Download PDF
Diabetologie und Stoffwechsel 2014; 9(S 02): S196-S201
DOI: 10.1055/s-0034-1385400
DDG Praxisempfehlung
© Georg Thieme Verlag KG Stuttgart · New York

Diabetes, Sport und Bewegung

K. Esefeld
1   Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
,
P. Zimmer
2   AG Diabetes und Sport der DDG
,
M. Stumvoll
3   Med. Klinik und Poliklinik III, Universitätsklinik Leipzig, Leipzig
,
M. Halle
1   Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München, München
2   AG Diabetes und Sport der DDG
4   DZHK (German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
5   Else Kröner Fresenius-Zentrum, Klinikum rechts der Isar, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2015 (online)

Also available at
    Permissions and Reprints

Physiologie der Muskelarbeit

Muskelarbeit bezeichnet ganz allgemein Körperbewegung oder körperliche Aktivität durch Muskelkontraktionen, die zu einem Energieverbrauch zusätzlich zum Grundumsatz führt. Jede Art körperlicher Aktivität, unabhängig davon, ob sie im Alltagsleben, im Beruf oder in der Freizeit in strukturierter Form als Sport geleistet wird, folgt den gleichen metabolischen und hormonellen Regelmechanismen.

Unter Ruhebedingungen wird der Energiebedarf der Skelettmuskulatur fast vollständig durch die Oxidation freier Fettsäuren gedeckt. Mit einsetzender Muskelarbeit steigt der Energiebedarf akut an und kann unter Umständen das 8- bis 10-Fache des Ruhebedarfs erreichen. Zur Deckung dieses Energiebedarfs greift die Muskulatur anfangs vorrangig auf Glukose und erst bei länger als einer Stunde andauernder Muskelarbeit auf eine Mischung aus freien Fettsäuren und Glukose zurück. Dabei überwiegt der Anteil der Fettsäureoxidation und variiert in Abhängigkeit vom Trainingszustand zwischen 60 und 75 % der VO2max.

Während körperlicher Aktivität verbraucht der Muskel zunächst freie Glukose, die anschließend aus dem Abbau der muskulären Glykogenreserven nachgeliefert wird. Für die Muskelarbeit wird zudem auch Glukose aus dem Blut verwendet und insulinabhängig in die Zelle aufgenommen. Die Steigerung des Glukosetransports aus dem Blut in die Muskelzelle erfolgt durch die Translokation der Glukosetransporter (GLUT-4) vom endoplasmatischen Retikulum in die Muskelzellmembran. Zusätzlich steigert jede Muskelaktivität genau diesen Vorgang insulin un abhängig. Die Eigenkontraktion der Muskulatur entspricht somit der physiologischen Wirkung des Insulins [1] [2] [3] [4].

Der durch die Muskelarbeit bedingte Glukoseabfall wird durch eine präzise und adäquate Steigerung der hepatischen Glukosefreisetzung ausgeglichen, wenn keine gleichzeitige Glukoseresorption aus der Nahrung zur Verfügung steht. Die Steigerung dieser Freisetzung wird im Wesentlichen durch eine Hemmung der pankreatischen Insulinsekretion und dem daraus resultierenden Abfall des Insulinspiegels im Pfortaderblut bewirkt. Unterstützend und modulierend wirken dabei die kontrainsulinären Hormone (Katecholamine, Glukagon, Cortisol und Wachstumshormone) [2] [3] [5] [6]. Diese Anpassungsvorgänge der Glukosebereitstellung führen je nach Dauer und Intensität der Muskelarbeit zur teilweisen bis vollständigen Entleerung der muskulären und hepatischen Glukosespeicher. Diese werden nach Beendigung der Muskelarbeit wieder aufgefüllt. Abhängig vom Entleerungsgrad kann die Glukoseaufnahme in die Muskulatur noch bis zu 48 Stunden nach Ende der Muskelarbeit erhöht sein.

 

