The aim of this study was to assess the effects of a twelve-week hydrotherapy group exercise programme on selected health-related fitness variables in older women with type II diabetes mellitus. This study included the testing of blood glucose levels, blood anthropometrical profile, body mass, height, body mass index, waist circumference, waist-to-hip ratio, upper body flexibility, lower body flexibility, grip strength, upper body and lower body muscular strength and endurance as well as aerobic endurance. Descriptive and inferential statistical techniques were used for this study utilising a quasiexperimental research design. A comparison group pre-test and post-test experimental design was employed at the Nelson Mandela Metropolitan University Biokinetics and Sports Science Unit. Approximately 16 senior female participants took part in the study. Participants were identified through convenience sampling and snowball sampling, of which, all the participants were clinically diagnosed with type II diabetes mellitus and had completed the study. The hydrotherapy participants (experimental group), took part in water-based (hydrotherapy) exercises three times a week for a period of twelve weeks. The hydrotherapy exercises began with a light half-hour workout per session and were progressively increased in intensity, duration, and number of the exercises performed. The participants not participating in the hydrotherapy exercises (control group) were instructed to remain sedentary throughout the duration of the intervention period. The dependant variables were gathered as raw data and analysed using descriptive statistics to form the means, standard deviations, medians, minimum and maximum values. Post hoc analysis was performed to determine whether differences existed between the experimental group and control group. Cohen’s D test was used to determine pre- and post-test differences for both groups to determine practical significance. An analysis of the results revealed significant improvements in some of the selected health and physical fitness parameters such as, upper body and lower body flexibility, upper and lower body muscular strength and endurance, as well as aerobic endurance. iii The aim and objectives of the study in exploring the effect of hydrotherapy as an intervention strategy to promote health and physical fitness in persons with type II diabetes mellitus were supported by the data collected in the pre-test and post-test analyses of the variables.

Insulin resistance is a precursor to type II diabetes mellitus and in conjunction with dyslipidaemia, hypertension, and obesity, these abnormalities constitute the metabolic syndrome. Insulin resistance usually develops before these other diseases and therefore identifying and successfully treating insulin resistant patients may have potentially great preventive value. Insulin resistance, obesity, and subsequently type II diabetes mellitus have increased dramatically and have reached epidemic proportions. The incidence of diabetes, and in particular type II diabetes mellitus, is increasing in developing countries and throughout the world and this is mainly as a result of increasingly sedentary lifestyle and obesity in an aging population. The specific aim of this study was to explore and describe the effect of a 14-week strength-based resistance training programme on insulin resistance amongst individuals aged 25 to 68 years, who are pre-diabetic, have T2DM, and/or are overweight. The research approach used in this investigation was explorative, experimental, and quantitative in nature. The quasi-experimental design consisted of a pre-test and post-test for an experimental and comparison group who were chosen through convenience and snowball sampling. A total of 30 participants were involved in this study, 15 participants in each group. The following dependent variables were selected, namely: body weight; BMI; body composition; waist-to-hip ratio; total cholesterol levels; triglyceride levels; HOMA-IR; and muscle strength for upper and lower body. Pre-and post-test analysis was performed at the Biokinetics and Sport Science Unit, located at the Nelson Mandela Metropolitan University (NMMU). Blood samples of the participants were drawn by nurses at the Health Clinic at the Nelson Mandela Metropolitan University and these blood plasma samples were stored at the Department of Microbiology and Biochemistry at NMMU for later analysis of glucose and insulin. The experimental group trained three times per week for a period of fourteen weeks, performing strength training exercises with progressive increments in the intensity of the exercise. The control group remained sedentary throughout the intervention period. Analysis of the data was conducted utilizing descriptive and inferential statistics. Analysis of variance (ANOVA) was used as a hypothesis-testing procedure to evaluate the mean differences. The following dependent variables showed a decrease in mean values: body weight, body mass index, body fat percentage, waist minimum, cholesterol and insulin. However these differences in results were not practically and statistically significant. The following dependent variables showed an increase in mean values: hip maximum, arm relaxed, arm flexed, thigh circumference, glucose and HOMA-IR. However these results were not practically and statistically significant. The mean differences in the plasma insulin level, pre- to post-test, between both groups indicated that a significant difference (t = -1.77, p = 0.044) existed between them. Cohen‟s d revealed a value of 0.64, which indicates moderate practical significance. The only dependent variable which showed both statistical and practical significance was sum of skinfolds. The findings for sum of skinfolds revealed that the mean differences, from pre- to post-test, between both groups indicated that a significant difference (t = -2.30, p = 0.015) existed between them. Cohen‟s d revealed a value of 0.84, which indicated a large practical significance. Although the sample size was too small to indicate generalisations to the diabetic population as a whole, strength training should be furthermore explored as an alternative and successful modality in the existing range of options available to the health and exercise professional to address the needs of the person with T2DM. The researcher proposed that a bigger sample size be used for the experimental and control group, the intervention period increased as well as various differences related to frequency, intensity and duration of strength training could possibly result in significant changes.

