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. 1999 Jun;33(3):161–173. doi: 10.1136/bjsm.33.3.161

Diabetes and exercise

N S Peirce
PMCID: PMC1756173  PMID: 10378067

Abstract

Exercise is frequently recommended in the management of type 1 and 2 diabetes mellitus and can improve glucose uptake by increasing insulin sensitivity and lowering body adiposity. Both alone and when combined with diet and drug therapy, physical activity can result in improvements in glycaemic control in type 2 diabetes. In addition, exercise can also help to prevent the onset of type 2 diabetes, in particular in those at higher risk, and has an important role in reducing the significant worldwide burden of this type of diabetes. Recent studies have improved our understanding of the acute and long term physiological benefits of physical activity, although the precise duration, intensity, and type of exercise have yet to be fully elucidated. However, in type 1 diabetes, the expected improvements in glycaemic control with exercise have not been clearly established. Instead significant physical and psychological benefits of exercise can be achieved while careful education, screening, and planning allow the metabolic, microvascular, and macrovascular risks to be predicted and diminished. 




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Selected References

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  1. Albert S. G., Gomez C. R., Russell S., Chaitman B. R., Bernbaum M., Kong B. A. Cerebral and ophthalmic artery hemodynamic responses in diabetes mellitus. Diabetes Care. 1993 Feb;16(2):476–482. doi: 10.2337/diacare.16.2.476. [DOI] [PubMed] [Google Scholar]
  2. Andersen P. H., Lund S., Schmitz O., Junker S., Kahn B. B., Pedersen O. Increased insulin-stimulated glucose uptake in athletes: the importance of GLUT4 mRNA, GLUT4 protein and fibre type composition of skeletal muscle. Acta Physiol Scand. 1993 Dec;149(4):393–404. doi: 10.1111/j.1748-1716.1993.tb09635.x. [DOI] [PubMed] [Google Scholar]
  3. Berger M., Assal J. P., Jorgens V. Effets endocriniens et métaboliques de l'exercise musculaire chez l'homme. Diabete Metab. 1980 Mar;6(1):59–69. [PubMed] [Google Scholar]
  4. Bierman E. L. George Lyman Duff Memorial Lecture. Atherogenesis in diabetes. Arterioscler Thromb. 1992 Jun;12(6):647–656. doi: 10.1161/01.atv.12.6.647. [DOI] [PubMed] [Google Scholar]
  5. Björntorp P., Fahlén M., Grimby G., Gustafson A., Holm J., Renström P., Scherstén T. Carbohydrate and lipid metabolism in middle-aged, physically well-trained men. Metabolism. 1972 Nov;21(11):1037–1044. doi: 10.1016/0026-0495(72)90034-0. [DOI] [PubMed] [Google Scholar]
  6. Björntorp P., Krotkiewski M. Exercise treatment in diabetes mellitus. Acta Med Scand. 1985;217(1):3–7. doi: 10.1111/j.0954-6820.1985.tb01626.x. [DOI] [PubMed] [Google Scholar]
  7. Blackburn H. Physical activity and hypertension. J Clin Hypertens. 1986 Jun;2(2):154–162. [PubMed] [Google Scholar]
  8. Blair S. N., Kohl H. W., 3rd, Barlow C. E., Paffenbarger R. S., Jr, Gibbons L. W., Macera C. A. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995 Apr 12;273(14):1093–1098. [PubMed] [Google Scholar]
  9. Blair S. N., Kohl H. W., 3rd, Paffenbarger R. S., Jr, Clark D. G., Cooper K. H., Gibbons L. W. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989 Nov 3;262(17):2395–2401. doi: 10.1001/jama.262.17.2395. [DOI] [PubMed] [Google Scholar]
