Type diabetes exercise guidelines -
This is due to the effects of stress hormones released during high-intensity activity. If your blood sugar level is high before you begin your workout, check your blood sugar more frequently during and after your workout. Make sure that you drink plenty of water or other liquids to stay hydrated.
Dehydration can increase your blood sugar concentration. If your blood sugar level is still high after exercising, you can take a small bolus of rapid-acting insulin to lower it. If you use an insulin pump, you can temporarily increase your basal insulin infusion until your blood sugar returns to the normal range.
If your ketone level is high, contact your doctor. Follow their treatment instructions and avoid vigorous activity until your blood sugar and ketone level return to normal. When you exercise, your body pulls sugar from your bloodstream to fuel the activity.
It also draws on sugar stored as glycogen in your muscles and liver. This is why your blood sugar level tends to drop during a workout. In most cases, hypoglycemia can be treated by eating or drinking fast-acting carbohydrates. In severe cases, hypoglycemia must be treated with a medication known as glucagon.
When you take a dose of insulin, it signals the cells in your muscles, liver, and fat to absorb sugar from your bloodstream. This helps prevent your blood sugar from getting too high when you eat.
Exercising can also cause your blood sugar to drop. To help prevent low blood sugar during and after workouts, your doctor or diabetes educator might advise you to reduce your insulin intake on days when you exercise.
It can take some trial and error to learn how your body responds to changes in your insulin intake, carbohydrate intake, and exercise routine. Keep records of your insulin intake, food intake, exercise activities, and blood sugar to help you learn how to coordinate your medication, meals, and snacks on days you work out.
To treat hypoglycemia in its early stages, consume about 15 grams of fast-acting carbohydrates , such as:. After eating or drinking 15 grams of fast-acting carbs, wait 15 minutes and check your blood sugar level again.
Repeat these steps until your blood sugar level returns to a normal range. After your blood sugar returns to normal, eat a small snack with carbs and protein. This can help keep your blood sugar steady. If left untreated, hypoglycemia can become severe. Severe hypoglycemia is a potentially life threatening condition that can cause seizures and loss of consciousness.
Your doctor can give you a prescription for a glucagon emergency kit or glucagon nasal powder. Consider telling your coach, trainer, or workout buddy where to find your glucagon.
Teach them when and how to use it in case of an emergency. Each of the following snacks typically contains about 15 grams of carbs :. When it comes time to eat your next meal, be sure to include both carbs and protein. To support your overall health and well-being, take part in regular exercise, including aerobic and resistance activities.
Exercise tends to lower your blood sugar, which can lead to hypoglycemia. To prevent hypoglycemia, try reducing your insulin dosage on days when you exercise or eat more carbs before your workouts.
You might also consider adjusting the exercise activities that you do. Your doctor and dietitian can help you learn how to coordinate your medication, meals, snacks, and workouts to keep your blood sugar in a safe range.
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Exercising with Type 1 Diabetes: How to Work Out and Stay Safe. Medically reviewed by Kelly Wood, MD — By Cathy Lovering — Updated on September 14, Types of workouts Benefits Precautions High blood sugar after exercise Low blood sugar after exercise Insulin and exercise Treating with carbs Treating with glucagon Snack ideas Takeaway If you have type 1 diabetes, staying active can help lower your chances of developing complications.
Importance of exercising with type 1 diabetes. Types of workouts you can do with type 1 diabetes. Benefits of exercise with type 1 diabetes. Precautions for working out with type 1 diabetes. High blood sugar after exercise. Low blood sugar after exercise.
Insulin and exercise. Treating hypoglycemia with carbohydrates. Treating severe hypoglycemia with glucagon. Pre- and postworkout meal and snack ideas. The takeaway.
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B Prolonged sitting should be interrupted with bouts of light activity every 30 min for blood glucose benefits, at least in adults with type 2 diabetes. C The above two recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement.
B Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes. C Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general.
B Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods.
C Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests. Table 1 Suggested carbohydrate intake or other actions based on blood glucose levels at the start of exercise. Pre-exercise blood glucose.
Carbohydrate intake or other action. Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease. View Large. Table 2 Suggested initial pre-exercise meal insulin bolus reduction for activity started within 90 min after insulin administration.
Exercise intensity. Exercise duration. C Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental nonexercise physical activity to gain additional health benefits.
C To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs. Table 3 Exercise training recommendations: types of exercise, intensity, duration, frequency, and progression.
Flexibility and Balance. Type of exercise Prolonged, rhythmic activities using large muscle groups e. C Pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20—30 min of moderate-intensity exercise on most or all days of the week.
C Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cooldown. C Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training.
C Exercise training should progress appropriately to minimize risk of injury. Table 4 Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments. Exercise considerations.
B Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. B The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity.
C Vigorous aerobic or resistance exercise; jumping, jarring, head-down activities; and breath holding should be avoided in anyone with severe nonproliferative and unstable proliferative diabetic retinopathy. E Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions.
C Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations. Table 5 Physical activity consideration, precautions, and recommended activities for exercising with health-related complications.
Health complication. All activities okay. Consider exercising in a supervised cardiac rehabilitation program, at least initially. Exertional angina Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes.
Hypertension Both aerobic and resistance training may lower resting blood pressure and should be encouraged. Some blood pressure medications can cause exercise-related hypotension.
Ensure adequate hydration during exercise. Avoid Valsalva maneuver during resistance training. Myocardial infarction Stop exercise immediately should symptoms of myocardial infarction such as chest pain, radiating pain, shortness of breath, and others occur during physical activity and seek medical attention.
Restart exercise after myocardial infarction in a supervised cardiac rehabilitation program. Start at a low intensity and progress as able to more moderate activities.
Both aerobic and resistance exercise are okay. Stroke Diabetes increases the risk of ischemic stroke. Restart exercise after stroke in a supervised cardiac rehabilitation program. Congestive heart failure Most common cause is coronary artery disease and frequently follows a myocardial infarction. Avoid activities that cause an excessive rise in heart rate.
Focus more on doing low- or moderate-intensity activities. Peripheral artery disease Lower-extremity resistance training improves functional performance All other activities okay.
Consider inclusion of more non—weight-bearing activities, particularly if gait altered. Local foot deformity Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Focus more on non—weight-bearing activities to reduce undue plantar pressures.
Examine feet daily to detect and treat blisters, sores, or ulcers early. Weight-bearing activity should be avoided with unhealed ulcers. Amputation sites should be properly cared for daily. Avoid jogging. Autonomic neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
Exercise-related hypoglycemia may be harder to treat in those with gastroparesis. With autonomic neuropathy, avoid exercise in hot environments and hydrate well. All activities okay with mild, but annual eye exam should be performed to monitor progression. Severe nonproliferative and unstable proliferative retinopathy Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment.
No exercise should be undertaken during a vitreous hemorrhage. Cataracts Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity. Avoid activities that are more dangerous due to limited vision, such as outdoor cycling. Consider supervision for certain activities.
Overt nephropathy Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease. Individuals should be encouraged to be active. End-stage renal disease Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Electrolytes should be monitored when activity done during dialysis sessions.
