Best Exercise INTENSITY to prevent Diabetes

A clinical trial compared LOW vs HIGH intensity exercise to prevent type 2 diabetes. The results are fascinating.
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Facebook: / drgilcarvalho
Twitter: / nutritionmades3
Animations: Even Topland @toplandmedia
References:
Original trial: jamanetwork.com/journals/jama...
9-year followup: jamanetwork.com/journals/jama...
Lifestyle trial: pubmed.ncbi.nlm.nih.gov/9096977/
20-year followup: www.thelancet.com/journals/la...
Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
#NutritionMadeSimple #GilCarvalho
0:00 Exercise Intensity
0:27 Trial Design
1:18 Results
2:39 Long-term follow-up
3:50 Interpretation
4:27 2nd Trial

[@24tommyst]

"The best exercise is the one you will actually do" That kind of rational humanism is why I come to this channel.

[@PaulB_864]

It's not a rational answer, given the specific question. We know all types of exercise is beneficial, but the question was 'which type of exercise provides us with more benefits.'

[@bellenesatan]

​@@PaulB_864it's the perfect answer for people who like splitting hairs over inconsequential things in the long run. If you consistently do any type of exercise that stimulates your cardiovascular system and improves your metabolic health, you're doing good. Period.

[@olddouchebag]

@@PaulB_864 It is a very rational answer. Because people often give up exercise that they don't like. So the best exercise is one that you will stick to and actually do. Some is better than none.

[@johnmelton4940]

Video Summary: Both groups, consisting of brisk walking for moderate intensity and jogging for vigorous intensity, showed equal reductions in liver fat. However, the vigorous exercise group saw greater improvements in total body fat, total visceral fat, and blood pressure. Both exercise groups had diabetes rates significantly lower than the control group, suggesting long-term benefits. A follow-up study nine years later showed increased physical activity levels but no longer reached statistical significance. A 20-year study on exercise and diabetes risk found a reduction in diabetes risk for regular exercisers but no significant difference in terms of caloric intake or physical activity over the long term.

[@walkinghills]

Thank you for the summary.

[@ajaxplay8]

I concur, and thanks for writing out a summary yourself instead of using an AI tool to do it. While those are good for generating "chapter points", I find that they often don't really convey the content of a video at all.

[@DrAJ_LatinAmerica]

What would be interesting to see added to the study would be cost and rate of injuries. Especially as people 40+ who take up jogging or sprinting after having 10+ yrs of sedentary lifestyle. I see it all the time. People want to get healthy but start out at an intensity far beyond what their body is ready to handle. Please start slow. Walking, walking in a pool, flexibility training, swimming, resistance training, treadmill / stair stepper, bike, then jogging. Save jogging and sprinting last. Please for the sake of your tendons and ligaments.

[@reallyanotheruser7290]

"flexibility training" seriously, i bought a water rower in november and it mercilessly showed me every shortcoming i have, even tho im 29 and have no health issues other than low stamina (also nowhere near overweight). I started training for one month about two~three times a week and had to stop because my muscles and tendons are already shortened to a point where i cant maintain a healthy posture during rowing and it hurt my lower back. My thigh muscles are too weak and out of balance to maintain a healthy knee movement. I have been doing 20 minutes of daily strechting for over a month now and began rowing again very slowly, to keep focus on posture and my knees, and its still a long road ahead until i can do it without any issues.

[@loganmedia1142]

I'd recommend be careful with any exercise at higher intensity when getting older. It's very easy to get seriously injured doing cycling and resistance training. And gets exponentially easier with each passing year. I'll just leave the jogging for never though. It must be one of the most tedious ways to exercise. I'd rather watching paint dry.

[@DrAJ_LatinAmerica]

@@loganmedia1142 keeping in mind "high" or "low" will be specific to each individual. Case by case, person by person. Plus, how they reach high / low intensity will be very different and must be individualized. Some might run, others sprint, some on a real bike, others on a stationary bike, others on a stationary bike with support braces, others might swim in the ocean, others in a special swim pool,..... Case by case.

[@stefaniesmith7117]

@@loganmedia1142under a proper training program, there is no reason at all for masters athletes to fear intensity. Just like anyone who may be coming from a sedentary lifestyle, appropriate progression is always key. As for jogging being tedious, for some it may be. And for others it’s a fantastic way to work on positive mood.

[@Magnulus76]

Jogging is an exercise that is best left for people that are already reasonably physically fit.

