Exercise therapy in Japan.

The purpose of this report is to outline the exercise therapy of diabetes mellitus that has been administered in Japan during the past 10 years, with special emphasis on the results of studies on metabolic effects as well as on practical aspects of exercise therapy. The studies on the response to exercise clarified neuroendocrine mechanisms involved in the regulation of carbohydrate and fat metabolism in exercise and provided a basis for the indication of exercise therapy in view of the pre-existing metabolic abnormalities. Concerning the training effects, changes of insulin sensitivity have been chiefly studied in relation to metabolic improvement by physical training using the insulin clamp method. The improvement of glucose and lipid metabolism obtained during the training program, consisting of fast walking or jogging corresponding to 40-60% of predictive VO2 max for 30-60 min daily, was suggested to be related to improved insulin sensitivity in patients with NIDDM. Intensive studies have been made on exercise programs, and medical checks and guidelines for exercise prescription have been provided. Aerobic exercises with stretching and low-level callisthenics are recommended, and the usefulness of a multi-stage exercise loading test and the necessity of self-monitoring of blood glucose are stressed for the successful management of exercise therapy.