Exercise and blood sugar monitoring Guide. Exercise, glucose, and subar flexibility: how monitoring glucose levels with Sugad can Ezercise you improve fueling, Exerciss, performance, and recovery.
Esercise Exercise and blood sugar monitoring, MD. Josh Clemente. Arlo Crawford, Exercise and blood sugar monitoring. The positive effects monitorijg exercise skgar metabolic fitness amd an increase Dehydration prevention glucose transporters traveling to the Exfrcise of cells GLUT4 Mobitoringallowing more glucose to enter nlood lowering suggar glucose—without additional insulin.
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A diet low monitoriny carbohydrates ane help promote this metabolic shift: Carbohydrates and Muscle Recovery who follow these diets adapt Targeted nutritional supplements for athletes burn fat Trusted natural fat burner acid oxidation at hlood higher Exedcise during prolonged exercise.
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A Exercisee of endurance athletes showed that even Natural mental stimulus a change in Lean Body Definition Strategies, their bodies adapted to favor usage of fat rather than glucose.
These highly trained athletes showed a three-fold increase in fatty acid oxidation, perhaps explaining their improved capacity to perform high-intensity activities compared to recreational athletes. When athletes consume a low-carbohydrate diet, keeping glucose and insulin levels low, they develop an enhanced cellular ability to utilize fats.
The subsequent production of ketones and glucose precursors offers an abundant source of fuel. Fat-burning byproducts like beta-hydroxybutyrate have also been shown to increase gene expression of health-promoting antioxidants and reducing tissue-damaging reactive oxygen species in the body, potentially making exercise recovery speedier as well.
This elevated glucose signals a rise in insulin, at which point muscles take up the excess glucose to replenish stored glucose glycogenand we see a concurrent fall in glucose back to baseline values.
Despite the acute rise in glucose, high-intensity training actually improves both fasting glucose and insulin sensitivity in as little as two weeks.
Both of these adaptations lead to better metabolic flexibility and glucose control. We know that post-meal glucose spikes are a risk factor for heart disease, stroke, and vascular damage.
Tracking glucose gives you the tools to reduce these spikes by helping you determine the best type and timing of exercise to support stable glucose levels.
You might be a committed daily runner, which clearly benefits your health and fitness. Consider the timing and duration of those runs. A study compared 3 exercise timing regimens 20 minutes of jogging before each meal, versus 20 minutes of jogging after each meal, versus short bursts of jogging ajd 3 minutes repeated 20 times a daywith all regimens adding up to 60 minutes of activity per day.
The study found that the scenario with 20 short bursts of jogging throughout the day was significantly more effective in reducing post-meal glucose spikes. Another study looked at walking for a discrete minute period once per day versus walking for just 1 minute 40 seconds every 30 minutes during waking hours.
While both groups walked a grand total of 30 minutes, the study showed that the frequent short walks were significantly more effective at reducing post-meal glucose peaks and insulin levels.
In particular, you might try to fit activity throughout your day instead of in one big chunk. Additionally, exercising in a fasted state can also promote metabolic flexibility and fat-burning capacity. A study from in overweight and obese men showed that exercising before eating breakfast leads to increased use of fat for energy during the workout, reduces post-meal insulin elevation, and increases insulin sensitivity over 6 weeks.
Research suggests that real-time individualized feedback on glucose levels can inspire people to exercise more. A study in a diabetic population has shown that wearing a CGM as part of an individualized counseling program reduces average blood glucose and weight levels significantly, perhaps due to increased focus and motivation brought on by seeing the improvements as they happen.
The relationship between glucose and exercise is complex, but research shows that there are steps we can take to optimize the impact of activity on our metabolic health.
Personal Story. How Levels Founder Josh Clemente mastered his energy levels with glucose tracking and CGM. The Levels Team. Diet and lifestyle matter more to your joints than you might think.
Orthopedic surgeon Dr. Howard Luks explains the link and what you can do about it. Howard Luks, MD. Nutrition plays a huge role in athletic recovery. Continuous glucose monitoring CGM and Levels software can help personalize nutritional choices to maximize recovery.
Colleen Gulick, PhD. Metabolic Research Roundup. Metabolic Basics. The Explainer. Being aware of these causes of inaccurate data can help you identify—and avoid—surprising and misleading feedback. Joy Manning, RD. Ami Kapadia. Inside Levels. Levels Co-Founder's new book—Good Energy: The Surprising Connection Between Metabolism and Limitless Health—releases May 14; available for pre-order today.
Metabolic flexibility means that your body can switch easily between burning glucose and fat, which means you have better energy and endurance. Jennifer Chesak. Dominic D'Agostino, PhD.
Metabolic Health. Ask The Expert. Holistic physician Rich Joseph explains the science behind these ancient treatments and shares how to get started. Rich Joseph, MD. Author Casey Means, MD. Author Josh Clemente. Author Arlo Crawford. The timing and type of exercise monitoting have an effect on how the body taps into energy sources, ideally shifting towards fat usage for energy over glucose.
Continuous glucose monitoring CGM gives you visibility into the relationship between your specific exercise routines and your glucose levels, allowing you to track the metabolic progress of your hard work.
Two Ways That Glucose Awareness Makes Exercise Even Better By optimizing the timing and type of your exercise routine: We know that post-meal glucose spikes monitoriing a risk factor for heart disease, stroke, and vascular damage.
Increasing how often you exercise Research suggests that real-time individualized feedback on glucose levels can inspire people to exercise more. Get monitorung, new articles, exclusive discounts, and more. Email Required. This field is for validation purposes and should be left unchanged.