Strengthen muscles around affected joints with resistance training. Avoid activities that increase plantar pressures with Charcot foot changes. Arthritis Common in lower-extremity joints, particularly in older adults who are overweight or obese. Participation in regular physical activity is possible and should be encouraged.
Moderate activity may improve joint symptoms and alleviate pain. C For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis.
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Algorithm that delivers an individualized rapid-acting insulin dose after morning resistance exercise counters post-exercise hyperglycaemia in people with type 1 diabetes. Hyperglycemia after intense exercise in IDDM subjects during continuous subcutaneous insulin infusion.
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Acute effects of carbohydrate supplementation on intermittent sports performance. Prevention of exercise-associated dysglycemia: a case study-based approach.
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The use of technology to promote physical activity in type 2 diabetes management: a systematic review. Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
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Close Modal. This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. Prolonged, rhythmic activities using large muscle groups e.
Stretching: static, dynamic, and other stretching; yoga Balance for older adults : practice standing on one leg, exercises using balance equipment, lower-body and core resistance exercises, tai chi.
Stretch to the point of tightness or slight discomfort Balance exercises of light to moderate intensity.
A greater emphasis should be placed on vigorous intensity aerobic exercise if fitness is a primary goal of exercise and not contraindicated by complications Both HIIT and continuous exercise training are appropriate activities for most individuals with diabetes.
Deficiency: hyperglycemia, ketoacidosis Excess: hypoglycemia during and after exercise. Slight risk of congestive heart failure with saxagliptin and alogliptin.
Hypoglycemia unawareness and unresponsiveness; may reduce maximal exercise capacity. Check blood glucose before and after exercise; treat hypoglycemia with glucose. Regular exercise training may lower blood pressure; some agents increase risk of dehydration.
If you have BMI Calculation Formula 1 Type diabetes exercise guidelines, staying active can help lower your gudelines of developing complications. These can include high blood pressure, exerfise disease, nerve Maximizing fat burning during the eating window, and vision loss. Regular exercise can help you manage your weight, improve your mood, and contribute to better sleep. These are some reasons why the Centers for Disease Control and Prevention recommends regular exercise for people with diabetes. But some people with type 1 diabetes may hesitate to exercise.Video
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Exercise that is too light may not give you the recommended health benefits while exercise that is too hard can place you at risk of over-training and injury. Undertake muscle strengthening activities on at least 2 days each week.
Strengthening activities include anything that requires your body to move against a weight or gravity. This would include activities such as lifting tins of food, repeated sitting and standing from a chair or seated leg raises. Minimise the amount of time spent in prolonged sitting.
Break up long periods of sitting as often as possible. Meet a friend for a walking date rather than a coffee, stand on public transport rather than sit or ask whether your workplace can provide standing workstations.
Increasing your general physical activity is also helpful, e. taking the stairs instead of the lift, moving during the ad breaks of your favourite TV program, completing housework, and gardening.
Avoid watching too much TV or sitting at the computer for a long time. Regular exercise is an important part of your diabetes management. It will help your insulin to work more efficiently and assist with your blood glucose management. However, if you have fluctuating or high blood glucose levels i.
Exercise in these circumstances can actually elevate blood glucose and increase ketone production. It may be necessary to reduce your insulin dose prior to exercise, depending on the intensity and duration.
Insulin adjustment will vary with each individual so it is important to discuss appropriate adjustments with your doctor or Credentialled Diabetes Educator. You may also require extra carbohydrate before, during and after exercise. Discuss adjusting carbohydrate intake with your doctor or dietitian.
How much exercise should I do? Benefits of exercise Exercising safely with diabetes Exercise programs for people with diabetes A guide to BGLs and exercise Steps to get started with exercise Exercise advice for people with type 1 diabetes How much exercise should I do? Plan ahead — Dedicate time each day to exercise, it will be easier to keep to a schedule and you will start to form a routine.
Motivation — Surround yourself with positive role models to remind you why exercise is important and encourage you to continue. Reward yourself — Treat yourself to new exercise gear or a massage to keep you motivated and celebrate your achievements. Benefits of exercise Physical activity is one of the best things you can do for your overall health.
For a person with diabetes, exercise can help: Insulin to work better, which will improve your diabetes management Reduce insulin resistance and reduce blood glucose levels Improve joint and muscle movement, and strengthen bones Maintain a healthy weight Lower your blood pressure Reduce your risk of heart disease Reduce stress and anxiety Improve your sleep.
Exercise is important but before you start, make sure you assess safety first by considering the following: Where do you start? How are your feet? What about changes in BGLs? Before an exercise session Ask yourself: Am I feeling well?
It is not recommended that you exercise when you are feeling unwell. Take time out to rest and start exercising again when you are feeling better. Have I checked my BGL? When you are starting a new exercise routine or changing your current routine, it is important to check your BGLs more regularly.
For people who require blood glucose lowering medication or insulin you should check your BGLs before, during and after exercise to avoid hypoglycaemia. During an exercise session Check your BGLs every minutes if the intensity, type or duration is new to you, or you experience symptoms of hypoglycaemia or hyperglycaemia.
After an exercise session Check your BGL and monitor it for up to 24 hours. Have a carbohydrate snack or meal, if required. Be aware of overnight hypoglycaemia. Have a low GI snack before bed if you think your BGLs might drop during the night.
If you require blood glucose lowering medication or insulin you may need to adjust your dose as your BGL reduces as a result of the exercise. This is particularly important if you are exercising at a high intensity or for longer than 30 minutes at a time.
Speak to your health care team before making any changes to your medication dose. A guide to BGLs and exercise Discover the effects of your blood glucose levels and exercise. What should my BGLs be when I exercise? Know the warning signs to stop exercising While exercise is generally a safe activity, there are some warning signs to look out for.
If you experience any of the following during exercise, stop and rest. Chest, abdominal, neck, jaw or arm pain or tightness Palpitations, irregular or racing heart beat Feeling faint, light headed or dizzy Leg cramps or pain Symptoms of hypoglycaemia stop immediately and treat!
Steps to get started with exercise Being active can help you manage your diabetes by keeping your blood glucose levels BGLs within your target range and helping you to achieve and maintain a healthy weight. The National Physical Activity Guidelines for Australian Adults recommend: Think of movement as an opportunity, not an inconvenience.
Be active every day in as many ways as you can. Engage in at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week. Do muscle strengthening activities on at least 2 days per week Break up long periods of sitting as often as possible, and If possible, also enjoy some regular, vigorous activity for extra health and fitness.
Step 1 — Start small Doing any physical activity is better than doing none. Step 2 — Move more Adults are recommended to be active on most, preferably all, days of the week. Which is your preferred exercise intensity level? The guidelines recommend you do between minutes of moderate intensity exercise each week.
The guidelines recommend you undertake between minutes of vigorous intensity exercise each week, if you are able. Step 4 — Include resistance activities Undertake muscle strengthening activities on at least 2 days each week.
Exercise advice for people with type 1 diabetes Regular exercise is an important part of your diabetes management. What state or territory do you live in? I live in Victoria I live in another state or territory.
