Exercise and Diabetes: A Narrative Review

Disparities in diabetic foot examinations: a cross-sectional analysis of the behavioural risk factor surveillance system

AIM

This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.

BACKGROUND

Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.

METHODS

We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.

FINDINGS

Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days - a statistically significant association (AOR: 1.25; 95% CI: 1.09-1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14-1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

Delving Into the Interaction Between Exercise and Diabetes on Methylation of the FKBP5 Gene

Objective: FKBP5 is a critical gene involved in regulating the hypothalamic-pituitary-adrenal (HPA) axis and stress response. Aberrant DNA methylation at FKBP5 cytosine-phosphate-guanine (CpG) sites, such as cg22363520 and cg00862770, has been implicated in mental health disorders and metabolic diseases, including Type 2 diabetes. Exercise is a modulator of DNA methylation and metabolic health. This study investigates the interaction between exercise, diabetes, and FKBP5 methylation at cg22363520 and cg00862770 and explores their implications for mental health and disease development. Materials and Methods: FKBP5 methylation levels at cg22363520 and cg00862770 were analyzed in a cohort stratified by diabetes and exercise. Multiple linear regression models assessed the main effects and interactions of exercise and diabetes on FKBP5 methylation, with further stratified analyses for site-specific effects. Results: Exercise and diabetes showed significant and site-specific effects on FKBP5 methylation at cg22363520 and cg00862770. At cg22363520, exercise significantly reduced methylation levels in nondiabetic participants (β = -0.00195, p = 0.0157), while no significant effect was observed in diabetic individuals. Conversely, at cg00862770, exercise significantly decreased methylation levels in diabetic participants (β = -0.00611, p = 0.0081), with no significant effect in the nondiabetic group. Diabetes itself was associated with increased FKBP5 methylation at both sites, particularly in individuals without regular exercise. Additionally, significant interaction effects between exercise and diabetes were identified for both cg22363520 (p = 0.0336) and cg00862770 (p = 0.0021), highlighting the interplay between metabolic status and physical activity in regulating FKBP5 methylation. Conclusion: This study demonstrates that the effects of exercise on FKBP5 methylation are site-specific and influenced by diabetes status. Exercise reduces methylation at cg22363520 in nondiabetics and at cg00862770 in diabetics, indicating its role in modulating epigenetic regulation of stress and metabolic pathways. These findings underscore the interplay between exercise, diabetes, and FKBP5 methylation, with potential implications for improving mental health and metabolic outcomes.

Improvement in physical function and lipid profile following low-intensity resistance training and a lower limb conditioning program in people with diabetic neuropathy

BACKGROUND

Diabetic peripheral neuropathy (DPN) impairs glucose and fat metabolism and physical functioning. This study examined the effects of low-intensity resistance exercise training (LI-RT) and a lower limb conditioning program (LLCP) on physical function and lipid profile in DPN.

METHODS

Forty-five diabetic women with mild to moderate neuropathy (55.5 ± 3.1 y) were randomly assigned to one of three groups: LI-RT (n = 15), LLCP (n = 15), and control (n = 15). The LI-RT and LLCP groups trained 3 times/week (90 min/session) for 12 weeks. The LI-RT group completed 3 sets of 10 repetitions for ten exercises at 30-repetition maximum; the LLCP group performed 12 lower extremity motions designed for peripheral neuropathy; and the control group followed their routine daily activities. Physical function was assessed using the Timed Up and Go Test (TUG), Five Times Sit-to-Stand (FTSTS) test, and 6-min walking test (6MWT). Blood lipid profile was assessed.

RESULTS

Both the LI-RT and LLCP groups significantly improved in TUG scores compared to the control group (p ≤ 0.05). No significant changes between groups were observed for the FTSTS and 6MWT. The LI-RT and LLCP groups, compared to the control group, showed a significant reduction in low-density lipoprotein (p ≤ 0.05), and triglycerides (p ≤ 0.001). High-density lipoproteins showed non-significant changes.

CONCLUSION

Low intensity training involving resistance exercises or lower limb range of motion enhance physical function and lipid profile in patients with DPN. High intensity exercise could be risky and deter adherence. Hence, these gentler exercise programs offer viable options for enhancing health and fitness in DPN patients.