[@seanwhitehall4652]

Opening with facts right in the first 30 seconds

[@blumingwellness]

50% reduction in diabetes is impressive! I'm surprised liver fat reduction (and visceral fat reduction in the joggers) didn't lead to lower fasting blood glucose. Don't we have many studies to show those types of fat reduction do lead to lower fasting blood glucose? I know studies aren't perfect. Also, I would expect some participants might have changed their diet a bit during the study since I see all the time people wanting to make other lifestyle changes when they've gotten traction on one. It would have been great if the participants had received more support to keep developing health habits after the study. Thanks for another clear and informative video! ~ Marian

[@marty5627]

As others have pointed out, the fundamental issue is that 30 minutes of more vigorous exercise will have more impact than 30 minutes of less vigorous exercise on pretty much everything. Would be interesting to see what the results would be if they adjusted the time such that calorie burn was equivalent.

[@jmass4207]

But can you say that’s particularly relevant to most people? That they’ll end up taking on the same caloric ‘load’ no matter the intensity they take on? Especially as one gets more and more fit, it will be hard for the low intensity regimen to keep up.

[@immers2410]

Up to a point. Very vigorous exercise is a stressor and will cause elevated glucose levels in diabetics

[@MikeScherneck]

Most reliable unbiased health/nutrition channel on youtube ! Keep doing what your doing. Changing many lives for the better !

[@ZukuseiStudios]

I would like to measure walking vs jogging based on calories burned instead of time. As obviously the joggers do 2X more calories, so twice as much exercise in terms of work done. Double the walking time so calories the same and I guarantee results the same for benefits and way less injuries and soreness in walking . Also you can easily keep increasing your walking for much longer than you can increase the jogging miles/kms per week.

[@gordonv.cormack3216]

Walking and running consume similar energy (calories) for the same distance. Whether benefit is strictly proportional to calories is unclear, but I would not be surprised if energy (calories or distance) was a better approximation than time.

[@rdbm-uo5zt]

I've been doing regular vigorous cardio and weight training since 1977 (I'm 68, male), and I still went on to develop type 2 diabetes. I managed to get flagged for the condition by my GP last year when I experimented with a typical Western Diet last year to save some money on cheaper high carb food: I got an hba1c of 6.00. I switched back to my usual diet which resembles the Mediterranean Diet and my hba1c went way back down into the 5 range (@ 5.50). My doctors say that you don't actually prevent or cure diabetes; instead, you aim to keep it in remission. It continues to slowly develop; it's a progressive condition. To those, like myself, it hides in the shadows waiting to bite me when I bite down on too much 'forbidden food' or take the gas pedal off my exercise regime for too long. The goal is to fight a losing battle without losing! My GP anticipates (in 10, 20, 30 years) that I will eventually need more big guns (e.g., Metformin, Ozempic, etc.) to continue fighting this battle.

[@gordonv.cormack3216]

You might want to get a second opinion on the prevention/cure thing, at least for Type 2. I suspect the problem with your western diet was saturated fat and hyperpalatability, rather than high carb per se. The biggest factor in t2d is overnutrition, and if the overnutrition includes a lot of saturated fat, so much the worse.

[@scienceislove2014]

Metmorphin is actually quite Good.. it probably promotes longevity (this was found through a studies which looked at how those with diabetes taking metmorphin lived longer than those who didn't take metmorphin...and even those who didn't have diabetes to begin with!).

[@scienceislove2014]

Mediterranean diet is really good... As a broke student , my vegan diet is not quite Mediterranean style but i do eat home cooked meals almost always... Not ultra processed junk.. But i can't afford good quality olive oil and a plethora of nuts and seeds.. so I just stick to walnuts and almonds.. I also eat seasonal veggies.. and fruits.. This keeps me working.. only thing I can't avoid is stress 😔

[@scienceislove2014]

A

[@jimscanoe]

Exercise doesn't prevent diabetes-not eating meat, eggs, and/or dairy products (the consumption of saturated fats) prevents (or gets rid of) diabetes. No amount of exercise makes up for an unhealthy diet.

[@jmilton5842]

My son, now 18, has genetic markers for juvenile diabetes. He participated in a longitudinal study that tracked lifestyle factors. Thus far, intense frequent exercise has been shown to at least delay the onset of type I diabetes. He has two of the three antibodies and has been a multi sport athlete since grade school, so it tracks. The study is known as TEDDY.

