Diabetologie und Stoffwechsel 2017; 12(02): 112-126
DOI: 10.1055/s-0042-121407
DuS-Refresher
© Georg Thieme Verlag KG Stuttgart · New York

Körperliche Aktivität und Sport bei Typ-2-Diabetes

Physical Activity and Sports in Patients With Type 2 Diabetes
Andreas M. Nieß
,
Ansgar Thiel
Further Information

Publication History

Publication Date:
03 May 2017 (online)

Zusammenfassung

Ein ausreichender Umfang an körperlicher Aktivität zählt zu den wichtigsten nicht medikamentösen Maßnahmen zur Prävention und Therapie des Typ-2-Diabetes. Von einem regelmäßigen körperlichen Training profitieren Patienten mit Typ-2-Diabetes nicht nur in Hinblick auf eine verbesserte glykämische Kontrolle. Weitere positive Wirkungen sind eine günstige Beeinflussung kardiovaskulärer Risikofaktoren, eine Verringerung ektoper Fettdepots, eine Unterstützung bei der Reduktion von Übergewicht, antiinflammatorische Effekte und eine Verbesserung und Stabilisierung der körperlichen Fitness. Somit senkt ein ausreichender Umfang an körperlichem Training sowohl die Gesamtmortalität als auch die kardiovaskuläre Sterblichkeit bei Typ-2-Diabetes.

Nach den Leitlinien zur Therapie des Typ-2-Diabetes sollen betroffene Erwachsene angehalten werden, mindestens 150 min pro Woche an moderat-intensiven aeroben Ausdauerbelastungen (50 – 70 % der maximalen Herzfrequenz) zu absolvieren. Dieses Training sollte auf mindestens 3 Tage pro Woche verteilt sein und es sollten nicht mehr als 2 trainingsfreie Tage dazwischen liegen. Sofern keine Kontraindikationen bestehen, wird Erwachsenen mit Typ-2-Diabetes zusätzlich ein Krafttraining mit zumindest zweimaliger Durchführung pro Woche empfohlen. Des Weiteren sollten Phasen längeren Sitzens vermieden werden und Sitzzeiten alle 90 min unterbrochen werden.

Sowohl eine unzureichende glykämische Kontrolle als auch Folgeschäden der Diabeteserkrankung wie eine Retinopthie, eine autonome Neuropathie oder eine koronare Herzerkrankung können im Rahmen des körperlichen Trainings für den Patienten ein Risiko darstellen und dessen körperliche Belastbarkeit einschränken. Aus diesem Grund wird vor Beginn eines körperlichen Trainings eine sorgfältige Eingangsdiagnostik und wenn notwendig eine Anpassung des Trainingsprogramms empfohlen. Weiterhin sollte bei trainierenden Patienten mit Typ-2-Diabetes unter Medikation mit Insulin oder Sekretagoga je nach individueller Konstellation die Medikation angepasst werden. Im Falle von Blutzuckerwerten unter 100 mg/dl vor Belastungsbeginn sollten zusätzlich Kohlenhydrate zugeführt werden.

Körperliche Aktivität ist ein überaus wichtiger Bestandteil der Therapie und Prävention des Typ-2-Diabetes – leider scheitern wirksame Trainingsprogramme häufig an mangelnder Motivation der betroffenen Patienten. Dieser Beitrag beleuchtet die positiven Effekte des körperlichen Trainings, erläutert die Leitlinienempfehlungen und gibt praktische Tipps zur individuellen Trainingsplanung und -beratung.

Abstract

A sufficient amount of physical activity is an important tool to prevent and treat type 2 diabetes. Beside an improvement in glycemic control, beneficial effects of physical activity and exercise training include a reduction of the cardiovascular risk profile, body weight and ectopic fat stores, anti-inflammatory properties and also an increase of physical fitness. In this context, exercise training lowers all-cause and cardiac mortality in type 2 diabetes.

Actual recommendations reflect that adults with type 2 diabetes should be advised to perform at least 150 min per week of moderate intensive aerobic exercise training (50 – 70 % maximum heart rate). The training activity should be spread over at least three sessions during a week, and resting periods between the sessions should not exceed two days. In addition, in the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at a minimum of twice a week. Moreover, a reduction of sedentary time by breaking up periods of sitting longer than 90 minutes should be realized.