More on Exercise. Inside Levels Personal Story How Levels founder Josh Clemente mastered his energy levels with CGM How Levels Founder Josh Clemente mastered his energy levels with glucose tracking and CGM. Exercise Ultimate Guide How metabolic health affects your joints Diet and lifestyle matter more to your joints than you might think.
Exercise Ultimate Guide How to maximize athletic recovery with continuous glucose monitoring CGM Nutrition plays a huge role in athletic recovery. The Latest From Levels.
Metabolic Basics The Monittoring 7 things that can falsely impact glucose readings Being aware of these causes of inaccurate data can help you identify—and avoid—surprising and misleading feedback. Inside Levels Announcement Announcing: Dr. Metabolic Basics The Explainer What is metabolic flexibility, and why is it important?
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: Exercise and blood sugar monitoring| Why Does Exercise Sometimes Raise Blood Glucose | ADA | Are continuous glucose monitors and insulin pumps covered by Medicare? Everything you need to know about what about birth control options and concerns for women with type 1 diabetes. Everything you need to know about preparing for travel and TSA rules with type 1 diabetes as COVID subsides. A diabetes advocate in Ireland explains the patient community and St. Patrick's Day. Cauliflower Pizza is now big business. Why is this so exciting for people with type 1 diabetes? DiabetesMine interviews researcher Dr. Howard Wolpert on technology and other progress revolutionizing diabetes care. The exciting first-ever implantable continuous glucose monitor CGM Eversense can now be worn for 6 months straight. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Diabetes Mine Influencer Why Does Exercise Sometimes Make Your Blood Sugar Spike? Medically reviewed by Marina Basina, M. Release of glucose-raising hormones. Share on Pinterest. How to counter glucose spikes from exercise. How we reviewed this article: History. Oct 5, Written By Corinna Cornejo. Share this article. Read this next. Omnipod 5: First Tubeless Automated Insulin Delivery System with Smartphone Control Insulet's Omnipod 5 becomes the first commercially available Automated Insulin Delivery AID system with no tubes and smartphone control. READ MORE. Advocates Take a Stand Against Diabetes Stigma The diaTribe Foundation has launched a new resource hub to help people with diabetes fight stigma. Please choose the single best answer to each question. At the end of the quiz, your score will display. All rights reserved. University of California, San Francisco About UCSF Search UCSF UCSF Medical Center. Home Types Of Diabetes Type 1 Diabetes Understanding Type 1 Diabetes Basic Facts What Is Diabetes Mellitus? What Are The Symptoms Of Diabetes? Diagnosing Diabetes Treatment Goals What is Type 1 Diabetes? What Causes Autoimmune Diabetes? Who Is At Risk? The food you eat before or during a workout may also contribute to a glucose rise. Eat too many carbs before exercising, and your sweat session may not be enough to keep your blood glucose within your goal range. Now that you know what causes a blood glucose rise after or during exercise, you may expect and accept it during your next workout session because you know the benefits of exercise outweigh the rise in glucose. Physical activity is important for everyone with diabetes. Managing glucose levels with any form of exercise is possible once you understand your personal patterns doing regular blood glucose checks and keeping a workout log can help and making adjustments that make sense to you and your lifestyle. Breadcrumb Home You Can Manage and Thrive with Diabetes Fitness Why Does Exercise Sometimes Raise Blood Glucose? Adrenaline Can Raise Blood Glucose Levels Using your muscles helps burn glucose and improves the way insulin works. Strategies to Keep Blood Glucose From Rising During Workouts Now that you know what causes a blood glucose rise after or during exercise, you may expect and accept it during your next workout session because you know the benefits of exercise outweigh the rise in glucose. |
| TYPES AND CLASSIFICATIONS OF DIABETES AND PREDIABETES | Learn more about Amanda. The s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, et al. Lastly, another limitation is the low number of longer-term studies and we would caution against inferring that chronic exercise training no more effective than shorter-term exercise due to the timing of the CGM measures in the longer-term studies. In another example, competitive activities will often raise the blood sugar. |
| The importance of exercise when you have diabetes - Harvard Health | You may be told to test your blood sugar with a finger stick before, during or after exercise. Dunstan ; David W. Exercise makes the body more sensitive to insulin the hormone that allows cells in the body to take up sugar for energy , which helps lower blood sugar levels. There were fewer longer-term studies identified and only two with randomization to a non-exercise control condition. The health benefits of resistance training for all adults include improvements in muscle mass, body composition, strength, physical function, mental health, bone mineral density, insulin sensitivity, blood pressure, lipid profiles, and cardiovascular health Request Appointment. |
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Monitoring Blood Glucose Levels \u0026 What Does EXERCISE Do? - Dr. Casey Means Metabolic Health BasicsExercise and blood sugar monitoring -
was included. The study from Savikj et al. Table 1 includes characteristics of the 23 eligible short-term studies. A total of participants were included. The majority of these participants were males males vs. Many of the studies included multiple exercise groups for a total of 40 exercise groups.
There were a variety of exercise prescriptions, with studies prescribing low, moderate, and high-intensity aerobic exercise, including different forms of high-intensity interval training HIIT. The timing in relation to meals varied among studies but was reported in all but 2 studies.
Eleven studies provided all of the meals to the participants throughout the h period, 6 studies provided some meals but not all, and 6 studies did not provide any meals. In the studies that did not provide meals, or partially provided meals, participants were often asked to maintain similar dietary intakes across conditions.
Of the 23 short-term studies, one study used an intermittently scanned CGM Freestyle Libre, Abbott. Three studies used the Guardian or MiniMed Medtronic CGM which provided real-time data to participants. Five studies used GlucoDay S A. Menarini Diagnostics CGM, which has the capability of showing real time glucose concentrations but was likely blinded.