The overarching aim of this thesis was to examine factors that affect post-exercise glycaemia and contribute to minimising the risk of hypoglycaemia after exercise. An inability to regulate circulating insulin concentrations is considered the primary gluco-regulatory defect within T1DM. Therefore, the aim of chapter 3 was to examine the effects of pre-exercise rapid-acting insulin reductions on blood glucose responses before and after running in T1DM individuals, to test the hypothesis that reducing pre-exercise insulin dose may help preserve post-exercise glycaemia. The results demonstrate that a 75% reduction to pre-exercise rapidacing insulin dose best preserved blood glucose before and after exercise, without increasing the risk of ketoacidosis, and reduced the risk of hypoglycaemia in free living conditions for 24 hours following running. An important factor determining blood glucose concentrations and subsequent patterns of fuel oxidation is the rate of appearance of carbohydrate into the circulation. Potentially, low GI carbohydrates may raise blood glucose less and increase the percentage contribution of lipids as a fuel because of a slower digestion. Therefore, the aim of chapter 4 was to examine the metabolic and blood glucose responses to ingestion of a high or low GI carbohydrate, combined with a 75% reduced insulin dose, before, during and for 24 hours after running. The results demonstrate that compared to a high GI carbohydrate, the low GI carbohydrate increased blood glucose concentrations less before exercise and maintained blood glucose better for 24 hours after running, via lower carbohydrate and higher lipid oxidation rates during the latter stages of running. After manipulating both the insulin dose and the pre-exercise carbohydrate GI, to improve post-exercise blood glucose concentrations, the timing of the ingestion of carbohydrate (alongside a reduced insulin dose) before exercise is an important factor which may further refine these strategies. Therefore, chapter 5 examined the metabolic and blood glucose responses to alterations in the timing of carbohydrate feeding and insulin administration prior to running. Our results demonstrated that administration of both a reduced rapid-acting insulin dose and low GI carbohydrate 30 minutes before exercise improved glycaemia for 24 hours after running, by reductions in carbohydrate oxidation, leading to increased carbohydrate availability post-exercise.

The impact of acute resistance exercise (RE) on glycaemia in type 1 diabetes (T1DM) individuals is poorly understood. Yet, such knowledge would have great use in improving our understanding of blood glucose control during and after the performance of RE. Increasing research in this area might help minimise complications associated with blood glucose vulnerability and potentially maximise health benefits related to RE which are known to be obtained by people without diabetes. The overarching aim of this thesis was to examine the impact of acute RE on glycaemia in T1DM individuals, and promote confidence in people with T1DM to partake in this form of exercise and lead a more physically active lifestyle. Exercise volume, or the total weight lifted during a RE session, is a primary component in the design of a RE session. Therefore, Chapter 3 examined the acute impact of manipulating RE session volume in T1DM individuals. The results demonstrate that exercise volume is an important factor in determining the blood glucose responses to RE; specifically, blood glucose concentrations rose above rest for one hour after one and two sets of similar intensity RE, but this exercise-induced hyperglycaemia was attenuated by increasing the volume of exercise by addition of a similar intensity third set of RE. Additionally, performing morning RE after an overnight fast and in the absence of rapid-acting insulin, did not induce acute hypoglycaemia, ketoacidosis or raise a marker of muscle damage, but caused metabolic acidosis in a dose-dependent fashion. Exercise intensity is a characteristic that is integral to the design of a RE session, and this characteristic might play a role in explaining the exercise-induced hyperglycaemia caused by the thirty minute (two-set) RE sessions in Chapter 3. The aim of Chapter 4 was to examine the impact of manipulating exercise intensity in T1DM individuals. The findings from this study demonstrate that performing a low intensity RE session evoked a similar magnitude of post-exercise hyperglycaemia and metabolic acidosis than a higher intensity RE session, when sessions were matched for total weight lifted. In an attempt to alleviate the consistent exercise-induced hyperglycaemia presented by the two-set RE session, the aim of Chapter 5 was to implement a modified algorithm that delivers an individualized dose of rapid-acting insulin after morning RE, to counter acute post-exercise hyperglycaemia in T1DM individuals. The results demonstrate that post-exercise rapid-acting insulin injection delivered by means of an algorithm resulted in reductions to post-RE hyperglycaemia without the occurrence of hypoglycaemia during two hours after exercise. However, during the subsequent twenty hours of freely living conditions, T1DM individuals remained unprotected from post-exercise hypoglycaemia as per a control condition. Overall, the findings of this thesis underpin some important factors that determine the glycaemic and metabolic responses to acute performance of RE, which may facilitate the better management of blood glucose around this form of exercise, in T1DM individuals.