[@gordonv.cormack3216]

I'm going to be a bit pedantic here, because I see a lot of popular (and scientific) statements that imply that lack of significance means either there is no effect or the effect is small. All it means is that the experiment is not powerful enough to show the effect with some (arbitrary) level of confidence. It is much better to report an estimate for the effect with a confidence interval. If the estimate is positive, the result is evidence of a positive effect, but not with enough confidence that this estimate alone should be taken as truth. It may well be possible to combine this estimate with estimates from other studies to achieve the requisite level of confidence. That's what a meta-analysis does. Many systematic reviews include meta-analyses that do this combination. But many do not, and many combine studies that don't measure exactly the same thing. So while meta-analysis is a confidence multiplier, I would not put it without question at the top of the food chain. Two important examples where the meta-analysis was restrictive and failed to show significance and has been misinterpreted are one on masks for virus transmission, and the (in)famous one on saturated fat and CVD outcomes. In both cases, pundits have incorrectly cited these as evidence of "no effect" or "small effect."

[@blumingwellness]

Thanks, that's helpful to know that no significant effect does not mean no effect.

[@gordonv.cormack3216]

@@blumingwellness "No significant effect/difference" is indeed an unfortunate phrasing, that indeed does not mean "no effect/difference."

[@gordonv.cormack3216]

@@blumingwellness Looks like I'm your first subscriber!

[@TeeGar]

I fell asleep halfway through this comment

[@loganmedia1142]

@@blumingwellness It means that any effect was probably due to chance, not the intervention being studied. It does indeed effectively mean the intervention made difference or had no effect.

[@HelloWorld-bc9fe]

Would you be willing to cover beta carotene conversion? I’m seeing it claimed that certain genetic variants make it impossible to obtain enough active vitamin A on a plant based diet. Thanks!

[@jacobstaff549]

Good analysis 👏👏👏👏👍💐🙏

[@AndrewPawley11]

Excellent.

[@hyperbodyhub]

Very informative 🙏

[@AnHourOfWolves]

Pretty interesting. 🔥

[@TeeGar]

Whatever exercise you're willing to do is always the best exercise

[@D.von.N]

0:56 so the HI had a higher energy expenditure than the walkers? Of course the walkers caught up with them after a year. You need to walk longer to achieve the same cresult as the HI group. How could this go missed? Also, for a HI you need to be somewhat fitter than just walk, so was there some skew effect, like a body weight lowe in HI to start with?

[@adelabdelaziz-zh4zh]

could you do a specific video about the benefit of brisk walking which is something that could be proper for the vast majority cause it is free , zero risk , doing anywhere when travel , for elderly and kids , and consistent cause it is not hard , i personally can't afford be in a gym but i walk everyday beside the nile river for 45 minutes and have been doing it for years with some music and that's it it would be a great video also for lazy and people who don't want to start

[@hubby_medical5454]

great channel! You kinda look like Ozil! He is a legendary Football player, so its a high praise (: Thank you for your content.

[@kennethyuman1940]

@gil, your insight on the difference between the study populations is spot on and explains my recent experience: for overweight people, cardio is effective; for the lean, weight-training is more important. I have stepped up running in the past months and while satisfied with making personal records at 10K, my a1c surprisingly spiked up by 0.2 pct point. I guess that the body reacts to zone 3/4 vigorous running with elevated glucose.

[@Sikyu-ye4ns]

just at the right time. guess you read my mind

[@ewen1140]

I really think @nutrition made simple should do a podcast on Urilithin A that has major scientific studies backing

[@gailm.8190]

This was nice, but I really wish you had delved deeper into heart rates, timing of exercise around meals, and being active vs perhaps sedentary for the majority of the day except for the bit of time the subjects spent exercising. Also, this study took place in China so although the variable of their individual diets didn’t change, their diet overall could contribute to their outcomes. Interesting, but there is so much more to discuss. I hope you’ll do a deeper dive…perhaps an interview with Dr Martin Gibala who is an exercise physiologist in Canada. I always enjoy your presentations and content! 😊

[@AliceFarmer-bg4dw]

Gill, how do we as common man know what science to trust when they allowed Transfatty acids to be in our food supply for nearly 75 years and still allow a small amount as legal? Tell us how to read these studies.

[@Guishan_Lingyou]

The lasting benefits makes me feel less bad about having taken a 3 year hiatus from exercise after many years of keeping in very good shape.

[@anthonyrondolino8148]

Very hard to believe one year of exercise created a long lasting benefit of so many years. There must have been some continuity of change

[@Magnulus76]

In my experience, and based on the data I've seen, exercise has limited effects on controlling fat accumulation. It has to be accompanied by changes in diet.

[@rosegirl9874]

So frustrating that it was all cardio based. Strength training is the best!

[@rosegirl9874]

I just got to the end of your video, I'll watch the weight training one!

[@gordonv.cormack3216]

False dichotomy.

