The significant increase in chronic diseases related to metabolic syndrome is exploding in our nation. The number of people in the US that have diabetes has increased over 3-fold since I began practicing physical therapy 29 years ago. That statistic makes it a sure bet that many of your patients will have diabetes. As an important part of your physical therapy intervention you will want to educate and assist your patient in the development of a program that will help control their blood glucose.
Research has demonstrated active muscle is the chief contributor of blood glucose removal and increases in whole body muscle mass lead to improved insulin sensitivity and decreased prevalence of diabetes. In one study each 10% increase in whole body muscle mass was correlated with a 12% relative reduction in pre-diabetes prevalence.
Exercise increases glucose uptake independent from the effects of insulin. Either aerobic, resistive or a combination have shown to improve blood glucose levels. Exercise upregulates transport proteins that increase insulin sensitivity. It is interesting to note the effects from exercise go beyond expending energy and a few hours of increased glucose disposal. The effects of high intensity exercise improves blood glucose 1 to 3 days post-exercise in both diabetics and non-diabetics.
As a physical therapist you will want to select exercises for your patient that will activate as much muscle as possible. This will ensure the most whole body muscle mass is stimulated and will maximize glucose disposal. The additive effect on total glucose uptake and increased insulin sensitivity will get the most out of your patient’s exercise time. Using compound movements for resistive exercise such as chest press, leg press, rowing and lifting activities can achieve this effect. Aerobic exercises that work large muscle groups such as walking, cycling, and elliptical trainers are good options. Plan to make a difference in the health of your diabetic patients by incorporating these principles into your practice.
Jeff Gilliam PT PhD: is a weight loss specialist, who has studied extensively in the areas of health behavior, exercise physiology and nutritional biochemistry at the University of Florida. Jeff has taught a course at the University of Florida called ’Research Applications to Obesity and Weight Loss’. He has also taught courses for the DPT program at UF in Health Promotion and Wellness’ and ‘Evidence Based Practice III’. His PhD research was in the area of effective behavioral interventions for obesity and its associated diseases. He is founder of Physicians’ Choice for Weight Loss a successful lifestyle/weight loss program, which can be found in over 40 clinics in the southeastern US. He currently is clinical director of ReQuest Physical Therapy (Gainesville, Florida) and incorporates his lifestyle/weight loss program into his patients’ physical therapy to help them achieve their healthiest body weight.
Jeff Gilliam is an Orthopedic Certified Specialist through the American Board of Physical Therapy Specialties.
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