Exercise as it relates to Disease/Physical Activity and Sedentary Behavior in Adolescents With Type 1 Diabetes

This WIKIBOOK fact sheet is a critical analysis on the study 'Physical Activity and Sedentary Behavior in Adolescents With Type 1    Diabetes'. The study looks at the association between the levels of physical activity in adolescents with type 1 diabetes and their participation in a personalized exercise program.

What is the background to this research?
Type 1 diabetes is an auto-immune system disorder whereby the immune system kills the cells in the pancreas that create insulin. Lack of insulin causes people who suffer from type 1 diabetes to struggle with the uptake of glucose and convert it into energy. Causes of type 1 diabetes is still unknown, however we do understand there is a strong family link. Obtaining the disease has nothing to do with lifestyle factors but it is believed maintaining a healthy lifestyle is important to manage the disorder.

Type 1 diabetes accounts for 10% of all types of diabetes and it is rising therefore more research in this area is needed as it is crucial in improving our knowledge and understanding. Understanding key physiological adaptations that occur from exercise may be the key to improving the lifestyle of a type 1 diabetic.

To the best of the authors knowledge they haven't been able to find any data that examines adolescents varying levels of physically activity with type 1 diabetes. What they do know from other studies is, that individuals are far more likely to take part in physical activities when the exercise program is specifically designed to the individual.

Where is the research from?
The study was undertaken by researchers from the College of Nursing at the University of Arizona.

What kind of research was it?
It is a qualitative study providing primary research into how exercise influences physiological responses in type 1 diabetics. It is also a longitudinal study meaning they collected data from the same subjects over a period of time, for example months or years. For this study the period of observed time was 16 weeks.

What did the research involve?
"The purpose of the study was to describe the association between levels of physical activity measured by accelerometry and changes in fitness, body composition, lipids and glucose control in type 1 diabetic adolescents with a personalized exercise program". The population group consisted of adolescents between 12–17 years, they had to have been diagnosed with type 1 diabetes for at least 1 year and have 1 family member such as a parent or guardian willing to engage in physical activity with the adolescent. The adolescent had to wear an accelerometer on their hip which is a device that measures energy expenditure, they only had to wear the accelerometer while they were awake for 16 weeks. They then measured the amount of time spent in moderate or vigorous activity levels. Moderate levels being from 3.00 - 5.99 METS and vigorous >6.00 METS. METS is a way in determining energy expenditure whereby 1MET is a person while they are resting. An example of some of the exercises include kickboxing, dancing and walking.

There are a few limitations to the study. The sampling size is only 16 adolescents, this reduces the statistical significance of the findings and I would suggest to at least double the population group to 30 participants. Another limitation is they never took into account current or previous fitness levels, this would influence the results and perceived exertion as one individual may be working at 6.00 METS but doesn't feel as though it is fatiguing on the body. This means that they are less likely to see adaptations or changes from baseline readings.

What were the basic results?
From the use of the accelerometers they found that they spent about 80% of the recorded time in a sedentary state and on average they spent 43 minutes a day doing moderate to vigorous physical activity. American guidelines suggest 60 minutes a day for adolescents. They had a simple and sensible assumption that if the levels of moderate to vigorous physical activity increased then the time spent in a sedentary state should decrease. However their results suggest that they can still spend the majority of their time in a sedentary state and will still achieve the required amount of moderate to vigorous physical activity.

A lot of their results are what you would expect. They found that the amount of time spent in a sedentary state was associated with an increase in cholesterol. Likewise with the amount of body fat percentage, the more time spent in a sedentary state the higher the percentage of body fat. In summary those who spent less time in a sedentary state and more time involved in physical activity achieved greater positive changes in the physiological tests that they conducted.

What conclusions can we take from this research?
This research confirms how important participation in moderate to vigorous exercise is especially when the program is individualized the participants coherence is increased. From the study we can conclude that the adolescents who spent less time in a sedentary state and more in moderate to vigorous exercise had improved results when looking at total cholesterol and triglyceride levels. People with type 1 diabetes have a higher risk of falling victim to cardiovascular disease, therefore reducing cholesterol and triglyceride levels will help in reducing the risk of succumbing to cardiovascular disease through exercise. I believe and agree with the basic results and findings, I think the measures used were appropriate and important indicators. A related study of the same duration in 2009 found that “Promoting exercise in young people with type1 diabetes is one of the most salient strategies for achieving optimal outcomes for physical fitness and CV health, thus preventing devastating complications from heart disease.” These results align with the findings of the Physical Activity and Sedentary Behavior in Adolescents with Type 1 Diabetes study.

Practical advice?
While the research findings were positive, it is not always possible for an individual to gain access to an individualized exercise program. This may be due to either their socioeconomic or sociocultural factors. Before starting an exercise program the type 1 diabetic needs to gain medical clearance from a doctor or at least undertake some sort of prescreening process. Another consideration for a type 1 diabetic is knowing and understanding their body's response to exercise. This is very important as a lack of glucose can cause hypoglycemia, this has the potential to be detrimental to their health as falling into a hypoglycemic state can result in dizziness, comas and possible death.

Further information and resources
For more information in regards to type 1 diabetes and the affect of exercise, the links below may be able to provide a greater insight.
 * Diabetes Australia https://www.diabetesaustralia.com.au/
 * A personalized approach to exercise promotion in adolescents with type 1 diabetes http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354713/
 * Diabetes New Zealand http://www.diabetes.org.nz/living_well_with_diabetes/living_with_type_1_diabetes/physical_activity