Fitness & Physical Activity

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If you have type 2 diabetes, regular physical activity should be an integral part of your overall care plan. Not only will a program of regular physical activity improve glycemic control, it is a an important part of maintaining a healthy weight and reducing your risk for cardiovascular disease (heart disease and stroke) and other health complications for which people with diabetes are at high risk. Physical activity also has long list of other benefits. It is a great way to lift your mood and spirits, improve your outlook, and improve your sleep. If you join a regular exercise group (for example, a walking group or a movement class) you can make your physical activity a fun, social experience, as well.1

What do studies tell us about the benefits of physical activity for people with diabetes?

The short-term and long-term benefits of physical activity for people with diabetes have been demonstrated in a variety of well-controlled studies.

Improved insulin sensitivity. In people with type 2 diabetes, one of the short-term benefits of physical activity is improved sensitivity to insulin. As a person exercises, muscles require glucose for energy. This has the effect of helping our bodies make better use of the insulin that we produce so that glucose can be made available to the muscle cells where it is needed.1,2

With type 1 diabetes, where people make very little or no insulin and insulin injections are required, physical activity can have different effects on blood glucose. The effect will depend on how much insulin is present in the body at the time of physical activity and the timing of the most recent insulin injection1,2

Improved glycemic control. A number of studies have shown the benefit of regular physical activity on glycemic control (blood glucose). An analysis of results from several studies measuring the effects of physical activity on people with type 2 diabetes found that a regular exercise program resulted in reductions in A1C values by 0.5% to 0.7% compared with a control group (a comparison group made up of people with type 2 diabetes who did not engage in exercise). 1,2

Results from some studies suggest that an exercise program that combines both aerobic and resistance training (see below for examples of these types of exercise) may achieve the greatest benefits in terms of glycemic control. For instance, in one study conducted in 252 adults with type 2 diabetes, the combination of resistance (weight training) and aerobic (running, walking) training had a greater reduction in A1C (almost 1% point compared with a control group that did not engage in exercise) than either type of physical activity alone.3

Overall health benefits. In the Look AHEAD Study, a 4-year randomized, controlled trial conducted in 4,503 adults with type 2 diabetes who had a body mass index (BMI) of 25 or higher, an intensive program of lifestyle modification, including a program of regular physical activity, resulted in a range of health benefits, including an increased likelihood of remission of type 2 diabetes to prediabetes, improved blood glucose control, improvements in blood pressure, lipids, improvements in quality of life, improved mobility and reduced muscle and joint problems, and decreased risk for a range of diabetes-related complications (e.g., kidney disease, retinopathy).4
Although regular moderate physical activity alone is probably not sufficient for achieving and maintaining weight loss, as part of a comprehensive program of lifestyle modification, including healthy eating and calorie restriction, physical activity can be an important part of achieving and maintaining a healthy weight.4,5

Other studies have also shown the significant benefits of physical activity in terms of cardiovascular health in people with type 2 diabetes. The Nurses’ Health Study, a large, health study conducted among nurses in the US, found that among 5,125 female participants with type 2 diabetes, those who engaged in moderate to vigorous physical activity for at least 4 hours per week decreased their risk of cardiovascular disease (including stroke and coronary heart disease) by 40%.6 In the Aerobics Center Longitudinal Study, a study conducted in 2,316 men with type 2 diabetes, risk of death from cardiovascular disease and other causes was 1.7 to 6.6 times higher among participants who were defined as low-fit compared with those who were high-fit.7,8

Before you start an physical activity routine

There are many physical activity options for people with diabetes, including walking, cycling, swimming, rowing, and running. Your healthcare provider will determine whether it is necessary to do a pre-exercise examination, depending on the intensity of the physical activity your are planning to engage in and other factors, such as your age and existing health problems. For most people, with type 2 diabetes who want to engage in low-intensity physical activity, such as walking, no pre-exercise examination is necessary. However, if you are an older person not used to physical activity, you will benefit from an assessment.1

Since physical activity affects blood glucose, you should get a sense of how your exercise routine affects your blood glucose by measuring levels before, during, and after your exercise routine. This will allow you to know how you will need to adjust your insulin dose (if you take insulin) or to develop a strategy for eating foods that will keep your blood glucose at a normal level during and after physical activity. Make sure to drink adequate amounts of liquids before, during, and after physical activity to avoid becoming dehydrated. In people with diabetes, dehydration can have a direct impact on blood glucose levels.9
Learn more about factors to consider before I start a training program.