: Type diabetes exercise guidelines| Consensus Statements and Recommendations | Authoring Typ American College of Sports Medicine. Effect of the low- versus high-intensity guivelines training Type diabetes exercise guidelines endoplasmic reticulum Boosting immune defenses and GLP-1 in Anti-hangover remedy exrrcise type 2 diabetes mellitus. Guidelines regarding glucose monitoring, carbohydrate ingestion, and medication adjustments are included. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. See also Medication-free hypertension control A1C test Alcohol: Does it affect blood pressure? Speak with your doctor if you are unsure of the type of medication you are taking. |
| Diabetes Canada | Clinical Practice Guidelines | Arnold, MD, Contributing Editor. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. search close. PREV Jan NEXT. From the AFP Editors. Impact of Physical Activity on People With Diabetes. Physical Activity Recommendations. Management of Health Complications With Physical Activity. Exercise Timing. Dietary Considerations. Diabetes Medications. Shaughnessy, PharmD, MMedEd, and Lisa Cosgrove, PhD. Guideline source: American College of Sports Medicine. Published source: Med Sci Sports Exerc. February 1, ;54 2 — mil health. This series is coordinated by Michael J. Arnold, MD, associate medical editor. Continue Reading. More in AFP. In most cases, exercise causes blood sugar to drop. But sometimes, short, intense bouts of exercise can cause your blood sugar to rise. This is due to the effects of stress hormones released during high-intensity activity. If your blood sugar level is high before you begin your workout, check your blood sugar more frequently during and after your workout. Make sure that you drink plenty of water or other liquids to stay hydrated. Dehydration can increase your blood sugar concentration. If your blood sugar level is still high after exercising, you can take a small bolus of rapid-acting insulin to lower it. If you use an insulin pump, you can temporarily increase your basal insulin infusion until your blood sugar returns to the normal range. If your ketone level is high, contact your doctor. Follow their treatment instructions and avoid vigorous activity until your blood sugar and ketone level return to normal. When you exercise, your body pulls sugar from your bloodstream to fuel the activity. It also draws on sugar stored as glycogen in your muscles and liver. This is why your blood sugar level tends to drop during a workout. In most cases, hypoglycemia can be treated by eating or drinking fast-acting carbohydrates. In severe cases, hypoglycemia must be treated with a medication known as glucagon. When you take a dose of insulin, it signals the cells in your muscles, liver, and fat to absorb sugar from your bloodstream. This helps prevent your blood sugar from getting too high when you eat. Exercising can also cause your blood sugar to drop. To help prevent low blood sugar during and after workouts, your doctor or diabetes educator might advise you to reduce your insulin intake on days when you exercise. It can take some trial and error to learn how your body responds to changes in your insulin intake, carbohydrate intake, and exercise routine. Keep records of your insulin intake, food intake, exercise activities, and blood sugar to help you learn how to coordinate your medication, meals, and snacks on days you work out. To treat hypoglycemia in its early stages, consume about 15 grams of fast-acting carbohydrates , such as:. After eating or drinking 15 grams of fast-acting carbs, wait 15 minutes and check your blood sugar level again. Repeat these steps until your blood sugar level returns to a normal range. After your blood sugar returns to normal, eat a small snack with carbs and protein. This can help keep your blood sugar steady. If left untreated, hypoglycemia can become severe. Severe hypoglycemia is a potentially life threatening condition that can cause seizures and loss of consciousness. Your doctor can give you a prescription for a glucagon emergency kit or glucagon nasal powder. Consider telling your coach, trainer, or workout buddy where to find your glucagon. Teach them when and how to use it in case of an emergency. Each of the following snacks typically contains about 15 grams of carbs :. When it comes time to eat your next meal, be sure to include both carbs and protein. To support your overall health and well-being, take part in regular exercise, including aerobic and resistance activities. Exercise tends to lower your blood sugar, which can lead to hypoglycemia. To prevent hypoglycemia, try reducing your insulin dosage on days when you exercise or eat more carbs before your workouts. You might also consider adjusting the exercise activities that you do. Your doctor and dietitian can help you learn how to coordinate your medication, meals, snacks, and workouts to keep your blood sugar in a safe range. Age-related decrements in heat dissipation during physical activity occur as early as the age of Carter MR, McGinn R, Barrera-Ramirez J, et al. Impairments in local heat loss in type 1 diabetes during exercise in the heat. Med Sci Sports Exerc ;— Kenny GP, Stapleton JM, Yardley JE, et al. Older adults with type 2 diabetes store more heat during exercise. Larose J, Boulay P, Wright-Beatty HE, et al. Age-related differences in heat loss capacity occur under both dry and humid heat stress conditions. J Appl Physiol ;— Larose J, Wright HE, Sigal RJ, et al. Do older females store more heat than younger females during exercise in the heat? Larose J, Wright HE, Stapleton J, et al. Whole body heat loss is reduced in older males during short bouts of intermittent exercise. Am J Physiol Regul Integr Comp Physiol ;R— Stapleton JM, Poirier MP, Flouris AD, et al. At what level of heat load are age-related impairments in the ability to dissipate heat evident in females? Aging impairs heat loss, but when does it matter? Kenny GP, Sigal RJ, McGinn R. Body temperature regulation in diabetes. Tem-perature Austin ;— Yardley JE, Stapleton JM, Carter MR, et al. Is whole-body thermoregulatory function impaired in type 1 diabetes mellitus? Curr Diabetes Rev ;— Jensen TE, Richter EA. Regulation of glucose and glycogen metabolism during and after exercise. J Physiol ;— Riddell MC, Zaharieva DP, Yavelberg L, et al. Exercise and the development of the artificial pancreas: One of the more difficult series of hurdles. J Diabetes Sci Technol ;— Brazeau AS, Rabasa-Lhoret R, Strychar I, et al. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care ;—9. Exercise and newer insulins: How much glucose supplement to avoid hypoglycemia? Rabasa-Lhoret R, Bourque J, Ducros F, et al. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen ultralente-lispro. Grimm JJ, Ybarra J, Berne C, et al. A new table for prevention of hypoglycaemia during physical activity in type 1 diabetic patients. Diabetes Metab ;— Franc S, Daoudi A, Pochat A, et al. Diabetes Obes Metab ;—7. Sonnenberg GE, Kemmer FW, Berger M. Exercise in type 1 insulin-dependent diabetic patients treated with continuous subcutaneous insulin infusion. Prevention of exercise induced hypoglycaemia. Chu L, Hamilton J, Riddell MC. Clinical management of the physically active patient with type 1 diabetes. Phys Sportsmed ;— Perkins BA, Riddell MC. Type 1 diabetes and exercise: Using the insulin pump to maximum advantage. Can J Diabetes ;—9. Riddell MC, Bar-Or O, Ayub BV, et al. Glucose ingestion matched with total car-bohydrate utilization attenuates hypoglycemia during exercise in adoles-cents with IDDM. Int J Sport Nutr ;— Francescato MP, Stel G, Stenner E, et al. Prolonged exercise in type 1 diabe-tes: Performance of a customizable algorithm to estimate the carbohydrate supplements to minimize glycemic imbalances. Campbell MD, Walker M, Trenell MI, et al. Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in type 1 diabetes patients: A randomised clinical trial. PLoS ONE ;9:e Taplin CE, Cobry E, Messer L, et al. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr ;—8, e1. Diabetes Research in Children Network Study Group, Tsalikian E, Kollman C, et al. Prevention of hypoglycemia during exercise in children with type 1 dia-betes by suspending basal insulin. Diabetes Care ;—4. McAuley SA, Horsburgh JC, Ward GM, et al. Insulin pump basal adjustment for exercise in type 1 diabetes: A randomised crossover study. Campbell MD, Walker M, Bracken RM, et al. Insulin therapy and dietary adjust-ments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: A randomized controlled trial. BMJ Open Diabe-tes Res Care ;3:e Bussau VA, Ferreira LD, Jones TW, et al. A s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. The s maximal sprint: A novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care ;—6. Guelfi KJ, Ratnam N, Smythe GA, et al. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and uti-lization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab ;E— Turner D, Gray BJ, Luzio S, et al. Similar magnitude of post-exercise hypergly-cemia despite manipulating resistance exercise intensity in type 1 diabetes indi-viduals. Scand J Med Sci Sports ;— Purdon C, Brousson M, Nyveen SL, et al. The roles of insulin and catechol-amines in the glucoregulatory response during intense exercise and early recov-ery in insulin-dependent diabetic and control subjects. J Clin Endocrinol Metab ;— Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: Implications for diabetes. Diabetes ;51 Suppl. Harmer AR, Chisholm DJ, McKenna MJ, et al. High-intensity training improves plasma glucose and acid-base regulation during intermittent maximal exercise in type 1 diabetes. Turner D, Luzio S, Gray BJ, et al. Algorithm that delivers an individualized rapid-acting insulin dose after morning resistance exercise counters post-exercise hyperglycaemia in people with type 1 diabetes. Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A system-atic review and meta-analysis. Wilmot EG, Edwardson CL, Achana FA, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: Systematic review and meta-analysis. Glenn KR, Slaughter JC, Fowke JH, et al. Physical activity, sedentary behavior and all-cause mortality among blacks and whites with diabetes. Ann Epidemiol ;— Loprinzi PD, Sng E. The effects of objectively measured sedentary behavior on all-cause mortality in a national sample of adults with diabetes. Prev Med ;—7. Cooper AJM, Brage S, Ekelund U, et al. Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. Cooper AR, Sebire S, Montgomery AA, et al. Sedentary time, breaks in seden-tary time and metabolic variables in people with newly diagnosed type 2 dia-betes. Falconer CL, Page AS, Andrews RC, et al. The potential impact of displacing sedentary time in adults with type 2 diabetes. Med Sci Sports Exerc ;—5. Fritschi C, Park H, Richardson A, et al. Association between daily time spent in sedentary behavior and duration of hyperglycemia in type 2 diabetes. Biol Res Nurs ;—6. Healy GN, Winkler EA, Brakenridge CL, et al. Lamb MJE, Westgate K, Brage S, et al. Prospective associations between sed-entary time, physical activity, fitness and cardiometabolic risk factors in people with type 2 diabetes. Dempsey PC, Larsen RN, Sethi P, et al. Benefits for type 2 diabetes of inter-rupting prolonged sitting with brief bouts of light walking or simple resis-tance activities. Dunstan DW, Kingwell BA, Larsen R, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Duvivier BMFM, Schaper NC, Hesselink MKC, et al. Breaking sitting with light activities vs structured exercise: A randomised crossover study demon-strating benefits for glycaemic control and insulin sensitivity in type 2 dia-betes. Diabetologia ;—8. Korkiakangas EE, Alahuhta MA, Laitinen JH. Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: A systematic review. Health Promot Int ;— Lascar N, Kennedy A, Hancock B, et al. Attitudes and barriers to exercise in adults with type 1 diabetes T1DM and how best to address them: A qualitative study. Tulloch H, Sweet SN, Fortier M, et al. Exercise facilitators and barriers from adoption to maintenance in the diabetes aerobic and resistance exercise trial. Can J Diabetes ;— Brown SA, Garcia AA, Brown A, et al. Biobehavioral determinants of glycemic control in type 2 diabetes: A systematic review and meta-analysis. Patient Educ Couns ;— Olson EA, McAuley E. Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes. J Behav Med ;— Tate DF, Lyons EJ, Valle CG. High-tech tools for exercise motivation: Use and role of technologies such as the internet, mobile applications, social media, and video games. Blackford K, Jancey J, Lee AH, et al. Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of meta-bolic syndrome: A randomised controlled trial. Int J Behav Nutr Phys Act ; Armstrong MJ, Campbell TS, Lewin AM, et al. Motivational interviewing-based exercise counselling promotes maintenance of physical activity in people with type 2 diabetes. Can J Diabetes ;S3. Song D, Xu TZ, Sun QH. Effect of motivational interviewing on self-management in patients with type 2 diabetes mellitus: A meta-analysis. Int J Nurs Sci ;—7. Chlebowy DO, El-Mallakh P, Myers J, et al. Motivational interviewing to improve diabetes outcomes in African Americans adults with diabetes. West J Nurs Res ;— Wolever RQ, Dreusicke M, Fikkan J, et al. Integrative health coaching for patients with type 2 diabetes: A randomized clinical trial. Diabetes Educ ;— Pillay J, Armstrong MJ, Butalia S, et al. Behavioral programs for type 2 diabe-tes mellitus: A systematic review and network meta-analysis behavioral pro-grams for type 2 diabetes mellitus. Biddle SJ, Edwardson CL, Wilmot EG, et al. A randomised controlled trial to reduce sedentary time in young adults at risk of type 2 diabetes mellitus: Project STAND Sedentary Time ANd Diabetes. Jansink R, Braspenning J, Keizer E, et al. No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interview-ing: A cluster randomised trial. Scand J Prim Health Care ;— Miller WR, Rollnick S. Rollnick S, Miller WR, Moyers TB, eds. Motivational inter-viewing: helping people change. New York: The Guilford Press, Rouleau CR, Lavoie KL, Bacon SL, et al. Training healthcare providers in moti-vational communication for promoting physical activity and exercise in cardiometabolic health settings: Do we know what we are doing? Curr Cardiovasc Risk Rep ;—8. Behavioral counseling to promote physi-cal activity and a healthful diet to prevent cardiovascular disease in adults: A systematic review for the U. Preventive Services Task Force. Avery L, Flynn D, Dombrowski SU, et al. Successful behavioural strategies to increase physical activity and improve glucose control in adults with type 2 diabetes. Avery L, Flynn D, van Wersch A, et al. Changing physical activity behavior in type 2 diabetes: A systematic review and meta-analysis of behavioral inter-ventions. Bailey KJ, Little JP, Jung ME. Self-monitoring using continuous glucose moni-tors with real-time feedback improves exercise adherence in individuals with impaired blood glucose: A pilot study. Diabetes Technol Ther ;— Miller CK, Bauman J. Goal setting: An integral component of effective diabe-tes care. Curr Diab Rep ; Petry NM, Cengiz E, Wagner JA, et al. Incentivizing behaviour change to improve diabetes care. Diabetes Obes Metab ;—6. Markowitz JT, Cousineau T, Franko DL, et al. Text messaging intervention for teens and young adults with diabetes. Morton K, Sutton S, Hardeman W, et al. A text-messaging and pedometer program to promote physical activity in people at high risk of type 2 diabe-tes: The development of the PROPELS follow-on support program. JMIR Mhealth Uhealth ;3:e Piette JD, List J, Rana GK, et al. Mobile health devices as tools for worldwide cardiovascular risk reduction and disease management. Bacon SL, Lavoie KL, Ninot G, et al. An international perspective on improv-ing the quality and potential of behavioral clinical trials. Curr Cardiovasc Risk Rep ; Lavoie KL, Campbell TS, Bacon SL. Behavioral medicine trial design: Time for a change. Arch Intern Med ;—1. author reply 1. Campbell TS, Bacon SL, Corace K, et al. Diabetes Educ ; —6. Yates T, Haffner SM, Schulte PJ, et al. Association between change in daily ambu-latory activity and cardiovascular events in people with impaired glucose tol-erance NAVIGATOR trial : A cohort analysis. Lancet ;— Dasgupta K, Rosenberg E, Joseph L, et al. Physician Step prescription and Moni-toring to improve ARTERial health SMARTER : A randomized controlled trial in type 2 diabetes and hypertension. Diabetes Obes Metab ;— Qiu S, Cai X, Chen X, et al. |