An additional 12 studies used iPro Medtronic CGM technology, which are blinded to participants and researchers until the data is download after removal of the sensor. An additional three studies did not specify the type of Medtronic CGM but provided enough detail to suggest that the data were also examined retrospective and not available in real-time.
Twenty of the 23 short-term studies provided some information on the type of medication. Menopausal status was reported in 6 of the 15 short-term studies that included women. In these 6 studies, almost all participants were postmenopausal a total of only 3 women were not.
Table 2 describes the five eligible longer-term studies. Interventions ranged from 8 to 16 weeks in duration. A total of 99 participants 57 males and 42 females were included in 9 different exercise interventions, but only 15 participants in two separate control groups 60 , Francois et al.
Consequently, we only included the HIIT group that received the flavored water placebo from Francois et al. Of the five longer-term studies, two used the blinded iPro CGM, two used the Guardian CGM and one used a MiniMed system that also included a portable monitor all from Medtronic.
Among the 23 short-term studies, 22 reported h glucose concentrations. Several studies had multiple exercise conditions, which led to a total of 39 exercise groups included in the overall analyses. Compared to control, exercise reduced h glucose concentrations by 0.
Figure 2. CI, confidence interval; SE, standard error; 1RM, one repetition maximum; HIIT, high-intensity interval training; REHIT, reduced exertion high intensity interval training.
Due to the significant heterogeneity among studies, analysis was performed by dividing studies into subgroups according to the timing of exercise, type of exercise, dietary control, and type of CGM see Table 3. Table 3. Meta-regression was performed to predict changes in h glucose concentrations following exercise with other variables such as h glucose concentrations in the control condition, baseline A1C, age, BMI, or the percentage of female participants.
Note that the same participants completed both the control and exercise conditions i. Figure 3. Meta-regression to predict changes in mean h glucose concentrations following exercise according to: A mean h glucose concentrations in the control condition, and B percentage of females.
Change in secondary glycemic outcomes are summarized in Table 4. Time spent in hyperglycemia was analyzed from 16 studies, which included 30 exercise vs. control comparisons. The subgroup differences reflected the findings from the h glucose concentrations but are not presented as some of the subgroups were much smaller e.
Indices of glycemic variability were reported in 11 studies with a total of 18 subgroups. Many different measures e. MAGE was the most frequently reported index of glycemia variability and was available in all but two subgroups. On the other hand, fasting glucose and time in hypoglycemia were not significantly affected by exercise.
Four of the studies started post-training CGM measures 48—72 h after the last bout of exercise and described the post-intervention measurements within 1 week of the last bout of exercise.
However, only 4 exercise conditions were included in this exercise vs. control comparison with a total of 49 participants in the exercise groups and 15 in the control groups. Figure 4. A Exercise vs. control pre-intervention, B exercise vs.
control post-intervention. CI, confidence interval; SE, standard error; 1RM, one repetition maximum; HIIT, high-intensity interval training. Secondary analysis of the pre- and post-exercise comparisons resulted in the inclusion of 9 longer-term exercise conditions with a total of participants.
Subgroup analyses, regression analyses, and examination of other outcomes were not performed due to the low number of available comparisons. Figure 5. Summaries according to the Cochrane Collaboration Risk of Bias tool are provided in Supplementary Figures 1 , 2 for short and longer-term studies, respectively.
As expected in exercise trials, blinding of participants to the exercise intervention is not feasible. Funnel plots were also generated to examine the potential for publication bias.
For the primary outcome of mean h glucose concentrations, funnel plots are provided in Supplementary Figures 3 , 4 for short and longer-term studies, respectively.
Visual inspection of the funnel plots did not reveal any asymmetries, with the exception of the outlier from Cruz et al. However, this group also had average size SE, which would not be expected in a typical publication bias scenario where studies with the largest SE tend to show more beneficial effects.
The present systematic review and meta-analyses confirms our previous findings that exercise reduces mean h glucose and time spent in hyperglycemia 5 , but also builds on this work in several ways:. The number of eligible short-term studies reporting the effects of exercise on CGM outcomes in T2D has approximately tripled from 8 to 23 studies; or from to participants.
The greater number of short-term studies allowed for hypothesis generating subgroup and meta-regression analyses, which helped explain the heterogeneous responses among trials e. There were a sufficient number of trials to include outcomes that were not previously considered; including glycemic variability in short-term studies and mean h glucose in longer-term studies.
The improvement in mean h glucose concentrations following short-term exercise was 0. The differences may be due to the higher variability among trials in our current review as reflected in the higher I 2 -value i. It is possible that this would have reached statistical significance had fasting glucose been reported in more short-term studies.
Nonetheless, it may be that exercise has a greater impact on postprandial glucose, which is more strongly linked to muscle insulin resistance, whereas fasting glucose is believed to be more strongly associated with hepatic insulin resistance 63 , Longer-term studies have shown reductions in fasting glucose with exercise 65 , but it is difficult to know to what extent this was due to weight loss.
To better understand the heterogeneity among short-term trials, we conducted a series of subgroup meta-regression analyses. It is important to note that since participants were not randomly assigned to the subgroups, we cannot determine if it was a causal relationship.
In addition, some variables in our subgroup and meta-regression analyses were not pre-specified. Consequently, results from our subgroup analyses should be interpreted with caution and confirmed by randomized trials. In our meta-regression analyses, the strongest predictor of greater improvements in glycemic control was the mean h glucose concentrations from the control condition, suggesting that participants with elevated glucose concentrations had greater reductions following exercise.
Although this may seem intuitive, it is potentially affected by a regression to the mean artifact [as previously reviewed by Sheppard 66 ]. Sex, but not age or BMI, was associated with changes in mean h glucose. Studies that had a higher proportion of males were associated with greater reductions in mean h glucose.
