People do not always get healthier after exercise – that is the finding of several EU-funded research projects looking into the prevention of lifestyle-related diabetes, heart failure and osteoporosis. Now they are trying to work out why.
‘With the prevention of the development of Type 2 diabetes, which our project is looking at, some people respond better to exercise than others,’ explained Professor John Nolan, coordinator of Dexlife, a project looking at the use of exercise to tackle diabetes.
Adults who suffer from lifestyle-related Type 2 diabetes, its most common form, are typically unable to process sugar in their bodies properly. It generally emerges in middle age, unlike Type 1, which develops in childhood. According to the World Health Organization, about 10 % of Europeans aged 25 years and over have diabetes, and this number is increasing due to unhealthy lifestyles.
Now into its third year of operation, the Dexlife project has set up several exercise groups across Europe for observation. One was a group of young adults under the age of 25 – many of whom were obese, a characteristic factor in accelerating the progression of diabetes.
For three months, they took part in aerobic exercise, running on treadmills and cycling. ‘These young people generally responded poorly to exercise. Their skeletal muscles were not stimulated in the way we would have expected,’ Prof. Nolan said.
With its other groups, Dexlife saw different results. In Ireland, 30 000 men and women between 45 and 75 years of age were screened by the project for diabetes risk. A subgroup took part in an exercise and diet intervention.
‘Some of these people responded very well. From our observations, a standard middle-aged person with prediabetes will lose weight through exercise. Sport can be a beautiful therapy,’ said Prof. Nolan.
Urgent prevention measures
As part of its studies, Dexlife also observed a group of 10 000 middle-aged to elderly men in Finland. Clinical tests helped establish a more accurate mapping of ageing and of people who might be at risk of developing Type 2 diabetes.
‘What we’re trying to achieve with all our measurements,’ said Prof. Nolan, ‘is to predict which person will respond well to lifestyle interventions and who will not.’
‘What we’re trying to achieve with all our measurements is to predict which person will respond well to lifestyle interventions and who will not.’
Prof. John Nolan, coordinator, Dexlife
For those who do respond, the project wants to enable doctors to design an exercise regime specifically for them. ‘By the end of the project (in 2015), we want to have developed simple measurement tools to assess who’s at risk of developing Type 2 diabetes and to customise exercise programmes for such individuals.’
The project foresees the development of a new menu of tests for biological indicators of disease - known as markers - that can inform clinical practice. ‘With time, what we’d like to see is GPs able to order a panel of markers – like specific blood tests – that will help them draw up a personalized profile of a patient. Those demonstrating a high risk of developing diabetes can then follow, say, a six-month tailored exercise programme to minimize its progression,’ said Prof. Nolan.
Prevention is very much the emphasis of Dexlife’s work: ‘It’s urgent that we get prevention measures in place. Once you have Type 2 diabetes, it’s very hard to shift because you’re more likely to be treating the medical complications it brings on than anything else,’ he said.
‘Now that giant swathes of the world’s population have diabetes, it’s ever more important to develop prevention measures for people at risk and also to reduce the burden on health insurance systems.’
Hearts and bones
The same can in many ways be said about cardiovascular disease and osteoporosis. More than 3.6 million Europeans are victims of heart failure each year and approximately 2.7 million European men and women suffer fractures caused by osteoporosis every year.
The Norwegian University of Science and Technology is heading up the EU-funded project OptimEx that is conducting research into the prevention and treatment of diastolic heart failure. This specific form of heart failure involves impaired functionality in the left chamber of the heart during diastole, the phase of the cardiac cycle when the heart relaxes and gets filled with blood.
Diastolic heart failure is increasingly prevalent among the elderly and one of its primary features is exercise intolerance. This has led OptimEx to look into exercise as a key factor in preventing and treating the disease’s development.
Over the next three years, the project will focus on the cardiovascular effects of exercise in humans and animals, aiming to establish the fundamental cellular and molecular mechanisms that underpin exercise-induced changes in the heart, blood vessels and skeletal muscles.
Meanwhile, at the UK’s University of Exeter, the small-scale project PRO-BONE is addressing the development of osteoporosis in later life. It is carrying out a study among teenagers to see the effect of exercise on the development of healthy bones in childhood. Though it is commonly recognised that exercise contributes to healthy bones, some sports improve overall bone mineral density and bone mineral content better than others.
During the course of its study, PRO-BONE is recruiting 105 boys aged between 12 and 14 to play football, or go cycling and swimming. Their bone health and metabolism will be measured alongside that of a control group. The project is expecting to see lower bone mineral content and bone mineral density in cyclists and swimmers than that of footballers and controls.
In addition, a number of the boys will follow a nine-month course of an exercise regime known as jump training, where people use jumping to exercise their muscles, to assess its impact on outcomes. Jump training is generally considered to have a positive effect on bone mass and the results for all intervention groups are expected to indicate its potential benefit for bone health.
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