TY - JOUR

T1 - Why prescribe exercise as therapy in type 2 diabetes? We have a pill for that!

AU - Ried-Larsen, Mathias

AU - MacDonald, Christopher S.

AU - Johansen, Mette Y.

AU - Hansen, Katrine B.

AU - Christensen, Robin

AU - Almdal, Thomas P.

AU - Pedersen, Bente K.

AU - Karstoft, Kristian

PY - 2018

Y1 - 2018

N2 - The majority of T2D cases are preventable through a healthy lifestyle, leaving little room for questions that lifestyle should be the first line of defence in the fight against the development of T2D. However, when it comes to the clinical care of T2D, the potential efficacy of lifestyle is much less clear‐cut, both in terms of impacting the pathological metabolic biomarkers of the disease, and long‐term complications. A healthy diet, high leisure‐time physical activity, and exercise are considered to be cornerstones albeit adjunct to drug therapy in the management of T2D. The prescription and effective implementation of structured exercise and other lifestyle interventions in the treatment of T2D have not been routinely used. In this article, we critically appraise and debate our reflections as to why exercise and physical activity may not have reached the status of a viable and effective treatment in the clinical care of T2D to the same extent as pharmaceutical drugs. We argue that the reason why exercise therapy is not utilized to a satisfactory degree is multifaceted and primarily relates to a “vicious cycle” with lack of proven efficacy on T2D complications and a lack of proven effectiveness on risk factors in the primary care of T2D. Furthermore, there is a lack of experimental research establishing the optimal dose of exercise. This precludes widespread and sustained implementation of physical activity and exercise in the clinical treatment of T2D will not succeed.

AB - The majority of T2D cases are preventable through a healthy lifestyle, leaving little room for questions that lifestyle should be the first line of defence in the fight against the development of T2D. However, when it comes to the clinical care of T2D, the potential efficacy of lifestyle is much less clear‐cut, both in terms of impacting the pathological metabolic biomarkers of the disease, and long‐term complications. A healthy diet, high leisure‐time physical activity, and exercise are considered to be cornerstones albeit adjunct to drug therapy in the management of T2D. The prescription and effective implementation of structured exercise and other lifestyle interventions in the treatment of T2D have not been routinely used. In this article, we critically appraise and debate our reflections as to why exercise and physical activity may not have reached the status of a viable and effective treatment in the clinical care of T2D to the same extent as pharmaceutical drugs. We argue that the reason why exercise therapy is not utilized to a satisfactory degree is multifaceted and primarily relates to a “vicious cycle” with lack of proven efficacy on T2D complications and a lack of proven effectiveness on risk factors in the primary care of T2D. Furthermore, there is a lack of experimental research establishing the optimal dose of exercise. This precludes widespread and sustained implementation of physical activity and exercise in the clinical treatment of T2D will not succeed.

KW - clinical care

KW - complications

KW - exercise

KW - lifestyle intervention

KW - physical activity

KW - treatment

KW - type 2 diabetes

U2 - 10.1002/dmrr.2999

DO - 10.1002/dmrr.2999

M3 - Review

C2 - 29488311

VL - 34

JO - Diabetes/Metabolism Research and Reviews

JF - Diabetes/Metabolism Research and Reviews

SN - 1520-7552

IS - 5

M1 - e2999

ER -