How resistance exercise like Pilates can drop your diabetes risks

International guidelines on diabetes recommend aerobic and resistance exercise like Pilates

We all should know now the benefits of exercise in preventing and controlling diabetes, heart disease, vascular disease and even early onset dementia. Guidelines for exercise have always suggested medium to high intensity workouts 3 times per week to benefit from these exercise effects. There is now a mounting stack of evidence concluding that strength or resistance training has an equally positive effect on us. This is particularly so with respect to type 2 or non-insulin dependent diabetes.

I recently read a short grab in a health magazine. It read like this:

150 minutes per week of aerobic exercise + 60 minutes of resistance work per week = 40% drop in diabetes risk!

I was intrigued and so read further on this topic myself.

The website for the Joslin Centre for Diabetes research at the Harvard Medical School was a fantastic source of medical facts, recent research findings and practical tips for preventing and managing the disease. Here I have extracted some of the most interesting of facts and tips from my reading.

• High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently (the past 10 years), but it is now well established that participation in regular physical activity at a moderate to high intensity improves blood glucose control and can prevent, delay and manage type 2 diabetes.
• The international guideline specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people, brisk walking is a moderate to high-intensity exercise.
• To measure 40-60% maximal aerobic capacity, the 'talk test' can be used as an additional suggested guideline. This 'talk test' recommends that you are able to maintain (just), a 'breathy' conversation with your exercise partner to estimate this level of effort.
• For people who already have type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week.
• The international guideline also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week — ideally 3 times a week — on non-consecutive days.
• Resistance training is defined as any exercise incorporating weight, whether that be through weights at the gym or home, body weight, resistance bands and the like.
• People with or without type 2 diabetes who perform resistance training strengthen their muscles.  This results in a higher metabolism and more calories burnt, improving insulin sensitivity (glycaemic control, or ability and effectiveness for insulin to convert your sugars to energy). This also helps with weight loss, and may reduce the amount of diabetes medications required if already diagnosed as a diabetes sufferer.

Offering practical exercise sessions and advice about exercise, the Joslin Centre website had me thinking that many of our exercises at The Fix Program were very much similar to their programs. They suggested exercises such as weighted biceps curls, chest presses, tricep dips, squat, lunges and planks. Sound familiar?

Think of all those Pilates classes you have done at The Fix Program, with squats and lunges with weights from our beginners Pilates, wallplanks, 'mad minutes', 'skull crushers',' tree huggers' and 'scissor arms' from the advanced Pilates classes.

So, for all of you continuing with your classes with us currently, now all you need to do is add your 150 minutes of moderate to high intensity aerobic exercise, and you are well on your way to reducing not only your type 2 diabetes risk, but other health risks also. For those of you not continuing currently with weighted exercise, try these suggested exercises from our Pilates classes for an hour in total over your week.

• Squats and/or lunges with weighted biceps curls.

  Try 3 sets of 10 squats/lunges with your arms curling. Don't forget your deep and wide breath, pelvis neutral awareness and activation of your pelvic floor and deep abdominal muscles throughout. Remember that a slow movement in each direction (in time with your deep breaths to really slow you down) will increase the demand on your muscles and therefore the beneficial effects at the cellular level as outlined above.

• Scissor arms in sustained double float.

  Try 2 sets of 10 scissor arms. Again, keep in time with your deep and wide breath and become aware of your trunk and pelvis postures. Remember the low but constant activation of your pelvic floor and deep abdominal muscles throughout.

• Tree hugger in sustained pelvic bridge.

  Try 2 sets of 10 tree huggers. Remember all of the above for a controlled and slow loaded exercise for maximum benefit.

• Mad minute

  On your elbows and toes/knees, hold your plank for 60 seconds. Remember your low and constant pelvic floor and deep abdominal contractions, soft neck, shoulder blades in your 'pockets' and a good neutral spine and pelvis.

I've chosen these 4 Pilates exercises as they maximise the resisted or weighted demand on the body. Target large and multiple muscle groups to maximise the benefits of muscle strengthening and the effectiveness of insulin.

Another fine example of how 'slow and steady' will win the race - by Katie

Injury 

I was forced to stop running for nearly two months recently after experiencing hip pain/tightness. My physio did her job releasing tightness and prescribing a program of stretching and strengthening exercises to get my buttocks (gluts) working properly. After testing it out with a few long walks I wanted to start running again and was keen to get back into 10km fun runs as soon as possible. However I was scared about being sidelined with injury again if I went too hard, too fast.