Physical activity for depression among the chronically Ill: Results from older diabetics in the Irish longitudinal study on ageing

Among chronically-ill older adults, the benefits of moderate-to-vigorous physical activity (MVPA) are established. Comorbid depressive symptoms and Major Depression are prevalent among the chronically-ill, but how different doses of MVPA may protect against depression remains understudied. Thus, using 10 years of data from The Irish Longitudinal Study on Ageing, we quantified longitudinal associations between MVPA doses and depressive symptoms and Major Depression among chronically-ill older adults living with type 2 diabetes (T2DM). Continuous MVPA (MET.min.week-1), three dose and five dose MVPA categories were examined. Depressive symptoms and Major Depression were measured using the center for Epidemiological Studies Depression and the Composite International Diagnostic Interview for Major Depressive Episode. Negative binomial regression and logistic models, adjusted for covariates, quantified associations across time. Among the 2,262 participants, those adhering to the WHO guidelines of 600-<1,200 MET.min.week-1 had 28% lower odds of Major Depression compared to those not achieving the guidelines (OR: 0.72; 95%CI: 0.53-0.98). For depressive symptoms, a higher MVPA dose was required with a 13% (IRR: 0.87; 95%CI: 0.82-0.93) lower rate of symptoms among those exceeding recommendations (1200-<2,400 MET.min.week-1). Interventions should focus on enhancing achievability of and compliance with these MVPA doses among the chronically-ill, including T2DM, to protect against depression.

Correlation between symptoms of depression, attitude, and self-care in elderly with type 2 diabetes

OBJECTIVES

to correlate depressive symptoms, attitude, and self-care of elderly people with type 2 diabetes.

METHODS

study developed with 144 elderly people with diabetes; carried out in Family Health Units. A semi-structured instrument was used to obtain data on the sociodemographic profile; the Geriatric Depression Scale (15 items), the Questionário de Atitudes Psicológicas do Diabetes [Psychological Attitudes of Diabetes Questionnaire], and the Diabetes Self-Care Activities Questionnaire (DSCA) were also used.

RESULTS

it was identified that 24.3% of the participants presented depressive symptoms, and 93.8% presented negative attitudes of coping. A greater adherence to self-care activities related to the practice of medication was observed. In the correlation between the scales, a negative and inversely proportional correspondence was noted between depressive symptomatology and physical activity (p=0.010) and foot care (p=0.006), likewise between attitude and foot care (p=0.009).

CONCLUSIONS

self-care in elderly people with diabetes mellitus is influenced by depressive symptoms and negative coping attitudes.

The impact of physical activity, quality of life and eating habits on cardiometabolic profile and adipokines in youth with T1D

PURPOSE

Individuals with Type-1-Diabetes (T1D) are at higher risk of having premature cardiovascular-disease (CVD). Physical activity and healthy lifestyle are major components in the prevention of diabetes' related comorbidities and complications. The aim of this study was to investigate the impact of physical activity, eating habits and quality of life in children and adolescents with T1D on diabetic control, cardiovascular and biochemical profile, infection indices, and adipokine levels.

METHODS

This cross-sectional study involved 80 participants (36 boys/44 girls) with T1D, aged (mean ± SD) 14.9 ± 3.4 years, who attended the Diabetes and Metabolism Clinic of a University Children's Hospital, using anthropometric studies, lipid profile, high-sensitivity-C-Reactive-Protein(hs-CRP), Interleukin-6(IL6), leptin and adiponectin levels. Physical activity was assessed with pedometers (total-steps/week) and questionnaire.