Our meta-analysis does not permit us to identify the reasons why males may have responded more favorably compared to females. However, a greater effect of exercise on insulin sensitivity 67 and post-exercise glucose metabolism 68 has been previously observed in males compared to females.
The reasons for these differences are not well-known, but may be related to differences in substrate oxidation during exercise and recovery Of note, only 3 women were not postmenopausal among the 6 studies that reported menopausal status.
Consequently, it is possible that the results are not generalizable to women before menopause. However, we cannot rule out that the association with sex was caused by other confounders and we noted very high heterogeneity among the studies that only included males see left side of Figure 3B.
The association observed between the proportion of females and changes in mean h glucose following exercise was only observed after removing of a potential outlier. Indeed, the study by Cruz et al. They compared a single bout of exercise performed at 80 vs.
Resistance training was performed with a circuit in which each exercise was performed 3 times. To put this in perspective, this reduction is more than 5 times as much as the mean reduction in our meta-analyses and nearly twice as much as the next largest reduction among the 39 exercise conditions.
The authors suggest that the greater counterregulatory hormone responses with the greater resistance exercise intensity may have contributed to the differences between conditions. It is also noteworthy that the participants in the Cruz et al.
study were also the ones with the highest mean h glucose during the control condition and therefore had the potential for greater reductions without experiencing hypoglycemia. The timing of exercise was associated with some of the variance among short-term studies.
Again, in our subgroup analyses, most participants were not randomly assigned to different exercise timing and therefore causality cannot be inferred. However, five studies directly compared two similar amounts of exercise performed at different times of the day 39 , 43 , 54 , 56 , The results from Savikj et al.
However, this study involved HIIT training whereas most of the studies in our meta-analyses did not. They also offered a snack after morning exercise only. If changes in the timing of exercise can be found to consistently affect glycemic responses, this could be encouraging for people with T2D who could use such strategies to get more benefits from the same amount of exercise.
The decision to perform subgroup analyses based on exercise timing in relation to meals was a priori as a consequence of our findings in the study by Rees et al. However, we were unsure of the exact subgroups that would be available e. and divided our subgroups in a way to have multiple studies in each subgroup.
The reasons why fasting i. One potential explanation could be that, in the absence of exogenous fuels, fasting exercise must rely to a greater extent on endogenous fuels e. The first two longer-term training studies comparing fasting exercise to postprandial exercise in T2D have been recently published 71 , These longer-terms studies did not support a more favorable effect of fasting exercise compared to postprandial exercise.
However, the postprandial exercise was performed shortly after breakfast not in the afternoon in both of these studies 71 , It is currently difficult to understand to what extent the effects of fasting exercise are due to fasting itself or to the time of day i.
To further complicate matters, in people with T2D, many glucose lowering medications are taken with meals and we found an association with the use of sulfonylurea within a study in changes in hr glucose following exercise vs.
control, but not for other categories of medication. Interpretation of differences among subgroups is based on comparing results from different exercise conditions that did not benefit from randomization, therefore subgroup comparisons may be affected by several confounding variables and should be confirmed by randomized trials.
Several studies included in our meta-analysis did directly compare the effect of different exercise intensities. Some compared continuous exercise to different forms of higher intensity interval training 45 , 49 , 54 , 73 , one compared low vs.
moderate intensity continuous exercise 48 , and one compared different intensities of resistance exercise As in the subgroup analyses from our meta-analysis, no clear pattern emerged when examining these studies individually.
However, a previous meta-analysis of longer-term studies with head-to-head comparison of exercise of different intensities suggested that higher intensity exercise led to greater declines A1C 8. Another difference was that the trials in the earlier meta-analysis had similar or greater energy expenditures in the high intensity groups compared to the lower intensity groups from the same trial.
Likewise, the aerobic vs. resistance training comparison in the short-term trials may not reflect longer term adaptations. The mechanisms leading to improvements in glycemic control following continuous aerobic, HIIT and resistance training may be different, and are beyond the scope of our meta-analysis.
Methodological aspects unrelated to exercise, such as the type of CGM real-time vs. intermittently scanned as well as the level of dietary control i. However, the absence of significant subgroup differences may be due to the presence of other confounders as there was high heterogeneity within many different subgroups.
The type of CGM or the degree of dietary control may influence compensatory behaviors from participants e. Glycemic variability may be independently associated with cardiovascular disease When examining the change across all short-term studies, we observed a consistent and statistically significant reduction in MAGE.
There were several indices of glycemic variability. Although these indices differ in their calculations, they were highly related to each other. For example, correlation coefficients were all above 0. There were fewer longer-term studies identified and only two with randomization to a non-exercise control condition.
The pre- vs. post-analyses led to different conclusions than the randomized exercise vs. control comparison. post-comparison had a smaller mean difference but reached statistical significance, in part due to the greater number of participants but also because of the increased statistical power within participant analyses.
Interestingly, the weighted mean difference in the pre- and post-analyses was similar to the weighted mean difference found in the acute studies i. Based on conversions between A1C and estimated average glucose 76 , such a reductions could correspond to a 0.
This is not surprising given that the post-training CGM measures typically started at least h after the last bout of exercise to minimize the acute effect from this last bout. Therefore, we would expect the weekly average glucose to be lower in these participants who prescribed exercise three times per week or more.
Weight loss in longer-term exercise trials may mediate some of the improvements in glycemic control. Consequently, we believe that most of the changes were observed in the absence of meaningful weight loss. The main limitation of this meta-analysis is the high heterogeneity among the shorter-term studies and that we were only partially successful at explaining the heterogeneity.