  10. Blair S. N., Powell K. E., Bazzarre T. L., Early J. L., Epstein L. H., Green L. W., Harris S. S., Haskell W. L., King A. C., Koplan J. Physical inactivity. Workshop V. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health. Circulation. 1993 Sep;88(3):1402–1405. doi: 10.1161/01.cir.88.3.1402. [DOI] [PubMed] [Google Scholar]
  11. Bloomgarden Z. T. American Diabetes Association Annual Meeting, 1997. Obesity, diabetes prevention, and type 1 diabetes. Diabetes Care. 1997 Dec;20(12):1913–1917. doi: 10.2337/diacare.20.12.1913. [DOI] [PubMed] [Google Scholar]
  12. Borg G. A. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. [PubMed] [Google Scholar]
  13. Broadstone V. L., Roy T., Self M., Pfeifer M. A. Cardiovascular autonomic dysfunction: diagnosis and prognosis. Diabet Med. 1991;8(Spec No):S88–S93. doi: 10.1111/j.1464-5491.1991.tb02165.x. [DOI] [PubMed] [Google Scholar]
  14. Bruce R. A., Hossack K. F., DeRouen T. A., Hofer V. Enhanced risk assessment for primary coronary heart disease events by maximal exercise testing: 10 years' experience of Seattle Heart Watch. J Am Coll Cardiol. 1983 Sep;2(3):565–573. doi: 10.1016/s0735-1097(83)80286-1. [DOI] [PubMed] [Google Scholar]
  15. Butler R. M., Goldberg L. Exercise and prevention of coronary heart disease. Prim Care. 1989 Mar;16(1):99–114. [PubMed] [Google Scholar]
  16. Chantelau E., Kushner T., Spraul M. How effective is cushioned therapeutic footwear in protecting diabetic feet? A clinical study. Diabet Med. 1990 May;7(4):355–359. doi: 10.1111/j.1464-5491.1990.tb01404.x. [DOI] [PubMed] [Google Scholar]
  17. Dahlquist G., Aperia A., Carlsson L., Linné T., Persson B., Thorén C., Wilton P. Effect of metabolic control and duration on exercise-induced albuminuria in diabetic teen-agers. Acta Paediatr Scand. 1983 Nov;72(6):895–902. doi: 10.1111/j.1651-2227.1983.tb09837.x. [DOI] [PubMed] [Google Scholar]
  18. Davis M. D. Diabetic retinopathy. A clinical overview. Diabetes Care. 1992 Dec;15(12):1844–1874. doi: 10.2337/diacare.15.12.1844. [DOI] [PubMed] [Google Scholar]
  19. DeFronzo R. A., Goodman A. M. Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. The Multicenter Metformin Study Group. N Engl J Med. 1995 Aug 31;333(9):541–549. doi: 10.1056/NEJM199508313330902. [DOI] [PubMed] [Google Scholar]
  20. Dela F., Ploug T., Handberg A., Petersen L. N., Larsen J. J., Mikines K. J., Galbo H. Physical training increases muscle GLUT4 protein and mRNA in patients with NIDDM. Diabetes. 1994 Jul;43(7):862–865. doi: 10.2337/diab.43.7.862. [DOI] [PubMed] [Google Scholar]
  21. Devlin J. T. Effects of exercise in diabetes mellitus. J Fla Med Assoc. 1986 Aug;73(8):602–603. [PubMed] [Google Scholar]
  22. Devlin J. T., Hirshman M., Horton E. D., Horton E. S. Enhanced peripheral and splanchnic insulin sensitivity in NIDDM men after single bout of exercise. Diabetes. 1987 Apr;36(4):434–439. doi: 10.2337/diab.36.4.434. [DOI] [PubMed] [Google Scholar]
  23. Dunstan D. W., Puddey I. B., Beilin L. J., Burke V., Morton A. R., Stanton K. G. Effects of a short-term circuit weight training program on glycaemic control in NIDDM. Diabetes Res Clin Pract. 1998 Apr;40(1):53–61. doi: 10.1016/s0168-8227(98)00027-8. [DOI] [PubMed] [Google Scholar]
  24. Edelman S. V. Importance of glucose control. Med Clin North Am. 1998 Jul;82(4):665–687. doi: 10.1016/s0025-7125(05)70019-5. [DOI] [PubMed] [Google Scholar]
  25. Edelmann E., Staudner V., Bachmann W., Walter H., Haas W., Mehnert H. Exercise-induced hypoglycaemia and subcutaneous insulin infusion. Diabet Med. 1986 Nov-Dec;3(6):526–531. doi: 10.1111/j.1464-5491.1986.tb00808.x. [DOI] [PubMed] [Google Scholar]