Risks during exercise training can arise from a non-optimal glycemic control. Moreover, long-term complications of diabetes such a retinopathy, autonomic neuropathy and coronary heart disease may lower tolerance to exercise. Thus, a pre-training evaluation and clinical judgement should be performed. If necessary, the training regimen has to be adapted to the individual case. To avoid hypoglycemia in patients treated with insulin or secretagogues, the medication dose has to be adapted individually and/or additional carbohydrates supplemented, if pre-exercise plasma glucose is measured below 100 mg/dl.

 
  • Literatur

  • 1 Lindström J. Peltonen M. Eriksson JG. et al. Finnish Diabetes Prevention Study (DPS). Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia 2013; 56: 284-293
  • 2 Umpierre D. Ribeiro PA. Schaan BD. et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 2013; 56: 242-251
  • 3 Yang Z. Scott CA. Mao C. et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 2014; 44: 487-499
  • 4 Hu G. Jousilahti P. Barengo NC. et al. Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. Diabetes Care 2005; 28: 799-805
  • 5 Ratner R. Goldberg R. Haffner S. Diabetes Prevention Program Research Group. et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care 2005; 28: 888-894
  • 6 Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
  • 7 Rejeski WJ. Ip EH. Bertoni AG. Look AHEAD Research Group. et al. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med 2012; 366: 1209-1217
  • 8 Hallal PC. Andersen LB. Bull FC. et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 380: 247-257
  • 9 Nelson KM. Reiber G. Boyko EJ. NHANES III. Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III). Diabetes Care 2002; 25: 1722-1728
  • 10 Ekelund U. Steene-Johannessen J. Brown W. Lancet Physical Activity Series 2 Executive Committe; Lancet Sedentary Behaviour Working Group. et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 2016; 388: 1302-1310
  • 11 Biswas A. Oh PI. Faulkner GE. et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 2015; 162: 123-132
  • 12 Colberg SR. Sigal RJ. Fernhall B. American College of Sports Medicine; American Diabetes Association. et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care 2010; 33: 2692-2696
  • 13 Kessler HS. Sisson SB. Short KR. The potential for high-intensity interval training to reduce cardiometabolic disease risk. Sports Med 2012; 42: 489-509
  • 14 Henriksen EJ. Invited Review: Effects of acute exercise and exercise training on insulin resistance. J Appl Physiol 2002; 93: 788-796
  • 15 Jørgensen SB. Richter EA. Wojtaszewski JF. Role of AMPK in skeletal muscle metabolic regulation and adaptation in relation to exercise. J Physiol 2006; 574: 17-31
  • 16 Kramer HF. Goodyear LJ. Exercise, MAPK, and NF-kappaB signaling in skeletal muscle. J Appl Physiol 2007; 103: 388-395
  • 17 Bruce CR. Hawley JA. Improvements in insulin resistance with aerobic exercise training: a lipocentric approach. Med Sci Sports Exerc 2004; 36: 1196-1201
  • 18 Kantartzis K. Thamer C. Peter A. et al. High cardiorespiratory fitness is an independent predictor of the reduction in liver fat during a lifestyle intervention in non-alcoholic fatty liver disease. Gut 2009; 58: 1281-1288
  • 19 Brouwers B. Hesselink MK. Schrauwen P. et al. Effects of exercise training on intrahepatic lipid content in humans. Diabetologia 2016; 59: 2068-2079
  • 20 Slentz CA. Bateman LA. Willis LH. et al. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Am J Physiol Endocrinol Metab 2011; 301: E1033-E1039
  • 21 Sarzynski MA. Burton J. Rankinen T. et al. The effects of exercise on the lipoprotein subclass profile: A meta-analysis of 10 interventions. Atherosclerosis 2015; 243: 364-372
  • 22 Hayashino Y. Jackson JL. Fukumori N. et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2012; 98: 349-360
  • 23 Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“ 2014. AWMF-Register Nr. 050/001. Im Internet: http://www.awmf.org/leitlinien/detail/ll/050-001.html . Stand: 21.03.2017