Consequently, interpreting the overall effects should be done with caution. Based on our findings, it is unlikely that exercise increases blood glucose; it is more likely that the heterogeneity is in the degree of the positive to no effects.
The apparent heterogeneity may in fact be in part a result of the analytical approach that we chose. Indeed, the within participant mean change and SE used in the generic inverse method approach, leads to much narrower confidence internals than if we compared the mean glucose from the exercise vs.
control using the between participant standard deviation in each condition. When the latter approach is used, the weighted mean difference remained similar 0.
The heterogeneity may also be caused my methodological issues. Several CGM devices require multiple calibrations per day and errors in calibration values can have a meaningful impact on h outcomes. In addition, investigators often have to make difficult decisions on how to treat missing CGM values.
Lastly, another limitation is the low number of longer-term studies and we would caution against inferring that chronic exercise training no more effective than shorter-term exercise due to the timing of the CGM measures in the longer-term studies.
In conclusion, both short-term and long-term exercise can reduce mean h glucose concentrations. Short-term exercise also reduces other CGM-derived outcomes such as glycemic variability, while additional longer-term studies are needed to examine such outcomes. The glycemic response to short-term exercise can be variable, and exploratory analyses suggests that the heterogeneity among studies might in part be explained by the extent to which glycaemia is impaired on non-exercise days, or factors such as the timing of exercise and the sex of participants.
MM, CO, AM-C, and JR contributed to data extraction. MM, CO, and NB performed the statistical analysis and wrote sections of the manuscript.
All authors contributed to the conception and design of the study, manuscript revision, read, and approved the submitted version. This research was performed without financial support. MM was supported by graduate student stipends from the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta.
AM-C was supported by the Fonds de recherche du Québec — Santé. NB has received continuous glucose monitors from Medtronic Canada for previous studies.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We would like to thank Linda Slater who helped us develop previous search strategies from which the current one was produced.
We also thank Dominic Tremblay who assisted AM-C with data extraction. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. doi: PubMed Abstract CrossRef Full Text Google Scholar.
Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, et al. Other strategies involve including short sprints, performing resistance exercise before aerobic exercise in the same session, and activity timing. Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cooldown.
Exercising with hyperglycemia and elevated blood ketones is not recommended. Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training.
Exercise-induced hypoglycemia is common in people with type 1 diabetes and, to a lesser extent, people with type 2 diabetes using insulin or insulin secretagogues. In addition to insulin regimen and carbohydrate intake changes, a brief 10 s maximal intensity sprint performed before or after a moderate-intensity exercise session may protect against hypoglycemia Performing high-intensity bouts intermittently during moderate aerobic exercise also slows blood glucose declines 81 , , , as can resistance exercise done immediately prior to aerobic Exercise-induced nocturnal hypoglycemia is a major concern Exercise-induced hyperglycemia is more common in type 1 diabetes.
Purposeful insulin omission before exercise can promote a rise in glycemia, as can malfunctioning infusion sets Individuals with type 2 diabetes may also experience increases in blood glucose after aerobic or resistance exercise, particularly if they are insulin users and administer too little insulin for meals before activity Overconsumption of carbohydrates before or during exercise, along with aggressive insulin reduction, can promote hyperglycemia during any exercise Very intense exercise such as sprinting , brief but intense aerobic exercise , and heavy powerlifting , may promote hyperglycemia, especially if starting blood glucose levels are elevated Hyperglycemia risk is mitigated if intense activities are interspersed between moderate-intensity aerobic ones 82 , Similarly, combining resistance training done first with aerobic training second optimizes glucose stability in type 1 diabetes Millán, personal communication.
Excessive insulin corrections after exercise increase nocturnal hypoglycemia risk, which can result in mortality Adults with diabetes are frequently treated with multiple medications for diabetes and other comorbid conditions.
Some medications other than insulin may increase exercise risk and doses may need to be adjusted , Although appropriate changes should be individualized, Table 4 lists general considerations and guidelines for medications.
Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments. If exercise-induced hypoglycemia has occurred, decrease dose on exercise days to reduce hypoglycemia risk. May increase risk of hypoglycemia when used with insulin or sulfonylureas but not when used alone.
Generally safe; no dose adjustment for exercise but may need to lower insulin or sulfonylurea dose. Doses may need to be adjusted to accommodate the improvements from training and avoid dehydration. Physical activity increases bodily heat production and core temperature, leading to greater skin blood flow and sweating.
In relatively young adults with type 1 diabetes, temperature regulation is only impaired during high-intensity exercise , With increasing age, poor blood glucose control, and neuropathy, skin blood flow and sweating may be impaired in adults with type 1 , and type 2 diabetes, increasing the risk of heat-related illness.
Chronic hyperglycemia also increases risk through dehydration caused by osmotic diuresis, and some medications that lower blood pressure may also impact hydration and electrolyte balance.
Active individuals with type 1 diabetes are not at increased risk of tendon injury , but this may not apply to sedentary or older individuals with diabetes. Given that diabetes may lead to exercise-related overuse injuries due to changes in joint structures related to glycemic excursions , exercise training for anyone with diabetes should progress appropriately to avoid excessive aggravation to joint surfaces and structures, particularly when taking statin medications for lipid control Physical activity with vascular diseases can be undertaken safely but with appropriate precautions.
Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity.
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.
Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions. Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations. Macrovascular and microvascular diabetes-related complications can develop and worsen with inadequate blood glucose control , Vascular and neural complications of diabetes often cause physical limitation and varying levels of disability requiring precautions during exercise, as recommended in Table 5.
Physical activity consideration, precautions, and recommended activities for exercising with health-related complications. Coronary perfusion may actually be enhanced during higher-intensity aerobic or resistance exercise. Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes.