  26. Eriksson K. F., Lindgärde F. No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise. Diabetologia. 1998 Sep;41(9):1010–1016. doi: 10.1007/s001250051024. [DOI] [PubMed] [Google Scholar]
  27. Eriksson K. F., Lindgärde F. No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise. Diabetologia. 1998 Sep;41(9):1010–1016. doi: 10.1007/s001250051024. [DOI] [PubMed] [Google Scholar]
  28. Eriksson K. F., Lindgärde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmö feasibility study. Diabetologia. 1991 Dec;34(12):891–898. doi: 10.1007/BF00400196. [DOI] [PubMed] [Google Scholar]
  29. Estacio R. O., Regensteiner J. G., Wolfel E. E., Jeffers B., Dickenson M., Schrier R. W. The association between diabetic complications and exercise capacity in NIDDM patients. Diabetes Care. 1998 Feb;21(2):291–295. doi: 10.2337/diacare.21.2.291. [DOI] [PubMed] [Google Scholar]
  30. Ewing D. J., Campbell I. W., Clarke B. F. Heart rate changes in diabetes mellitus. Lancet. 1981 Jan 24;1(8213):183–186. doi: 10.1016/s0140-6736(81)90061-1. [DOI] [PubMed] [Google Scholar]
  31. Ewing D. J., Campbell I. W., Clarke B. F. The natural history of diabetic autonomic neuropathy. Q J Med. 1980 Winter;49(193):95–108. [PubMed] [Google Scholar]
  32. Ferrari A. U. Modulation of parasympathetic and baroreceptor control of heart rate. Cardioscience. 1993 Mar;4(1):9–13. [PubMed] [Google Scholar]
  33. Frayn K. N. Calculation of substrate oxidation rates in vivo from gaseous exchange. J Appl Physiol Respir Environ Exerc Physiol. 1983 Aug;55(2):628–634. doi: 10.1152/jappl.1983.55.2.628. [DOI] [PubMed] [Google Scholar]
  34. Goodyear L. J., Kahn B. B. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med. 1998;49:235–261. doi: 10.1146/annurev.med.49.1.235. [DOI] [PubMed] [Google Scholar]
  35. Gudat U., Bungert S., Kemmer F., Heinemann L. The blood glucose lowering effects of exercise and glibenclamide in patients with type 2 diabetes mellitus. Diabet Med. 1998 Mar;15(3):194–198. doi: 10.1002/(SICI)1096-9136(199803)15:3<194::AID-DIA546>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  36. Helmrich S. P., Ragland D. R., Leung R. W., Paffenbarger R. S., Jr Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991 Jul 18;325(3):147–152. doi: 10.1056/NEJM199107183250302. [DOI] [PubMed] [Google Scholar]
  37. Hilsted J., Galbo H., Christensen N. J. Impaired responses of catecholamines, growth hormone, and cortisol to graded exercise in diabetic autonomic neuropathy. Diabetes. 1980 Apr;29(4):257–262. doi: 10.2337/diab.29.4.257. [DOI] [PubMed] [Google Scholar]
  38. Hilsted J., Galbo H., Christensen N. J., Parving H. H., Benn J. Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy. Diabetologia. 1982 May;22(5):318–323. doi: 10.1007/BF00253574. [DOI] [PubMed] [Google Scholar]
  39. Hjermann I. The metabolic cardiovascular syndrome: syndrome X, Reaven's syndrome, insulin resistance syndrome, atherothrombogenic syndrome. J Cardiovasc Pharmacol. 1992;20 (Suppl 8):S5–10. doi: 10.1097/00005344-199200208-00002. [DOI] [PubMed] [Google Scholar]
  40. Horton E. S. Exercise and decreased risk of NIDDM. N Engl J Med. 1991 Jul 18;325(3):196–198. doi: 10.1056/NEJM199107183250308. [DOI] [PubMed] [Google Scholar]
  41. Hughes V. A., Fiatarone M. A., Fielding R. A., Kahn B. B., Ferrara C. M., Shepherd P., Fisher E. C., Wolfe R. R., Elahi D., Evans W. J. Exercise increases muscle GLUT-4 levels and insulin action in subjects with impaired glucose tolerance. Am J Physiol. 1993 Jun;264(6 Pt 1):E855–E862. doi: 10.1152/ajpendo.1993.264.6.E855. [DOI] [PubMed] [Google Scholar]
