Stepping up to the Challenge of Diabetes

Stepping

up

to the

challenge of diabetes

Proposal to support

The Physical Activity and Diabetes Laboratory in the

Alberta Diabetes Institute at the University of Alberta

a

new era in diabetes research

“ Walking is man’s best medicine.”

Hippocrates (ca. 460-370 BC) Ancient Greek physician

The Challenge Diabetes is one of the most prevalent and perplexing diseases facing the modern world – and it’s on the rise. According to the Canadian Diabetes Association nearly six million Canadians are living with pre-diabetes, a condition where blood glucose levels are higher than normal – and that up to 50 per cent of those will eventually go on to develop type 2 diabetes.

Type 2 diabetes affects 90 per cent of all people with diabetes and more than 20 people are diagnosed with the disease every hour of every day.

This increasingly prevalent, yet largely preventable disease, is characterized by high blood glucose caused by a combination of reduced sensitivity to the hormone, insulin, and impaired insulin secretion. Excess body fat and a sedentary lifestyle are considered important, modifiable risk factors for type 2 diabetes.

Type 1 diabetes impacts 10 percent of people with diabetes. Most commonly diagnosed in childhood and adolescence it can be life-threatening if not managed appropriately. In type 1 diabetes the beta cells in the pancreas fail to produce insulin for reasons science doesn’t yet fully understand and management of blood glucose levels becomes critical for survival.

The Canadian Diabetes Association’s (CDA) landmark report, An economic tsunami: the cost of diabetes in Canada, estimates that by 2020, the number of Canadians with diabetes is expected to rise to at alarming 3.7 million. Currently health care costs for diabetes amount to 3.5 per cent of public healthcare spending in Canada, according to the CDA’s study. In Alberta, the Alberta Diabetes Surveillance System found that the number of Albertans with diabetes doubled between 1995 and 2007 to one in 20.

Diabetes: physical activity leads the way to better management of the disease

These are staggering numbers to contemplate and ones researchers in the Faculty of Physical Education and Recreation are determined to tackle – and reverse.

Alarmingly, obesity has surpassed smoking as the biggest threat to overall health. With obesity and overweight comes a pronounced risk for many chronic diseases, including cardiovascular disease, hypertension and stroke, cancer – and type 2 diabetes.

We know why the increase in type 2 diabetes is occurring: the population is aging, obesity rates are climbing, Canadians are increasingly sedentary despite a plethora of welldocumented and publicized evidence showing the importance of regular physical activity and healthy food choices.

Within a multicultural Canada, approximately 80 per cent of new Canadians come from populations that are at higher risk for type 2 diabetes, including people of Hispanic, Asian, South Asian or African descent. Particularly hard hit are Aboriginal people, who are three to five times more likely than the general population to develop type 2 diabetes.

Diabetes negatively impacts quality of life and shortens lives: people with type 2 diabetes can expect to live up to a decade less than other Canadians.

Recently, we’ve become aware that there is a growing incidence of type 2 diabetes among children as childhood obesity in Canada continues to rise. One in five children in Canada is not sufficiently physically active to derive health benefits from it.

Rising obesity and type 2 diabetes rates mean rising healthcare costs. A person with diabetes can rack up medical expenses two to three times higher than those of a person without diabetes. People living with this debilitating disease can also incur direct costs for medications and supplies, some as high as $15,000 annually. Rough estimates put the cost of combating diabetes to the Canadian healthcare system at about $13.2 billion every year.

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Meeting the Challenge There are now more obese people in the world than undernourished people. Many obese people have blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes, a condition called pre-diabetes.

Our Physical Activity and Diabetes Laboratory (PADL) will open the doors wide to new discoveries in diabetes treatment.

Our researchers know that if people can manage their blood glucose when they have pre-diabetes, they can delay or prevent the onset of type 2 diabetes. They also know that physical activity is critical for assisting with glucose control and reducing many of the negative side effects of both type 1 and type 2 diabetes. Our goal is to stem the onslaught of diabetes by understanding the subtle physiological changes occurring in the body and devising effective physical activity and behaviour modification strategies that stop diabetes in its tracks or mitigate its impacts on quality of life.