Three basic types exercises you need

Type

Examples

Resistance Training
  • Weight training
  • Yoga
  • Resistance training
Endurance (aerobic) training
  • Running
  • Swimming
  • Cycling
  • Walking
Flexibility Training
  • Yoga
  • Stretching (passive and active)
  • Pilates

What are my options for physical activity?

The list of activities that you can engage in to get exercise is almost limitless. From swimming and jogging to yoga and dancing, there is a form of physical activity that is fun and rewarding for every person.

Learn more about different types of exercise options

There are three basic types of exercise: resistance training, endurance (aerobic) training, and flexibility (range of motion) training. Ideally, you should combine all three to get the full benefit of a total workout. You’ll find that certain activities are sources for some or all of the three types of exercise you need. For instance, yoga and Tai Chi can be used to increase or maintain both strength and range of motion. Some water aerobics programs are designed to provide aerobic and strength training at the same time.

However you mix these forms of physical activity, you should aim to get 150 minutes per week of moderate- to vigorous-intensity aerobic training, spread out during at least 3 days per week, with no more than 2 consecutive days between training sessions.1 Aerobic training of moderate intensity involves getting your heart rate up to 65% of its maximum.

Learn some pointers on how to start an aerobic training exercise routine

A good sign that your endurance training is vigorous enough is if you sweat and feel an increase in your heart rate and breathing. A good tip for how hard you should extend yourself is to find a pace at which you are slightly short of breath, but can still carry on a conversation. Determining your target heart rate is also a way to make sure that you are working hard enough, but not overdoing it. Check out the simple target heart rate calculator to find out what you should be aiming for during your workout.

Figuring out your target heart rate (HR)

Subtract your age from 220 for your maximum HR 220 – YOUR AGE (example: 50) = 170
Subtract your resting HR from your max HR 170 – RESTING HR (example: 70) = 100
Multiply the answer by 0.7 and 0.5 0.7 X 100 = 70 (70% of max reserve HR)
0.5 X 100 = 50 (50% of max reserve HR)
Add your resting HR to each of these numbers to get your target HR range 70 + 70 = 140 beats per minute
50 + 70 = 120 beats per minute
While you are exercising your heart rate should stay between 120 and 140 beats per minute
view references
1. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and Type 2 Diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010;33:e147-e67.-- 2. McCulloch DK. Effects of exercise in diabetes mellitus in adults. Nathan DM, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013. -- 3. Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-69. -- 4. Delahanty LM. The Look AHEAD study: implications for clinical practice go beyond the headlines. J Acad Nutr Diet 2014;114:537-42. -- 5. Delahanty LM, McCulloch DK. Nutritional considerations in type 2 diabetes mellitus. Nathan DM, Lipman TO, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013.-- 6. Hu FB, Stampfer MJ, Solomon C, et al. Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med 2001;134:96-105. -- 7. Church TS, Cheng YJ, Earnest CP, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 2004;27:83-8.-- 8. Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med 2005;165:2114-20.-- 9. McCulloch DK. Patient information: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics). Nathan DM, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013. further reading
What I need to know about physical activity and diabetes. US Department of Health and Human Services. National Institutes of Health. NIH Publication No. 13–5180. November 2012. Rubin AL. Diabetes for Dummies. 4th ed. Hoboken, NJ: Wiley Publishing, Inc; 2012. American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts. 5th ed. American Diabetes Association. Alexandria, VA: American Diabetes Association; 2011.
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