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Low to moderate intensity exercise (even without weight loss or significant lipid changes) has risk reduction utility. Ralph Manders and coworkers at Masstricht in the Netherlands demonstrated, as has other investigators, how low vs high intensity exercise may be better suited for type 2 diabetics with regard to lessening hyperglycemia. He compared 60 minutes of cycling at 30% of aerobic capacity versus 30 minutes at 70% of capacity and showed significant reductions in hyperglycemia in the 24 hours following exercise compared to high intensity exercise. See the last PDF file on the "groups files" link on the Exercise and Physical Activity opening page.

Dear Ralph:

Thank you for bringing this pivotal study to my attention. This information gives me more "ammo" at the Metabolic Syndrome Center to recommend Low Intensity exercise (walking, treadmill, stationary bike, etc) as protective against CHD events and improving gucose control during the day. This Study should on billboards around the country and in every major medical journal. We are using the Roche 360 View tool ( Accu Check 360 View Blood Glucose Analysis Tool) to monitor both diabetic and metabolic syndrome patients in order to get a snapshot of glucose excursions throughout the day. It would be easier to do this of course than CGM, however, it wouldn't be as accurate. The focus on post prandial sugars has been a major concern of ours in our clinical work. I am glad to have research such as this to show that LI exercise benefits the patient in control of PPG. -Nick Saunders

Personal experience.

I was 280 pounds. I had exercised daily for two years and continued to gain weight as I started taking insulin.

I lost 80 pounds with the 3 hour diet by Jorge Cruise.

I have since gained back 50 pounds despite increasing my exercise to more than 2 hours a day.

I have faithfully continued to eat every three hours and feel I have much more control over my eating than i ever did.

Why did I gain weight. At 200 pounds I was cold all the time. I am 5 feet 11 inches. I am supposed to be 170 pounds. My waist was 40 inches.

I could not lose more weight despite exercise and continued diet.

I was in a semi-starvation state.

I am still off insulin and I documented the details of this history in my book, The Tubby Theory from Topeka.

Despite gaining back weight i continue to have a Hgb a1c <7.0 and my LDL-P is < 800 and my CIMT atheroma has not progressed.

NCEP guidelines advising weight loss and exercise first is a futile exercise. Focus on the message STATINS and develop a more aggressive plan to prevent Sudden Death by finding Subclinical atherosclerosis.

As per p 188 in Rethinking Thin by Gina Kolata, people do have some control over weight. Research shows that individuals have a range of weights, often spanning as much as 20 to 30 pounds.

On 2/17/2006 I weighed 283 pounds. It is now 4 years later and I am at the lower range at 250 pounds. I did it with two hours of exercise a day.

This is probably the best I can hope for as I am no longer in a semi-starvation state. I have regained a great deal of muscle.

I still try to keep my calories to less than 2,000 a day but for every day I did not, my body took full advantage of it to get me back to 250 pounds.

WHEN THE DOCTOR SAYS LOSE WEIGHT AND EXERCISE IT IS HEARD AS BLAH, BLAH, BLAH by the patient.

THE PATIENT IS NOT FOOLED BY THIS EMPTY ADVICE.

However when you show a patient his Calcium score or his CIMT > 50% risk; you can tell him something new and something he has heard of before.

That subclinical plaque can have inflammation and rupture it's membrane to cause sudden death. This is important news to the patient.

Now you have his attention. Just as all our patients know of a woman who discovered breast cancer before 50 years of age with mammography, the patient also knows of people who had Sudden Death before age 50. The incidence of both are very similar.

Nobody knows anyone who has had permanent weight loss.

Thanks for your response and very helpful clinical information disclosure regarding your weight loss (loss/regain). Clearly you have reduced your cardiometabolic risk. As you say, very very few (if any) individuals loose all the "proposed" weight and then keep it off. There are numerous risk reduction mechanisms afforded by exercise well beyond inflammatory markers that also aid in reducing risk and I think this is also important to understand although not demonstrated in a multi-color CRT visual. I hope providers learn never to expect universal success and attendance to perfect weight loss maintenance but more importantly the goal of risk reduction. Perhaps the most telling is the National Weight Control Registry of a very large group of patients who have successfully maintained 30+ lbs of weight loss (this may only represent 50% of what they "need" to loose) over many years on average. One finding from a recent paper published on this registry was that registry entrants reported an average of 2621 kca/wk of exercise for relative maintenance of their weight loss. At the average body weight in this registry this volume of physical activity approximates 15-20 miles a week of walking (~3 miles/day, 7 days/wk).