RESULTS

In 20(25%) children the level of exercise was >75th percentile, in 20(25%) <25th percentile and in 40(50%) children ranged between 25-75th percentile, respectively. Higher levels of physical activity were associated with weight (beta = -0.053, p < 0.001), waist circumference (beta = -0.077, p < 0.001), BMI (beta = -0.167, p = 0.009), muscle mass (beta = -0.0619, p = 0.001) and HDL-C (beta = 0.039, p = 0.033). Quality of life was positively related to weight (beta = 5.49511, p = 0.002), waist circumference (beta = 6.593345, p = 0.012), muscle mass (beta = 7.324088, p < 0.001) and T1D duration (beta = 19.22442, p = 0.005). Lipid profile was positively associated with sweets and chocolate consumption (beta = 0.348, p < 0.05), while vegetable (beta = -0.245, p < 0.05) and white milk consumption (beta = -0.2295, p < 0.05) were negatively associated with waist/height ratio.

CONCLUSIONS

In the present study, higher levels of physical activity were associated with improved lipid profile (HDL-C, triglycerides) and body composition [waist circumference, Body-Mass-Index (BMI] of children and adolescents with T1D. Higher scoring in quality-of-life questionnaires were related to older children with longer diabetes duration. Unhealthy eating habits unfavorably affected lipid profile and body composition in T1D youth.

Aquatic training improves HbA1c, blood pressure and functional outcomes of patients with type 2 diabetes: A systematic review with meta-analysis

AIM

This study aimed to summarize the effects of aquatic training on the health outcomes of type 2 diabetes (T2D) patients.

METHODS

This is a systematic review with meta-analysis that followed the PRISMA recommendations. Searches were performed in four databases in April 2021. The following eligibility criteria were adopted: adults with T2D; aquatic training (AT) intervention in an upright position; pre- and post-intervention assessments of the following outcomes: HbA1c, SBP and DBP, functional capacity, VO_2peak. The random-effects meta-analysis results are presented as mean differences and 95% confidence intervals.

RESULTS

Of the 375 studies, 12 studies were eligible and included in the meta-analysis. Favorable effects of AT post-intervention were observed in HbA1c (-0.62 %), VO_2peak (2.16 mL.Kg^-1.min^-1), SBP (-5.55 mmHg), DBP (-4.99 mmHg), and the 6-minute walk test (76.64 m). AT also revealed superior effects when compared to the control group (CG) and similar effects to land training (LT) in HbA1c (AT vs CG = -0.67 % and AT vs LT = -0.40 %), VO_2peak (AT vs CG = 3.78 mL.Kg^-1.min^-1; AT vs LT = -0.12 mL/Kg-1.min^-1), SBP (AT vs LT = -0.85 mmHg), and DBP (AT vs LT = 2.12 mmHg).

CONCLUSION

AT improves HbA1c, VO_2peak, SBP, DBP, and functional capacity in T2D patients. Beneficial effects favored AT over CG, while similar effects were verified between AT and LT on HbA1c, VO_2peak, and blood pressure.

The Role of Exercise on Cardiometabolic Profile and Body Composition in Youth with Type 1 Diabetes

Exercise has a direct positive effect on glycemic control by promoting insulin secretion from β-pancreatic islet-cells and by increasing skeletal muscle glucose uptake. The reduction in daily insulin needs and the optimization of glycemic control improves the patient's quality of life, self-esteem, mental wellness, as well as diabetes-related mobility and mortality. The aim of this study was to investigate the effect of physical activity in children and adolescents with type-1 diabetes (T1D) on diabetic control, cardiovascular, and biochemical profiles; hs-CRP; IL6; leptin; and adiponectin levels of the population under study. This is a prospective cross-sectional study that involved 80 participants (36 boys and 44 girls) with T1D, who were aged 6-21 years and who attended the Diabetes and Metabolism Clinic of the 2nd Pediatric Department, University of Athens, "P & A Kyriakou" Children's Hospital of Athens. Twenty (25%) children were above the 75th percentile regarding total levels of physical activity, while 40 (50%) and 20 (25%) were between the 25th and 75th percentile, as well as below the 25th percentile, respectively. In the group with an intermediate level of exercise, physical activity was negatively associated with the participant's family situation (traditional, single parent, grandparent, with others, or by himself/herself) (p = 0.013), ferritin (p = 0.031), lipoprotein(a) [Lp(a)] (p = 0.016), and squared leptin levels (p = 0.040). Whereas in the groups with extreme vs. no exercise there was a negative association with the number of daily glucose measurements (p = 0.047). However, in the group with non-vigorous exercise, physical activity was positively associated with high density lipoprotein-c (HDL-c) levels (p = 0.048). The findings of this study are indicative of the beneficial role of exercise on children and adolescents with T1D, which is achieved by primarily improving their cardiometabolic profile through the amelioration of lipid profile [HDL-c, Lp(a)] and leptin levels, as well as by reducing chronic systemic inflammatory response (ferritin) and ultimately decreasing the overall diabetes morbidity.