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.
Stop exercise immediately if symptoms of a stroke occurring suddenly and often affecting only one side of the body happen during exercise. Lower-extremity resistance training improves functional performance Low- or moderate-intensity walking, arm ergometer, and leg ergometer preferred as aerobic activities Regular aerobic exercise may also prevent the onset or delay the progression of peripheral neuropathy in both type 1 and type 2 diabetes Proper care of the feet is needed to prevent foot ulcers and lower the risk of amputation 6.
Keep feet dry and use appropriate footwear, silica gel or air midsoles, and polyester or blend socks not pure cotton. Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Moderate walking is not likely to increase risk of foot ulcers or reulceration with peripheral neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
With postural hypotension, avoid activities with rapid postural or directional changes to avoid fainting or falling. With cardiac autonomic neuropathy, obtain physician approval and possibly undergo symptom-limited exercise testing before commencing exercise With blunted heart rate response, use heart rate reserve and ratings of perceived exertion to monitor exercise intensity Individuals with mild to moderate nonproliferative changes have limited or no risk for eye damage from physical activity.
With moderate nonproliferative retinopathy, avoid activities that dramatically elevate blood pressure, such as powerlifting. Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment.
Avoid activities that dramatically elevate blood pressure, such as vigorous activity of any type. Avoid vigorous exercise; jumping, jarring, and head-down activities; and breath holding 6. Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity.
Exercise does not accelerate progression of kidney disease even though protein excretion acutely increases afterward 6 , Greater participation in moderate-to-vigorous leisure time activity and higher physical activity levels may actually moderate the initiation and progression of diabetic nephropathy — All activities okay, but vigorous exercise should be avoided the day before urine protein tests are performed to prevent false positive readings.
Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease. All activities okay, but exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Individuals with diabetes are more prone to structural changes to joints that can limit movement, including shoulder adhesive capsulitis, carpal tunnel syndrome, metatarsal fractures, and neuropathy-related joint disorders Charcot foot In addition to engaging in other activities as able , do regular flexibility training to maintain greater joint range of motion 10 , Stretch within warm-ups or after an activity to increase joint range of motion best Most low- and moderate-intensity activities okay, but more non—weight-bearing or low-impact exercise may be undertaken to reduce stress on joints.
Do range-of-motion activities and light resistance exercise to increase strength of muscles surrounding affected joints. Avoid activities with high risk of joint trauma, such as contact sports and ones with rapid directional changes.
Targeted behavior-change strategies should be used to increase physical activity in adults with type 2 diabetes. For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes.
Behavioral interventions can significantly increase physical activity in adults with type 2 diabetes , and A1C reductions produced by such interventions have been sustained to 24 months However, motivational interviewing is not significantly better than usual care , and other intervention factors associated with weight loss, such as number and duration of contacts, have been inconsistent or not associated with greater participation Wearing the device may prompt activity, and it provides feedback for self-monitoring.
Pedometer use in adults with type 2 diabetes increased their daily steps by 1,, but did not improve A1C Using a daily steps goal e.
The positive findings for pedometers are not universal , however, and some individuals may require greater support to realize benefits. Longer-term efficacy and determination of which populations can benefit from pedometers and other wearable activity trackers require further evaluation.
Given that the majority of individuals with type 2 diabetes have access to the Internet, technology-based support is appealing for extending clinical intervention reach. For adults with type 2 diabetes, Internet-delivered physical activity promotion interventions may be more effective than usual care More evidence is needed regarding social media approaches, given the importance of social and peer support in diabetes self-management Physical activity and exercise should be recommended and prescribed to all individuals with diabetes as part of management of glycemic control and overall health.
Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications. Recommendations should be tailored to meet the specific needs of each individual.
In addition to engaging in regular physical activity, all adults should be encouraged to decrease the total amount of daily sedentary time and to break up sitting time with frequent bouts of activity.
Finally, behavior-change strategies can be used to promote the adoption and maintenance of lifetime physical activity. Duality of Interest. No potential conflicts of interest relevant to this article were reported. This position statement was reviewed and approved by the American Diabetes Association Professional Practice Committee in June and ratified by the American Diabetes Association Board of Directors in September Sign In or Create an Account.
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toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. 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.
Try to fit in at least 20 to 25 minutes of activity every day, which will help it become a habit. Low-impact activities like pool walking and swimming are examples. Talk to your health care provider about activities that you can do to get started. Start slowly, and work your way up to your desired level.
Discuss other ideas with your health care provider. Special Considerations for People With Diabetes Protect your feet by wearing cotton socks with well-fitting athletic shoes. Video: Being Active Physical Activity Basics Physical Activity and Health Measuring Physical Activity Intensity More People Walk to Better Health Exercise and Type 1 Diabetes.
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Ultimate Exercuse. Exercise, glucose, and Exercise and blood sugar monitoring flexibility: how monitoring visceral fat reduction methods levels with CGM can help Exercise and blood sugar monitoring improve fueling, endurance, performance, and recovery. Casey Monutoring, MD. Josh Bloood. Arlo Crawford. The positive monitorijg of exercise mmonitoring metabolic monitpring include an increase in glucose transporters traveling to the lining of cells GLUT4 channelsallowing more glucose to enter and lowering circulating glucose—without additional insulin. Exercise may also improve the function of pancreatic beta cells which produce insulin and insulin activityincrease the amount of fat we burn between meals, and increase the number of mitochondria we have in our cells where the cell burns fat and glucose to make energy.Exercise and blood sugar monitoring -
So, try to assess the situation in terms of your insulin intake, or insulin on board IOB. BG spikes caused by bursts of adrenaline can be hard to anticipate, as they happen most often smack in the middle of a an exercise session.