The aim of this study was to determine the effect of whole body vibration training on selected health and fitness parameters, including: blood glucose levels, blood pressure, anthropometric profile, muscular flexibility, muscular strength, muscular endurance, and aerobic endurance of persons with diabetes mellitus type II. The study was conducted in a descriptive, explorative manner utilizing a quasiexperimental design with an equistatic approach, employing match-pair design to participant grouping. The experimental design was a non-randomized two-group pre- and post-test design, in which approximately 16 male and female participants, who were chosen through convenience and snowball sampling with diabetes mellitus type II, completed the study. Pre- and post-test analysis was performed at the Biokinetics and Sport Science Unit. The whole body vibration training (experimental) group, trained three times a week for a period of ten weeks, performing exercises on the vibration platform with progressive increments in the intensity, duration, and number of the exercises. The control group remained sedentary throughout the intervention period. The dependant variables were analyzed using descriptive statistics. ANOVA was done to determine pre- and post-test differences for both the experimental and control groups for all the variables. Post-Hoc analysis was done to determine and compare differences which may have existed between the experimental and control groups, with practical significance being determined by Cohen’s D analysis. The analysis of the results revealed significant improvements in systolic blood pressure, muscular strength, muscular endurance, and aerobic endurance.

Background: Despite growing utilization of mobile phones and websites for consumers seeking health care advice, the area is largely understudied. A niche market for these applications is in diabetes care. Since diabetes is a chronic condition requiring daily monitoring it is a good candidate for consumer health informatics and especially interactive websites and mobile phone applications. As the obesity epidemic continues, so too the prevalence of type 2 diabetes continues to rise. This chronic condition can lead to major complications and high medical cost. It is on the rise in countries all over the world, and beginning to impact people at younger ages. Low cost interventions are being explored to mitigate these complications and cost. Objective: To examine the effectiveness of consumer health informatics, such as websites, personal digital assistants, and mobile phone applications that claim to help people with diabetes self-monitor diet and exercise behaviours to lose weight. Methods: A search for relevant literature was conducted using PUBMED, Cochrane, and IEEE Xplore, with the search terms: (mhealth OR mobile health OR phone OR web* OR ehealth OR internet OR ICT) AND diabetes AND (diet* OR exercise OR physical activity). Also, a bibliographic search was done to identify any studies that were missed in the initial search. The search was not limited to any date range, but articles were identified from the time period of September 2000 through April 2012. Only articles in English were included. Studies were included if the program included an interactive logging feature for diet and/or physical activity. Studies that looked at type 1 disbetes were excluded. Results: A total of 10 original studies were found that met the inclusion criteria. Including 2 qualitative design, 1 randomized trial, and 7 randomized control trials. There was a great deal of heterogeneity among the studies. Delivery methods varies, studies including the following are: *  Mobile device only: 3 *  Website only: 6 *  Website plus mobile device: 1 Many different outcome measures were used across the studies including: behavioural, physiological, psychosocial, as well as usability and satisfaction. Overall, adherence and follow up were low. Dietary tracking generally appears not to be as effective as broad goals such as, “each more fruits and vegetables”. Exercise tracking was more effective at increasing physical activity. Message boards and peer support did not show an increase in effectiveness, but personal online coaches and personalized emails showed promising results. Usability and satisfaction was high in those that reported it, but the large number of dropouts are not considered in this. Conclusions: At this time, consumer health informatics does not seem to be an effective solution in facilitating significant behavior change for people who have type 2 diabetes. Future programs should look at ways to increase adherence and usage of the programs because the people who did use the programs daily benefited more than sporadic users. Components that showed promising results are access to a personal online coach, personalized weekly emails, integration with a pedometer that automatically uploads to a tracking program, and broader food related goals. Further testing is necessary to determine if this type of intervention is effective. / published_or_final_version / Public Health / Master / Master of Public Health