  42. Huttunen N. P., Länkelä S. L., Knip M., Lautala P., Kär M. L., Laasonen K., Puukka R. Effect of once-a-week training program on physical fitness and metabolic control in children with IDDM. Diabetes Care. 1989 Nov-Dec;12(10):737–740. doi: 10.2337/diacare.12.10.737. [DOI] [PubMed] [Google Scholar]
  43. Ivy J. L. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus. Sports Med. 1997 Nov;24(5):321–336. doi: 10.2165/00007256-199724050-00004. [DOI] [PubMed] [Google Scholar]
  44. Jörgens V., Grüsser M., Bott U., Mühlhauser I., Berger M. Effective and safe translation of intensified insulin therapy to general internal medicine departments. Diabetologia. 1993 Feb;36(2):99–105. doi: 10.1007/BF00400688. [DOI] [PubMed] [Google Scholar]
  45. Kahn J. K., Sisson J. C., Vinik A. I. QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. J Clin Endocrinol Metab. 1987 Apr;64(4):751–754. doi: 10.1210/jcem-64-4-751. [DOI] [PubMed] [Google Scholar]
  46. Kannel W. B. Lipids, diabetes, and coronary heart disease: insights from the Framingham Study. Am Heart J. 1985 Nov;110(5):1100–1107. doi: 10.1016/0002-8703(85)90224-8. [DOI] [PubMed] [Google Scholar]
  47. Karlefors T. Exercise tests in male diabetics. I. Electrocardiographic study. Acta Med Scand Suppl. 1966;449:3–18. doi: 10.1111/j.0954-6820.1966.tb01316.x. [DOI] [PubMed] [Google Scholar]
  48. Kaye S. A., Folsom A. R., Sprafka J. M., Prineas R. J., Wallace R. B. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44(3):329–334. doi: 10.1016/0895-4356(91)90044-a. [DOI] [PubMed] [Google Scholar]
  49. Kemmer F. W. Prevention of hypoglycemia during exercise in type I diabetes. Diabetes Care. 1992 Nov;15(11):1732–1735. doi: 10.2337/diacare.15.11.1732. [DOI] [PubMed] [Google Scholar]
  50. Kilgour R. D., Williams P. A. Diabetes affects blood pressure and heart rate responses during acute hypothermia. Acta Physiol Scand. 1998 Jan;162(1):27–32. doi: 10.1046/j.1365-201X.1998.0283f.x. [DOI] [PubMed] [Google Scholar]
  51. King A. C., Blair S. N., Bild D. E., Dishman R. K., Dubbert P. M., Marcus B. H., Oldridge N. B., Paffenbarger R. S., Jr, Powell K. E., Yeager K. K. Determinants of physical activity and interventions in adults. Med Sci Sports Exerc. 1992 Jun;24(6 Suppl):S221–S236. [PubMed] [Google Scholar]
  52. King A. C., Haskell W. L., Taylor C. B., Kraemer H. C., DeBusk R. F. Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial. JAMA. 1991 Sep 18;266(11):1535–1542. [PubMed] [Google Scholar]
  53. King H., Kriska A. M. Prevention of type II diabetes by physical training. Epidemiological considerations and study methods. Diabetes Care. 1992 Nov;15(11):1794–1799. doi: 10.2337/diacare.15.11.1794. [DOI] [PubMed] [Google Scholar]
  54. King P., Kong M. F., Parkin H., Macdonald I. A., Tattersall R. B. Well-being, cerebral function, and physical fatigue after nocturnal hypoglycemia in IDDM. Diabetes Care. 1998 Mar;21(3):341–345. doi: 10.2337/diacare.21.3.341. [DOI] [PubMed] [Google Scholar]
  55. Klesges R. C., Klesges L. M., Haddock C. K., Eck L. H. A longitudinal analysis of the impact of dietary intake and physical activity on weight change in adults. Am J Clin Nutr. 1992 Apr;55(4):818–822. doi: 10.1093/ajcn/55.4.818. [DOI] [PubMed] [Google Scholar]
  56. Koivisto V. A., Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl J Med. 1978 Jan 12;298(2):79–83. doi: 10.1056/NEJM197801122980205. [DOI] [PubMed] [Google Scholar]
  57. Koivisto V. A., Jantunen M., Sane T., Helve E., Pelkonen R., Viinikka L., Ylikorkala O. Stimulation of prostacyclin synthesis by physical exercise in type I diabetes. Diabetes Care. 1989 Oct;12(9):609–614. doi: 10.2337/diacare.12.9.609. [DOI] [PubMed] [Google Scholar]
