Evidence shows that physical inactivity, together with poor nutrition, increase the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) which are responsible for 71 per cent of all deaths worldwide. For instance, diabetes is one of the top causes of death globally. The International Diabetes Federation (IDF) with the World Health Organization (WHO) have estimated that 451 million adults live with diabetes worldwide. In Africa, more than 19 million adults are living with diabetes, according to IDF, with a projected increase to 47 million by 2045. According to the Diabetes Atlas, the prevalence of diabetes in Rwanda is about 3.16 per cent of the population with more than 2000 diabetes related deaths per year. Today, many people struggle to brighten their future by working hard. On reaching there, they find themselves unable to enjoy what they have been struggling for due to serious conditions that force them to change their lifestyle. They then realise that they forgot about two important things— exercise and diet. Non-communicable diseases have so many complications which may lead people to leave work at an early age, face amputation or impairment of reproductive functions, as well as live under harsh conditions, and many other consequences. However, there are some preventive measures for these diseases. What is the role of physical activity in fighting NCDs? Also, diabetes as a major non-communicable disease, what are its types, symptoms, prevention and management? How and why are exercise and diet the best ways to control diabetes? Non-communicable diseases (NCDs) are conditions that are not transferred from person to person, or are non-contagious diseases. They are categorised into four main types; cardiovascular diseases like stroke and heart attacks, cancers, chronic respiratory diseases and diabetes. Those NCDs are closely linked to obesity, a disorder involving excessive body fat and being overweight beyond 30 body mass index (BMI). Increase in physical inactivity due to the sedentary nature nowadays work and modes of transportation, together with shift in eating habits towards diets containing energy-dense foods high in fat and sugar, are main modifiable risk factors that affect an individual’s susceptibility to NCDs. There are other non-modifiable risk factors like genetic makeup, and tobacco and excessive alcohol intake. Research shows that physical inactivity is the most common cause of NCDs. Physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure. Regular and adequate levels of physical activity helps to improve muscular and cardiorespiratory fitness, improve bone and functional health, reduce risks of obesity, hypertension, coronary heart disease, stroke, diabetes and various types of cancer since they are fundamental to energy balance and weight control. Don’t confuse physical activity with exercise which is a planned, structured, and repetitive subcategory of physical activity—with the aim of improving and maintaining components of physical fitness. Physical inactivity shortens lifespan by three to five years and, it burdens society through the hidden and growing cost of medical care and loss of productivity. About diabetes Diabetes is a condition that impairs the body’s ability to process blood glucose or blood sugar. Diabetes can occur when the pancreas (organ behind the stomach) produces very little or no insulin (for type I, or insulin dependent and juvenile diabetes). Or when the body does not respond appropriately to insulin for type 2 or non-insulin dependent, and then gestational diabetes where the body becomes less sensitive to insulin during pregnancy. Glucose is the type of sugar coming from food taken which fuels the body, and insulin is the only hormone responsible to carry glucose into the cells throughout the body, which use it as a source of energy. Simply, insulin controls blood sugar levels by returning high back to normal. The insulin deficiency leads to hyperglycaemia (build-up of sugar in blood) and overtime, it becomes life threatening since serious health complications such as stroke, heart and kidney diseases, high blood pressure, nerve damage like neuropathy and blindness may start without ongoing and careful management. Anyone can be affected by diabetes but some are at greater risk than others. People with pre-diabetes (high blood sugar but not high enough to be type 2 diabetes) are at risk of developing type 2 diabetes, and those conditions share similar risk factors. These include being overweight, family history of diabetes, cardiovascular disease and high blood pressure, gestational diabetes, history of polycystic ovary syndrome, being over 45 years old, sedentary lifestyle, high-density lipoprotein, cholesterol level lower than 40mg/dl, high risk races with ethnicity and geographical location. There is no known cause for type I diabetes while type 2 has clear causes. The occurrence of diabetes is much higher in men but seriousness of the disease is more prevalent among women. How can you determine you are diabetic? At the start of disease, only a few symptoms appear so you can’t know what condition you are suffering from. American Diabetes Association (ADA) estimates about eight million people have the disease and don’t know it. Type 2 diabetes is the most common with about 90 per cent of cases. If