  • 24 Niess A. Thiel A. Ursachen der Adipositas: Änderung des Bewegungsverhaltens. In: Bischoff SC. Hrsg. Adipositas – Grundlagen und Praxis. Mechanismen, Prävention und Therapie. Berlin: Walter de Gruyter Verlag; (im Druck)
  • 25 Donath MY. Multiple benefits of targeting inflammation in the treatment of type 2 diabetes. Diabetologia 2016; 59: 679-682
  • 26 Karstoft K. Pedersen BK. Exercise and type 2 diabetes: focus on metabolism and inflammation. Immunol Cell Biol 2016; 94: 146-150
  • 27 Handschin C. Spiegelman BM. The role of exercise and PGC1α in inflammation and chronic disease. Nature 2008; 454: 463-469
  • 28 Hopps E. Canino B. Caimi G. Effects of exercise on inflammation markers in type 2 diabetic subjects. Acta Diabetol 2011; 48: 183-189
  • 29 Hayashino Y. Jackson JL. Hirata T. et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism 2014; 63: 431-440
  • 30 Sixt S. Beer S. Blüher M. et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Heart J 2010; 31: 112-119
  • 31 Ribeiro F. Alves AJ. Duarte JA. et al. Is exercise training an effective therapy targeting endothelial dysfunction and vascular wall inflammation?. Int J Cardiol 2010; 141: 214-221
  • 32 Olver TD. Laughlin MH. Endurance, interval sprint, and resistance exercise training: impact on microvascular dysfunction in type 2 diabetes. Am J Physiol Heart Circ Physiol 2016; 310: H337-H350
  • 33 Voulgari C. Pagoni S. Vinik A. et al. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism 2013; 62: 609-621
  • 34 ADA. Foundations of cara: education, nutrition, physical activity, smoking cessation, psychological care, and immunization. Sec. 4. In Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015; 38: S20-S30
  • 35 Church TS. Cheng YJ. Earnest CP. et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 2004; 27: 83-88
  • 36 Lee DC. Sui X. Artero EG. et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation 2011; 124: 2483-2490
  • 37 Sawada SS. Lee IM. Naito H. et al. Long-term trends in cardiorespiratory fitness and the incidence of type 2 diabetes. Diabetes Care 2010; 33: 1353-1357
  • 38 Thamer C. Stumvoll M. Niess A. et al. Reduced skeletal muscle oxygen uptake and reduced beta-cell function: two early abnormalities in normal glucose-tolerant offspring of patients with type 2 diabetes. Diabetes Care 2003; 26: 2126-2132
  • 39 Bouchard C. Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc 2001; 33: S446-S451
  • 40 Bouchard C. Blair SN. Church TS. et al. Adverse metabolic response to regular exercise: is it a rare or common occurrence?. PLoS One 2012; 7: e37887
  • 41 Böhm A. Weigert C. Staiger H. et al. Exercise and diabetes: relevance and causes for response variability. Endocrine 2016; 51: 390-401
  • 42 Pandey A. Swift DL. McGuire DK. et al. Metabolic effects of exercise training among fitness-nonresponsive patients with type 2 diabetes: The HART-D Study. Diabetes Care 2015; 38: 1494-1501
  • 43 Henson J. Davies MJ. Bodicoat DH. et al. Breaking up prolonged sitting with standing or walking attenuates the postprandial metabolic response in postmenopausal women: a randomized acute study. Diabetes Care 2016; 39: 130-138
  • 44 Bailey DP. Broom DR. Chrismas BC. et al. Breaking up prolonged sitting time with walking does not affect appetite or gut hormone concentrations but does induce an energy deficit and suppresses postprandial glycaemia in sedentary adults. Appl Physiol Nutr Metab 2016; 41: 324-331
  • 45 Peddie MC. Bone JL. Rehrer NJ. et al. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: A randomized crossover trial. Am J Clin Nutr 2013; 98: 358-366
  • 46 Van Dijk JW. Venema M. Van Mechelen W. et al. Effect of moderate-intensity exercise versus activities of daily living on 24-hour blood glucose homeostasis in male patients with type 2 diabetes. Diabetes Care 2013; 36: 3448-3453
  • 47 Sigal RJ. Armstrong CEP. Colby P. et al. Clinical Practice Guidelines. Physical Activity and Diabetes. Can J Diabetes 2013; 37: S40-S44
  • 48 Pollock ML. Franklin BA. Balady GJ. AHA Science Advisory. et al. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation 2000; 101: 828-833
  • 49 ACSM Position Stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998; 30: 975-991