  58. Krolewski A. S., Kosinski E. J., Warram J. H., Leland O. S., Busick E. J., Asmal A. C., Rand L. I., Christlieb A. R., Bradley R. F., Kahn C. R. Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus. Am J Cardiol. 1987 Apr 1;59(8):750–755. doi: 10.1016/0002-9149(87)91086-1. [DOI] [PubMed] [Google Scholar]
  59. Krolewski A. S., Warram J. H., Valsania P., Martin B. C., Laffel L. M., Christlieb A. R. Evolving natural history of coronary artery disease in diabetes mellitus. Am J Med. 1991 Feb 21;90(2A):56S–61S. doi: 10.1016/0002-9343(91)90040-5. [DOI] [PubMed] [Google Scholar]
  60. Kästenbauer T., Sokol G., Auinger M., Irsigler K. Running shoes for relief of plantar pressure in diabetic patients. Diabet Med. 1998 Jun;15(6):518–522. doi: 10.1002/(SICI)1096-9136(199806)15:6<518::AID-DIA623>3.0.CO;2-J. [DOI] [PubMed] [Google Scholar]
  61. Landry G. L., Allen D. B. Diabetes mellitus and exercise. Clin Sports Med. 1992 Apr;11(2):403–418. [PubMed] [Google Scholar]
  62. Langer A., Freeman M. R., Josse R. G., Steiner G., Armstrong P. W. Detection of silent myocardial ischemia in diabetes mellitus. Am J Cardiol. 1991 May 15;67(13):1073–1078. doi: 10.1016/0002-9149(91)90868-l. [DOI] [PubMed] [Google Scholar]
  63. Lipman R. L., Raskin P., Love T., Triebwasser J., Lecocq F. R., Schnure J. J. Glucose intolerance during decreased physical activity in man. Diabetes. 1972 Feb;21(2):101–107. doi: 10.2337/diab.21.2.101. [DOI] [PubMed] [Google Scholar]
  64. Lohmann D., Liebold F., Heilmann W., Senger H., Pohl A. Diminished insulin response in highly trained athletes. Metabolism. 1978 May;27(5):521–524. doi: 10.1016/0026-0495(78)90017-3. [DOI] [PubMed] [Google Scholar]
  65. MacDonald M. J. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care. 1987 Sep-Oct;10(5):584–588. doi: 10.2337/diacare.10.5.584. [DOI] [PubMed] [Google Scholar]
  66. Maehlum S., Dahl-Jørgensen K., Meen H. D. Sukkersyke og fysisk aktivitet. Tidsskr Nor Laegeforen. 1980 May 5;100(12B):840–844. [PubMed] [Google Scholar]
  67. Manson J. E., Nathan D. M., Krolewski A. S., Stampfer M. J., Willett W. C., Hennekens C. H. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA. 1992 Jul 1;268(1):63–67. [PubMed] [Google Scholar]
  68. Manson J. E., Rimm E. B., Stampfer M. J., Colditz G. A., Willett W. C., Krolewski A. S., Rosner B., Hennekens C. H., Speizer F. E. Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991 Sep 28;338(8770):774–778. doi: 10.1016/0140-6736(91)90664-b. [DOI] [PubMed] [Google Scholar]
  69. Margonato A., Gerundini P., Vicedomini G., Gilardi M. C., Pozza G., Fazio F. Abnormal cardiovascular response to exercise in young asymptomatic diabetic patients with retinopathy. Am Heart J. 1986 Sep;112(3):554–560. doi: 10.1016/0002-8703(86)90521-1. [DOI] [PubMed] [Google Scholar]
  70. Matsuoka K., Nakao T., Atsumi Y., Takekoshi H. Exercise regimen for patients with diabetic nephropathy. J Diabet Complications. 1991 Apr-Sep;5(2-3):98–100. doi: 10.1016/0891-6632(91)90032-k. [DOI] [PubMed] [Google Scholar]
  71. Mayer-Davis E. J., D'Agostino R., Jr, Karter A. J., Haffner S. M., Rewers M. J., Saad M., Bergman R. N. Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA. 1998 Mar 4;279(9):669–674. doi: 10.1001/jama.279.9.669. [DOI] [PubMed] [Google Scholar]
  72. Mikines K. J., Sonne B., Farrell P. A., Tronier B., Galbo H. Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol. 1988 Mar;254(3 Pt 1):E248–E259. doi: 10.1152/ajpendo.1988.254.3.E248. [DOI] [PubMed] [Google Scholar]
