CAQ REVIEW

Downloaded from http://journals.lww.com/acsm-csmr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCyw

Exercise and Chronic Disease Management

CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 03/06/2024

Lisa C. Barkley, MD, FAAFP, FACSM, FSAHM1 and Phyllisa Reams, BS2

Introduction Diabetes and Exercise

Noncommunicable diseases are the leading cause of morbidity Physical activity is beneficial for blood glucose management
and mortality globally (1). Physical activity can reduce chronic and overall health in individuals with diabetes and prediabetes,
disease prevalence, morbidity and mortality rates, and leading to reduction in hemoglobin A1c levels. Regular aerobic
positively impact overall health, fitness, and quality of training increases cardiorespiratory fitness, decreases insulin re-
life (2). Exercise interventions have been associated with sistance, enhances insulin sensitivity (4), and improves lipid
an 80% reduction in cardiovascular disease (CVD) risk, 90% levels and endothelial function (4). Aerobic exercise may
reduction in type 2 diabetes risk, 33% reduction in cancer risk, prevent or delay type 2 diabetes development. Resistance training
and 17% reduction in all-cause mortality. Depression and can reduce the risks of exercise-induced hypoglycemia, reduce
anxiety symptoms also are improved with daily exercise (2). insulin resistance, and improve blood pressure (4).
The Physical Activity Guidelines for Americans, 2nd edi-
tion (3) recommends the following: Recommendations
Daily exercise is preferred to consistently affect insulin action.
• Children and adolescents: engage in at least 60 min·d−1 If aerobic and resistance training are performed in one training
of moderate- or vigorous-intensity aerobic activity, session, it is advised that resistance training is done prior to aer-
with muscle and bone-strengthening at least 3 d·wk−1. obic training to reduce the risks of exercise-induced hypo-
• Adults: engage in at least 150 min·wk−1 of moderate in- glycemia (4). Women with preexisting diabetes or risks of
tensity aerobic exercise. Additional muscle strengthen- gestational diabetes of any type should be advised to engage
ing exercise should be done at least two times per week. daily in 20 min to 30 min of moderate physical activity prior
to and during pregnancy. Additional glucose monitoring is
• Older adults: in addition to the aerobic training for adults,
necessary to avoid hypoglycemia as blood sugar response to
flexibility and balance training are recommended two to
exercise will vary. Include additional intake of carbohydrates
three times per week. Yoga and tai chi may be included and have them present during exercise to use as needed.
based on individual preferences to increase flexibility, Insulin or other medication regimens may need to be
muscular strength, and balance. adjusted in response to the exercise program (4).
The exercise prescription in patients with chronic diseases
should include the above recommendations but be individualized. Hypertension and Exercise
Age, ethnicity, socioeconomic status, and weight should be consid- According to the World Health Organization, the American
ered when creating an exercise plan and the goals should be spe- Heart Association, and the American College of Sports Medicine,
cific, measurable, attainable, relevant, and time-based (SMART). increased physical activity is considered a first line intervention
The physical activity should be tailored to the person's ability for preventing hypertension, progression in prehypertensive pa-
and should avoid inactivity (3). The rest of this article will focus tients, and treating newly diagnosed hypertension patients (5).
on diabetes, hypertension, and obesity physical activity benefits Exercise releases anti-inflammatory chemicals through the
and recommendations. sympathetic nervous system and hypothalamic-pituitary-adrenal
axis, which directly target blood pressure (6). Regular physical
1
Department of Family Medicine, Charles R. Drew University of Medicine & activity can influence baroreceptor sensitivity, decrease
Science, Los Angeles, CA; and 2Department of Family Medicine, College of norepinephrine levels, and reduce pulmonary vascular resistance.
Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
Aerobic exercise decreases left ventricular mass and wall
Address for correspondence: Lisa C. Barkley MD, FAAFP, FACSM, FSAHM, thickness, upregulates central antioxidant concentrations,
Department of Family Medicine, Charles R. Drew University of Medicine & improves lipid levels, and reduces prooxidant levels and
Science, 1731 E. 120th St, Los Angeles, CA 90059; E-mail: arterial stiffness (6). Resistance exercise, if monitored and
[email protected]. executed properly, can be sufficient to reduce systolic and
Column Editor: Lisa C. Barkley MD, FAAFP, FACSM, FSAHM diastolic blood pressures.
E-mail: [email protected]

1537-890X/2008/387–388
Recommendations
Current Sports Medicine Reports As part of the initial treatment, aerobic exercise is recom-
Copyright © 2021 by the American College of Sports Medicine mended in patients with stage 1 hypertension with no other

www.acsm-csmr.org Current Sports Medicine Reports 387

Copyright © 2021 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 coronary risk factors and no evidence of CVD. Preparticipation the patient problem solve any barriers encountered since the
screening should be conducted for patients with stage 2 or stage last visit is critical to maximizing success. Incorporation of
3 hypertension and CVD patients and drug therapy should be commercial mobile applications is encouraged to assist in
used before starting an exercise program (6). dietary and physical activity.

Obesity and Exercise The authors declare no conflict of interest and do not have
Even in the absence of weight loss, exercise can result in sig- any financial disclosures.
Downloaded from http://journals.lww.com/acsm-csmr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCyw

nificant improvements in cardiometabolic health (7). Regular

exercise regimens can reduce the risks of developing medical References
1. Diem G, Brownson RC, Grabauskas V, et al. Prevention and control of
comorbidities of obesity such as musculoskeletal injuries,
CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 03/06/2024

noncommunicable diseases through evidence-based public health: implementing

heat illness, binge eating, sleep disorders, depression, and the NCD 2020 action plan. Glob Health Promot. 2016; 23:5–13.
chronic pain. There also is a positive correlation between 2. Durstine JL, Gordon B, Wang Z, Luo X. Chronic disease and the link to physical
regular physical activity and healthier dietary consumption. activity. J. Sport Health Sci. 2012; 3–11.
A combination of exercise and reduced caloric intake has 3. U.S. Department of Health and Human Services. Physical Activity Guidelines for
Americans. 2nd ed. Washington, DC: U.S. Department of Health and Human
been shown to be effective to treat obesity (7). Services; 2018.
4. Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a
Recommendations position statement of the American Diabetes Association. Diabetes Care. 2016;
An initial weight loss goal of 5% to 10% of weight is recom- 39:2065–79.
mended for overweight and obese adults, which is a rate of 1 to 5. Smart NA, Howden R, Cornelissen V, et al. Physical activity to prevent and treat
hypertension: a systematic review. Med. Sci. Sports Exerc. 2020; 52:1001–2.
2 lb·wk−1 (7). Gradually increasing exercise via smaller,
6. Ghadieh A, Saab B. Evidence for exercise training in the management of hyper-
incremental goals will be more effective than starting with tension in adults. Can. Fam. Physician. 2015; 61:233–9.
an ambitious static goal (7). Increasing accountability through 7. Fitzpatrick SL, Wischenka D, Appelhans BM, et al. An evidence-based guide for
regular follow-ups to review self-monitoring records and help obesity treatment in primary care. Am. J. Med. 2016; 129:115.e1–7.

388 Volume 20  Number 8  August 2021 CAQ Review

Copyright © 2021 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.