This means that rather than treat the spike immediately, you most likely will need to wait and take additional insulin after the fact. More insulin is also needed when the spike results from fasted exercise.
Some additional insulin will be needed, but not so much that it leads to a hypoglycemic episode during or after exercise. Unfortunately, there are no hard and fast rules for making these insulin dosing adjustments.
Each situation for each person will require an individualized response. That being said, both Vieira and Oerum suggest taking notes and tracking your experience so that you can learn from your experiences.
You may find that for you personally, particular activities have a predictable BG spike effect. Over time you can develop a routine that allows you to both get the exercise you need and anticipate those frustrating spikes. Once you understand why BG levels spike during exercise, and accept that this is not necessarily a bad thing, you will hopefully notice a mental shift, away from being frustrated and disappointed toward appreciating what you can do in response.
While there is no one-size-fits-all guidance, know that over time you can build an exercise routine that includes small amounts of glucose and insulin dosing that keeps your BG levels manageable.
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Diabetes is an independent risk factor for low muscular strength 20 and accelerated decline in muscle strength and functional status The health benefits of resistance training for all adults include improvements in muscle mass, body composition, strength, physical function, mental health, bone mineral density, insulin sensitivity, blood pressure, lipid profiles, and cardiovascular health The effect of resistance exercise on glycemic control in type 1 diabetes is unclear However, resistance exercise can assist in minimizing risk of exercise-induced hypoglycemia in type 1 diabetes When resistance and aerobic exercise are undertaken in one exercise session, performing resistance exercise first results in less hypoglycemia than when aerobic exercise is performed first Resistance training benefits for individuals with type 2 diabetes include improvements in glycemic control, insulin resistance, fat mass, blood pressure, strength, and lean body mass Flexibility and balance exercises are likely important for older adults with diabetes.
Limited joint mobility is frequently present, resulting in part from the formation of advanced glycation end products, which accumulate during normal aging and are accelerated by hyperglycemia Stretching increases range of motion around joints and flexibility 10 but does not affect glycemic control.
Balance training can reduce falls risk by improving balance and gait, even when peripheral neuropathy is present The benefits of alternative training like yoga and tai chi are less established, although yoga may promote improvement in glycemic control, lipid levels, and body composition in adults with type 2 diabetes Tai chi training may improve glycemic control, balance, neuropathic symptoms, and some dimensions of quality of life in adults with diabetes and neuropathy, although high-quality studies on this training are lacking All adults, and particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior.
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.
The above two recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement. Sedentary behavior—waking behaviors with low energy expenditure TV viewing, desk work, etc.
Higher amounts of sedentary time are associated with increased mortality and morbidity, mostly independent of moderate-to-vigorous physical activity participation 31 — In people with or at risk for developing type 2 diabetes, extended sedentary time is also associated with poorer glycemic control and clustered metabolic risk 36 — In adults with type 2 diabetes, interrupting prolonged sitting with 15 min of postmeal walking 45 and with 3 min of light walking and simple body-weight resistance activities every 30 min 46 improves glycemic control.
The longer-term health efficacy and durability of reducing and interrupting sitting time remain to be determined for individuals with and without diabetes. Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to enhance insulin action.
Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes.
Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general. Insulin action in muscle and liver can be modified by acute bouts of exercise and by regular physical activity Acutely, aerobic exercise increases muscle glucose uptake up to fivefold through insulin-independent mechanisms.
If enhanced insulin action is a primary goal, then daily moderate- or high-intensity exercise is likely optimal Regular training increases muscle capillary density, oxidative capacity, lipid metabolism, and insulin signaling proteins 47 , which are all reversible with detraining Both aerobic and resistance training promote adaptations in skeletal muscle, adipose tissue, and liver associated with enhanced insulin action, even without weight loss 56 , Regular aerobic training increases muscle insulin sensitivity in individuals with prediabetes 58 and type 2 diabetes 59 in proportion to exercise volume Resistance training enhances insulin action similarly 56 , as do HIIT and other modes 2 , 15 — Combining endurance exercise with resistance exercise may provide greater improvements 61 , and HIIT may be superior to continuous aerobic training in adults with diabetes The Look AHEAD Action for Health in Diabetes trial 62 was the largest randomized trial evaluating a lifestyle intervention in older adults with type 2 diabetes compared with a diabetes support and education control group.
Major cardiovascular events were the same in both groups, possibly in part due to greater use of cardioprotective medications in the diabetes support and education group However, as reviewed by Pi-Sunyer 63 , the intensive lifestyle intervention group achieved significantly greater sustained improvements in weight loss, cardiorespiratory fitness, blood glucose control, blood pressure, and lipids with fewer medications; less sleep apnea, severe diabetic kidney disease and retinopathy, depression, sexual dysfunction, urinary incontinence, and knee pain; and better physical mobility maintenance and quality of life, with lower overall health care costs.
This trial provided very strong evidence of profound health benefits from intensive lifestyle intervention. For glycemic control, combined training is superior to either type of training undertaken alone 61 , Therefore, adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes.
Randomized trials evaluating exercise interventions in youth with type 2 diabetes are limited and inconclusive, although benefits are likely similar to those in adults. In the Treatment Options for Type 2 Diabetes in Adolescents and Youth TODAY study 67 , youth aged 10—17 years with type 2 diabetes were stabilized on metformin and then randomized to metformin plus placebo, metformin plus rosiglitazone, or metformin plus lifestyle intervention and followed for a mean of 3.