This study was conducted to determine if improvements in glucose tolerance could be demonstrated following an acute bout of progressive resistance exercises. Fourteen individuals, not currently weight training, were assigned to two groups using the guidelines established by the WHO for NIDDM and normal (CON), based on the results of a three hour 75 g (-1.2M) load oral glucose tolerance test (OGTT). Eight blood samples were collected during the OGTT and assayed for glucose, insulin, and C-peptide. Each subject from the NIDDM (n=7) and CON (n=7) groups participated in a familiarization period, including a IRM, with eight different Nautilus selectorized exercise machines utilizing both the upper and lower body. A 3 set x 10 repetition exercise protocol based on the IRM was conducted and followed 18 hours later by another OGTT. Two day diets were replicated from the prior OGTT. Analysis of variance failed to demonstrate significant differences in the total responses or at any specific sampling points from pre to postprotocol for glucose (p=0.53), C-peptide (p=0.07) or the C-peptide:insulin ratio (p=0.16) in either group. Blood insulin levels from pre to postprotocol were significantly reduced (p=0.001) by 24% and 22% for the NIDDM and CON groups, respectively. These data suggest that a single series of progressive resistance exercises improve insulin uptake by the tissues without augmenting glucose disposal. / School of Physical Education

[Truncated abstract] Exercise is generally recommended for individuals with type 1 diabetes mellitus since it is associated with numerous physiological and psychological benefits. However, participation in exercise can also increase the risk of experiencing severe hypoglycaemia both during exercise and recovery. Unfortunately, existing guidelines to minimise the risk of exercise-induced hypoglycaemia are often general and fail to take into account that different precautions are required for exercise of varying type, duration and intensity. Specifically, there are no evidence-based guidelines for safe participation in intermittent high-intensity exercise (IHE), which characterises the activity patterns of most team and field sports, manual labour occupations and spontaneous play in children. This is because the response of blood glucose levels to this type of exercise is not known. Consequently, the purpose of this thesis was to investigate the glucoregulatory responses to IHE that replicates the high-intensity work-to-recovery ratios observed in intermittent sports in individuals with type 1 diabetes, in order to assess the associated risk of hypoglycaemia. The first study of this thesis examined the effect of the repeated bouts of high-intensity exercise that characterise IHE compared to remaining inactive, on blood glucose and glucoregulatory hormone levels in individuals with type 1 diabetes. Eight healthy individuals with type 1 diabetes were tested on two separate occasions during which either a 20 minute rest (CON) or an IHE protocol designed to simulate the activity patterns of team sports was performed (repeated 4 second sprints every 2 minutes). ... During the second hour of recovery, Ra and Rd returned to baseline following MOD, but remained elevated after IHE. These changes in Ra and Rd were consistent with a lower glucose infusion rate (GIR) during early recovery from IHE and a higher GIR after 2 hours of recovery compared to MOD. In conclusion, the repeated bouts of high-intensity exercise associated with IHE stimulate a more rapid and greater increment in Ra during exercise and attenuate glucose Rd during early recovery. These findings assist in explaining, in part, the previous observation that the risk of hypoglycaemia might be lower during IHE and early recovery compared to MOD. Overall, the findings of this thesis have implications for current recommendations aimed at managing blood glucose levels during and after exercise to avoid hypoglycaemia.