Research shows that while a sedentary lifestyle is not a major risk factor for type 1 diabetes, which is primarily a result of pancreatic beta cell destruction, exercise can play an important role in managing it. Our research in the Physical Activity and Diabetes Laboratory (PADL) could shed valuable insights on a number of key health impacts associated with type 1 diabetes, including: reducing the risk of hypoglycemia or hyperglycemia during and after exercise, reducing the risk of diabetes-related complications and improve quality of life, and reducing insulin requirements

Vision

While there is no cure for diabetes, it can be managed effectively with a combination of exercise, nutrition and medication.

of physical activity

Our laboratory at the ADI will be at the heart of an outstanding, collaborative research enterprise at the University of Alberta. Here, a capable community of students, professors, health science and community partners will collaborate to advance the frontiers of knowledge about the prevention and mitigation of diabetes.

To optimize the use in the prevention and management of diabetes.

Mission

To develop physical activity research, education and opportunities for people with diabetes and their health care providers.

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The floors and walls are in place. Our plan is to complete the outfitting of the laboratory late in the spring of 2011.

PADL’s goals and amenities Specific goals of the Physical Activity and Diabetes Laboratory We will • Incorporate research in all aspects of the PADL’s work.

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Provide evidence-based education and training on physical activity and diabetes to graduate students and health care professionals working with people with diabetes.

Forge vital links and partnerships with fitness facilities in the community to expand opportunities for people with diabetes to be physically active in a sensitive, appropriate environment closer to their home or work.

Disseminate and deliver expert resources and education to trainers and facilities throughout the Capital Region to expand their knowledge of diabetes and how they can accommodate the physical activity, fitness, and health and lifestyle goals of people with diabetes.

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Provide a high-quality, first-class physical activity facility to people with diabetes; our aim is to transition those with well-controlled diabetes to facilities in their own communities over time.

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Accommodate those with more specific needs, such as people with poorly-controlled glycemia; newly diagnosed diabetes, those with amputations, or are morbidly obese, etc. with the opportunity to exercise with specialized equipment and supervision at the Physical Activity and Diabetes Laboratory.

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Conduct fitness and behavioural assessments for people with diabetes to ensure safe exercise participation.

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Collaborate with the nutrition group in the Faculty of Agriculture, Life and Environmental Sciences on combined nutrition and physical activity interventions.

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Measure the effect of prescribed physical activity on people with diabetes and those susceptible to the disease.

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Assist people who struggle with motivation and adherence to exercise, to prevent chronic diseases.

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Additionally the laboratory will serve as a physical activity centre, to enable researchers to monitor and supervise participants’ progress towards sustainable and effective activity levels.

We foresee PADL as a central hub advancing opportunities to conduct long term studies of diabetes patients to identify successful and effective exercise prescriptions, training factors, and behavioural motivation strategies which are most likely to result in lasting, positive changes.

Amenities in the Physical Activity and Diabetes Laboratory This >5002m laboratory space will consist of two principal spaces, designed to target improvements in musculo-skeletal and cardio-respiratory fitness and health, including 1. A 1502 m physical activity centre

This is where diabetes patients will be taught, supervised and monitored as they undertake various exercise prescriptions.

We know that adherence to any exercise prescription is vital to its effectiveness, and that for the uninitiated, supervised physical activity is the best way to ensure and verify participation.

The fitness centre will include • industrial-grade fitness equipment such as treadmills, cycles and, • strength training equipment.

2. A 1002 m fitness, lifestyle and health assessment laboratory, including a space for blood analyses.

It’s here that our researchers will conduct long term studies, critical for determining whether lasting changes in exercise behaviour and levels of physical activity have been realized, and to identify those exercise prescriptions and training factors which are most likely to effect permanent changes in behaviour.

The laboratory will include • Metabolic measurement systems • Electrocardiograms • Musculo-skeletal assessment equipment for measuring strength, flexibility and power • Behavioural assessment room • Equipment for blood drawing, storing and analyses.

In addition to these major components, the PADL will also have 1. 1002 m in office space to house researchers and graduate students

Physical Activity Centre

2. 1502 m for consultation rooms, locker rooms and storage

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Our Researchers It’s a dynamic group of investigators who have coalesced within the Faculty who look forward to conducting their work in one of the world’s most advanced laboratories of its kind.

Heading up the laboratory will be Dr. Normand Boulé. He has been studying the relationships between physical activity, obesity and type 2 diabetes. He has recently focused on identifying more effective physical activity approaches for the management of diabetes. He’s optimistic that combining these approaches with appropriate changes in the behavioral and environmental determinants of physical activity can dramatically reduce the impact of diabetes.