  73. Miller W. J., Sherman W. M., Ivy J. L. Effect of strength training on glucose tolerance and post-glucose insulin response. Med Sci Sports Exerc. 1984 Dec;16(6):539–543. [PubMed] [Google Scholar]
  74. Minuk H. L., Vranic M., Marliss E. B., Hanna A. K., Albisser A. M., Zinman B. Glucoregulatory and metabolic response to exercise in obese noninsulin-dependent diabetes. Am J Physiol. 1981 May;240(5):E458–E464. doi: 10.1152/ajpendo.1981.240.5.E458. [DOI] [PubMed] [Google Scholar]
  75. Mittleman M. A., Maclure M., Tofler G. H., Sherwood J. B., Goldberg R. J., Muller J. E. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993 Dec 2;329(23):1677–1683. doi: 10.1056/NEJM199312023292301. [DOI] [PubMed] [Google Scholar]
  76. Moss S. E., Klein R., Klein B. E. Cause-specific mortality in a population-based study of diabetes. Am J Public Health. 1991 Sep;81(9):1158–1162. doi: 10.2105/ajph.81.9.1158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Naka M., Hiramatsu K., Aizawa T., Momose A., Yoshizawa K., Shigematsu S., Ishihara F., Niwa A., Yamada T. Silent myocardial ischemia in patients with non-insulin-dependent diabetes mellitus as judged by treadmill exercise testing and coronary angiography. Am Heart J. 1992 Jan;123(1):46–53. doi: 10.1016/0002-8703(92)90745-h. [DOI] [PubMed] [Google Scholar]
  78. Nermoen I., Jorde R., Sager G., Sundsfjord J., Birkeland K. Effects of exercise on hypoglycaemic responses in insulin-dependent diabetes mellitus. Diabetes Metab. 1998 Apr;24(2):131–136. [PubMed] [Google Scholar]
  79. Nesto R. W., Phillips R. T., Kett K. G., Hill T., Perper E., Young E., Leland O. S., Jr Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy. Ann Intern Med. 1988 Feb;108(2):170–175. doi: 10.7326/0003-4819-108-2-170. [DOI] [PubMed] [Google Scholar]
  80. Norton K., Olds T., Bowes D., Van Ly S., Gore C. Applying the Sports Medicine Australia pre-exercise screening procedures: who will be excluded? J Sci Med Sport. 1998 Jan;1(1):38–51. doi: 10.1016/s1440-2440(98)80007-8. [DOI] [PubMed] [Google Scholar]
  81. Oshida Y., Yamanouchi K., Hayamizu S., Sato Y. Long-term mild jogging increases insulin action despite no influence on body mass index or VO2 max. J Appl Physiol (1985) 1989 May;66(5):2206–2210. doi: 10.1152/jappl.1989.66.5.2206. [DOI] [PubMed] [Google Scholar]
  82. Paffenbarger R. S., Jr, Hyde R. T. Exercise as protection against heart attack. N Engl J Med. 1980 May 1;302(18):1026–1027. doi: 10.1056/NEJM198005013021810. [DOI] [PubMed] [Google Scholar]
  83. Paffenbarger R. S., Jr, Hyde R. T., Wing A. L., Hsieh C. C. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986 Mar 6;314(10):605–613. doi: 10.1056/NEJM198603063141003. [DOI] [PubMed] [Google Scholar]
  84. Pan X. R., Li G. W., Hu Y. H., Wang J. X., Yang W. Y., An Z. X., Hu Z. X., Lin J., Xiao J. Z., Cao H. B. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997 Apr;20(4):537–544. doi: 10.2337/diacare.20.4.537. [DOI] [PubMed] [Google Scholar]
  85. Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1987 Mar;30(3):123–131. doi: 10.1007/BF00274216. [DOI] [PubMed] [Google Scholar]
  86. Pate R. R., Pratt M., Blair S. N., Haskell W. L., Macera C. A., Bouchard C., Buchner D., Ettinger W., Heath G. W., King A. C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995 Feb 1;273(5):402–407. doi: 10.1001/jama.273.5.402. [DOI] [PubMed] [Google Scholar]
  87. Perry T. L., Mann J. I., Lewis-Barned N. J., Duncan A. W., Waldron M. A., Thompson C. Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM). Eur J Clin Nutr. 1997 Nov;51(11):757–763. doi: 10.1038/sj.ejcn.1600478. [DOI] [PubMed] [Google Scholar]
