Stroke Smart Magazine

January/February 2008
PREVENTION

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Walk Away from Diabetes

by Pete Lewis

Exercise can benefit almost all stroke survivors. An exercise program can help build strength, increase flexibility and endurance, improve movement of arms and legs, reduce cholesterol and manage weight. And while the exercisers improve, those who don't exercise tend to deteriorate.

"There is strong evidence that older stroke patients who are inactive show significant declines in fitness, walking function and balance," said neurologist Dr. Richard Macko, director of the Center of Excellence in Exercise and Robotics for Neurological Disorders in Baltimore.

Now exercise has been shown to improve or prevent the advancement of diabetes among stroke survivors. This is important because having diabetes increases your chances for another stroke.

With diabetes, the body either produces too much or too little insulin, or doesn't properly respond to insulin. When we digest food, our bodies convert the nutrients into a type of sugar called glucose and use it for energy.

"Stroke doesn't just impact the brain," said Macko. "It affects the muscles and changes how they metabolize sugar."

When a part of our body is paralyzed or partially paralyzed after a stroke, the muscles in that area become less sensitive to insulin and do not convert glucose into energy normally. This can lead to the development or worsening of diabetes. About 80

percent of stroke survivors are either diabetic or have abnormal glucose metabolism, a condition known as pre-diabetic.

Macko and a team of researchers recently completed a study that examined stroke, exercise and glucose metabolism. The subjects in the study were in their 60s, had some paralysis and had suffered a stroke an average of five years earlier. Macko placed them on a moderate aerobic exercise program primarily consisting of walking on a treadmill twice a week.

"We started slow and customized the program to each patient," Macko said. "At the start of the study, some patients couldn't walk more than 10 meters 30 feet with assistance."

After two months, average walking speed improved 30 percent and cardiovascular fitness improved 17 percent among subjects. More remarkable, 58 percent showed improvements in glucose tolerance. Of the 12 subjects who were either diabetic or pre-diabetic before the study, five improved enough to be reclassified from pre-diabetic to normal, and two improved enough to be reclassified from diabetic to pre-diabetic.

Macko said that without a lifestyle change, 10 percent of pre-diabetic people will become diabetic in a year. With moderate exercise and modest weight loss, pre-diabetic patients over 60 years old can reduce their chances of developing diabetes by 71 percent.

"Diabetes is usually progressive [gets worse with time], so the fact that exercise can reverse and reduce insulin resistance is really remarkable," Macko said.

While Macko's study clearly shows the benefits of exercise, he said more research is needed to determine what intensity is most beneficial.

"Exercise is potent, just like a medicine, we need to study dosage, just like we study the proper dosage of a medicine," he said. 

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