The researchers also found that the exercise session had diverted more fatty acids to be stored as IMTG than without exercise, and, as a result, fewer fatty acids were available to become the harmful metabolites known to impair insulin sensitivity.
“Some of the key health benefits of exercise are not related to improved fitness, but instead the residual effects from the most recent exercise sessions are most important,” Horowitz says.
Horowitz is currently researching how much the exercise dose must be and how long the effects last in order for an obese person to reap the benefits.
Combined aerobic and resistance training is more effective than aerobic training alone. Aerobic or resistance training stabilizes blood sugar levels for people with diabetes, and those improvements are twice as good with combined aerobic and resistance training, according to a September study published in the Annals of Internal Medicine.
“We all know that exercise is good for us, but for individuals with type 2 diabetes, exercise can play a key role in improving blood sugar control. Our study has put exercise at the forefront in the prevention, control and treatment of diabetes,” says Glen Kenny, who works in the department of human kinetics at the University of Ottawa, Canada. “Our study shows that both aerobic and resistance exercise training can improve glycemic control, so individuals with type 2 diabetes have a choice of the type of exercise training program they can follow. However, the key to maximizing the benefits of an exercise training program on blood glucose control is to incorporate both aerobic and resistance exercise in the training program.”
Researchers studied 251 people with type 2 diabetes in a six-month randomized control trial in Ottawa. The combined exercise and resistance training group experienced a 0.51 percent improvement, or drop, in blood sugar levels. The exercise group experienced a 0.38 percent drop, and the resistance training group had a 0.22 percent drop in blood sugar levels.
A 1 percent drop in glucose levels reduces the risk of a major cardiovascular event such as stroke or heart attack by 15 to 20 percent and other events such as blindness, kidney failure or amputations by 25 to 37 percent.
What Is Diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action or both.
Type 1 diabetes was previously called insulin-dependent diabetes mellitus, or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes may account for 5 percent to 10 percent of all diagnosed cases of diabetes.
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus, or adult-onset diabetes. Type 2 diabetes may account for about 90 percent to 95 percent of all diagnosed cases of diabetes and usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race or ethnicity. African-Americans, Hispanic and Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes, which is increasingly being diagnosed in children and adolescents.
Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. Gestational diabetes occurs more frequently among African-Americans, Hispanic and Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5 percent to 10 percent of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20 percent to 50 percent chance of developing diabetes in the next five to 10 years.
Pre-diabetes is a term used to distinguish people who are at increased risk of developing diabetes. People with pre-diabetes have impaired fasting glucose or impaired glucose tolerance. Some people may have both. Progression to diabetes among those with pre-diabetes is not inevitable. Studies show that weight loss and increased physical activity among people with pre-diabetes can prevent or delay diabetes and may return blood glucose levels to normal.
Source: Centers for Disease Control and Prevention
“You have to be careful about pushing products such as vitamins or protein powder,” she says. “You may not know if it's medically safe, and be extremely cautious unless the member has medical clearance.”