When To Adjust Your PreDiabetes Exercise Prescription

Movement is important for cardiovascular health in people with or without prediabetes metabolic syndrome.  It also engages your all-important musculoskeletal system which regulates your metabolism.

couple exercising on bikesDespite this, when you begin to incorporate some exercise activity into your life there is a chance you may go through a period of adjustment. This is not reason to stop, but some modification may be necessary.

Researchers have looked at different groups of people and their blood tests after beginning an exercise program. An analysis of 6 major exercise studies involving 1,687 people, found that on average about 10% of people show an apparent worsening in at least one measure of cardiovascular health in response to exercise. It is important to note that they did not follow these people over time to see how things turned out in the long run. As you begin to participate in an increased exercise-movement lifestyle, you may need to adjust your exercise routine. Not a big deal. Read on…

The cardiovascular test results looked at in the analysis are well-known to Nutrientology readers:

  • Blood pressure
  • Insulin level
  • HDL cholesterol
  • Tiglycerides

The prevalence of a negative reaction for one risk factor varied from 8.3% for the exercise induced changes in insulin level, to 13.3% for the changes in HDL-cholesterol level.

About 7% had negative changes on at least two measures.

The studies used varied groups of people that included:

  • Families with parents 65 years of age or less and their children ranging in age from 17 to 41 years.
  • Sedentary, high-normal blood pressure, postmenopausal, overweight or obese women.
  • Sedentary men and women between the ages of 30 and 75 years who had an elevated plasma C-reactive protein (CRP) concentration (≥2.0 mg/L but <10.0 mg/L). An increase CRP indicates inflammation in their system.
  • Sedentary, overweight, or mildly obese (BMI 25–35 kg/m2), dyslipidemic, men and women between 40- to 65-year-of age.
  • Men and women ages 50 to 75 years who were sedentary, nondiabetic, and nonsmoking, with no prior history of cardiovascular disease but with one National Cholesterol Education Program lipid abnormality or blood pressure in the pre-hypertensive range.
  • Healthy, sedentary 40- to 67-year-old men and women were also recruited.

man with abdominal obese stomach areaThese people are by no means a picture of health. AND the participants in these studies did not change their diets! Are we surprised that about less than one out of ten had an apparent negative test result ostensibly because of beginning the exercise program?  I am not.

Not everyone having the same response to exercise is not all that surprising to me, especially given the groups of people used in the study analysis as shown above.

One out of ten people having a negative change on one of the measures above is something that we certainly should pay attention to, and perhaps the exercise prescription needs to be adjusted, but it is not necessarily a reason to discontinue the exercise-movement prescription altogether.

Many people in the analysis had a positive response, and in some respects, given the groups of study subjects used in the various studies, it’s more surprising to me that there were not more people showing a negative response to one of the metrics studied.

The people in the studies were sedentary and many were overweight or obese. There are many changes taking place physiologically in the body as one begins an exercise lifestyle. There may also be some physiologic disruption, and the establishment, or invigoration, of various metabolism pathways that may have been “dormant.”

The body takes time to adapt. To suddenly thrust someone who is unfit and has been living a sedentary lifestyle into an exercise program is bound to “rock their metabolic boat.”

The smart readers of Nutrientology know that we advocate a go-slow approach to initiating a program of exercise-movement, especially if you have been sedentary.

Many people think about this advice from the perspective of not wanting to pull a muscle or strain a joint, but the physiologic changes that you don’t feel can be just as significant. Just as your muscles, bones, and joints can become conditioned for movement, your physiology will also need time to adjust.  Oh, and obviously, if you have not been eating healthy food, you should make changes in that area as well.

Pay attention to your response to exercise.

  • How are you feeling?
  • How are you functioning?
  • How is your body composition responding?
  • How is your diet (food quality)?
  • How well are you sleeping?
  • What do your laboratory biomarkers of cardiovascular health and inflammation show on your blood tests?

The researchers in this study found that the negative change was not related to:

  • How fit the people were at the start of the study.
  • How much their fitness improved with exercise.
  • Age
  • Race or gender.
  • Medications
  • Exercise intensity

The authors report that they could not find any trait that could predict who would have an adverse response.

They believe this is critical in writing the proper exercise prescription.

In addition, they also mentioned other measures of a healthy metabolism that should be evaluated, such as LDL-cholesterol, small LDL particles, other markers of low-grade inflammation, and one’s pattern of fat deposition, for example.

For now, generally take it slow, “listen to your body,” make adjustments (in consultation with your doctor and/or exercise trainer if available) and keep moving. You will get it done, and be glad you did.

They conclude that, “adverse responses to regular exercise in cardiovascular and diabetes risk factors occur. Identifying the predictors of such unwarranted responses and how to prevent them will provide the foundation for personalized exercise prescription.”

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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.

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