His colleague, Dr. Gordon Bell is particularly interested in the physiological assessment and prescription for fitness and healthrelated development. In particular, he has studied the role of physical activity in improving glucose uptake into muscle, and has recently worked closely with colleagues, studying the effect of physical activity of different intensities on glucose control, fasting insulin, insulin resistance and body weight management.

Their colleague, Dr. Wendy Rodgers is working with organizations that are closest to the problems, such as the Edmonton Public Schools and the Alberta Diabetes Foundation.

She’s studying the social psychology of exercise, health and lifestyle behavior; she’s interested in understanding the theoretical and practical issues of starting and maintaining effective exercise programs.

These exercise physiologists and behavioural scientists are bringing substantial research funding to their new laboratory.

They have received funding from the primary research granting councils in Canada, such as Alberta Innovates and the Canadian Institutes of Health Research, and a number of supportive nonprofit associations committed to tackling the diabetes epidemic.

This dynamic group of researchers is attempting to answer some of the most challenging questions related to diabetes.

These are the researchers that form the core of the work that will be conducted within the walls of the Physical Activity and Diabetes Laboratory and in the broader community.

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Our Research In the front ranks of the crusade to prevent and better manage diabetes A growing body of research clearly indicates that people at risk of developing type 2 diabetes can make substantial progress in avoiding the disease if they adopt healthier diets and engage in more active lifestyles. Likewise, many individuals with type 1 diabetes can benefit immensely from new and innovative physical activity and lifestyle interventions and reduce many of the complications associated with this disease.

Researchers in the Faculty of Physical Education and Recreation are researching new ways to deliver and sustain effective programs that help at-risk people and those already diagnosed with diabetes do just that. Those efforts will have huge implications for the overall health of Canadians and sustainability of the health care system.

Current research by investigators from the Faculty of Physical Education and Recreation includes: •

Investigations of the role of different types of physical activity on glucose control, body weight management and overall health design to improve the prevention and management of diabetes.

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Studying the interaction of various physical activity programs combined with different nutritional strategies for individuals with diabetes or those at risk for diabetes.

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Studies that attempt to understand the complex interaction between different types of physical activity and the effect of various medications commonly prescribed to those with diabetes.

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Designing and implementing different ways to increase physical activity intensity and the health benefits of doing so.

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Researching the effectiveness of using new technology and web-based strategies to implement and monitor physical activity and lifestyle change prescriptions.

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Investigating physical activity and lifestyle strategies for home based prescriptions for the individual and those that are more effective for the larger population.

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More fully understanding the role that physical activity and lifestyle can have on changing the growing trend of obesity and early onset of diabetes in our children and youth.

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Understanding the behavioural and social-cognitive aspects of physical activity, lifestyle and diabetes.

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Investigations of behavioural modification strategies and understanding why individuals adhere, or do not adhere, to physical activity and lifestyle programs that are designed to improve their health and physical activity levels.

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Investigating strategies to connect with other health care professionals and researchers in both urban and rural settings and ways to provide better diabetes prevention and management strategies to those with diabetes.

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Studying the growing incidence of diabetes in certain at risk cultures such as Canadian First Nations.

Fitness, lifestyle and health assessment laboratory

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Our Publications Relevant Publications about Diabetes and Physical Activity Johnson ST, McCargar L, Bell GJ, Catrine Tudor-Locke C, Harber Rhonda Bell R. Walking Faster: Distilling a complex prescription for type 2 diabetes management through pedometry. Diabetes Care, 2008:29(7):1654-5

Boulé NG, Weisnagel SJ, Lakka TA, Tremblay A, Bergman RN, Rankinen T, Leon AS, Skinner JS, Wilmore JH, Rao DC, Bouchard C. Effects of exercise training on glucose homeostasis: the HERITAGE Family Study. Diabetes Care. 2005;28:120-126.

Johnson ST, Robert C, Bell GJ, Bell R, Lewanczuk R, Boulé NG Acute effect of metformin on exercise capacity in active males.

Diabetes, Obesity and Metabolism, 2008(10):747-754

Boulé NG, Bouchard C, Tremblay A. Physical Fitness and the Metabolic Syndrome in Adults from the Quebec Family Study.

Canadian Journal of Applied Physiology. 2005;30: 140-156.

Johnson ST, Boulé NG, Bell GJ, Bell RC Walking: a matter of quantity and quality physical activity for type 2 diabetes management Appl. Physiol. Nutr. Metab. 2008:33:797-801

Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Metaanalysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia.

