This document summarizes research on the impact of exercise for individuals with and without a family history of diabetes. It finds that while both groups improved their fitness and saw reductions in weight and waist size from a 6-month exercise program, those with a family history of diabetes did not see as much benefit and exercised more intensely. This suggests tailored exercise programs may be needed to most effectively reduce diabetes risk based on individual genetic factors.

1. Individualized exercise to battle diabetes
Ola Hansson (Ola.Hansson@med.lu.se)

2. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas
Type 1 diabetes Type 2 diabetes Gestational diabetes
• Lack of insulin
• Autoimmune
• Usually children
• Defect insulin
secretion
• Insulin resistance
• Lifestyle factors
• Usually adults
• Insulin resistance
• During pregnancy
• Risks to mother
and child
Main “types” of diabetes

3. The risk of complications is reduced by good glycaemic control
25 times higher
risk of
eye problems
6 times higher
risk for
stroke
5 times higher
risk of kidney
disease
20 times higher
risk of
lower limb
amputation
2-4 times
higher risk for
heart attack
High blood glucose leads to long term
complications
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

4. Seshasai et al. N Engl J Med 2011;364:829-41
.
0
7
6
5
4
3
2
1
0
40 50 60 70 80 90
Age (years)
Yearsoflifelost
Men
7
6
5
4
3
2
1
0
40 50 60 70 80 900
Age (years)
Women
Non-vascular
deaths
Vascular deaths
On average, a 50-year-old individual with diabetes and no history
of vascular disease will die 6 years earlier compared to someone
without diabetes
Diabetes is associated with significant loss
of life years

5. • Not curable
• But can be controlled with
Education Healthy Diet Proper
Medications
Regular Check
ups
Regular
Exercise
Diabetes management

6. Diabetes: A global
emergency
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

7. 2014 2040
WORLD
41
5
millio
n
WORLD
642
million
people living
with diabetes
Middle East and North Africa 85%
South East Asia 64%
South and Central America 55%
Western Pacific 46%
North America and Caribbean 30%
Europe 33%
Africa 93%
55%
Diabetes: A global
emergency
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

8. Diabetes is a human and economic burden
4.9 million deaths per
year
50% of deaths under
60 years of age
Intersects with all
dimensions of
development
US$612 billion
11% of worldwide healthcare
expenditure
… and the costs to society are high and
escalating
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium, 2013. http://www.idf.org/diabetesatlas

9. Lifestyle (diet and exercise) is better
than drugs in preventing diabetes…
Knowler W.C. et al., N Engl J
Med. , 2002

10. …but we don´t respond to exercise in
the same way
Bouchard, C., et al., J Appl Physiol (1985),
1999

11. The Malmö exercise intervention study
(50 ♂)
FH - FH +
Age (years) 37,8 ± 4,7 38,4 ± 3,9
weight (kg) 94,8 ± 10,2 92,4 ± 12,8
BMI (kg/m2) 29,0 ± 2,9 28,4 ± 2,8
Waist (cm) 101,0 ± 7,8 98,1 ± 8,2
VO2max (ml/kg/
min)
30,5 ± 4,7 32,5 ± 4,6
HbA1c (%) 4,3 ± 0,3 4,3 ± 0,4
Glucose, 2h (mM) 5,8 ± 1,4 5,8 ± 1,2
Do individuals with a genetic predisposition
for diabetes respond in the same way to
exercise?
Elgzyri et al., JCEM,
2012

12. Exercise at “Friskis och Svettis”
Screening
•Health declaration
•Physical
examination
•Blood tests
•Submax bike
ergometer test
•OGTT
Pre-training
•Anthropometric
measurements
•Blood tests
•Max exercise
test
•Muscle & fat
biopsies
•BIA
•Actiheart
recording
Mid-training
•Anthropometric
measurements
•Submax bike
ergometer test
•Actiheart recording
Post-
training
•Anthropometric
measurements
•Blood tests
•Max exercise test
•Muscle & fat
biopsies
•BIA
•OGTT
•Actiheart
recording
6 months
Ekman et al., JAP, 2015

13. FH+ individuals exercised more
Ekman et al., JAP, 2015

14. What happened after 6 months of
exercise?
FH - FH +
Before After Before After
Weight (kg) 94,8 ±
10,2
94,3 ±
10,5
92,4 ±
12,8
90,4 ±
12,6
BMI (kg/m2) 29,0 ± 2,9 28,8 ± 3,0 28,4 ± 2,8 27,8 ± 2,9
Waist (cm) 101,0 ±
7,8
99,2 ± 7,8 98,1 ± 8,2 94,3 ± 7,3
VO2max (ml/kg/
min)
30,5 ± 4,7 34,6 ± 5,5 32,5 ± 4,6 36,9 ± 5,7
HbA1c (%) 4,3 ± 0,3 4,3 ± 0,3 4,3 ± 0,4 4,3 ± 0,4
Glucose, 2h (mM) 5,8 ± 1,4 5,7 ± 1,7 5,8 ± 1,2 5,4 ± 1,3
? ?
Ekman et al., JAP, 2015

15. How much did the fitness improve?
FH- FH+
Ekman et al., JAP, 2015

16. … and the same for weight and waist!
Ekman et al., JAP, 2015

17. Conclusions
• Even a relatively modest increase in physical activity
during 6 months improves physical fitness and thereby
some cardiometabolic risk factors
• The FH+ group took part in ~45% more exercise sessions
and spent ~60% more energy compared to the FH-
• However, individuals with FH did not benefit from the
exercise intervention to the same extent as those without
a FH
? Should individuals at risk of diabetes
exercise in a specific way to reduce the
risk.
? How can we tailor exercise for the
individual for the most effective health
improvement
? Biomarkers

18. Albert Szent-Györgyi
(Nobel prize, 1937)
”Biological
structures
and living
systems are
worn out by
inactivity and
developed by
use”By the courtesy of Bengt Saltin
Thank you to all participants
in the study!