Type 2 diabetes mellitus (T2DM) is mainly caused by genetic modifications and inappropriate life styles. The complexity of T2DM has brought us challenges for a comprehensive understanding of altered metabolic pathways that contributing to the development of T2DM. Therefore, a comprehensive metabolic analysis is needed. To date, taking regular exercise is a common and effective therapeutic way known to antagonize the metabolic disorders of T2DM. However, the regulatory effects of exercise on T2DM or T2DM induced complications have not been clearly characterized. Here, we present the effect of physical activity on biochemical changes in diabetic db/db mice in plasma, urine, skeletal muscle and kidney samples. Based on liquid chromatography coupled with high resolution Orbitrap mass spectrometry (LC-MS) and gas chromatography coupled with mass spectrometry (GC-MS), two major approaches, untargeted and targeted metabolomics studies, have been developed to delineate metabolic signatures in various kinds of biofluid and tissue samples. Targeted quantification methods on acylcarnitines and acyl-CoA have been developed. Untargeted metabolomics analysis by GC-MS and LC-MS have also been developed to draw a more comprehensive view of the metabolic changes in response to T2DM and exercise on db/db diabetic mice. The transcript expressions of mRNA in pathways of interest have also been measured to confirm the hypothesis. Firstly, a targeted quantification method of acylcarnitines by using high resolution parallel reaction monitoring (PRM) on LC-MS platform has been developed. A total of 117 acylcarnitines were detected from plasma and urine samples. The application of targeted profiling of acylcarnitines in db/m+ control and db/db diabetic mice indicated incomplete amino acid and fatty acid oxidation in diabetic mice. Interestingly, the reduction of medium odd-numbered chain acylcarnitines in urine samples was firstly observed between db/m+ and db/db mice. The high resolution PRM method makes it possible to monitor the widespread metabolic changes of the acylcarnitines in response to stimuli. Besides, the accurate MS and MS/MS spectra data of the 117 acylcarnitines could be used as mass spectrometric resources for the identification of acylcarnitines. In addition to targeted metabolomics analysis, untargeted metabolomics profiling analysis in plasma samples indicated that db/db diabetic mice may be more susceptible to exercise for energy expenditure. Interestingly, all the results from plasma, skeletal muscle and kidney samples may demonstrate that physical activity could mitigate insulin resistance in T2DM mice through improving fatty acid β-oxidation (FAO) and eliminating overloaded intermediate which contribute to insulin resistance. Specifically, the results from kidney samples demonstrated that exercise exhibit beneficial effect in reducing hyperlipidemia, expression levels of inflammatory markers (TNFα, IL-6 and COX2) and fibrosis markers (Collagen 1), and alleviating diabetic nephropathy (DN) induced mesangial expansion in kidneys of diabetic mice. The results of metabolic changes in kidney of db/db mice revealed that the accumulation of acyl-CoA, phospholipids and hydroxylated acylcarnitines were substantially ameliorated by exercise, and the reduction of important enzymes CTP1α and Acadl in FAO were partially reversed. In addition, branched-chain amino acids (BCAA) metabolism which positively related to inflammation (TNFα) was down-regulated in DN mice by exercise. What’s more, the accumulation of uric acid, which contributes to inflammation and tubulointestitial fibrosis in kidney disease, together with its six precursors have also been substantially reduced. The results in kidney samples demonstrated that in addition to beneficial effect in alleviating lipotoxicity through improving FAO efficiency, exercise also ameliorated diabetic induced inflammation and fibrosis via promoting BCAA catabolism and accelerating the elimination of uric acid. Together, the mass spectrometry-based metabolomics study is a powerful tool to investigate the regulatory effect of exercise on complex metabolic diseases. The results may provide informative insights into the underlying the mechanism of exercise on T2DM and T2DM induced complications.

Although the benefits of exercise to non-insulin-dependent diabetes mellitus (NIDDM) are well-known, individuals with NIDDM are at risk for macrovascular and microvascular complications associated with an abnormal systolic blood pressure (SBP) elevation during exercise. In order to compare the SBP and rating of perceived exertion (RPE) response between individuals with NIDDM and apparently healthy controls during submaximal exercise, eight individuals representative of each group completed a 10-minute submaximal treadmill exercise trial at 65% of functional capacity. Heart rate, blood pressure and RPE were monitored throughout the trial. Between group comparisons were made for SBP and RPE response, and the frequency of exercise SBP response _> 200 mmHg was investigated. No significant differences were observed in either SBP or RPE response between groups during the submaximal treadmill trials. In addition, none of the subjects from either group achieved a SBP ? 200 mmHg. While this study indicates that exercise at 65% of functional capacity is safe for this particular group of subjects with NIDDM, additional research is warranted to investigate cardiovascular response to exercise in a broader subject pool representative of the entire NIDDM population. / School of Physical Education