| Diabetes and exercise | If you are sick before you start exercising, consider rescheduling the activity. Contact your doctor and follow their instructions to treat the elevated ketones. In most cases, exercise causes blood sugar to drop. But sometimes, short, intense bouts of exercise can cause your blood sugar to rise. This is due to the effects of stress hormones released during high-intensity activity. If your blood sugar level is high before you begin your workout, check your blood sugar more frequently during and after your workout. Make sure that you drink plenty of water or other liquids to stay hydrated. Dehydration can increase your blood sugar concentration. If your blood sugar level is still high after exercising, you can take a small bolus of rapid-acting insulin to lower it. If you use an insulin pump, you can temporarily increase your basal insulin infusion until your blood sugar returns to the normal range. If your ketone level is high, contact your doctor. Follow their treatment instructions and avoid vigorous activity until your blood sugar and ketone level return to normal. When you exercise, your body pulls sugar from your bloodstream to fuel the activity. It also draws on sugar stored as glycogen in your muscles and liver. This is why your blood sugar level tends to drop during a workout. In most cases, hypoglycemia can be treated by eating or drinking fast-acting carbohydrates. In severe cases, hypoglycemia must be treated with a medication known as glucagon. When you take a dose of insulin, it signals the cells in your muscles, liver, and fat to absorb sugar from your bloodstream. This helps prevent your blood sugar from getting too high when you eat. Exercising can also cause your blood sugar to drop. To help prevent low blood sugar during and after workouts, your doctor or diabetes educator might advise you to reduce your insulin intake on days when you exercise. It can take some trial and error to learn how your body responds to changes in your insulin intake, carbohydrate intake, and exercise routine. Keep records of your insulin intake, food intake, exercise activities, and blood sugar to help you learn how to coordinate your medication, meals, and snacks on days you work out. To treat hypoglycemia in its early stages, consume about 15 grams of fast-acting carbohydrates , such as:. After eating or drinking 15 grams of fast-acting carbs, wait 15 minutes and check your blood sugar level again. Repeat these steps until your blood sugar level returns to a normal range. After your blood sugar returns to normal, eat a small snack with carbs and protein. This can help keep your blood sugar steady. If left untreated, hypoglycemia can become severe. Severe hypoglycemia is a potentially life threatening condition that can cause seizures and loss of consciousness. Your doctor can give you a prescription for a glucagon emergency kit or glucagon nasal powder. Consider telling your coach, trainer, or workout buddy where to find your glucagon. Teach them when and how to use it in case of an emergency. Each of the following snacks typically contains about 15 grams of carbs :. When it comes time to eat your next meal, be sure to include both carbs and protein. To support your overall health and well-being, take part in regular exercise, including aerobic and resistance activities. Exercise tends to lower your blood sugar, which can lead to hypoglycemia. To prevent hypoglycemia, try reducing your insulin dosage on days when you exercise or eat more carbs before your workouts. You might also consider adjusting the exercise activities that you do. Your doctor and dietitian can help you learn how to coordinate your medication, meals, snacks, and workouts to keep your blood sugar in a safe range. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Exercising with Type 1 Diabetes: How to Work Out and Stay Safe. Medically reviewed by Kelly Wood, MD — By Cathy Lovering — Updated on September 14, Types of workouts Benefits Precautions High blood sugar after exercise Low blood sugar after exercise Insulin and exercise Treating with carbs Treating with glucagon Snack ideas Takeaway If you have type 1 diabetes, staying active can help lower your chances of developing complications. Importance of exercising with type 1 diabetes. Types of workouts you can do with type 1 diabetes. Benefits of exercise with type 1 diabetes. Precautions for working out with type 1 diabetes. High blood sugar after exercise. Low blood sugar after exercise. Insulin and exercise. Treating hypoglycemia with carbohydrates. Treating severe hypoglycemia with glucagon. Most people with diabetes who have no symptoms of coronary ischemia do not require medical clearance before starting a low-to-moderate intensity exercise program. However, middle-aged and older individuals with diabetes who wish to undertake very vigorous or prolonged exercise, such as competitive racing, high-intensity interval training with intervals at maximal effort, or long-distance running should be assessed for conditions that may place them at increased risk for an adverse event. Preproliferative or proliferative retinopathy should be treated and stabilized prior to commencement of vigorous exercise. People with severe peripheral neuropathy should be instructed to inspect their feet daily, especially on days they are physically active, and to wear appropriate footwear. Although previous guidelines stated that persons with severe peripheral neuropathy should avoid weight-bearing activity, more recent studies indicate that individuals with peripheral neuropathy may safely participate in moderate weight-bearing exercise provided they do not have active foot ulcers 58— Studies also suggest that people with peripheral neuropathy in the feet, who participate in daily weight-bearing activity, are at decreased risk of foot ulceration compared with those who are less active A resting ECG should be performed, and an exercise ECG stress test should be considered, for individuals with typical or atypical chest discomfort, unexplained dyspnea, peripheral arterial disease, carotid bruits or history of angina, myocardial infarction MI , stroke or transient ischemic attacks see Screening for the Presence of Cardiovascular Disease chapter, p. S who wish to undertake exercise more intense than brisk walking, especially if considering very intense, prolonged aerobic exercise. The value and utility of medical screening procedures prior to exercise, such as resting ECG and exercise stress testing in asymptomatic individuals has been the subject of much debate There is now an increased appreciation that exercise testing is a poor predictor of future cardiovascular disease CVD events because such testing detects flow-limiting coronary lesions while sudden cardiac arrest is usually produced by the rapid progression of a previously non-obstructive lesion Nevertheless, identifying individuals who are symptomatic remains very important. People who are symptomatic, either before or during exercise, should be referred for ECG stress testing and further cardiac evaluation prior to participating or continuing in an exercise program see Screening for the Presence of Cardiovascular Disease chapter, p. Performing physical activity, especially in the heat, places individuals at risk for heat-related injuries. The increase in metabolic heat production augments the rate at which heat must be dissipated to the environment to prevent dangerous increases in core temperature. Reduced physical fitness 70 and the presence of metabolic, CV and neurologic dysfunctions, which are often associated with diabetes 71 , further exacerbate an already compromised ability to dissipate heat. People with diabetes should be aware that heat stress is associated with a reduction in exercise capacity and an increase in disease-related symptoms an air-conditioned training centre, room with fans if it is very hot outdoors. If activities e. gardening, cycling, etc. must be performed outdoors when the weather is hot, the activities should be conducted in the early or later hours of the day when the temperatures are cooler and the sun is not at its peak. Middle-aged and older people with diabetes should try to avoid performing exercise in hot humid conditions as these