[@smkozlowski]

Nope. Sorry "Rose"

[@irfanm5892]

Some people cant do strength training

[@gordonv.cormack3216]

@@irfanm5892 Most people can do strength training, if it is calibrated to their ability. Everybody should, and it is especially important for seniors.

[@dave3gan]

Guess I got my exercise levels wrong. I would have thought walking was low, jogging was moderate and running was high or vigorous

[@thanhdang2546]

Any research on weight training alone on diabetes. Thanks.

[@D.von.N]

Any activity that helps to use glucose in the muscles makes them open to more glucose from the blood, i.e. reducing insulin resistance, i.e. reducing the risk of diabetes. Whether cardio or resistance, they all help. Each to their own. It is about the energy balance after all. Staying constantly in a positive one will lead to insulin resistance.

[@Dingdong3696oyvey]

As always do both.

[@bengt_axle]

Comes at a good time, because "Zone 2" training is now all the rage with endurance athletes. However, the recommendation is taken completely out of context. Low intensity is important for mitochondrial activity but it has to be of long duration, and it cannot replace higher intensity. If you only have 3 hours per week, make the workout count with an intensity level that is high enough to make you sweat. Use an old pair of jeans to see how much fat you've lost. The looser the fit, the more belly fat you've lost and this is significant because it means that your glucose has likely been kept lower as well, causing a reduction in fat stores in the liver.

[@AliceFarmer-bg4dw]

Gill, What does the studies and books say that is the cause of T2D? Is it the carbohydrate Insulin theory or the Twin Cycle/Lipo toxicity theory? Is it dietary carbohydrate elevating hormones such as insulin or dietary fat elevating causing diabetes? If so which dietary fat, is it the fat from food or is it the de novo lipogenesis from the simple carbohydrates?

[@HakuCell]

please provide a "summary" chapter

[@consideritdunn691]

I am a big fan but I watched this to the end but struggled to hear the message or get the answer to the title.

[@evanhadkins5532]

Both work but more vigorous is somewhat better.

[@consideritdunn691]

thanks Evan@@evanhadkins5532

[@stamy74]

What about higher intensity exercises? Like sprinting or HIIT.

[@applerunner1184]

Hmm, isn’t the answer 1) Some aerobic and 2) Some anaerobic and 3) some weight training?

[@jimscanoe]

Exercise doesn't prevent diabetes-not eating meat, eggs, and/or dairy products (the consumption of saturated fats) prevents (or gets rid of) diabetes. No amount of exercise makes up for an unhealthy diet.

[@williamc4221]

Weight training is an example of an anaerobic exercise.

[@Luke-tm6oo]

High intensity health channel needs a KZbin peer review.

[@cyndij8312]

Did I hear no effect on triglycerides? I thought it was mentioned in a recent video (no sure if it was yours or not) that exercise helps low triglycerides.

[@knockingseeker]

It’s quite possible this was because the exercisers increased calories to make up for the calorie burn resulting in the tryg levels not changing. Still impressive that they lowered diabetes risk

[@cyndij8312]

@knockingseeker That's a possibility, I suppose. Thanks for taking the time to respond.

[@jesseshaver2262]

Do you think t2 diabetes can be reversed or only managed?

[@rjmclean1979]

Its the same thing. You reverse it by managing it. Its always there though and as soon as you stop managing it, back it comes.

[@kevinfearssatan1437]

Check out the video with Roy Taylor on this channel about reversing t2 diabetes.

[@runalong]

Virta Health is a company that helps some people significantly reduce their need for diabetes medication, effectively reversing much of the disease.

[@roustabout4fun]

This was a rather moving vide0~

[@TheRst2001]

Walking is quite variable , i walk as an exercise and make an effort to walk up and fown a hill , that gets my heart rate up and strengths muscles and ligaments , and for about 1hr roughly , it takes about 30mins to warm up 🙂

[@loganmedia1142]

After 30 minutes I'm already done exercising.

[@ruthhorowitz7625]

How would someone who has type 2 diabetes jog for 30 minutes 5 days a week. I mean, we are talking about people who are overweight, and out of shape. I'd be injured by the second day if I did that, and I jog twice a week. I can't do more than that without injuring myself.

[@joesphbegley3088]

The best exercise for diabetes is pushing yourself away from the table !

[@orhanyuce2864]

Biking

[@baddoboss9075]

Questionable morals on this study, so the control group who are a bunch of pre-diabetics is just told to change nothing at all and continue getting sicker?

[@R2WatchingTetris]

I'm sure they weren't explicitly told NOT to change, it was probably just that they weren't instructed TO change during the study period.

