Via practica 1/2020

Physical activity recommendations in the management of patients with obesity and type 2. diabetes

A lack of physical activity is associated with low energy expenditure and low physical fitness, and together with increased intake of energetically dense and nutritionally unbalanced food determine pandemic proportions of obesity, prediabetes and type 2 diabetes. Sedentary, inactive lifestyle, paralleled by unfavorable shifts in body composition, characterized by visceral adiposity and sarcopenia, accelerate dysfunction of systemic energy and glucose metabolism. Metabolic dysfunction plays an important role not only in the pathogenesis of type 2 diabetes, but substantially contributes also to the pathogenesis of many other chronic noncommunicable diseases, including cardiovascular, neurodegenerative or oncologic diseases. Thus, physical inactivity has been identified as one of the key modifiable lifestyle factors, which increases global morbidity and mortality. On the other hand, ample clinical evidence points at beneficial effects of regular exercise on energy metabolism, muscle strength and cardiorespiratory fitness. Large scale intervention trials provide evidence on the effectivity of a complex lifestyle modification in prevention of type 2 diabetes and on the long-term sustainability of these effects. It is important to note that lifestyle modification and weight reduction can lead to type 2 diabetes remission in the early phases of disease. The aim of our work is to point at an important role of regular exercise in the prevention of type 2 diabetes in at risk individuals as well as in the management of patients with diabesity (obesity and type 2 diabetes). Sufficient dose of physical activity can influence the whole spectrum of comorbidities and/or chronic diabetes complications, including atherosclerosis or cognitive dysfunction, in parallel with improving metabolism. Thus, recommendations and physical activity prescription represent one of the cornerstones in the management of patients with obesity, prediabetes or type 2 diabetes.

Keywords: physical activity recommendation and prescription, obesity, type 2 diabetes, sarcopenia, energy & glucose metabolism