When the new Alberta Diabetes Institute opened its doors in the new Health Research Innovation Facility (HRIF) on North Campus to plenty of fanfare last November it marked a new day
? and an exciting new venue - for the Faculty?s exercise physiologists and scientists in behavioural medicine to continue to forge new knowledge about physical activity?s impact on diabetes, it?s prevention and mitigation.
The Institute will also house biomedical research for the Faculty of Medicine and Dentistry, the Faculty of Agriculture, Life and Environmental Sciences. It?s here that collaborative, interdisciplinary and multi-disciplinary research will take place in coming to grips with one of Canada?s most prevalent diseases.
Dr. Normand Boul? has spent much of his career gathering evidence that shows physical activity is effective to help prevent and treat diabetes. But he's also found that traditional clinical approaches to treat the disease may not take full advantage of this fact.
"It's known that physical activity is an important element in the treatment of diabetes, but I'd say most clinics?maybe more than 95 per cent of the places I've surveyed?do not have exercise specialists promoting physical activity and answering related questions," says Boul?, a professor in exercise physiology in the Faculty of Physical Education and Recreation.
"These places have physicians, nutritionists, pharmacists, and nurses on staff, but physical activity experts are mostly left out," he adds.
The University of Alberta diabetes treatment program is one of those that have not ignored the importance of physical activity. For more than a decade, exercise physiologist Dr. Gordon Bell, was part of the diabetes education centre run at University of Alberta Hospital.
"The centre previously offered a team-based approach to teach diabetes patients about the disease from A to Z, and my part has been to educate them about the importance of physical activity and how it can help them," Bell says.
It may not be surprising that the University of Alberta has taken such progressive steps to treating diabetes, a disease that Health Canada says is currently present in more than two and a quarter million Canadians, with the number expected to rise to more than three million by the end of the decade.
The U of A has long been known as a world-leader in diabetes research and treatment. In particular, the U of A is the birthplace of the Edmonton Protocol, a method to transplant islet cells in patients with type 1 diabetes to help them produce their own insulin.
However, with all that has been achieved in diabetes research and treatment at the U of A, many feel the best is yet to come, and will come soon.
The reason for the optimism is the recent opening of the Alberta Diabetes Institute (ADI) on campus. The $300 million research and clinical facility will support more than 35 principal researchers from across five different U of A faculties. It will also include more than 200 support staff, all of them working with the single goal of finding a cure for diabetes.
"This new building really is a hallmark of our international success so far, and it's a landmark for things to come in the field of diabetes treatment and research," says Dr. Ron Plotnikoff, who is one of Canada?s foremost scholars in behavioural epidemiology. Plotnikoff is the director of the Physical Activity and Population Health Research Laboratory in the Centre for Health Promotion Studies in the School of Public Health and holds a CIHR Applied Public Health Chair.
Diabetes results from a person's total inability to produce insulin (Type 1) or a partial inability to produce insulin (Type 2). Insulin is needed to turn glucose into energy in the body, and when this process breaks down it can lead to a number of other health deficiencies, such as blindness and heart disease. Type 2 diabetes, which many experts believe is becoming an epidemic in North America, generally occurs in mature adults as a result of a poor diet and a sedentary lifestyle. Type 2 diabetes is often linked with obesity and is becoming more prevalent in the young as well.
With the increased attention on physical activity and its affect on diabetes, four professors from the Faculty of Physical Education and Recreation are among the 35 principal researchers at the ADI.
Dr. Wendy Rodgers will join Bell, Boul? and Plotnikoff at the ADI, where they will continue their work exploring issues related to physical activity and diabetes.
"Gord and I study the physiological side of things, such as how exercise affects glucose levels and how cells become sensitive to insulin. And Ron and Wendy work on the behavioral side, learning about how to develop programs that make exercise more enjoyable for people so that they'll actually do it and keep it up," Boul? says.
Among many research projects, Boul? will look at different types of exercise and whether or not they can lead to the preferential loss of different types of fat, particularly deep abdominal fat, which is associated with most forms of obesity and often leads to diabetes.
"There are a lot of myths with regard to doing exercises in order to target certain areas of the body, like the flab behind the arms, and we've agreed that's not how things work for that particular area of the body. But for other types of fat, such as deep abdominal fat, we may be able to mobilize and utilize different types of behavior to target that area," he says.