2003;46(8):1071-81.

Boulé NG, Chaput J-P, Doucet E, Richard D, Després J-P, Bouchard C, Tremblay A. Glucose homeostasis predicts weight gain: prospective and clinical evidence. Diabetes/Metabolism Research and Reviews. 2008;24(2):123-9.

Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud’homme D, Fortier M, Reid RD, Tulloch H, Coyle D, Phillips P, Jennings A, Jaffey J. Effects of Aerobic Exercise, Resistance Exercise, or Both on Glycemic Control in Type 2 Diabetes. A Randomized Trial.

Annals of Internal Medicine. 2007;147(6):I16.

Boulé NG, Sigal RJ. Physical Activity Recommendations in Type 2 Diabetes: From Theory to Practice. The Diabetes Communicator. 2007, May/June Issue.

Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Journal of the American Medical Association. 2001;286(10):1218-27.

Rodgers WM, Murray TC, Courneya KS, Bell GJ, Harber VJ. The Specificity of Self-Efficacy over the Course of a Progressive Exercise Programme. Applied Psychology: Health and Well-Being.

2009, 1 (2): 211-232 Hansen G, Blanchard C, Rodgers WM, Bell GJ. Efficacy of Prescribing Endurance Training Intensity Using the Ventilatory Equivalents for Oxygen and Carbon Dioxide in Untrained Men and Women. Research in Sports Medicine. 2003 (11): 23-32 Bell GJ, Harber VJ, Murray TC, Courneya KS, Rodgers WM. A Comparison of Fitness Training to a Pedometer-Based Walking Program Matched for Total Energy Cost. Journal of Physical Activity and Health. 2010 (7), 203-213

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Vision and Mission The Alberta Diabetes Institute Investigators: ADI brings together more than 45 basic and clinical investigators from across five different U of A faculties: Faculty of Agriculture, Forestry and Home Economics, Faculty of Medicine and Dentistry, Faculty of Physical Education and Recreation, the School of Public Health and the Faculty of Pharmacy and Pharmaceutical Sciences.

Research Programs: ADI investigators are active in basic and clinical islet transplantation, xenotransplantation and stem cell research, immunology and tolerance induction, beta cell signaling, nutrition and metabolism, population health, law, ethics, public policy, exercise physiology and human behaviour. The Faculty of Physical Education and Recreation is integral to the latter work.

Educational Programs: In partnership with the Alberta Diabetes Foundation, ADI offers financial support for innovative pilot project grants and graduate student awards. The ADI holds annual research days, typically attracting more than 100 participants. ADI has its own newsletter, Diabetes Future, and will be launching its own website and speakers program.

The Alberta Diabetes Institute: Vision and Mission A collaborative new way to tackle an old disease The vision of the Alberta Diabetes Institute is to lead the world in curing diabetes. Through scientific excellence and teamwork, we will discover new methods to prevent, treat, and cure diabetes. These discoveries will be rapidly translated into patient care in our clinics and shared world-wide.

Li Ka Shing Centre for Health Research Innovation: ADI researchers will occupy space on six of the building’s seven floors, providing exciting opportunities for cross-disciplinary collaboration and teamwork. This is where the Physical Activity and Diabetes Laboratory will be housed.

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Our Proposal Supporting innovative

Supporting our researchers and students

ways of tackling diabetes

Our Laboratory within the Institute will be much more than bricks and mortar. Our researchers currently enjoy substantial support from Canada’s research granting agencies, for example, Alberta Innovates and the Canadian Institutes of Health Research.

Since the early days of J.B. Collip—a University of Alberta biochemist who worked closely with Banting, Best and MacLeod to purify insulin, this University’s researchers have been on the forefront of pioneering new treatments for diabetes. However, for almost a century those same researchers have acknowledged the obvious: - Insulin is not a cure. Researchers associated with the Physical Activity and Diabetes Laboratory are pioneering new ways of preventing and treating people living with type 1 and type 2 diabetes.

The goal is simple: to optimize the use of physical activity in the prevention and management of diabetes mellitus and develop physical activity research, education and opportunities for people with diabetes and their health care providers. We believe this is the best way to combat the epidemic now upon us.

There are several ways you can support their important work.

Philanthropy makes the difference between solid financial support and outstanding financial support. The creation of a Faculty endowment in physical activity and health, therefore, will enable us to attract and retain the best scholars in the field.

Endowments allow us to provide scholarships, bursaries, travel supplements, stipends and salary support.