Xylooligosaccharides and aerobic training regulate metabolism and behavior in rats with streptozotocin-induced type 1 diabetes

Type 1 diabetes mellitus is characterized with decreased microbial diversity. Gut microbiota is essential for the normal physiological functioning of many organs, especially the brain. Prebiotics are selectively fermentable oligosaccharides [xylooligosaccharides (XOS), galactooligosaccharides, etc.] that promote the growth and activity of gut microbes and influence the gut-brain axis. Aerobic exercise is a non-pharmacological approach for the control of diabetes and could improve cognitive functions. The potential beneficial effect of XOS and/or aerobic training on cognition, the lipid profile and oxidative stress markers of experimental rats were evaluated in this study. Male Wistar rats were randomly divided into three streptozotocin-induced diabetic groups and a control group. Some of the rats, either on a XOS treatment or a standard diet, underwent aerobic training. The results showed that the aerobic training independently lowered the total cholesterol levels compared to the sedentary diabetic rats (p = 0.032), while XOS lowers the malondialdehyde levels in the trained diabetic rats (p = 0.034). What is more the exercise, independently or in combination with XOS beneficially affected all parameters of the behavioral tests. We conclude that aerobic exercises alone or in a combination with the prebiotic XOS could ameliorate the dyslipidemia, oxidative stress, and cognitive abilities in experimental type 1 diabetic animals.

Physical exercise and mitochondrial function: New therapeutic interventions for psychiatric and neurodegenerative disorders

Psychiatric and neurodegenerative diseases, including major depression disorder (MDD), bipolar disorder, and Alzheimer's disease, are a burden to society. Deficits of adult hippocampal neurogenesis (AHN) have been widely considered the main hallmark of psychiatric diseases as well as neurodegeneration. Herein, exploring applicable targets for improving hippocampal neural plasticity could provide a breakthrough for the development of new treatments. Emerging evidence indicates the broad functions of mitochondria in regulating cellular behaviors of neural stem cells, neural progenitors, and mature neurons in adulthood could offer multiple neural plasticities for behavioral modulation. Normalizing mitochondrial functions could be a new direction for neural plasticity enhancement. Exercise, a highly encouraged integrative method for preventing disease, has been indicated to be an effective pathway to improving both mitochondrial functions and AHN. Herein, the relative mechanisms of mitochondria in regulating neurogenesis and its effects in linking the effects of exercise to neurological diseases requires a systematic summary. In this review, we have assessed the relationship between mitochondrial functions and AHN to see whether mitochondria can be potential targets for treating neurological diseases. Moreover, as for one of well-established alternative therapeutic approaches, we summarized the evidence to show the underlying mechanisms of exercise to improve mitochondrial functions and AHN.

SARS-COV-2 in Type 2 Diabetic Patients: Possible Roles of Exercise Training as a Medicine

SARS-COV-2 is the novel type of beta coronavirus that was first evolved in December 2019 in Wuhan, China. People with type 2 diabetes are the most vulnerable group to SARS-COV-2 and its associated complications. Many factors such as medication, pathophysiologic-induced compensatory mechanisms, and alterations in protein expression and immune system function can all contribute to severe outcomes in diabetics. In this review article, we first described the possible mechanisms of increased risk and more severe complications rate of SARS-COV-2 in diabetic patients. Secondly, we discussed the crucial role of exercise in diabetic patients in balancing the RAS system (ACE2/ACE). Finally, we examine the possible roles of acute and chronic exercise in reducing SARS-COV-2 severe outcomes in people with diabetes in accordance with the latest evidence. We concluded that regular exercise (especially moderate-intensity exercise) can play a role in immune- enhancing, anti-inflammatory, and anti-oxidant activities and can balance the ACE2/ACE ratio (decreasing ANG2 levels) in diabetic subjects.

