ISLAMABAD – According to the World Health OrganizationTrusted Source, obesity rates have tripled worldwide since 1975. The connection between obesity and insulin resistance is bidirectional. Insulin resistance often develops due to being overweight or obese, which can lead to type 2 diabetes.

Since type 2 diabetes can be a costly disease to treat, contribute to many health issues, and even be fatal, researchers are interested in learning about different ways to improve insulin resistance.

Exercise is an important aspect of health. Prior studies have shown it can improve insulin resistance. In a new study published in Diabetologia (the journal of the European Association for the Study of Diabetes), researchers found a connection between exercise timing and insulin resistance.

Insulin resistance and type 2 diabetes

The beta cells in the pancreas produce insulin, a hormone the body creates that is responsible for regulating blood sugar levels.

Some medical conditions can impact the body’s ability to produce or respond well to insulin, including type 1 diabetes and type 2 diabetes.

Type 1 diabetes occurs when a person’s body produces little or no insulin. Doctors usually diagnose this form of diabetes earlier in life, and there is no cure.

Someone who develops insulin resistance may be diagnosed with type 2 diabetes.

According to the American Diabetes Association, insulin resistance occurs when a person’s body has “built up a tolerance to insulin, making the hormone less effective. As a result, more insulin is needed to persuade fat and muscle cells to take up glucose and the liver to continue to store it.”

This form of diabetes is more common in middle-aged and older people. Type 2 diabetes is also more prevalentTrusted Source in people who are either overweight or have obesity, and they can manage it through medications, diet, and exercise.

Unlike type 1 diabetes, people with type 2 diabetes can go into remission with lifestyle changes in some cases, including substantial weight loss.

Analysis of physical activity

The researchers examined data from the Netherlands Epidemiology of Obesity cohort study, which collected data from 6,671 individuals ages 45 to 65 between 2008 to 2012.

Some of the collected data included BMI, fasting and after-meal blood glucose and insulin samples, and MRI scans of people who could undergo imaging. Additionally, 955 participants wore activity monitors for 4 days.

From the group that wore activity monitors, the researchers whittled down the participant pool to 775 participants with an average age of 56. The group makeup was 42% male and 58% female, with an average BMI of 26.2.

Through examining data from the activity monitors, the researchers divided up the daily periods into three segments: 6:00 a.m. to 12:00 p.m. (morning), 12:00 a.m. to 6 p.m. (afternoon); and 6 p.m. to 12 a.m. (evening). They excluded the hours from 12 a.m. to 6 a.m.

For each of the 6-hour periods, the researchers looked at the different levels of activity recorded by the heart rate monitors.

Benefits of afternoon or evening exercise

After analyzing the data collected, the researchers did not find a link between breaks in sedentary activity and reduced insulin resistance.

However, they did find an association between insulin resistance and the time of day the participants performed moderate-to-vigorous physical activity, as recorded by the activity monitors.

The findings suggest that moderate-to-vigorous physical activity in the afternoon led to an 18% reduction in insulin resistance, and the same types of activity in the evening were linked to a 25% reduction — in comparison to physical activity spread throughout the day.

They found no difference in MVPA and reduced insulin resistance in the morning segment of the data.

The researchers also examined the liver fat captured in the MRI scans and noted that the number of breaks in sedentary time did not impact liver fat content.

“Further studies should assess whether timing of physical activity is indeed important for the occurrence of type 2 diabetes,” the authors wrote.

Implications on exercise recommendations

Dr. Michael Sagner, President of the European Society of Preventive Medicine, spoke with Medical News Today about the study’s findings.

“It is certainly timely to investigate chronobiological effects of exercise,” said Dr. Sagner. “Timing of exercise is a relatively unexplored field in human studies and needs more studies.”

Dr. Sagner noted a weakness of the study being the limited 4-day window in which the participants were monitored and said more research is needed “if certain types of activity provide more health benefits when done during specific times of the day.”

“The present study cannot lead to any changes in the current recommendations. Physical activity is essential for health and disease prevention and should be built into the weekly routine, nevertheless the timing throughout the day.”
– Dr. Michael Sagner

Dr. Ishita Patel, a board certified endocrinologist with Texas Diabetes and Endocrinology, also spoke with MNT about the study. Dr. Patel also thought that exercise timing in reducing insulin resistance needs more research.

“The study data analyzed was over a short period – four days” Dr. Patel pointed out. “It would be interesting to assess the liver fat and insulin resistance over a prolonged period of time, and also [its] relevance to populations of concern – such as pre-diabetics and diabetics.”

As Dr. Sagner also mentioned, Dr. Patel thought the important thing about exercise is to make it part of the routine rather than focus on the timing.

“The vast majority of people are so busy that finding any time to exercise regularly is challenging. Similarly to how we counsel on diet, I feel that consistency with exercise should be encouraged more than adding the additional challenge of finding ‘the perfect time’ to exercise.”

