Is Exercise a Solution for Every Individual Living with Chronic Conditions
Authored by Martin Sénéchal
Opinion
The simple answer is probably 'it depends'! The
outcomes experienced as a result of exercise varies depending on the
expected outcome, the chronic condition, and how exercise is defined. In
past decades,the public health messages have shouted from every rooftop
that exercise is a corner stone to manage chronic conditions. We would
argue that while this argument is correct from a general health
perspective, however for some individuals their odds of achieving their
health goals through engagement in exercise may not be as glorious as
expected. In other words, a patient might experience some of the
reported benefits of engagement in exercise, such as a reduction in
blood pressure and improvement in glycemic control, but experience a
lack of improvement in other areas, such as not returning to their
desired weight.
Most agencies that provide recommendations for Type2
diabetes (T2D) prevention and treatment highlight regular exercise as
one of the most important behavioral changes individuals with T2D can
make to improve their condition. Typically, it is promoted that such
improvements include enhanced glycemic control and protection against
the onset of diabetes-related complications [1].
One such agency includes Diabetes Canada, whore commends 150 minutes of
moderate- to-vigorous aerobic activity in addition to two sessions of
resistance exercise per week [2].
Similarly, the American College of Sports Medicine (ACSM) calls for
obese individuals to perform a minimum of 150 minutes of
moderate-to-vigorous intensity to expect modest weight loss [3].
While some health benefits associated with exercise are undeniable for
the majority of the population, predicting the specific outcomes
experienced has proven difficult [4].
Typically, improvements in cardiorespiratory fitness (CRF) will be the
primary trigger for metabolic and functional improvements. However,
despite seeming lyubiquitous reports of the benefits associated with
exercise, numerous findings exist indicating that some individuals do
not improve their CRF following an intervention [4-6].
These individuals have previously been termed 'non-responders'. That
said, our group investigated youth at risk of T2D and found a
significant variability in metabolic response across changes in CRF. In
other words, youth who change their CRF over 6-month intervention are
the one who increase their health [7].
Recently alterative studies have attempted to eradicate the presence of
exercise non-response through the modification of exercise parameters.
For example, Ross et al. [8].
Investigated the effect of various combinations of walking-based
activity volume and intensity with 121 obese participants over 24 weeks.
The authors found that increasing exercise volume and intensity
eliminated all non-responders based on CRF metrics, whereas lower
volumes and intensities could not. Additionally, Montero & Lund [9]
randomized participants into one of five exercise programs, each
differing in the volume of exercise completed per week. The authors
reported that those completing the highest volume of exercise had no
trace of non-response. Meanwhile, groups completing lower volumes of
exercise displayed a multitude of non-responders. The non-responders
then progressed through a second training period with an increased
volume, and found that doing so disposed of all non-response. The
findings from these authors provide evidence that non-response to
exercise may not truly exist, and that some individuals require higher
exercise volumes or intensities to achieve desired health outcomes.
Similar to the currently prevailing mindset, studies completed by
Senechal et al. [10] and Church et al. [11].
Reported large heterogeneity in their participant abilities to enhance
glycemic control in response to exercise programs. The rate of
nonresponse interms of the ability of exercise to benefit those with T2D
has been estimated to be about 20% [12].
Moreover, are view completed by Bouchard et al. [13].
Found that some experience adverse metabolic effects to engagement in
exercise, including are ported 8.3% of participants who increased their
fasting insulin concentrations, suggesting a decrease in insulin
sensitivity or glucose metabolism efficiency. As evidence continues to
mount showing that adaptations to current exercise programs, potentially
through increases in the intensity and duration recommended by current
exercise guidelines provided through agencies such as Diabetes Canada
and ACSM, it may be time to reexamine the way in which exercise is
prescribed to individuals. Alternatively, research should start
investigating alternative strategies and combinations of exercise and
lifestyle modifications to assist those who are currently described as
non-responders.
One such strategy worth investigating may the
expansion of the current recommendation of 'exercise' for a set time
each week, to observing how incorporating physical activity throughout a
full day, every day can contribute the treatment of chronic conditions.
Focusing efforts exclusively on moderate- to-vigorous aerobic exercise
that accounts for less than 5% of a full day [14]
limits our understanding of how exercise and physical activity are
potentially associated with metabolic and functional health benefits.
Perhaps a comprehensive approach including all activities performed in a
day, despite their mode or intensity, should be evaluated to truly
understand the role of physical activity on metabolic and functional
health. Chaput et al. suggested that the combined effects of different
intensities and modes of activities extend beyond the individual
contributions of each on health [14]. This was supported by other subsequent evaluations [15,16].
In addition, a large body of literature suggests that sedentary time
must be considered to evaluate the importance of physical activities for
health [17-21].
Recent epidemiological studies have shown that despite adherence to the
physical activity guidelines, the risk of mortality and onset of
cardiovascular disease increases with more than six hours of sitting per
day [22,23].
However, a meta-analysis of one million participants completed by
Ekelundet al. found that a high level of moderate intensity physical
activity (>60 minutes per day) seems to eliminate the increased
mortality risk associated with high volumes of sitting [24].
The importance of using a comprehensive approach to evaluate the
association between total daily physical activity and health has been
proposed in the past decade and has proved to be quite useful,
especially in children [14,25,26].
Different modes and intensities of physical activity needs to be
studied to understand the ideal combination that should be targeted to
maximize metabolic and functional health benefits in adults.
Based on the literature presented above, it may be
possible that adapting the approach to exercise and physical activity
may lead to an increased volume of patients responding favorably, thus
enhancing the number of those who identifying as 'responders'. The
benefits of modifying the treatment in terms of intensity, mode, volume,
or by adopting a more comprehensive, physical activity lifestyle
approach has shown great promise thus far, but additional research
remains necessary. While previous examination indicates that alterations
to an unsuccessful exercise training program may convert previous
non-responders to responders, these studies focused mostly on
fitness-based outcomes. Understanding the ability of enhanced training
programs for those labeled as non-responders and understanding mechanism
by which chronic diseases improvement is observed could re-establish
exercise as a treatment option for those living with conditions such as
T2D or obesity, there by positively impacting the quality of life of
additional patients. Based on the current literature, there is a need to
identify these non-responding patients, and work with them to determine
the most effective alterations to currently offered programs to help
them respond. This could include a more individualized increase
intensity, duration, mode of activities, a combination of these
variables, or a broader approach inclusive of all daily physical
activity outcomes.
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