Dietary and lifestyle habits of patients with type 2 diabetes in Subotica

Introduction: The activities of the health care service in the control of diabetes and the improvement of glucoregulation of patients are primarily focused on lifestyle modification. The goal of this study was to review the recommendations in the field of adequate nutrition and lifestyle and to assess the health behavior of patients with type 2 diabetes in Subotica. Methodology: The research was conducted in the form of a cross-sectional study in February 2017 at the Diabetes Counseling Center of the Health Center in Subotica, Serbia. The study included 114 patients with type 2 diabetes. The research instrument consisted of a customized survey questionnaire. Results: Only a third of the patients actually consumed at least five meals a day, that was suggested as part of the treatment. Three-quarters of patients always prepared their own meals, but 41% of them never read the declarations about the ingredients of the food they consumed. Twenty percent of patients did not know how to assemble a healthy plate and what low-carbohydrate foods were. Two-thirds of patients used dietary supplements. A relatively small number, one-quarter of patients, consumed alcoholic beverages and 22 patients were active smokers. More than half of the patients exercised lightly, although 68% of them were dissatisfied with their body weight. Conclusion: We identified some deficiencies in the health behavior and lifestyle of people with diabetes. There is a recommendation to repeat the information on proper nutrition and the importance of physical activity in achieving ideal health and optimal glucoregulation during the educational work with patients.

Incidence and Risk Factors for Progression to Diabetes Mellitus: A Retrospective Cohort Study

(1) Objective: This study examined the incidence and risk factors contributing to the progression to diabetes mellitus (DM) in a seven-year follow-up study of non-diabetic National Health Examinees. (2) Methods: For this retrospective observational cohort study, we used two national representative databases: the National Health Screening (HEALS) database 2009 and the National Health Insurance Service (NHIS) database 2009-2015. The eligible subjects without DM with blood sugar levels of <126 mg/dL were selected using the HEALS database. The subsequent follow-up and clinical outcomes were evaluated using the NHIS database. Cox proportional hazard regression was applied to examine the effects of the covariates on progression to diabetes. (3) Results: Among those who took part in the national health screening in 2009, 4,205,006 subjects who met the eligibility criteria were selected. Of these, 587,015 were diagnosed with DM during the follow-up by 2015. The incidence of progression from non-diabetes to DM was 14.0%, whereas that from impaired fasting glucose (IFG) to DM was 21.9%. Compared to the normal group, the newly diagnosed DM group was more likely to comprise older, female, currently smoking, and high-risk drinking participants and participants with IFG, hypertension, dyslipidemia, and metabolic syndrome. (4) Conclusions: This epidemiological study in the Republic of Korea found risk factors similar to those of other studies, but the incidence of progression to DM was 22.8 per 1000 person-years, which is higher than that previously reported. Hence, more care is needed to prevent DM.

Physical activity and adipokine levels in individuals with type 2 diabetes: A literature review and practical applications

We review the effects of acute and long-term physical activity on adipokine levels in individuals with type 2 diabetes (T2D). Three electronic databases were searched. Studies made in animal models were excluded, while studies based on participants with and without T2D, and also studies with type 1 diabetes were included. Of the 2,450 citations, 63 trials, including randomised control trials, cross-sectional and longitudinal studies, met our inclusion criteria. Seventy and five percent of studies reported the effects of physical activity on tumor necrosis factor-alpha (TNFα), interleukin 6 (IL-6), adiponectin, visfatin, omentin-1, and leptin levels. There are no robust results due to variations in exercise modality, intensity, duration, and also differences in cohort characteristics in the literature. Only four studies described the effects of an acute session of physical activity on adipokine levels. Overall, physical activity improves diabetes status by regulating adipokine levels. However, long-term aerobic + resistance training combined with dietary modifications is likely to be a more effective strategy for improving adipokines profiles in patients with type 2 diabetes.