  88. Rasmussen O. W., Lauszus F. F., Hermansen K. Effects of postprandial exercise on glycemic response in IDDM subjects. Studies at constant insulinemia. Diabetes Care. 1994 Oct;17(10):1203–1205. doi: 10.2337/diacare.17.10.1203. [DOI] [PubMed] [Google Scholar]
  89. Reaven G. M. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]
  90. Regensteiner J. G., Shetterly S. M., Mayer E. J., Eckel R. H., Haskell W. L., Baxter J., Hamman R. F. Relationship between habitual physical activity and insulin area among individuals with impaired glucose tolerance. The San Luis Valley Diabetes Study. Diabetes Care. 1995 Apr;18(4):490–497. doi: 10.2337/diacare.18.4.490. [DOI] [PubMed] [Google Scholar]
  91. Richter E. A., Ploug T., Galbo H. Increased muscle glucose uptake after exercise. No need for insulin during exercise. Diabetes. 1985 Oct;34(10):1041–1048. doi: 10.2337/diab.34.10.1041. [DOI] [PubMed] [Google Scholar]
  92. Riddle M. C., McDaniel P. A., Tive L. A. Glipizide-GITS does not increase the hypoglycemic effect of mild exercise during fasting in NIDDM. Diabetes Care. 1997 Jun;20(6):992–994. doi: 10.2337/diacare.20.6.992. [DOI] [PubMed] [Google Scholar]
  93. Rubler S., Chu D. A., Bruzzone C. L. Blood pressure and heart rate responses during 24-hour ambulatory monitoring and exercise in men with diabetes mellitus. Am J Cardiol. 1985 Mar 1;55(6):801–806. doi: 10.1016/0002-9149(85)90160-2. [DOI] [PubMed] [Google Scholar]
  94. Rubler S., Gerber D., Reitano J., Chokshi V., Fisher V. J. Predictive value of clinical and exercise variables for detection of coronary artery disease in men with diabetes mellitus. Am J Cardiol. 1987 Jun 1;59(15):1310–1313. doi: 10.1016/0002-9149(87)90910-6. [DOI] [PubMed] [Google Scholar]
  95. Sacco R. L., Gan R., Boden-Albala B., Lin I. F., Kargman D. E., Hauser W. A., Shea S., Paik M. C. Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study. Stroke. 1998 Feb;29(2):380–387. doi: 10.1161/01.str.29.2.380. [DOI] [PubMed] [Google Scholar]
  96. Salzsieder E., Fischer U., Stoewhas H., Thierbach U., Rutscher A., Menzel R., Albrecht G. A model-based system for the individual prediction of metabolic responses to improve therapy in type I diabetes. Horm Metab Res Suppl. 1990;24:10–19. [PubMed] [Google Scholar]
  97. Schiffrin A., Parikh S. Accommodating planned exercise in type I diabetic patients on intensive treatment. Diabetes Care. 1985 Jul-Aug;8(4):337–342. doi: 10.2337/diacare.8.4.337. [DOI] [PubMed] [Google Scholar]
  98. Schneider S. H., Amorosa L. F., Khachadurian A. K., Ruderman N. B. Studies on the mechanism of improved glucose control during regular exercise in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1984 May;26(5):355–360. doi: 10.1007/BF00266036. [DOI] [PubMed] [Google Scholar]
  99. Schneider S. H., Vitug A., Ananthakrishnan R., Khachadurian A. K. Impaired adrenergic response to prolonged exercise in type I diabetes. Metabolism. 1991 Nov;40(11):1219–1225. doi: 10.1016/0026-0495(91)90219-m. [DOI] [PubMed] [Google Scholar]
  100. Segal K. R., Edano A., Abalos A., Albu J., Blando L., Tomas M. B., Pi-Sunyer F. X. Effect of exercise training on insulin sensitivity and glucose metabolism in lean, obese, and diabetic men. J Appl Physiol (1985) 1991 Dec;71(6):2402–2411. doi: 10.1152/jappl.1991.71.6.2402. [DOI] [PubMed] [Google Scholar]
  101. Sheps S. G., Dart R. A. New guidelines for prevention, detection, evaluation, and treatment of hypertension: Joint National Committee VI. Chest. 1998 Feb;113(2):263–265. doi: 10.1378/chest.113.2.263. [DOI] [PubMed] [Google Scholar]