DNA

Islamabad, NOV 4: Constitutional supremacy, electoral reforms to ensure inclusivity, rule of law, focus on public service delivery, leadership development, taking responsibility and ownership, citizenship awareness, participatory governance based on the realities of socio-political culture of Pakistan instead of adopting Western models, and optimum use of technology for creating efficient systems for governance at all levels of the state were the salient ideas put forward and extensively debated by eminent policy practitioners and academics in a seminar jointly organized by Institute of Policy Studies (IPS) and Islamabad Policy Research Institute (IPRI).

The session titled ‘Political System and Governance in Pakistan’ was part of the ‘Grand National Dialogue’ initiated by IPRI recently, aiming to take inputs and ideas from academics, intellectuals and practitioners over a host of national issues, in a bid to convert them into actionable recommendations for policy makers.

Chaired by Chairman IPS Khalid Rahman and co-hosted by Brig (r) Raashid Wali Janjua, director research at IPRI and Ambassador (r) Syed Abrar Hussain, vice chairman at IPS, the seminar was addressed by Syed Abu Ahmad Akif (SI), former federal secretary, Dr Syed Tahir Hijazi, former member governance, Planning Commission of Pakistan, Dr Noreen Saher, associate professor/chairperson, Department of Anthropology, International Islamic University, Islamabad (IIUI), Muhammad Arshad, CEO, Sehat Sahulat Program, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, and Jawad Akhtar Khokhar, advisor, maritime affairs, Planning Commission of Pakistan. Naufil Shahrukh, IPS’ GM Operation, moderated the session.

Initiating the discussion, Akif put up a series of questions highlighting several internal and external contributory factors leading to the governance deficit in Pakistan. He underscored economic mismanagement, political disorder, deteriorating civil services, civil-military relations, internal conflicts, lawlessness, extremism, militancy, intolerance, rising debts, external forces, and geo political circumstances as some of the reasons behind the sorry state of affairs in the country.

He urged on the need to change the mindset to a productive and constructive one, stressing that no problem can be solved by the same thinking that generated it in the first place.

Arshad backed Akif’s notions, maintaining that not everything was bad in the country and several success stories can be seen in its journey of seventy-five-years. The development of nuclear weapons and the success against the war on terror were a couple of highlighted examples, but the country has also witnessed commendable progress in some other areas as well and the national capacity to use ICT for governance and public service delivery is at par with the developed nations.

The speaker termed the successful planning and implementation of Sehat Sahulat program no less than an achievement itself, as it was delivering health services to 170 million people through 1036 hospitals across the country. A precedence of such a model with such magnitude and in the face of such insurance challenges, according to him, was not even seen in the G7 countries, and the fact that all this was done with any political conformity makes this achievement even sweeter.

The speaker maintained that this is just another success example that can be replicated in other sectors as well. The only requirement is to channelize the available resources and adopt the real model of inclusive governance where everyone has a specific role to play, for which he takes ownership and becomes responsible and accountable.

Khokhar spoke from the perspective of Gwadar, pointing out challenges in the areas of Gwadar port and city integration, travelling, connectivity and training. On the other hand, he also highlighted some achievements with the help of Chinese institutions in the area and participation of all stakeholders at the federal, provincial and local government levels. He claimed that the genuine, basic demands of the natives were being taken care of now and the past mistakes have been mostly rectified.

Dr Hijazi mentioned NADRA as one of the country’s biggest success stories as a facilitator and catalyst of good governance.

Dr Seher termed negativity and pessimism about our own culture as a disease. She quoted that nations face good and bad times, but ethnocentrism prevents them from going down. We, on the other hand, are facing Xenocentrism, which is the result as well as the target of the fifth-generation warfare.

She pointed out that there exists extensive natural and cultural diversity in Pakistan, but the real problem is the lack of ownership and twisted priorities. With 60 percent youth population, Pakistan is extremely rich in its contemporary resource and only need to bring competence into the mainstream. In the era where proxy war is being waged to divide the country, we need to capitalize on our strengths of collectivism and networking.

Khalid Rahman, concluded the session by advocating for electoral reforms for proportionate democracy, strengthening local body system and student unions as nurseries of healthy democracy, intra-party democracy, use of technology and digitization for governance, smaller administrative units and fiscal devolution.

He also highlighted the Principles of Policy of the Constitution of Pakistan that are a guiding light for the essential morality and value framework for the country’s governance at all levels.

He viewed that there were need for reforms in many areas, but the constitution should always be protected and the parliament should be strengthened. The hybrid model of governance should gradually be eliminated, though not by means of any conflict. Instead of being wasted on finger pointing, the energies should rather be utilized to come out of the problems collectively.

Rahman opined that we need to look through a bifocal lens, through which we could see both our weaknesses and strengths. On the other hand, we must not stay in the mode of denial, and start taking ownership of our own responsibilities while avoiding any blame game.

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