Gut Microbiota and Type 2 Diabetes Mellitus: Association, Mechanism, and Translational Applications

Gut microbiota has attracted widespread attention due to its crucial role in disease pathophysiology, including type 2 diabetes mellitus (T2DM). Metabolites and bacterial components of gut microbiota affect the initiation and progression of T2DM by regulating inflammation, immunity, and metabolism. Short-chain fatty acids, secondary bile acid, imidazole propionate, branched-chain amino acids, and lipopolysaccharide are the main molecules related to T2DM. Many studies have investigated the role of gut microbiota in T2DM, particularly those butyrate-producing bacteria. Increasing evidence has demonstrated that fecal microbiota transplantation and probiotic capsules are useful strategies in preventing diabetes. In this review, we aim to elucidate the complex association between gut microbiota and T2DM inflammation, metabolism, and immune disorders, the underlying mechanisms, and translational applications of gut microbiota. This review will provide novel insight into developing individualized therapy for T2DM patients based on gut microbiota immunometabolism.

Body Mass Index Effect on Health Service Utilization Among Active Duty Male United States Army Soldiers

INTRODUCTION

Obesity and overweight, defined as body mass index (BMI) of 30.0 and above or 25.0-29.9, respectively, are of significant concern to the military population, due to their associated comorbidities and potential for impaired readiness. In 2016, the US Army reported a prevalence of 17.3% obesity and 52.9% overweight among soldiers, despite both physical demands of the job and Department of Defense (DoD) guidelines which recommend separation from service for those unable to meet body composition standards. This study examines the health service utilization of active duty, male Army soldiers in order to determine the prevalence of obesity and overweight and to estimate the effects of these conditions on readiness.

MATERIALS AND METHODS

This was a cross-sectional study utilizing fiscal year (FY) 2015 TRICARE claims and military treatment facility (MTF) encounter data obtained from the Military Health System Data Repository (MDR), for 467,732 US Army male Soldiers on active duty. We obtained basic demographic information (age, race, and rank) from the Defense Enrollment Eligibility Reporting System (DEERS). Next, we calculated BMI for this cohort by matching patients to their vital statistics of height and weight measurements. Finally, we obtained their health service utilization by querying and matching patients to their healthcare claims in 2015 by major diagnostic category.

FINDINGS

More than half (51.2%) of subjects had overweight, 28.9% had normal weight, 19.7% had obesity, and less than 1% had underweight. Soldiers with overweight and obesity were most common among the 25-34 years age range and enlisted ranks. Normal weight and underweight soldiers had a median of 7 healthcare visits in FY 2015, compared with 8 for soldiers with overweight and 12 for those with obesity. Soldiers with obesity, but not overweight, had a disproportionately greater number of healthcare encounters for diagnostic categories including musculoskeletal; mental health; ear, nose, and throat; and endocrine system. In contrast, soldiers with obesity had disproportionately fewer healthcare encounters for multiple significant trauma and for infectious and parasitic diseases.

CONCLUSIONS

More than 70% of soldiers had overweight or obesity in FY 2015, showing the highest prevalence yet measured for these conditions. Previous reports of lower prevalence may be due to the inclusion of circumference-based body fat assessments, which have been criticized for inaccuracy. In our study, disproportionately high health service use by soldiers with obesity suggests decreased readiness, as these soldiers may experience both poorer health and lose necessary training time due to increased provider visits. Proportional usage by soldiers with overweight suggests the protective effect of regular physical activity, though these soldiers should be monitored to ensure that they do not progress to obesity. Additional research should establish the burden of cost, absenteeism, and presenteeism of obesity on the MHS, as well as developing more appropriate field tests for body fat assessment and BMI standards to better support military readiness.

The effects of genetic background on exercise performance in Drosophila

The use of the Drosophila model for studying the broad beneficial effects of exercise training has grown over the past decade. As work using Drosophila as an exercise model becomes more widespread, the influence of genetic background on performance should be examined in order to better understand its influence on assessments used to quantitatively measure and compare exercise phenotypes. In this article, we review the various methods of exercise training Drosophila, and the performance of different wild-type Drosophila strains on various physiological assessments of exercise response. We conclude by summarizing the performance trends of commonly used strains.