  102. Sonnenberg G. E., Kemmer F. W., Berger M. Exercise in type 1 (insulin-dependent) diabetic patients treated with continuous subcutaneous insulin infusion. Prevention of exercise induced hypoglycaemia. Diabetologia. 1990 Nov;33(11):696–703. doi: 10.1007/BF00400572. [DOI] [PubMed] [Google Scholar]
  103. Tattersall R. B. A force of magical activity: the introduction of insulin treatment in Britain 1922-1926. Diabet Med. 1995 Sep;12(9):739–755. doi: 10.1111/j.1464-5491.1995.tb02076.x. [DOI] [PubMed] [Google Scholar]
  104. Torjesen P. A., Birkeland K. I., Anderssen S. A., Hjermann I., Holme I., Urdal P. Lifestyle changes may reverse development of the insulin resistance syndrome. The Oslo Diet and Exercise Study: a randomized trial. Diabetes Care. 1997 Jan;20(1):26–31. doi: 10.2337/diacare.20.1.26. [DOI] [PubMed] [Google Scholar]
  105. Trovati M., Carta Q., Cavalot F., Vitali S., Passarino G., Rocca G., Emanuelli G., Lenti G. Continuous subcutaneous insulin infusion and postprandial exercise in tightly controlled type I (insulin-dependent) diabetic patients. Diabetes Care. 1984 Jul-Aug;7(4):327–330. doi: 10.2337/diacare.7.4.327. [DOI] [PubMed] [Google Scholar]
  106. Vered A., Battler A., Segal P., Liberman D., Yerushalmi Y., Berezin M., Neufeld H. N. Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol. 1984 Sep 1;54(6):633–637. doi: 10.1016/0002-9149(84)90263-7. [DOI] [PubMed] [Google Scholar]
  107. Wallberg-Henriksson H., Gunnarsson R., Henriksson J., DeFronzo R., Felig P., Ostman J., Wahren J. Increased peripheral insulin sensitivity and muscle mitochondrial enzymes but unchanged blood glucose control in type I diabetics after physical training. Diabetes. 1982 Dec;31(12):1044–1050. doi: 10.2337/diacare.31.12.1044. [DOI] [PubMed] [Google Scholar]
  108. Wasserman D. H., Abumrad N. N. Physiological bases for the treatment of the physically active individual with diabetes. Sports Med. 1989 Jun;7(6):376–392. doi: 10.2165/00007256-198907060-00003. [DOI] [PubMed] [Google Scholar]
  109. Wasserman D. H., Zinman B. Exercise in individuals with IDDM. Diabetes Care. 1994 Aug;17(8):924–937. doi: 10.2337/diacare.17.8.924. [DOI] [PubMed] [Google Scholar]
  110. Weyer C., Linkeschowa R., Heise T., Giesen H. T., Spraul M. Implications of the traditional and the new ACSM physical activity recommendations on weight reduction in dietary treated obese subjects. Int J Obes Relat Metab Disord. 1998 Nov;22(11):1071–1078. doi: 10.1038/sj.ijo.0800728. [DOI] [PubMed] [Google Scholar]
  111. Wing R. R., Venditti E., Jakicic J. M., Polley B. A., Lang W. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care. 1998 Mar;21(3):350–359. doi: 10.2337/diacare.21.3.350. [DOI] [PubMed] [Google Scholar]
  112. Young R. J., Ewing D. J., Clarke B. F. Nerve function and metabolic control in teenage diabetics. Diabetes. 1983 Feb;32(2):142–147. doi: 10.2337/diab.32.2.142. [DOI] [PubMed] [Google Scholar]
  113. Zimmet P. Z. Kelly West Lecture 1991. Challenges in diabetes epidemiology--from West to the rest. Diabetes Care. 1992 Feb;15(2):232–252. doi: 10.2337/diacare.15.2.232. [DOI] [PubMed] [Google Scholar]
  114. Zinman B. Diabetes and exercise. Postgrad Med. 1979 Nov;66(5):81–82. doi: 10.1080/00325481.1979.11715296. [DOI] [PubMed] [Google Scholar]
  115. Zinman B., Zuniga-Guajardo S., Kelly D. Comparison of the acute and long-term effects of exercise on glucose control in type I diabetes. Diabetes Care. 1984 Nov-Dec;7(6):515–519. doi: 10.2337/diacare.7.6.515. [DOI] [PubMed] [Google Scholar]

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