Katrina suggested I try the Couch to 5K program to gradually ease back into it. So I downloaded an iPhone app. The App was labelled as 'Couch Potato to 5km runner" and is an 8 week long program with 3 workouts a week to gradually get you from alternating walking with short interval runs, to a continuous 30 minute run. I was not exactly a couch potato because I had been keeping up my weekly Fix classes, an outdoor boot camp and weekly swimming squad sessions. So I toyed with the idea of skipping to week 3. Instead, I started at week 1 but moved through the 'weeks' a bit faster. 

Frustration

At first it was FRUSTRATING. I really enjoyed the run intervals but at only 1-2mins long I was only just getting into them before the App told me to start walking again. I just wanted to keep running. I had to keep telling myself that the end goal is to run 5K without reinjuring myself and I had to be patient.

Even though I thought I was fairly fit, the run intervals did start to get a bit harder from week 5. I guess my cardio fitness had dropped a bit. (Before injury I was exercising 5 times a week, including 3 runs). So from then on, I stuck to the prescribed 3 runs scheduled for each week.

I had a few weeks towards the end where my hip was sore again. I gave myself a couple of extra rest days but still finished the program in around 8 weeks. 

Success

It felt great to finally do the 30 min, 5km run and be back into running.

In the month since then I've been doing 3 runs per week, between 5-6kms. I have had a few niggles of pain & tightness and have had to accept that I will always need to keep up my strengthening exercises & stretches if I want to run regularly. It needs to be a permanent part of my schedule but I think it's worth it to be able to keep running.

The final word

Now Katie and I are running again! We have our 10k fun runs lined up for the coming months and it is great to have these as our next set of goals. It's all about finishing each one and with a hopeful PB!

If you are keen on starting your own running program to improve fitness, get ready for the City to Surf, or Blackmore's Bridge Run in September, now is the time to get started. Here are the Apps we suggest.

Here we are together at a recent fun run in Balmain.

http://c25kfree.com/ (watch the ads popping up regularly)

https://itunes.apple.com/au/app/c25k-5k-trainer-free/id485971733?mt=8

https://itunes.apple.com/au/app/run-10k-interval-training/id350529744?mt=8 

A big thank you to Katie for sharing her pacing experience.

Pop your paracetamol and keep moving

 http://www.smh.com.au/lifestyle/life/the-truth-about-back-pain-20131010-2vah5.html

It appears that as our medical technology and knowledge advances, we may still not be getting the management of back pain right. Over-scanning, over-medicating, over-diagnosing. This seems to be the trend in the diagnosis and treatment of acute back pain in recent times.

Dr Chris Maher in this October 2013 Sydney Morning Herald article explains some of these inappropriate treatments and other interesting conclusions from recent research.

Did you know that 90% of all acute back attacks are 'non-specific'?

This means they are due to altered postural loads on the back with no injury to back structures such as the joints, ligaments and discs. In other words, they are mostly muscular.

Did you know that over-complicating the care of someone with an acute back episode can actually lead to greater problems long term?

'Catastrophising' the diagnosis can have adverse affects on the attitudes to activity and therefore getting better in some. Over-medicating can cause drug dependence. Many unnecessary back surgeries are undertaken.

Did you know that MRI and CT scans will turn up a positive structural change in 33% of all people?

The interesting thing about this? Most will have no symptoms representative of these changes on film.

Did you know that it is now believed that there is a strong genetic component to suffering from back pain?

This is thought so as most other predictors of risk for back pain seem to be weak or inaccurate. This is seen with occupation, health and safety studies where there is little difference in the incidence of reported back injuries between control groups and those having received lifting education in the workplace.

Did you know that most people will suffer from more than one attack of back pain in their lives?

This is not unusual, and should therefore not come as a shock. If this does happen to you, stay calm, manage with mild pain killers and reassure yourself that this is the common trend.

What is the solution to this and also the international evidence-based clinical guidelines? Take mild pain killers such as paracetamol and stay as active as you can. In 90% of cases, this pain will pass within a few days to a week. If pain does linger, consult your physiotherapist for a lending hand.

And, of course, exercises to mobilise and strengthen the important pelvis and spinal postural muscles through Pilates.