For example •

A minimum gift of $1000 annually for five years can create a named, graduate scholarship.

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A gift of $24,000 or greater is required to establish an endowed award that will sustain the minimum of $1000 required for graduate awards. An endowment creates annual investment income that is used to fund the award.

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Create a combination of an endowment and an annual award.

Naming opportunities The Physical Activity and Diabetes Laboratory, anchored within the Alberta Diabetes Institute, promises to be the foremost facility of its kind in Canada, at the heart of the effort to control diabetes. Our Laboratory, located beside the ADI administrative offices and the Alberta Diabetes Foundation’s administrative offices on the main floor, places our efforts at the core of ADI’s activities. It’s prime real estate! A gift of $500,000 will secure the naming rights to the Laboratory and ensure your contribution is recognized in perpetuity.

Naming opportunities are also available for each component, and include •

The fitness centre

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The exercise physiology and behavioural assessment laboratory

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Fitness equipment

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Operating funds and scholarships

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Supporting equipment costs We estimate it will cost approximately $500,000 to fully equip the lab. To remain on the cusp of discovery, the most advanced and sophisticated equipment—the tools our researchers will use—will ensure the Laboratory is state-of-the-art. You can give our researchers to tools they need to do the job.

This also affords a naming opportunity for equipment, with each donated piece of equipment being named for its donor.

You can support our laboratory with gifts of equipment to outfit any or all of the component parts of the laboratory, including (approximate costs)

Costs Item

Estimated cost

Laboratory Equipment Two metabolic measurement systems . ............................ 60,000.00 Two electrocardiograms .................................................. 20,000.00 Two Industrial-grade testing treadmills ............................ 26,000.00 Isokinetic dynamometer .................................................. 67,000.00 Blood-drawing, storing and analyzing equipment . .......... 25,000.00 Computer hardware and software ................................... 20,000.00 Fitness Centre equipment Aerobic training equipment ............................................ 75,000.00 Strength training equipment ........................................... 50,000.00 Audio-visual equipment .................................................. 15,000.00 Sub-Total ................................................................... 358,000.00

Supporting the ongoing operations of the PADL Help us keep the lights on with the gift of operating funding. This is a nuts and bolts way in which you can assist us in our work. Without it we simply cannot operate. By committing funds to the operating expenses of our laboratory, you’ll be lending a much-needed hand in keeping the doors to the PADL open, so we can continue to shine a light on the search for a cure.

Research operating support Nursing support................................. 60,000-80,000.00 per annum Certified exercise physiologist............. 60,000-80,000.00 per annum

Graduate student support Endowed award................................................................ 24,000.00 Other graduate scholarships............................................. 56,000.00

Total ...................................................... $558,000 - $598,000.00

We thank you for your support.

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Faculty of Physical Education & Recreation On the leading edge of research across the human movement spectrum The Faculty of Physical Education and Recreation offers three undergraduate degree programs, ranging from arts to science, Master’s programs, a Doctor of Philosophy degree, and an MBA in Leisure and Sport Management with the School of Business.

The Faculty ranks as one of the premiere faculties for research among its peers in Canada, renowned for its world-class research, focused on a very broad spectrum of kinesiological and health research, physical education, sport science and leisure studies across the abilities spectrum and lifespan.

From our studies of issues like childhood obesity, or how electrical stimulation can help people who have spinal cord injuries to regain mobility, or how culture shapes our athletes, our work has a profound impact on our community.

Those researchers associated with the new Physical Activity and Diabetes Laboratory (PADL) are helping to define new and emerging ways of studying and tackling chronic diseases— particularly diabetes. Furthermore, they’re reaching out to their cross-campus colleagues to design and conduct interdisciplinary research—increasingly seen as the way chronic diseases such as diabetes will be treated.

Please contact us if you would like to discuss any aspect of this proposal. We look forward to talking to you about our research and the work we’ll do in the PADL to find ways of changing lives through prevention and mitigation of this debilitating condition.

Contacts Normand Boulé, PhD Faculty of Physical Education and Recreation University of Alberta normand.boule@ualberta.ca Tel: 780-492-4695

Faculty of Physical Education and Recreation W1-34 Van Vliet Centre University of Alberta Edmonton, Alberta T6G 2H9

Gordon Bell, PhD gordon.bell@ualberta.ca Tel: 780-492-2018 Wendy Rodgers, PhD wendy.rodgers@ualberta.ca Tel: 780-492-2677

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