[@bengt_axle]

All of these studies are with voluntary participants, who can quit at any time. Where is the ethical lapse if someone asks to follow what you are doing anyway? Any individual can say that they want to quit and do exercise. People who didn't did not because they don't want to.

[@gordonv.cormack3216]

Participants might question the benefit of exercise to the point that they wouldn't start a lifetime regimen without evidence. But they'd participate in a study to help gather the evidence. This isn't so different from many other intervention studies. For long term studies, the quit prematurely if the evidence of effectiveness (or harm) becomes overwhelming. Presumably all participants were informed of the results of the initial intervention, and were free to do whatever in the follow-up period.

[@peterbedford2610]

"Jogging" being characterized as vigorous?? I would think HIIT would be the standard for "vigorous". Especially given all the research showing its benefits.

[@delwoodkelp8590]

The problem with HIIT is for many people, especially seniors,.... even more so 70+... injury and strain by doing too much too soon. Tendons and injury put more people off of exercise if done with too much vigor. By the way, "jogging" at 75-80% of maximum heart rate, can be a good workout ld over 40+ minutes. I would guess than less than 5% of people over the age of 65 do 40+ minutes of cardio 3x a week.

[@cudgee7144]

Yes, 65% of your maximum heart rate is not vigorous.

[@loganmedia1142]

@@cudgee7144 It's close enough. Some sources say 70%. There are also other factors. If someone is out of breath then the exercise is vigorous regardless of their heart rate.

[@loganmedia1142]

There is also all the research showing that it is much riskier as well as being very hard for most people to do at all, never mind stick with it. You'd be wrong in thinking that high intensity is the standard for classifying exercise as vigorous. In fact the intensity of the exercise is totally irrelevant. Only how the person's body responds matters to the classification.

[@xynoxys]

Just walk Running will damage your knee Maybe not now, but when you are 50 or 60

[@gordonv.cormack3216]

I haven't seen evidence of this. Can you provide a reference?

[@privtprofile24]

@@gordonv.cormack3216 Running is actually protective against things like arthritis. You just have to do it right. Build it up SUPER slowly. If you cant run pain free, do exercises that help you get to a point where you can run free. So many people will start running, get some pain, keep pushing through it, destroy their knees, then they blame running.

[@BestLifeMD]

@@gordonv.cormack3216no, no they can't 🤣

[@keithbarbaro7590]

You're mostly right if you mean distance running. Knees get thrashed. Testosterone levels never improve and can decline. However, sprinting seems to be better. Sprinters age better. Look at Carl Lewis and Ben Johnson. They age well and haven't destroyed their knees and hips. Sprinting is good if you don't overdo it.

[@thedude5342]

If you run correctly probably not

[@hippiegirl5167]

It hereditary

[@anathardayaldar]

Heredity is one of the risk factors. It is not the only contributor.

[@wackthegood8884]

Not "less" people - "fewer" people.

[@evanhadkins5532]

Adding that much exercise and no change to diet? hmm. If diabetes remission is due to weight loss (Taylor) it may be due to untracked change in diet.

[@elduderino1329]

Walking is not exercise. Jogging is barely exercise. If the physical activity is not challenging enough, it won't force the body to adapt. It doesn't have to be very high intensity and/or a very long duration but it has to be intense and long enough for the body to try to grow to the task.

[@michelangelobuonarroti916]

False, especially in comparison to sitting.

[@delwoodkelp8590]

wait until you reach age 70

[@loganmedia1142]

Any physical activity is exercise.

[@elduderino1329]

Walking, cooking, golfing, even watching TV and eating comfort food is physical activity for some people yet it doesn't force the body to adapt and get better. That is why not all physical activity is an exercise. If your physical activity is not challenging enough it won't have the desired effect therefore it's not exercise just some physical activity for lazy people. It's really not that hard to understand for most people. @@loganmedia1142

[@elduderino1329]

Not true. @@loganmedia1142

[@quistplay7370]

kzbin.info/www/bejne/sJquhIqXi79leKMsi=OG2EZ0UrKwRNCzz8 @Nutrition Made Simple! What is your take on the dose respons curve for resistance training?

[@jonmoore4588]

Not related to this video, but i know you've touched on this previously somewhere. Came across a fascinating study that examines the effect of heating various culinary oils to typical kitchen temperatures and compositional changes in terms of LA, ALA, TFA, SFA statistics. Have a look at a study titled 'Effects of Repeated Heating on Fatty Acid Composition of Plant-Based Cooking Oils' Foods. 2022 Jan; 11(2): 192. Published online 2022 Jan 12. doi: 10.3390/foods11020192 PMCID: PMC8774349PMID: 35053923 Might be up your street for a future video.