  • Literatur

  • 1 Dohm GL. Invited review: Regulation of skeletal muscle GLUT-4 expression by exercise. J Appl Physiol 2002; 93: 782-787
    CrossrefGoogle Scholar
  • 2 O'Gorman DJ, Karlsson HK, McQuaid S et al. Exercise training increases insulin-stimulated glucose disposal and GLUT4 (SLC2A4) protein content in patients with type 2 diabetes. Diabetologia 2006; 49: 2983-2992
    CrossrefGoogle Scholar
  • 3 Rodnick KJ, Henriksen EJ, James DE et al. Exercise training, glucose transporters, and glucose transport in rat skeletal muscles. Am J Physiol 1992; 262: C9-C14
    Google Scholar
  • 4 Sigal RJ, Kenny GP, Wasserman DH et al. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006; 29: 1433-1438
    CrossrefGoogle Scholar
  • 5 Hamdy O, Goodyear LJ, Horton ES. Diet and exercise in type 2 diabetes mellitus. Endocrinol Metab Clin North Am 2001; 30: 883-907
    CrossrefGoogle Scholar
  • 6 Wojtaszewski JF, Nielsen JN, Richter EA. Invited review: effect of acute exercise on insulin signaling and action in humans. J Appl Physiol 2002; 93: 384-392
    CrossrefGoogle Scholar
  • 7 Herbst A, Kordonouri O, Schwab KO et al. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23,251 patients. Diabetes Care 2007; 30: 2098-2100
    CrossrefPubMedGoogle Scholar
  • 8 Selam JL, Casassus P, Bruzzo F et al. Exercise is not associated with better diabetes control in type 1 and type 2 diabetic subjects. Acta Diabetol 1992; 29: 11-13
    CrossrefGoogle Scholar
  • 9 Kemmer FW, Berger M. Therapy and better quality of life: the dichotomous role of exercise in diabetes mellitus. Diabetes Metab Rev 1986; 2: 53-68
    CrossrefGoogle Scholar
  • 10 Kemmer FW. Prevention of hypoglycemia during exercise in type I diabetes. Diabetes Care 1992; 15: 1732-1735
    CrossrefGoogle Scholar
  • 11 Goldstein DE, Little RR, Lorenz RA et al. Tests of glycemia in diabetes. Diabetes Care 2004; 27 (Suppl. 01) S91-S93
    CrossrefGoogle Scholar
  • 12 Thurm U, Harper PN. I'm running on insulin. Summary of the history of the International Diabetic Athletes Association. Diabetes Care 1992; 15: 1811-1813
    CrossrefGoogle Scholar
  • 13 Bussau VA, Ferreira LD, Jones TW et al. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care 2006; 29: 601-606
    CrossrefGoogle Scholar
  • 14 Davey RJ, Howe W, Paramalingam N et al. The effect of midday moderate-intensity exercise on postexercise hypoglycemia risk in individuals with type 1 diabetes. J Clin Endocrinol Metab 2013; 98: 2908-2914
    CrossrefGoogle Scholar
  • 15 Deuster PA, Chrousos GP, Luger A et al. Hormonal and metabolic responses of untrained, moderately trained, and highly trained men to three exercise intensities. Metabolism 1989; 38: 141-148
    CrossrefGoogle Scholar
  • 16 Flood L, Constance A. Diabetes and exercise safety. Am J Nurs 2002; 102: 47-55
    Google Scholar
  • 17 Frid A, Ostman J, Linde B. Hypoglycemia risk during exercise after intramuscular injection of insulin in thigh in IDDM. Diabetes Care 1990; 13: 473-477
    CrossrefGoogle Scholar
  • 18 Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care 2005; 28: 1289-1294
    CrossrefGoogle Scholar
  • 19 Guelfi KJ, Ratnam N, Smythe GA et al. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab 2007; 292: E865-E870
    Google Scholar
  • 20 Harris GD, White RD. Diabetes in the competitive athlete. Curr Sports Med Rep 2012; 11: 309-315
    CrossrefGoogle Scholar
  • 21 Kemmer FW, Berchtold P, Berger M et al. Exercise-induced fall of blood glucose in insulin-treated diabetics unrelated to alteration of insulin mobilization. Diabetes 1979; 28: 1131-1137
    CrossrefGoogle Scholar
  • 22 Koivisto VA, Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl J Med 1978; 298: 79-83
    CrossrefGoogle Scholar
  • 23 Rabasa-Lhoret R, Bourque J, Ducros F et al. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 2001; 24: 625-630
    CrossrefPubMedGoogle Scholar
  • 24 Ronnemaa T, Koivisto VA. Combined effect of exercise and ambient temperature on insulin absorption and postprandial glycemia in type I patients. Diabetes Care 1988; 11: 769-773
    CrossrefGoogle Scholar
  • 25 Sandoval DA, Guy DL, Richardson MA et al. Effects of low and moderate antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes. Diabetes 2004; 53: 1798-1806
    CrossrefGoogle Scholar
  • 26 Tonoli C, Heyman E, Roelands B et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med 2012; 42: 1059-1080
    CrossrefGoogle Scholar
  • 27 Tuominen JA, Karonen SL, Melamies L et al. Exercise-induced hypoglycaemia in IDDM patients treated with a short-acting insulin analogue. Diabetologia 1995; 38: 106-111
    CrossrefGoogle Scholar
  • 28 Yardley JE, Kenny GP, Perkins BA et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care 2012; 35: 669-675
    CrossrefGoogle Scholar
  • 29 Sigal RJ, Kenny GP, Wasserman DH et al. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004; 27: 2518-2539
    CrossrefPubMedGoogle Scholar
  • 30 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
    CrossrefGoogle Scholar
  • 31 Wing RR, Bolin P, Brancati FL et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
    CrossrefPubMedGoogle Scholar
  • 32 Di LC, Fanelli C, Lucidi P et al. Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care 2005; 28: 1295-1302
