Physical activity and sport in type 2 diabetes mellitus. Impact on prevention and therapy

Background. Physical activity and exercise training is a core interventional strategy for metabolic syndrome, impaired glucose tolerance and type 2 diabetes mellitus. Pathophysiologically, this is due to increased insulin resistance which can be improved by repetitive physical strain on muscle fibers and improved transmembranous glucose transport by which glucose transporter 4 (GLUT4) is translocated from the endoplasmic reticulum to the membrane and facilitates glucose transport into the cells. Results. Large randomized trials for primary and secondary prevention of type 2 diabetes mellitus have shown a 60 % reduction of the conversion of prediabetes into clinical diabetes. Recent trials have revealed that macrovascular complications cannot be influenced by life-style interventions but that microvascular complications can be influenced. This includes an improvement in the progression of nephropathy and also improvement in the diastolic function of the myocardium, an entity that is often observed in these patients and limits the physical capacity. Conclusion. In order to achieve sufficient results the following training principles have to be followed: 1) regular and daily exercise, 2) start low go slow, 3) integration of training intervals and 4) regular control of the individualized training program and motivation by the treating physician. When these measures are taken into consideration, the prospect of successful therapy has been proven. This results in healthcare insurance companies including appropriate programs, such as "sport as therapy" even for the prevention and therapy of type 2 diabetes mellitus.