conditions restrict the evaporation of sweat which is necessary to cool the body. Staying well hydrated will help ensure that the body can maintain an adequate cooling capacity during exercise by maintaining sweat production at normal levels especially in the heat, and prevent fluctuations in blood glucose levels 71,72 , and is likely to reduce the risk for heat-related complications, such as heat exhaustion or heat stroke. Prolonged aerobic exercise increases insulin sensitivity in recovery for up to 48 hours In type 1 diabetes, there is little or no endogenous insulin secretion, and achieving the appropriate balance of exogenous insulin and carbohydrate intake for the different forms and intensities of exercise can be challenging Fear of hypoglycemia is an important barrier to exercise in people with type 1 diabetes 75 and advice on physical activity to people with type 1 diabetes should include strategies to reduce risk of hypoglycemia. Several small studies have explored several types of strategies for the prevention of hypoglycemia in type 1 diabetes, including the consumption of extra carbohydrates for exercise 76 , limiting preprandial bolus insulin doses 77—79 or reducing the basal insulin rate for continuous subcutaneous insulin infusion CSII insulin pump users These strategies can be used alone or in combination 81, Increasing carbohydrate intake just before, during and immediately after exercise is a simple and effective way to prevent hypoglycemia, although the optimal carbohydrate intake rate varies based on the duration and intensity of the activity and the amount of insulin in the circulation at the time of exercise 78,83, Basal insulin reduction before exercise may also offer some protection for children 86 and for those people on CSII 79, A more aggressive basal rate reduction, such as basal rate suspension at exercise onset is somewhat effective, although blood glucose levels may still drop markedly at the start of exercise As such, additional carbohydrates may still be needed even following basal rate reductions. Another strategy to avoid hypoglycemia is to perform intermittent, brief 10 seconds , maximal-intensity sprints either at the beginning 90 or end 91 or intermittently during a moderate-intensity exercise session Performing resistance exercise immediately prior to aerobic exercise also helps reduce hypoglycemia risk, rather than performing aerobic exercise alone or aerobic exercise followed by resistance exercise Exercise performed late in the day or in the evening can be associated with increased risk of overnight hypoglycemia in people with type 1 diabetes Glucose levels can rise with brief intense exercise, such as sprinting 90—92 , resistance training 93 , 10 to 15 minutes of maximal-intensity aerobic exercise to exhaustion 94,95 or high-intensity interval training 96 in individuals with type 1 diabetes. If this occurs, it can be addressed by giving a small bolus of a rapid-acting insulin in exercise recovery 97 , or by temporarily increasing the basal insulin infusion in CSII users. Individuals with type 2 diabetes generally do not need to postpone exercise because of high blood glucose, provided they feel well. increased thirst, nausea, severe fatigue, blurred vision or headache , especially for exercise to be performed in the heat. In individuals with type 1 diabetes who are severely insulin deficient e. due to insulin omission or illness , hyperglycemia can worsen with exercise. Sedentary behaviours involve prolonged sitting or reclining while awake, including television viewing, working on a computer and driving. Systematic reviews of observational studies 98,99 have demonstrated positive associations between the amount of sitting and the risk of premature mortality within the general population and in people with diabetes , even after adjusting for time spent in moderate-to-vigorous physical activity 98— Several recent studies in people with diabetes have documented harmful associations between objectively measured sedentary time and cardiometabolic risk factors, such as A1C, central adiposity, BMI, fasting TG, systolic BP, C-reactive protein, and hyperglycemia — Studies in people with and without type 2 diabetes have demonstrated that interrupting sitting by light walking or light resistance training can attenuate postprandial increases in BG, insulin and TG — Given the evidence that sedentary behaviour is associated with adverse health outcomes, even after statistically adjusting for levels of moderate-to-vigorous exercise, physical activity levels and sedentary behaviours should be considered distinct and potentially independent behaviours. When discussing activity patterns with people with diabetes in clinical practice, it is reasonable, therefore, to promote both the reduction of prolonged sitting and the accumulation of moderate-to-vigorous physical activity in the person's daily routine. There are a number of barriers and facilitators to physical activity in people with diabetes — Interventions targeting these barriers and facilitators are needed to initially engage people with diabetes in, and then maintain, sufficient physical activity. Behaviour-change focused interventions added to exercise-based interventions have tended to focus on increasing physical activity self-efficacy i. an individual's desire or willingness to do physical activity For example, a recent meta-analysis suggested that the use of motivational interviewing-based interventions see description below not only improved physical activity but also decreased A1C by about 0. However, it should be noted that some other studies found this kind of intervention did not reduce A1C , The vast majority of the studies have examined motivational interviewing or motivational communication as the behaviour change intervention. Motivational interviewing is a goal-oriented, client-centred counselling style, which helps to explore and resolve ambivalence and increase intrinsic motivation in individuals in order to change behaviour Motivational communication represents a collection of evidence-based strategies drawn from motivational interviewing, cognitive-behavioural techniques and behaviour change theories e. self-determination theory, social-cognitive theory, theory of planned behaviour and the transtheoretical model that are used as a communication strategy to engage individuals in changing their behaviour For people with type 2 diabetes, evidence suggests that goal setting, problem solving, providing information on where and when to exercise, and self-monitoring e. use of objective monitoring with pedometers have some efficacy to increase physical activity and improve A1C ,— Newer evidence is starting to accumulate on the potential benefits of other motivational tools and techniques. Examples of these include reinforcement, such as providing direct, instantaneous rewards monetary or token-based for goal completion , text-messaging , , mobile applications, social media and video games , However, further higher level evidence is needed to demonstrate their benefits for both physical activity and diabetes-related outcomes ,— A pedometer is a wearable device that detects and counts each step a person takes. An accelerometer is a device that measures non-gravitational acceleration. Pedometers and accelerometers are well suited to measuring walking or jogging, but not bicycling or swimming. Pedometers measure steps but not speed, whereas accelerometers can measure both steps and speed. Large-scale cohort studies consistently demonstrate an inverse relationship between higher self-reported walking with CV events and both CV and all-cause mortality in type 2 diabetes, even with adjustments for other CV risk factors. In a randomized controlled trial examining the effect of a pedometer-based prescription in people with type 2 diabetes, the change in A1C at the end of the 1-year step count prescription intervention was 0. Active arm participants reviewed step count logs with their physicians at each clinic visit over a 1-year period, set step targets and received a written step count prescription. Those in the control arm were encouraged to be active 30 to 60 minutes daily. Smarter Step Count Prescription. In these trials, the active arms engaged in pedometer-based interventions with monitoring and recording of daily step counts often complemented by support from a facilitator with or without peers in a group. Physical Activity in Children with Type 2 Diabetes: see Type 2 Diabetes in Children and Adolescents chapter, p. A1C, glycated hemoglobin ; BG , blood glucose; BP , blood pressure; BMI , body mass index; CV , cardiovascular; CVD , cardiovascular disease; ECG , electrocardiogram; FPG , fasting plasma glucose; HDL-C ; high-density lipoprotein cholesterol; LDL-C , low-density lipoprotein cholesterol. Literature Review Flow Diagram for Chapter Physical Activity and Diabetes. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement. PLoS Med 6 6 : e pmed For more information, visit www. Sigal reports grants from Amilyn Pharmaceuticals, Boehringer Ingelheim, Prometic, Population Health Research Institute PHRI , and Sanofi; and personal fees from Novo Nordisk, outside the submitted work. Bacon reports personal fees from Kataka Medical Communications, Schering-Plough, Merck, and Sygesa; and grants from Abbive, outside the submitted work; also, he is Past-President of the Canadian Association of Cardiovascular Prevention and Rehabilitation. Riddell reports personal fees from Medtronic, Lilly Innovation, Insulet, and Ascencia Diabetes Care; grants and personal fees from Sanofi; and non-financial support from Dexcom, outside the submitted work. No other author has anything to disclose. All content on guidelines. ca, CPG Apps and in our online store remains exactly the same. For questions, contact communications diabetes. Become a Member Order Resources Home About Contact DONATE. Next Previous. Key Messages Recommendations Figures Full Text References. Chapter Headings Types of Exercise Benefits of Physical Activity Benefits of Interval Training Benefits of Resistance Exercise Benefits of Other Types of Exercise Supervised vs. Unsupervised Exercise The Look-AHEAD Trial Minimizing Risk of Exercise-Related Adverse Events Reduction of Sedentary Behaviour The Use of Adjunct Motivational Interventions to Improve Physical Activity Uptake Objective Monitoring of Physical Activity Exercise Prescription Examples Other Relevant Guidelines Relevant Appendix Author Disclosures. Key Messages Moderate to high levels of physical activity and cardiorespiratory fitness are associated with substantially lower morbidity and mortality in people with diabetes. Key Messages for People with Diabetes Physical activity often improves glucose control and facilitates weight loss, but has multiple other health benefits even if weight and glucose control do not change. Types of Exercise Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure 1. Benefits of Physical Activity Physical activity can help people with diabetes achieve a variety of goals, including increased cardiorespiratory fitness, increased vigour, improved glycemic control, decreased insulin resistance, improved lipid profile, blood pressure BP reduction and maintenance of weight loss 2—5. Benefits of Interval Training High-intensity interval training involves alternating between short periods of higher and lower-intensity exercise see Exercise Prescription Examples. Benefits of Resistance Exercise Resistance training in adults with type 2 diabetes improves glycemic control as reflected by reduced A1C , decreases insulin resistance and increases muscular strength 30 , lean muscle mass 31 and bone mineral density 32,33 , leading to enhanced functional status and prevention of sarcopenia and osteoporosis. Benefits of Other Types of Exercise To date, evidence for the beneficial effects of other types of exercise is not as extensive or as supportive as the evidence for aerobic and resistance exercise. Supervised vs. Unsupervised Exercise A systematic review and meta-analysis found that supervised programs involving aerobic or resistance exercise improved glycemic control in adults with type 2 diabetes, whether or not they included dietary co-intervention 6. Minimizing Risk of Exercise-Related Adverse Events Identifying individuals for whom medical evaluation should be considered prior to initiating an exercise program For most people with and without diabetes, being sedentary is associated with far greater health risks than exercise would be. Minimizing risk of heat-related illness Performing physical activity, especially in the heat, places individuals at risk for heat-related injuries. Minimizing risk of exercise-induced hypoglycemia in type 1 diabetes Prolonged aerobic exercise increases insulin sensitivity in recovery for up to 48 hours Minimizing risks related to hyperglycemia Glucose levels can rise with brief intense exercise, such as sprinting 90—92 , resistance training 93 , 10 to 15 minutes of maximal-intensity aerobic exercise to exhaustion 94,95 or high-intensity interval training 96 in individuals with type 1 diabetes. Reduction of Sedentary Behaviour Sedentary behaviours involve prolonged sitting or reclining while awake, including television viewing, working on a computer and driving. The Use of Adjunct Motivational Interventions to Improve Physical Activity Uptake There are a number of barriers and facilitators to physical activity in people with diabetes — Objective Monitoring of Physical Activity A pedometer is a wearable device that detects and counts each step a person takes. Exercise Prescription Examples The following are practical examples illustrating how exercise can be prescribed: Aerobic exercise Start by walking at a comfortable pace for as little as 5 to 15 minutes at one time. Gradually progress over 12 weeks to up to 50 minutes per session including warm-up and cool down of brisk walking. Alternatively, shorter exercise sessions in the course of a day, e. Resistance exercise Choose approximately 6 to 8 exercises that target the major muscle groups in the body. Gradually increase the resistance until you can perform 3 sets of 8 to 12 repetitions for each exercise, with 1 to 2 minutes of rest between sets The best evidence supports strength training with weight machines or free weights. Resistance bands may not be as effective to improve glycemic control, but they can help increase strength and can be a starting point to progress to other forms of resistance training. If you wish to begin resistance exercise, you should receive initial instruction and periodic supervision by a qualified exercise specialist to maximize benefits, while minimizing risk of injury, at least for the initial sessions Table 3. Interval exercise Exercise performed in intervals, alternating between higher intensity and lower intensity, can be used by participants who have trouble sustaining continuous aerobic exercise, or can be used to shorten total exercise duration or increase variety. Try alternating between 3 minutes of faster walking and 3 minutes of slower walking Another form of interval training, high-intensity interval training HIIT , can be performed through shorter intervals of higher-intensity exercise e. Start with just a few intervals and progress to longer durations by adding additional intervals. Aquatic exercise can include walking briskly in the water, swimming or classes that include a variety of exercises. Other types of exercise or exercise classes, such as yoga, may be appealing for reasons, such as stress management. Using pedometers or accelerometers Encourage people with diabetes to self-monitor physical activity with a pedometer or accelerometer. Ask them to record values, review at visits, set step count targets and formalize recommendations with a written prescription see Appendix 4. Breaking up sedentary time It is best to avoid prolonged sitting. Recommendations People with diabetes should ideally accumulate a minimum of minutes of moderate- to vigorous-intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise, to improve glycemic control [Grade B, Level 2, for adults with type 2 diabetes 2,4,6 and children with type 1 diabetes 20 ]; and to reduce risk of CVD and overall mortality [Grade C, Level 3, for adults with type 1 diabetes 14 and type 2 diabetes 10 ]. Interval training short periods of vigorous exercise alternating with short recovery periods at low-to-moderate intensity or rest from 30 seconds to 3 minute each can be recommended to people willing and able to perform it to