Exercise, Adiposity, and Regional Fat Distribution

Abstract

Being overweight or obese and physical inactivity markedly increases the risk of developing cardiovascular and other complications in persons with type 2 diabetes. Growing evidence highlights the adverse effect of having abdominal obesity on cardiometabolic health. There is also an increasing prevalence of non-alcoholic fatty liver disease, which also contributes to increased cardiometabolic risk among diabetics. Increasing levels of physical activity contribute to weight reduction, along with dietary interventions. However, independent of total body weight loss, exercise reduces abdominal obesity, and along with the concomitant benefits on multiple cardiometabolic risk factors such as hypertension, insulin resistance, hyperlipidemia, among others, plays a central role in reducing the complications of diabetes. There is some but not entirely conclusive evidence, mainly because of the lack of randomized, controlled trials, that exercise also reduces hepatic fat. Though exercise has been widely recognized as an cornerstone treatment in the medical management for type 2 diabetes, its benefits go beyond the established benefits on fitness levels. The discussion in this chapter focuses on the benefits of exercise on favorable altering body composition, which can occur largely independent of weight change. The resulting reduction in regional fat depots is an important benefit of regular physical activity. For most individuals with diabetes, participation in both aerobic and resistance exercise is recommended to maximize benefits on body composition. These benefits consist of reduction in fat and increased in lean mass.