Exercise as it relates to Disease/Improving type 2 diabetes risk factors through exercise

This is an analysis of the journal article “A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus”, by A. Mendham, R. Duffield, F. Marino & A. Coutts. (2015)

What is the Background to this Research?
Type 2 diabetes mellitus is a chronic disease state in which the body becomes resistant to the effects of insulin and/or loses the capacity to produce enough insulin in the pancreas. In the Indigenous Australian population, the prevalence of type 2 diabetes mellitus is far greater than the non-Indigenous Australian population. It is estimated that 1 in 3 Indigenous Australians has diabetes, with it being responsible for 8% of all deaths, and a contributor to the 10-20-year difference in life expectancy compared to non-Indigenous Australians.

There is an estimated 75% of Indigenous Australians in non-remote areas, that report sedentary behaviors and low levels of physical activity. As such, physical inactivity is strongly associated with the development of chronic diseases such as type 2 diabetes, chronic heart disease and the development of obesity.

It is commonly agreed that increasing levels of physical activity will assist in the management of diabetes, and may assist in preventing the development of chronic diseases occurring in high risk individuals.

Where is the Research From?
This study involved members of the Orange Aboriginal community, where it was conducted at the Charles Sturt University Exercise Physiology Laboratories in Bathurst, NSW, with pathology data collected by Central West Pathology, at Bathurst Base Hospital, NSW.

The authors that conducted the research hail from, The School of Human Movement Studies, Charles Sturt University, and The Sport and Exercise Discipline Group, UTS: Health, University of Technology Sydney.

What Kind of Research Was This?
This study was a quantitative, non-blinded research study, with the study cohort randomized into an exercise group, and a control group.

What Did the Research Involve?

 * Thirty-three inactive Indigenous Australian men volunteered to be included in the study, of which twenty-six met inclusion criteria.
 * Inclusion criteria was as follows; male, Indigenous Australian ancestry, no regular planned or incidental activity of >60 min p/week, no diagnosis of pre-existing CVD or metabolic disorders.
 * The participants were randomized into an exercise group (n=17) and control group (n=16).
 * Pre and post intervention testing sessions took place, involving testing of; oral glucose tolerance (OGTT), physical activity readiness questionnaire (PAR-Q), anthropometric measurements (stature, body mass, waist and hip circumference), blood pressure, and a graded exercise test (GXT).
 * The exercise group undertook supervised group-based cardiovascular and resistance exercises 2–3 days/week for 12 weeks.
 * The control group continued their usual inactive lifestyle and nutritional pattern for 12 weeks.

What Were the Basic Results?
Mendham, Duffield, Marino & Coutts found that the exercise group displayed positive results in both their primary and secondary outcome measures.

Primary
 * Insulin area under the curve (AUC) decreased significantly by 25±22% (p=0.018, compared to the control.
 * Whole body insulin sensitivity shows a significant increase by 35±62% (p=0.002), compared to the control.
 * Leptin significantly decreased (p=0.048), compared to the control.
 * Adiponectin and all inflammatory cytokines showed no significant changes (p>0.05).

Secondary
 * Significant decreases seen in the exercise group in body mass (p=0.042), BMI (p=0.013), waist circumference (p=0.004) and waist-hip ratio (p=0.041) compared to the control.
 * Significant increase in GXT duration (p=0.002), maximal aerobic workload (p=0.007), and peak oxygen consumption (p=0.021) pre and post intervention compared to the control.

What Conclusions Should be Taken Away From This Research?
The findings of this study suggest that group and sport based activities may lead to improving clinical risk factors associated with the development of type 2 diabetes, in the inactive Indigenous Australian male population. The primary and secondary outcome measures showed positive clinical outcomes in metabolic, anthropometric and aerobic fitness variables.

What are the Implications of This Research?
The findings of the study provide further evidence in the promotion of physical activity and the benefits provided to the diabetic population. Physical activity is one of the best forms of non-pharmacological treatments in the prevention and control of type 2 diabetes, and can assist in improving metabolic, anthropometric and fitness variables in the Indigenous Australian population.

In regard to exercise interventions for Indigenous Australians, it is important to understand that the development and ownership of interventions by the local Indigenous community is vital to the adherence and sustainability of a programs future. Indigenous populations have a very strong community focus, and as such the development of group and sports based activities are a far more appropriate form of intervention, than individualized gym-based programs, as they address individual and group needs for collaboration and support.

Further Information & Resources

 * Australian Indigenous Health Info Net – Online resource to inform practice and policy in Indigenous Health for health professionals and the general public alike.

http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes


 * Advice on What, Why, How and Now of Diabetes, Australia Wide Organisation

Diabetes Australia https://www.diabetesaustralia.com.au/aboriginal-and-torres-strait-islanders


 * Supporting Literature

Nguyen, H., Chitturi, S., & Maple-Brown, L. (2016). Management of Diabetes in Indigenous Communities: Lessons from the Australian Aboriginal Population. Intern Med J. http://dx.doi.org/10.1111/imj.13123


 * Aboriginal Medical Services in the local area, can provide invaluable support and information in the management of diabetes for Indigenous Australians.