you are experiencing slowness in wound healing, frequent urination, dry and itchy skin, extreme thirst and hunger, sudden weight loss, blurry vision, tingling and abnormal fatigue, bladder or vaginal yeast are warning signs of diabetes. Rapid and serious effects of diabetes are seen in its complications on eyes, kidney and cardiovascular systems. Confirmation of having diabetes is only made after its diagnosis by a qualified doctor who is the one to decide what follows. As mentioned before, diabetes can be triggered by abnormal function and cell resistance. For instance in type 1 diabetes, an autoimmune disease may occur where the body attacks and destroys its own cells. The exact cause of these reactions is not known but some specialists suggest that it may be infection with a particular virus or bacteria, or exposure to chemical toxins from food or cow’s milk during infancy—though still unverified. However, type 2 diabetes is caused by variation of insulin production and glucose transport to the cells due to obesity, unbalanced diet, physical inactivity, pregnancy, overuse of some medicine and other conditions such as pancreatitis. On the other hand, stress and high blood pressure have a close relationship with the occurrence of diabetes. Currently, there is no cure for diabetes, thus its management is still on preventive and treatment levels. Diabetes is diagnosed commonly with blood tests performed after you have had nothing to eat or drink for at least eight hours—it can be done even at home or with glycated haemoglobin test performed in a laboratory. Note that normal blood sugar levels sit between 70 and 99 mg/dl, pre-diabetes is between 100 to 125 mg/dl and 126mg/dl or higher for a diabetic one. If found, it is better to immediately start treatment strategies with the main goal of keeping the levels of blood sugar as normal as possible. This would include self-management, medical intervention and lifestyle modification. Treatment of diabetes varies within individuals depending on its type. In type I diabetes, treatment always involves insulin doses (injections or pumps) to replace absent one and keep blood sugar level steady, and must be accompanied by taking a balanced diet and exercise. Type 2 diabetes can be managed with lifestyle measures, oral medications, injections, and also insulin if other treatments are not successful. Weight reduction and exercise can be helpful since they increase the body’s sensitivity to insulin. The idea of artificial pancreas and insulin-producing pancreatic cells is ongoing research and scientific research is made in the hope of curing diabetes. Note that people can’t take insulin orally because the stomach breaks down the hormone. Moreover, a doctor may refer a person with diabetes or pre-diabetes to a nutritionist and physiotherapist. Physical activity and nutrition are important parts of a healthy lifestyle for diabetes management and prevention. What you choose to eat, how much or when you eat and drink are all significant in keeping your blood glucose level in range. Avoid food high in salt, cholesterol as well as empty carbohydrates and take fruits, vegetables, fibre-rich foods by dividing plate into three sections and take no or moderate alcohol. In addition, you have to exercise regularly by including a daily routine of aerobic exercises (bicycle riding, walking, and swimming) and stretching exercises like yoga. Eating well and being physically active most days of the week can help you to stay at a healthy weight, feel good and have more energy, keep your blood glucose level, blood pressure and cholesterol in the target range. In addition to a balanced diet and physical activity, here are other lifestyle behaviours that promote healthy blood sugar. You have to drink water as your primary beverage, try to lose weight if you are obese or overweight, quit smoking if you do so, follow a very low-carb diet, watch portion sizes and minimise the intake of processed food, avoid sedentary behaviour or sitting in a position for a long period of time, optimise your vitamin D levels, try to include coffee and tea and natural herbs such as berberine to increase insulin sensitivity, check your blood cholesterol and keep your blood pressure under control, drink in moderation, go for early detection of diabetes by being screened regularly to prevent complications and take medications as prescribed. Self-management measures can reduce blood sugar levels, mortality risks, health care costs as well as weight in obese people. Non-communicable diseases can be prevented, controlled or managed. People with chronic health problems can improve their health by learning how to increase physical activity levels and exercise safely under the guidance and instructions of physiotherapists. “Clinical trials have shown that exercises, healthy eating and modest weight reduction can prevent diabetes and others NCDs,” says endocrinologist Douglas Zlock, MD, Medical director of the Diabetes Center at John Muir Health. It takes time and effort to reduce your risks, however, this investment in your health is a valuable one. In case of disease, you have to follow nutrition and medication plans together with regular check-up and other lifestyle changes. “Let food be thy medicine and medicine be thy food”. The author is a medical student