Effects of Voluntary Running Exercise on Skeletal Muscle Properties in Nonobese Rats with Type 2 Diabetes

The skeletal muscles of animals and humans with type 2 diabetes have decreased oxidative capacity. Aerobic exercise can improve muscle oxidative capacity, but no data are available on the amount of exercise required. We investigated the effects of voluntary running exercise and running distance on the skeletal muscle properties of nonobese rats with type 2 diabetes. Six-week-old male diabetic Goto-Kakizaki rats were divided into nonexercised (GK) and exercised (GK-Ex) groups. The rats in the GK-Ex group were permitted voluntary running exercise on wheels for 6 weeks. Age-matched male Wistar rats (WR) were used as nondiabetic controls. Fasting blood glucose and HbA1c levels were higher in the GK and GK-Ex groups than in the WR group and lower in the GK-Ex group than in the GK group. Succinate dehydrogenase (SDH) activity and peroxisome proliferator-activated receptor γ coactivator-1α (Pgc-1α) mRNA levels in the soleus and plantaris muscles were higher in the WR and GK-Ex groups than in the GK group. HbA1c and total cholesterol levels were negatively correlated with running distance and SDH activity and Pgc-1α mRNA levels in the soleus muscle were positively correlated with running distance. The onset and progression of diabetes in nonobese diabetic rats were effectively inhibited by running longer distances.

Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: a qualitative study

Background and aim: Diabetes self-management behaviors are necessary to ensure optimum glycemic control. However, limited data were available regarding the practice of self-management by the Iraqi diabetic patients. This study aims to understand the knowledge, behaviors, and barriers of diabetes self-management among Iraqi type 2 diabetes mellitus (T2DM) patients in addition to their opinions and views toward the diabetes self-management educational program.

METHODS

A qualitative method approach was used to obtain the data from T2DM patients recruited from the National Diabetes Center, Baghdad, Iraq. Data were collected using a semi-structured interview guide, and a thematic analysis approach was used to process the data.

RESULTS

Most participants agreed to the importance of self-management practices especially healthy eating, exercise, taking medications, and healthy coping with stress to control DM and prevent its complications. Healthy eating and physical activity recommendations were inadequately practiced by most of the participants. Most participants reported irregular self-monitoring of blood glucose. Most of the participants properly adhered to the anti-diabetic medications. They generally lack proper information/knowledge about the importance of self-management practices of foot care and managing diabetes during sick days and how such practices should be implemented. Most participants have positive attitudes toward diabetes self-management practices. Face-to-face educational sessions are preferred by most patients.

CONCLUSION

The Iraqi diabetic patients have inadequate self-management behaviors. The main barrier to self-management practices was the lack of knowledge due to the absence of diabetes self-management educational programs in Iraq.

How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years

Background

Evidence suggests that a students’ beliefs already prior to entering a program may be important as a determinant in sustaining unsuitable health care beliefs. Our objectives were to investigate the proportion of Australian chiropractic students who hold non-evidence-based beliefs in the first year of study and the extent to which they may be involved in non-musculoskeletal health conditions. Finally, to see if this proportion varies over the course of the chiropractic program.

Method

In 2016, students from two Australian chiropractic programs answered a questionnaire on how often they would give advice on five common health conditions in their future practices as well as their opinion on whether chiropractic spinal adjustments could prevent or help seven health-related conditions.

Results

From a possible 831 students, 444 responded (53%). Students were highly likely to offer advice (often/quite often) on a range of non-musculoskeletal conditions. The proportions were lowest in first year and highest the final year. Also, high numbers of students held non-evidence-based beliefs about ‘chiropractic spinal adjustments’ which tended to occur in gradually decreasing in numbers in sequential years, except for fifth year when a reversal of the pattern occurred.

Conclusions

New strategies are required for chiropractic educators if they are to produce graduates who understand and deliver evidence-based health care and able to be part of the mainstream health care system.

Electronic supplementary material

The online version of this article (10.1186/s12998-018-0178-y) contains supplementary material, which is available to authorized users.