1 Physical activity, type II diabetes, and metabolic syndrome: prevention and intervention.

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Physical activity, type II diabetes, and metabolic syndrome:prevention and intervention

2糖尿病定義我國衛生署 , WHO, ADA

糖尿病空腹至少 8 小時靜脈血漿糖值≧ 126 mg/dl 75 公克口服葡萄糖耐量試驗 (oral glucose

tolerance test, OGTT) ， 2 小時的靜脈血漿糖值≧ 200 mg/dl

前期糖尿病 (prediabetes) 空腹血糖異常 (impaired fasting glucose, IFG): 空腹血漿糖值 110-126 mg/dl

葡萄糖耐量異常 (impaired glucose tolerance, IGT): OGTT2小時靜脈血漿糖值 140-200 mg/dl

3Key defects in onset of hyperglycemia in Type II DM

↑Hepatic glucose production ↓insulin secretion ↓insulin action Insulin resistance: suppressed or delayed

response to insulin Usually due to defect in cells that respond to

insulin, rather than insulin production Pivotal pathophysiological defects: Insulin

resistance in muscle and liver, beta-cell failure

Teixeira-Lemos, 2011

4Exercise/insulin activate GLUT-4 (glucose transporter-4) translocation

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葉曉文 , 2011

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葉曉文 , 2011

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葉曉文 , 2011

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葉曉文 , 2011

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Definition of metabolic Syndrome

National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III)

if 3 out of the following 5 criteria Central obesity 腰圍

Europe/US: ≥ 94 cm (male) or ≥ 80 cm (female) Taiwan: ≥ 90 cm (male) or ≥ 80 cm (female)

HDL < 40 mg/dl (male) or < 50 mg/dl (female) Triglycerides > 150 mg/dl fasting glucose > 100 mg/dl blood pressure > 130/85 mmHg

10Worldwide prevalence of metabolic syndrome

Desroches, 2007

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Definition of metabolic syndrome in children: International Diabetes Federation

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Lakka, 2007

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Physical activity in etiology of MetS

Lakka, 2007

14Obesity and diabetes37,878 women, 6.9 years follow-up

Weinstein, 2004

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PA and diabetes

Weinstein, 2004

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Energy expenditure and diabetes

Weinstein, 2004

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Walking and diabetes

Weinstein, 2004

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PA, obesity and diabetes

Weinstein, 2004

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PA, obesity and diabetes

Weinstein, 2004

20PA, obesity and diabetesneed to combine PA and weight loss

Weinstein, 2004

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PA, obesity, and risk for DM

Hu, 2007

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PA, fasting glucose, and risk for DM

Hu, 2007

23PA, fasting glucose, obesity, and risk for DM

Hu, 2007

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Bassuk, 2005

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Bassuk, 2005

26ProActive TrialPhysical activity measured by accelerometry30-50 yr, low PA, follow-up 1 year

Simmons, 2008

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Moderate PA reduce fasting insulinPhysical activity measured by accelerometry

Ekelund, 2009

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Vigorous PA and MetS

Lakka, 2007

29PA intensity and type II diabetesInsulin Resistance Atherosclerosis Study, n=1625, 1992-94

Mayer-Davis EJ, 1998

Vigorous: 6 METs

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PA intensity and type II diabetesInsulin Resistance Atherosclerosis Study, n=1625, 1992-94

Mayer-Davis EJ, 1998

Vigorous: 6 METs

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2-wk interval training in obese men

4-6 30s Wingate/session, 6 sessions

Whyte, 2010

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Whyte, 2010

2-wk interval training in obese men

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Change in PA and Type II DM

Lakka, 2007

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Increase PA, decrease DM risk

Hu, 2007

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Finnish Diabetes Prevention Program:3234 at-risk, 2.8 years follow-up

Church, 2011

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Lifestyle (exercise) prevent MS

Orchard, 2005

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Lifestyle (exercise) prevent MS

Orchard, 2005

38Exercise training and insulin resistance

Church, 2011

39MONET study137 overweight/obese postmenopausal women

MONET: Montreal–Ottawa New Emerging TeamKarelis, 2008

40MONET study137 overweight/obese postmenopausal women

Karelis, 2008

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MONET study6 mo. caloric restriction/resistance exercise