    CrossrefGoogle Scholar
  • 33 Gregg EW, Chen H, Wagenknecht LE et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA 2012; 308: 2489-2496
    CrossrefGoogle Scholar
  • 34 Unick JL, Beavers D, Bond DS et al. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Am J Med 2013; 126: 236-242
    CrossrefGoogle Scholar
  • 35 Yates T, Haffner SM, Schulte PJ et al. Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis. Lancet 2014; 383: 1059-1066
    CrossrefGoogle Scholar
  • 36 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
    CrossrefGoogle Scholar
  • 37 Knowler WC, Fowler SE, Hamman RF et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374: 1677-1686
    CrossrefGoogle Scholar
  • 38 Wing RR, Bolin P, Brancati FL et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
    CrossrefPubMedGoogle Scholar
  • 39 Pi-Sunyer X, Blackburn G, Brancati FL et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 2007; 30: 1374-1383
    CrossrefGoogle Scholar
  • 40 Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170: 1566-1575
    CrossrefPubMedGoogle Scholar
  • 41 Karstoft K, Winding K, Knudsen SH et al. The effects of free-living interval-walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 2013; 36: 228-236
    CrossrefGoogle Scholar
  • 42 Rynders CA, Weltman JY, Jiang B et al. Effects of exercise intensity on postprandial improvement in glucose disposal and insulin sensitivity in prediabetic adults. J Clin Endocrinol Metab 2014; 99: 220-228
    CrossrefGoogle Scholar
  • 43 The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002; 25: 2165-2171
    CrossrefGoogle Scholar
  • 44 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
    CrossrefGoogle Scholar
  • 45 Hu FB, Sigal RJ, Rich-Edwards JW et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999; 282: 1433-1439
    CrossrefGoogle Scholar
  • 46 Hu FB, Manson JE, Stampfer MJ et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345: 790-797
    CrossrefPubMedGoogle Scholar
  • 47 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34: 1249-1257
    CrossrefPubMedGoogle Scholar
  • 48 Knowler WC, Barrett-Connor E, Fowler SE et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
    CrossrefGoogle Scholar
  • 49 Lindstrom J, Ilanne-Parikka P, Peltonen M et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006; 368: 1673-1679
    CrossrefPubMedGoogle Scholar
  • 50 Pan XR, Li GW, Hu YH et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: 537-544
    CrossrefGoogle Scholar
  • 51 Petrella RJ, Lattanzio CN, Demeray A et al. Can adoption of regular exercise later in life prevent metabolic risk for cardiovascular disease?. Diabetes Care 2005; 28: 694-701
    CrossrefGoogle Scholar
  • 52 Ratner R, Goldberg R, Haffner S 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
    CrossrefGoogle Scholar
  • 53 Tuomilehto J, Lindstrom J, Eriksson JG et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-1350
    CrossrefPubMedGoogle Scholar
  • 54 Boule NG, Weisnagel SJ, Lakka TA et al. Effects of exercise training on glucose homeostasis: the HERITAGE Family Study. Diabetes Care 2005; 28: 108-114
    CrossrefPubMedGoogle Scholar
  • 55 Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218-1227
    CrossrefPubMedGoogle Scholar
  • 56 Sparks LM, Johannsen NM, Church TS et al. Nine months of combined training improves ex vivo skeletal muscle metabolism in individuals with type 2 diabetes. J Clin Endocrinol Metab 2013; 98: 1694-1702
    CrossrefGoogle Scholar
  • 57 Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006; 29: 2518-2527
    CrossrefPubMedGoogle Scholar
  • 58 Umpierre D, Ribeiro PA, Kramer CK et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011; 305: 1790-1799
    CrossrefGoogle Scholar
  • 59 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 2012;
    Google Scholar
  • 60 Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2005; 28: 2780-2786
    CrossrefGoogle Scholar
  • 61 Del Pozo-Cruz J, fonso-Rosa RM, Ugia JL et al. A primary care-based randomized controlled trial of 12-week whole-body vibration for balance improvement in type 2 diabetes mellitus. Arch Phys Med Rehabil 2013; 94: 2112-2118
    CrossrefGoogle Scholar
  • 62 Haffner SM, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229-234
    CrossrefGoogle Scholar
  • 63 Mittleman MA, Maclure M, Tofler GH et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 1993; 329: 1677-1683
    CrossrefPubMedGoogle Scholar
  • 64 Willich SN, Lewis M, Lowel H et al. Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med 1993; 329: 1684-1690
    CrossrefGoogle Scholar
  • 65 Zinman B, Ruderman N, Campaigne BN et al. Physical activity/exercise and diabetes mellitus. Diabetes Care 2003; 26 (Suppl. 01) S73-S77
    CrossrefGoogle Scholar
  • 66 Bhaskarabhatla KV, Birrer R. Physical activity and diabetes mellitus. Compr Ther 2005; 31: 291-298
    CrossrefGoogle Scholar
  • 67 Kemmer FW, Tacken M, Berger M. Mechanism of exercise-induced hypoglycemia during sulfonylurea treatment. Diabetes 1987; 36: 1178-1182
    CrossrefGoogle Scholar
  • 68 Gudat U, Bungert S, Kemmer F et al. The blood glucose lowering effects of exercise and glibenclamide in patients with type 2 diabetes mellitus. Diabet Med 1998; 15: 194-198
    CrossrefGoogle Scholar