For example, Boul? noted there is evidence showing that high intensity exercises have more benefits to prevent and treat diabetes than low intensity exercises, and he believes high intensity exercise may be a better type of exercise to reduce abdominal fat, as well.
"The difficulty is that high intensity exercises are not associated with pleasure, especially for someone who is used to living a sedentary lifestyle," Boul? says.
For his part, Bell hopes to do more collaborative research at the ADI by continuing to study the various benefits of physical activity in individuals with either Type 1 or Type 2 diabetes and is interested in how exercise affects patients who have gone through the Edmonton Protocol and have had islet cell transplantations.
"We know physical activity can also provide many benefits to people with Type 1 diabetes, but we don't know enough about how this translates to individuals who have received islet transplantations," Bell says. "But it's something we plan to find out and will be more possible by being able to work with other researchers and physicians that will also be a part of the ADI."
Both Bell and Boul? know that physical activity is a critical element of any comprehensive diabetes prevention and treatment plan, but finding ways to get the patients to exercise is just as important.
"Let's face it, we know physical activity is important for everyone, but with the increasing incidence of diseases such as diabetes obviously people are not doing it, so we need to find appropriate ways to ensure people will do enough physical activity and do enough of it to become healthy," Bell says.
"Why don't they want to exercise? It could be socio-economic reasons, they could be too busy, it could be environmental?maybe there are no safe places to walk in their neighborhood?but the point is we need to know how to design better programs so that people participate enough to get health benefits. That's why Wendy and Ron's work is so important," Bell adds.
For more than a decade, Rodgers has conducted research and developed programs and methods to encourage people to exercise and stick with it. She considers many of the factors that may affect people's behavior related to physical activity, and then she does fitness assessments and offers fitness "prescriptions".
She is planning to start a new study in January to test a theory related to the costs of self-regulation. A researcher named Roy Baumeister created the theory, and Rodgers wants to test it in the context of physical activity.
"The idea behind the theory is that if we have to make conscious efforts of will to self-regulate, such as consciously not eating a food we would really like to eat or making conscious efforts to keep our activity levels up, this depletes our self-regulatory muscle, so we become fatigued in the self-regulation department and therefore perform less well on subsequent tasks," Rodgers says. "We want to see if that has any real-life manifestations."
Plotnikoff also explores the factors that affect whether or not we exercise through his Physical Activity and Population Health Research Lab where he currently supervises a large group of graduate trainees and research staff on numerous studies.
"We have national- and provincial, and community- based studies (with both healthy and those living with diabetes populations) where we examine the determinants of physical activity. With this information, we then test and design theoretically-based, physical activity promotion interventions and programs," Plotnikoff says.
For example, Plotnikoff has examined whether or not e-mail messages, telephone counseling, print-based materials, pedometers or a combination of such strategies are effective approaches to encourage people to exercise. He also takes into consideration the costs of each method.
"With the growing rise of Type 2 diabetes, which is related to the obesity epidemic, it's extremely important for us to find ways to keep people active and healthy. Aside from the obvious benefits of improving the quality and length of life of people, a healthier population also saves our health care system significant costs," says Plotnikoff, who was recently named a Canadian Institutes Health Research Chair in Applied Health.
Plotnikoff and the other ADI-affiliated Physical Education and Recreation professors are all enthusiastic about the new research and treatment opportunities that the ADI will foster.
"We already collaborate with many researchers in clinicians from across faculties at the U of A, but our challenge is that we work in isolation of each other physically," Boul? says. "When we're all under the same roof and having coffee together at the ADI, there'll be a lot more opportunities for exchanging ideas and benefiting from common resources."
"Having many of the diabetes experts in the same building will definitely help solidify the integration of our interdisciplinary work," Plotnikoff adds. "The record of work at the University of Alberta in diabetes has been outstanding, and the exciting thing is that I think this will provide even more significant research advances in this area.?
- Centre for Health Promotion Studies, School of Public Health - Dr. Ron Plotnikoff
- Exercise Physiology Laboratory, Faculty of Physical Education and Recreation - Drs. Bell, Boul? and Rodgers