  • 50 Weston KS. Wisløff U. Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med 2014; 48: 1227-1234
  • 51 Tjønna AE. Lee SJ. Rognmo Ø. et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation 2008; 118: 346-354
  • 52 Adams J. Ogola G. Stafford P. et al. High-intensity interval training for intermittent claudication in a vascular rehabilitation program. J Vasc Nurs 2006; 24: 46-49
  • 53 Stefan N. Niess A. Körperliche Aktivität, Sport und Training. In: Häring HU. Gallwitz B. Müller-Wieland D. Usadel KH. Mehnert H. Hrsg. Diabetologie in Klinik und Praxis. Stuttgart: Thieme; 2011: 317-325
  • 54 Unick JL. Gaussoin SA. Hill JO. et al. Four-year physical activity levels among intervention participants with type 2 diabetes. Med Sci Sports Exerc 2016; 48: 2437-2445
  • 55 Carrell SE. Hoekstra M. West JE. Is poor fitness contagious?: Evidence from randomly assigned friends. Journal of Public Economics 2011; 95: 657-663
  • 56 Castellani W. Ianni L. Ricca V. et al. Adherence to structured physical exercise in overweight and obese subjects: a review of psychological models. Eat Weight Disord 2003; 8: 1-11
  • 57 Delahanty LM. Conroy MB. Nathan DM. Diabetes Prevention Program Research Group. Psychological predictors of physical activity in the diabetes prevention program. J Am Diet Assoc 2006; 106: 698-705
  • 58 Plotnikoff RC. Lippke S. Trinh L. et al. Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample. Br J Health Psychol 2010; 15: 643-661
  • 59 Robertson C. Archibald D. Avenell A. et al. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess 2014; 18: 1-424
  • 60 Korkiakangas EE. Alahuhta MA. Laitinen JH. Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review. Health Promot Int 2009; 24: 416-427
  • 61 Grace SL. Barry-Bianchi S. Stewart DE. et al. Physical activity behavior, motivational readiness and self-efficacy among Ontarians with cardiovascular disease and diabetes. J Behav Med 2007; 30: 21-29
  • 62 Sweet SN. Fortier MS. Guérin E. et al. Understanding physical activity in adults with type 2 diabetes after completing an exercise intervention trial: A mediation model of self-efficacy and autonomous motivation. Psychol Health Med 2009; 14: 419-429
  • 63 Thiel A. Thedinga HK. Thomas SL. et al. Have adults lost their sense of play? An observational study of the social dynamics of physical (in)activity in German and Hawaiian leisure settings. BMC Public Health 2016; 16: 689
  • 64 Bartlett JD. Close GL. MacLaren DP. et al. High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence. J Sports Sci 2011; 29: 547-553
  • 65 Foster C. Farland CV. Guidotti F. et al. The effects of high intensity interval training vs steady state training on aerobic and anaerobic capacity. J Sports Sci Med 2015; 14: 747-755
  • 66 Kirk A. Mutrie N. MacIntyre P. et al. Increasing physical activity in people with type 2 diabetes. Diabetes Care 2003; 26: 1186-1192
  • 67 Yoo M. D’Silva LJ. Martin K. et al. Pilot study of exercise therapy on painful diabetic peripheral neuropathy. Pain Med 2015; 16: 1482-1489
  • 68 Pop-Busui R. What do we know and we do not know about cardiovascular autonomic neuropathy in diabetes. J Cardiovasc Transl Res 2012; 5: 463-478
  • 69 Kenny GP. Sigal RJ. McGinn R. Body temperature regulation in diabetes. Temperature (Austin) 2016; 3: 119-145
  • 70 Bax JJ. Young LH. Frye RL. ADA. et al. Screening for coronary artery disease in patients with diabetes. Diabetes Care 2007; 30: 2729-2736
  • 71 Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP). S1-Leitlinie Vorsorgeuntersuchung im Sport. 2007 Im Internet: http://www.bayerischersportaerzteverband.de/fileadmin/user_upload/html/Download/S1_Leitlinie_DGSP.pdf Stand: 21.03.2017
  • 72 Kemmer FW. Halle M. Stumvoll M. et al. Diabetes Sport und Bewegung. DDG Praxisempfehlung. Diabetologie 2012; 7: S170-S172
  • 73 Gordon BA. Bird SR. MacIsaac RJ. et al. Does a single bout of resistance or aerobic exercise after insulin dose reduction modulate glycaemic control in type 2 diabetes? A randomised cross-over trial. J Sci Med Sport 2016; 19: 795-799