increase gains in cardiorespiratory fitness in type 2 diabetes [Grade B, Level 2 ] and to reduce risk of hypoglycemia during exercise in type 1 diabetes [Grade C, Level 3 28,29 ]. People with diabetes including elderly people should perform resistance exercise at least twice a week 39 and preferably 3 times per week [Grade B, Level 2 30 ] in addition to aerobic exercise [Grade B, Level 2 39—42 ]. Initial instruction and periodic supervision by an exercise specialist can be recommended [Grade C, Level 3 30 ]. In addition to achieving physical activity goals, people with diabetes should minimize the amount of time spent in sedentary activities and periodically break up long periods of sitting [Grade C, Level 3 ]. Setting specific exercise goals, problem solving potential barriers to physical activity, providing information on where and when to exercise, and self-monitoring should be performed collaboratively between the person with diabetes and the health-care provider to increase physical activity and improve A1C [Grade B, Level 2 , ]. Step count monitoring with a pedometer or accelerometer can be considered in combination with physical activity counselling, support and goal-setting to support and reinforce increased physical activity [Grade B, Level 2 , ]. Structured exercise programs supervised by qualified trainers should be implemented when feasible for people with type 2 diabetes to improve glycemic control, CV risk factors and physical fitness [Grade B, Level 2 6,39 ]. Abbreviations: A1C, glycated hemoglobin ; BG , blood glucose; BP , blood pressure; BMI , body mass index; CV , cardiovascular; CVD , cardiovascular disease; ECG , electrocardiogram; FPG , fasting plasma glucose; HDL-C ; high-density lipoprotein cholesterol; LDL-C , low-density lipoprotein cholesterol. Other Relevant Guidelines Monitoring Glycemic Control, p. S47 Glycemic Management in Adults with Type 1 Diabetes, p. S80 Hypoglycemia, p. S Screening for the Presence of Cardiovascular Disease, p. S Type 2 Diabetes in Children and Adolescents, p. Relevant Appendix Appendix 4. Author Disclosures Dr. References Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep ;— Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: A meta-analysis. Diabetes Care ;— Colberg SR, Sigal RJ, Yardley JE, et al. Snowling NJ, Hopkins WG. 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Frequent and intensive physi-cal activity reduces risk of cardiovascular events in type 1 diabetes. Church TS, LaMonte MJ, Barlow CE, et al. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Nielsen PJ, Hafdahl AR, Conn VS, et al. Meta-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes. Diabetes Res Clin Pract ;— Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications ;— Kennedy A, Nirantharakumar K, Chimen M, et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS ONE ;8:e MacMillan F, Kirk A, Mutrie N, et al. A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: Study characteristics, intervention design, and efficacy. 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Insulin action after resistive training in insulin resistant older men and women. J Am Geriatr Soc ;— Nelson ME, Fiatarone MA, Morganti CM, et al. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized con-trolled trial. JAMA ;— Engelke K, Kemmler W, Lauber D, et al. Exercise maintains bone density at spine and hip EFOPS: A 3-year longitudinal study in early postmenopausal women. Osteoporos Int ;— Ishiguro H, Kodama S, Horikawa C, et al. In search of the ideal resistance train-ing program to improve glycemic control and its indication for patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Sports Med ;— Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Dunstan DW, Daly RM, Owen N, et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Durak EP, Jovanovic-Peterson L, Peterson CM. Randomized crossover study of effect of resistance training on glycemic control, muscular strength, and cho-lesterol in type I diabetic men. Cauza E, Hanusch-Enserer U, Strasser B, et al. The relative benefits of endur-ance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil ;— Balducci S, Zanuso S, Nicolucci A, et al. Effect of an intensive exercise inter-vention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: A randomized controlled trial: The Italian Diabetes and Exer-cise Study IDES. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance train-ing on hemoglobin A1c levels in patients with type 2 diabetes: A random-ized controlled trial. Schwingshackl L, Missbach B, Dias S, et al. Impact of different training modali-ties on glycaemic control and blood lipids in patients with type 2 diabetes: A systematic review and network meta-analysis. Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance train-ing, or both on glycemic control in type 2 diabetes: A randomized trial. McGinley SK, Armstrong MJ, Boulé NG, et al. Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes melli-tus: A meta-analysis of randomised controlled trials. Yardley JE, Hay J, Abou-Setta AM, et al. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Yardley JE, Kenny GP, Perkins BA, et al. Resistance versus aerobic exercise: Acute effects on glycemia in type 1 diabetes. Effects of performing resistance exer-cise before versus after aerobic exercise on glycemia in type 1 diabetes. Dia-betes Care ;— Lee MS, Jun JH, Lim HJ, et al. A systematic review and meta-analysis of tai chi for treating type 2 diabetes. Maturitas ;— Yan JH, Gu WJ, Pan L. Lack of evidence on Tai Chi-related effects in patients with type 2 diabetes mellitus: A meta-analysis. Exp Clin Endocrinol Diabetes ;— Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: A systematic review of controlled trials. J Diabetes Res ; Kumar V, Jagannathan A, Philip M, et al. Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis. Complement Ther Med ;— Cui J, Yan JH, Yan LM, et al. Effects of yoga in adults with type 2 diabetes mel-litus: A meta-analysis. J Diabetes Investig ;—9. Centers for Disease Control Prevention. Arthritis as a potential barrier to physi-cal activity among adults with diabetes—United States, and MMWR Morb Mortal Wkly Rep ;—9. Lu M, Su Y, Zhang Y, et al. Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis. Z Rheumatol ;— Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthri-tis: Systematic review with meta-analysis. Phys Ther ;— Rees JL, Johnson ST, Boulé NG. Aquatic exercise for adults with type 2 diabe-tes: A meta-analysis. Acta Diabetol Lat in press. Look Ahead Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med ;— Pi-Sunyer X. The Look AHEAD Trial: A review and discussion of Its outcomes. Curr Nutr Rep ;— LeMaster JW, Mueller MJ, Reiber GE, et al. Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: Feet first randomized controlled trial. Lemaster JW, Reiber GE, Smith DG, et al. Daily weight-bearing activity does not increase the risk of diabetic foot ulcers. Med Sci Sports Exerc ;—9. Streckmann F, Zopf EM, Lehmann HC, et al. 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| Exercise & diabetes | Electrolytes should Maximizing fat burning during the eating window monitored when activity done during guixelines sessions. Type diabetes exercise guidelines AR, Sebire Shop smart for sports nutrition, Montgomery AA, exerciise al. If you receive insulin guidelibes an automated insulin delivery system, talk with your healthcare professional about that. Balance for older adults : practice standing on one leg, exercises using balance equipment, lower-body and core resistance exercises, tai chi. Make time for fitness A successful exercise routine works into the demands of your day. |
| ACSM Publishes New Recommendations on Type 2 Diabetes and Exercise | Riddell ; Michael C. Balducci S, Iacobellis G, Parisi L, et al. Before you work out, test your urine for substances called ketones. Does exercise improve glycaemic control in type 1 diabetes? Insulin and weight gain Isolated systolic hypertension: A health concern? These recommendations include at least minutes per week of moderate-intensity activity or 75 minutes per week of vigorous-intensity aerobic physical activity, and resistance exercise involving all major muscle groups on two or more days per week. |
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