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MONET study6 mo. caloric restriction/resistance exercise

Drapeau, 2011

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The HERITAGE Family Study

investigate the contribution of regular exercise to changes in risk factors for cardiovascular disease and Type 2 diabetes

genetics of cardiovascular, metabolic, and hormonal responses to exercise training ages of 17 and 65 yr healthy but sedentary

20-wk aerobic exercise training program

44PA decrease risk factors in those already having MetS

Katzmarzyk, 2003

45PA decrease number of risk factor in those already having MetS

Katzmarzyk, 2003

46PA decrease number of risk factor in high-risk subjects

Katzmarzyk, 2003

47Type II DM and reactive oxygen species (ROS)

oxidative stress secondary to hyperglycaemia and hyperlipidaemia occurs before the appearance of clinical manifestations of late diabetes complications suggesting a key role in the pathogenesis of the disease.

Insulin resistance and pancreatic b-cell dysfunctionare modulated by ROS

ROS disrupt insulin-induced cellular redistribution of insulin receptor substrate-1 (IRS-1) and phosphatidylinositol 3-kinase (PI3K), impairing insulin-induced glucose transporter type 4 (GLUT4) translocation in 3T3-L1 adipocytes


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Type II DM and inflammation dyslipidaemic phenotype of diabetes: ↑TG, ↑

oxidized LDL, ↓HDL lipotoxicity profile of diabetes Lack of exercise leads to accumulation of visceral or

deep subcutaneous adipose stores, leads to large adipocytes that are resistant to insulin-evoked lipolysis suppression, resulting in ↑release of FFA and glycerol

fat cells produce adipocytokines (adipokines) go to muscle, liver and arterial tissue, where exert

deleterious effects on metabolism and vascular function Adipose tissue of obese and type 2 diabetic

individuals is infiltrated by mononuclear cells and is in a state of chronic inflammation Teixeira-Lemos, 2011

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Type II DM and inflammation The adipocytes and infiltrated macrophages

secrete pro-inflammatory/pro-thrombotic cytokines TNF-a, IL-6, resistin, adipsin, acylation-

stimulating protein (ASP), plasminogen activator inhibitor 1 (PAI-1) and angiotensinogen

promote atherogenesis and cause insulin resistance

Low adiponectin in type II DM a potent insulin-sensitizing and anti-atherogenic

adipokineTeixeira-Lemos, 2011

50Exercise prevent Type II DMantioxidant and anti-inflammation


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PA and prevention of MetS Intervention studies show that exercise training has

a mild or moderate favorable effect on many metabolic and cardiovascular risk factors that constitute or are related to the MetS

favorable lifestyle changes, including regular physical activity, are effective in the prevention of type 2 diabetes in individuals with overweight and impaired glucose tolerance

↑total volume of moderate-intensity PA, maintain good cardiorespiratory and muscular fitness appears to markedly decrease the risk for MetS, especially in high-risk groups

Brisk walking > 30 min/dayLakka, 2007

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American Diabetes Association/ACSM Position Statement

Exercise plays a major role in the prevention and control of insulin resistance and type 2 diabetes

Both aerobic and resistance training improve insulin action and can assist with glucose levels, lipids, BP CV risk, mortality, and QOL

Exercise MUST be undertaken regularly to have continued benefits

Most persons with type 2 diabetes can perform exercise safely with certain precautions

Colberg, 2010

57Consensus in Insulin Resistance in Children

lack of a clear cutoff to define insulin resistance in children childhood weight gain increase the risk of insulin resistance

in children Insulin resistance is a risk factor for prediabetes and T2D in

childhood Exercise and fitness improve insulin sensitivity through

weight loss and also mechanisms independent of weight loss in adolescents

PA increases insulin sensitivity, an important component of any intervention

weight gain velocity during childhood is associated with lower insulin sensitivity in adulthood

prevention strategies should be started early in life lifestyle interventions should be included, whereas metformin

should be limited to selected casesLevy-Marchal,2010

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Telford 2007

1 Physical activity, type II diabetes, and metabolic syndrome: prevention and intervention.

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