It is the scourge of modern society and Sri Lanka is no exception. The spectre of Type 2 Diabetes Mellitus looms large, closely linked to cardiovascular disease (CVD).

With rising global mortality (deaths) due to diabetes, there is double jeopardy for those living in South Asia, which is home to almost one-fifth of the world’s population.

South Asians, when compared to other ethnicities, are more prone to diabetes, with a prevalence of 10-15% (more than 1 in 10 having diabetes). More bad news awaits Sri Lankans – for we are at greater risk of CVD.

It is in the light of exercise being known to improve blood glucose, lipid profiles, blood pressure and visceral adiposity (body fat that is stored within the abdominal cavity) which are goals of diabetes management that a young doctor has set about, through scientific study, to establish the impact of aerobic exercise training (AT) and resistance exercise training (RT),in the management and prevention of diabetes.

Having conducted a Randomized Control Trial (RCT) with patients from the Colombo district, Dr. Chathuranga Ranasinghe who is a Specialist in Sports and Exercise Medicine believes that his thesis titled, ‘The effects of supervised aerobic and resistance exercise training on Sri Lankan adults with type 2 diabetes mellitus’ or the ‘Sri Lanka Diabetes Aerobic and Resistance Training (SL-DART) Study’ is “novel”.

Dr. Ranasinghe has a PhD in Sports and Exercise Medicine, the only doctorate in this discipline in the country.
It is after this study that he reiterates that in the management and prevention of diabetes Sri Lanka should move away from the ‘disease model’ to a ‘health model’. Many lifestyle changes including exercise, nutrition and psychological aspects would help not only in managing diabetes but also in preventing people falling victim to this disease, says Dr. Ranasinghe who is a Lecturer at the Colombo Medical Faculty and Visiting Fellow at the School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia.

Before his groundbreaking study, there have been no documented studies in Sri Lanka and only limited studies in South Asia, comparing the effects of AT and RT on glycaemic control, visceral adiposity (anthropometric), liver enzymes and blood lipid profiles (biochemical) of people with diabetes, he says, explaining that to the best of his knowledge, there is no comparison of the effects of RT and AT on physiological and behavioural parameters in Sri Lankans.

Studies tend to be conducted with regard to Caucasians who have a different body composition to South Asians, while the addition of a qualitative study to assess the barriers and facilitators for compliance and adherence to exercise has not been documented to date, according to him.

Dr. Ranasinghe says that usually in Sri Lanka though the first-line of management of Type 2 Diabetes is nutrition and exercise, no interventional clinical studies have been done here. There is only one small-scale study in India about the impact of AT and RT.

This is the first RCT of this magnitude done in the region, with supervised intervention being carried out for three months. It had been conducted in collaboration with the Colombo Medical Faculty and the Queensland University of Technology.

For Dr. Ranasinghe’s study, he had recruited 86 sedentary Sri Lankans with diabetes in the age-group 35-65 years. Of them 53% were women. Most participants were overweight or obese, with a high prevalence of central obesity.
The study participants’ mean age, weight, height and BMI (body-mass index) were 50.1 years; 67.7kg; 1.6m and 26.4kg respectively.

“They were ‘randomized’ into aerobic exercise training (AT), resistance exercise training (RT) and control (CN) groups,” he says, which means that people were allocated at random (by chance alone) to receive one of the clinical interventions or none (control group). Those in the control group had only standard pharmaceutical care.

Of the 86 participants, 28 were in the AT category; another 28 in the RT category and 30 in the control group.
Supervised progressive exercises were conducted 2 days/week for 3 months.

A qualitative study using in-depth interviews had also been conducted to assess the experiences of the participants who completed the programme.

Exercise should be first-line of therapy for Lankans Exercise can be recommended for therapeutic management of Type 2 Diabetes and should be taken as a first-line of treatment in the Sri Lankan population, the study clearly showed, says Dr. Chathuranga Ranasinghe. The proof was evident, with the results being: There was a reduction in blood glucose and fasting insulin levels in those who engaged in progressive supervised aerobic exercise training (AT) and resistance exercise training (RT), compared to the control group. This showed the ability to use exercise as a therapeutic mode in the Sri Lankan population. The exercises used were different to just walking and common physical activities done by the public. Thus, progressive high intense activities are possible with proper screening and supervision. Other pre- and post-intervention measures were biochemical (blood lipids, liver enzymes, markers for measuring future heart disease risk); anthropometric [weight, body-fat percentage and lean muscle mass scans (DEXA scans) and waist circumference]; physical fitness (strength and endurance); and behavioural (preference for food and quality of life). Apart from blood glucose, other blood parameters improved Strength levels and aerobic endurance improved markedly Body fat levels and waist circumferences reduced Quality of life parameters increased Food preference to high fat, sweet food reduced People’s behaviour changed

What is AT and RT Aerobic training/exercise (AT) Aerobic training/exercise also known as cardiovascular endurance exercise is a relatively low-intensity exercise that depends primarily on the aerobic energy-generating process and uses oxygen via aerobic metabolism to adequately meet energy demands during exercise. The aerobic training intervention included three exercises — brisk walking on a treadmill; stepping up and down on a stepper and stationary cycling in moderate intensity in a circuit manner. Each session was 75 minutes, twice a week (150 minutes per week) continuously for 12 weeks. This group followed a supervised progressive aerobic training where the exercise intensity was monitored during exercise using heart rate monitors. Resistance training/ exercise (RT) Resistance exercise or strength training, uses resistance to induce muscular contraction which builds the strength, anaerobic endurance and size of skeletal muscles as well as improving bone strength and metabolism. Seven exercises targeted major muscle groups in the upper body (shoulder press, lateral pull down and biceps curl); lower body (leg press/squat, leg extension and heel lifts) and core (abdominal crunches starting with pelvic and core muscle activation). Body resistance, free weights and exercise machines were used for resistance in a circuit manner during the exercise sessions. Each session was 75 minutes, twice a week (150 minutes per week) continuously for 12 weeks. The volume of exercise progressed from 1 set of 8 repetitions up to 3 sets (1×8 to 3×8) and then with increasing resistance, according to individual capacity. All participants were supervised during exercise by Dr.Chathuranga Ranasinghe who is trained in clinical exercise prescription in Australia.

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