Exercise therapy is one of the fundamental treatment methods for diabetes. In China, there is a common saying: “Take a hundred steps after a meal, live to ninety-nine,” which reveals the benefits of exercise for human health. By the mid-18th century, European medical practitioners also began advocating for appropriate physical activity for individuals with diabetes, with some even considering diet control, exercise therapy, and medication as the three main pillars for treating diabetes.
Although the efficacy of contemporary exercise therapy in the treatment of diabetes still requires further exploration and evaluation, it has been observed that the four major factors influencing human longevity—obesity, hypertension, hyperlipidemia, and reduced glucose tolerance—are all related to insufficient physical activity. Therefore, exercise therapy holds significant importance in the prevention and management of diabetes and has been included as one of the five key measures in modern comprehensive treatment strategies.
The main therapeutic values of exercise therapy include the following aspects:
1.Improving insulin sensitivity and blood glucose control:
Through exercise, individuals with diabetes can experience a decrease in insulin levels and an increase in insulin sensitivity, even without accompanying weight loss. From a physiological perspective, acute exercise promotes the utilization and breakdown of glucose in muscle tissue, leading to a decrease in blood glucose levels. Long-term exercise improves the sensitivity of target tissues, such as muscles, to insulin, accelerating the breakdown of liver glycogen and muscle glycogen, as well as the utilization of glucose by peripheral tissues, resulting in lower blood glucose levels.
2.Accelerating fat breakdown, reducing body weight, and improving lipid metabolism:
Effective exercise increases the activity of lipoprotein lipase in muscle tissue, leading to a decrease in very low-density lipoprotein and an increase in high-density lipoprotein cholesterol. It also promotes fat breakdown and the utilization of free fatty acids and cholesterol. This not only helps in the consumption of excess fat tissue and weight loss but also plays a role in lowering lipid levels and regulating lipid metabolism, thereby preventing chronic vascular complications.
3.Enhancing physical fitness and exercise capacity, improving mental state:
Exercise can increase maximum oxygen consumption and long-term exercise can improve muscle strength, endurance, and overall physical fitness, making individuals more robust. It also promotes agility, flexibility, and other aspects of “exercise capacity.” Additionally, exercise can improve heart and lung function. On the other hand, exercise is beneficial for restoring psychological balance, eliminating anxiety and stress, providing a sense of satisfaction, boosting self-confidence and decision-making abilities, and improving work efficiency and quality of life. The restoration of physical strength and improvement in mental state are highly advantageous for diabetes management.
4.Preventing and controlling the occurrence and progression of chronic complications of diabetes:
Based on the therapeutic effects of exercise mentioned above, exercise can improve insulin sensitivity, reduce hyperinsulinemia, lower lipid levels, aid in weight loss, and lower blood glucose levels, which are favorable for comprehensive control of diabetes. Consequently, exercise contributes to the prevention and control of chronic complications such as cardiovascular and renal diseases.
5.The latest mechanisms of exercise effects further confirm the clinical value of exercise therapy.
Previous studies have indicated that exercise increases muscle glucose uptake, increases the number or affinity of insulin receptors, and enhances post-receptor effects such as increased succinate dehydrogenase activity, improved glucose utilization, and increased enzyme activity in the tricarboxylic acid cycle. Recently, modern molecular biology techniques have been used to explore the mechanisms of exercise therapy at the molecular level. It has been found that insulin resistance in type 2 diabetes is primarily due to a decrease in glucose transporter (GLUT4) and its messenger RNA (GLUT4 mRNA). Exercise can increase the levels of GLUT4 and its mRNA in muscle tissue, which is considered the main mechanism by which exercise therapy improves insulin sensitivity and glucose metabolism.