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Diabetologie und Stoffwechsel 2017; 12(02): 112-126
DOI: 10.1055/s-0042-121407
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© Georg Thieme Verlag KG Stuttgart · New York

Körperliche Aktivität und Sport bei Typ-2-Diabetes

Physical Activity and Sports in Patients With Type 2 Diabetes
Andreas M. Nieß
,
Ansgar Thiel
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Publication History

Publication Date:
03 May 2017 (online)

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Zusammenfassung

Ein ausreichender Umfang an körperlicher Aktivität zählt zu den wichtigsten nicht medikamentösen Maßnahmen zur Prävention und Therapie des Typ-2-Diabetes. Von einem regelmäßigen körperlichen Training profitieren Patienten mit Typ-2-Diabetes nicht nur in Hinblick auf eine verbesserte glykämische Kontrolle. Weitere positive Wirkungen sind eine günstige Beeinflussung kardiovaskulärer Risikofaktoren, eine Verringerung ektoper Fettdepots, eine Unterstützung bei der Reduktion von Übergewicht, antiinflammatorische Effekte und eine Verbesserung und Stabilisierung der körperlichen Fitness. Somit senkt ein ausreichender Umfang an körperlichem Training sowohl die Gesamtmortalität als auch die kardiovaskuläre Sterblichkeit bei Typ-2-Diabetes.

Nach den Leitlinien zur Therapie des Typ-2-Diabetes sollen betroffene Erwachsene angehalten werden, mindestens 150 min pro Woche an moderat-intensiven aeroben Ausdauerbelastungen (50 – 70 % der maximalen Herzfrequenz) zu absolvieren. Dieses Training sollte auf mindestens 3 Tage pro Woche verteilt sein und es sollten nicht mehr als 2 trainingsfreie Tage dazwischen liegen. Sofern keine Kontraindikationen bestehen, wird Erwachsenen mit Typ-2-Diabetes zusätzlich ein Krafttraining mit zumindest zweimaliger Durchführung pro Woche empfohlen. Des Weiteren sollten Phasen längeren Sitzens vermieden werden und Sitzzeiten alle 90 min unterbrochen werden.

Sowohl eine unzureichende glykämische Kontrolle als auch Folgeschäden der Diabeteserkrankung wie eine Retinopthie, eine autonome Neuropathie oder eine koronare Herzerkrankung können im Rahmen des körperlichen Trainings für den Patienten ein Risiko darstellen und dessen körperliche Belastbarkeit einschränken. Aus diesem Grund wird vor Beginn eines körperlichen Trainings eine sorgfältige Eingangsdiagnostik und wenn notwendig eine Anpassung des Trainingsprogramms empfohlen. Weiterhin sollte bei trainierenden Patienten mit Typ-2-Diabetes unter Medikation mit Insulin oder Sekretagoga je nach individueller Konstellation die Medikation angepasst werden. Im Falle von Blutzuckerwerten unter 100 mg/dl vor Belastungsbeginn sollten zusätzlich Kohlenhydrate zugeführt werden.

Körperliche Aktivität ist ein überaus wichtiger Bestandteil der Therapie und Prävention des Typ-2-Diabetes – leider scheitern wirksame Trainingsprogramme häufig an mangelnder Motivation der betroffenen Patienten. Dieser Beitrag beleuchtet die positiven Effekte des körperlichen Trainings, erläutert die Leitlinienempfehlungen und gibt praktische Tipps zur individuellen Trainingsplanung und -beratung.

Abstract

A sufficient amount of physical activity is an important tool to prevent and treat type 2 diabetes. Beside an improvement in glycemic control, beneficial effects of physical activity and exercise training include a reduction of the cardiovascular risk profile, body weight and ectopic fat stores, anti-inflammatory properties and also an increase of physical fitness. In this context, exercise training lowers all-cause and cardiac mortality in type 2 diabetes.

Actual recommendations reflect that adults with type 2 diabetes should be advised to perform at least 150 min per week of moderate intensive aerobic exercise training (50 – 70 % maximum heart rate). The training activity should be spread over at least three sessions during a week, and resting periods between the sessions should not exceed two days. In addition, in the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at a minimum of twice a week. Moreover, a reduction of sedentary time by breaking up periods of sitting longer than 90 minutes should be realized.

Risks during exercise training can arise from a non-optimal glycemic control. Moreover, long-term complications of diabetes such a retinopathy, autonomic neuropathy and coronary heart disease may lower tolerance to exercise. Thus, a pre-training evaluation and clinical judgement should be performed. If necessary, the training regimen has to be adapted to the individual case. To avoid hypoglycemia in patients treated with insulin or secretagogues, the medication dose has to be adapted individually and/or additional carbohydrates supplemented, if pre-exercise plasma glucose is measured below 100 mg/dl.

Schlüsselwörter

Typ-2-Diabetes - aerobes Ausdauertraining - Krafttraining - glykämische Kontrolle - sedenter Lebensstil

Key words

type 2 diabetes - aerobic exercise training - resistance training - glycemic control - sedentariness
 

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