DiMenna Fred J, Arad Avigdor D
1Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, Babcock 10th Floor, Suite 1020, New York, 10025 New York USA.
2Department of Biobehavioral Sciences, Columbia University Teachers College, 525 W. 120th Street, New York, 10027 New York USA.
BMC Sports Sci Med Rehabil. 2018 Nov 23;10:21. doi: 10.1186/s13102-018-0110-8. eCollection 2018.
Type 2 diabetes and obesity epidemics are in effect in the United States and the two pathologies are linked. In accordance with the growing appreciation that 'exercise is medicine,' it is intuitive to suggest that exercise can play an important role in the prevention and/or treatment of these conditions. However, if exercise is to truly be considered as a viable alternative to conventional healthcare prevention/treatment strategies involving pharmaceuticals, it must be prescribed with similar scrutiny. Indeed, it seems reasonable to posit that the recent initiative calling for 'precision medicine' in the US standard healthcare system should also be applied in the exercise setting. In this narrative review, we consider a number of explanations that have been forwarded regarding the pathological progression to type 2 diabetes both with and without the concurrent influence of overweight/obesity. Our goal is to provide insight regarding exercise strategies that might be useful as 'precision medicine' to prevent/treat this disease. Although the etiology of type 2 diabetes is complex and cause/consequence characteristics of associated dysfunctions have been debated, it is well established that impaired insulin action plays a critical early role. Consequently, an exercise strategy to prevent/treat this disease should be geared toward improving insulin sensitivity both from an acute and chronic standpoint. However, research suggests that a chronic improvement in insulin sensitivity only manifests when weight loss accompanies an exercise intervention. This has resonance because ectopic fat accumulation appears to represent a central component of disease progression regardless of whether obesity is also part of the equation. The cause/consequence characteristics of the relationship between insulin resistance, pathological fat deposition and/or mobilsation, elevated and/or poorly-distributed lipid within myocytes and an impaired capacity to use lipid as fuel remains to be clarified as does the role of muscle mitochondria in the metabolic decline. Until these issues are resolved, a multidimensional exercise strategy (e.g., aerobic exercise at a range of intensities and resistance training for muscular hypertrophy) could provide the best alternative for prevention/treatment.
2型糖尿病和肥胖症在美国呈流行态势，且这两种病症相互关联。随着人们越来越认识到“运动就是良药”，自然而然会认为运动在预防和/或治疗这些疾病方面可发挥重要作用。然而，如果要真正将运动视为涉及药物的传统医疗预防/治疗策略的可行替代方案，就必须进行类似严格的处方。事实上，在美国标准医疗体系中呼吁采用“精准医学”的近期倡议似乎也应适用于运动领域，这似乎是合理的。在这篇叙述性综述中，我们考虑了一些关于2型糖尿病病理进展的解释，无论是否伴有超重/肥胖的同时影响。我们的目标是深入了解可能作为“精准医学”用于预防/治疗这种疾病的运动策略。虽然2型糖尿病的病因复杂，相关功能障碍的因果特征也一直存在争议，但胰岛素作用受损在早期起着关键作用这一点已得到充分证实。因此，预防/治疗这种疾病的运动策略应从急性和慢性角度着眼于提高胰岛素敏感性。然而，研究表明，只有在运动干预伴随体重减轻时，胰岛素敏感性才会出现慢性改善。这具有重要意义，因为异位脂肪堆积似乎是疾病进展的核心组成部分，无论肥胖是否也是其中因素。胰岛素抵抗、病理性脂肪沉积和/或动员、心肌细胞内脂质升高和/或分布不均以及利用脂质作为燃料的能力受损之间关系的因果特征，以及肌肉线粒体在代谢衰退中的作用仍有待阐明。在这些问题得到解决之前，多维运动策略（例如，一系列强度的有氧运动和针对肌肉肥大的抗阻训练）可能是预防/治疗的最佳选择。