A recent systematic review of 53 studies 30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs that evaluated 66 lifestyle intervention programs reported that, compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence, body weight, and fasting blood glucose while improving other cardiometabolic risk factors Trials evaluating less resource-intensive lifestyle interventions have also shown effectiveness 3 , and adherence to guidelines is associated with a greater weight loss Youth and adults with type 1 diabetes can benefit from being physically active, and activity should be recommended to all.
Frequent blood glucose checks are required to implement carbohydrate intake and insulin dose adjustment strategies. Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods.
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. Youth experience many health benefits from physical activity participation 9. In adults, regular physical activity has been associated with decreased mortality There is insufficient evidence on the ideal type, timing, intensity, and duration of exercise for optimal glycemic control.
Blood glucose responses to physical activity in type 1 diabetes are highly variable In general, aerobic exercise decreases blood glucose levels if performed during postprandial periods with the usual insulin dose administered at the meal before exercise 73 , and prolonged activity done then may cause exaggerated decreases 74 — Exercise while fasting may produce a lesser decrease or a small increase in blood glucose Variable glycemic responses to physical activity 72 make uniform recommendations for management of food intake and insulin dosing difficult.
As recommended in Table 1 , blood glucose concentrations should always be checked prior to exercise undertaken by individuals with type 1 diabetes. Carbohydrate intake required will vary with insulin regimens, timing of exercise, type of activity, and more 87 , but it will also depend on starting blood glucose levels.
Continuous subcutaneous insulin infusion CSII users can reduce 90 or suspend 91 insulin delivery at the start of exercise, but this strategy does not always prevent hypoglycemia 91 , Frequent blood glucose checks are required when implementing insulin and carbohydrate adjustments.
Suggested carbohydrate intake or other actions based on blood glucose levels at the start of exercise. may not require any additional carbohydrate intake. For prolonged activities at a moderate intensity, consume additional carbohydrate, as needed 0.
Test for ketones. Do not perform any exercise if moderate-to-large amounts of ketones are present. Initiate mild-to-moderate intensity exercise. If ketones are negative or trace , consider conservative insulin correction e. Adapted from Zaharieva and Riddell Suggested initial pre-exercise meal insulin bolus reduction for activity started within 90 min after insulin administration.
Recommendations compiled based on four studies 94 — N-A, not assessed as exercise intensity is too high to sustain for 60 min. Estimated from study Individuals using CSII or MDI as a basal-bolus regimen can exercise with few restrictions.
CSII offers some advantages over MDI due to greater flexibility in basal rate adjustments and limiting postexercise hyperglycemia 98 , with some limitations.
For example, aerobic exercise may accelerate basal insulin absorption from the subcutaneous depot 74 , whereas basal insulin glargine absorption is largely unaffected Skin irritation, pump tubing, and wearing a pump that is visible to others can be concerns In certain sports, such as basketball or contact sports, wearing pumps and other devices may be prohibited during competition.
Frustration with CSII devices and exercise may lead to discontinuation of pump therapy Continuous glucose monitoring CGM may decrease the fear of exercise-induced hypoglycemia in type 1 diabetes by providing blood glucose trends that allow users to prevent and treat hypoglycemia sooner Although a few studies have found acceptable CGM accuracy during exercise — , others have reported inadequate accuracy and other problems, such as sensor filament breakage , , inability to calibrate , and time lags between the change in blood glucose and its detection by CGM Differences in sensor performance have also been noted — Although it is a potentially useful tool during and after exercise , CGM values have traditionally required confirmation by finger-stick glucose testing prior to making regimen changes, but approval of nonadjunctive use is likely forthcoming in the near future.
Pre-exercise medical clearance is generally unnecessary for asymptomatic individuals prior to beginning low- or moderate-intensity physical activity not exceeding the demands of brisk walking or everyday living.
B for type 2 diabetes, C for type 1 diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance. Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental nonexercise physical activity to gain additional health benefits.
To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs. The ACSM no longer includes risk factor assessment in the exercise preparticipation health screening process.
However, their recommendation is that anyone with diabetes who is currently sedentary and desires to begin physical activity at any intensity even low intensity should obtain prior medical clearance from a health care professional We believe this recommendation is excessively conservative.
Physical activity does carry some potential health risks for people with diabetes, including acute complications like cardiac events, hypoglycemia, and hyperglycemia.
In low- and moderate-intensity activity undertaken by adults with type 2 diabetes, the risk of exercise-induced adverse events is low.
In individuals with type 1 diabetes any age the only common exercise-induced adverse event is hypoglycemia. No current evidence suggests that any screening protocol beyond usual diabetes care reduces risk of exercise-induced adverse events in asymptomatic individuals with diabetes , Thus, pre-exercise medical clearance is not necessary for asymptomatic individuals receiving diabetes care consistent with guidelines who wish to begin low- or moderate-intensity physical activity not exceeding the demands of brisk walking or everyday living.
However, some individuals who plan to increase their exercise intensity or who meet certain higher-risk criteria may benefit from referral to a health care provider for a checkup and possible exercise stress test before starting such activities 6.
In addition, most adults with diabetes may also benefit from working with a diabetes-knowledgeable exercise physiologist or certified fitness professional to assist them in formulating a safe and effective exercise prescription.
People with diabetes should perform aerobic exercise regularly. Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to decrease insulin resistance, regardless of diabetes type 16 , Many adults, including most with type 2 diabetes, would be unable or unwilling to participate in such intense exercise and should engage in moderate exercise for the recommended duration Table 3.
Exercise training recommendations: types of exercise, intensity, duration, frequency, and progression. Balance for older adults : practice standing on one leg, exercises using balance equipment, lower-body and core resistance exercises, tai chi.
Moderate e. For adults able to run steadily at 6 miles per h 9. At least 8—10 exercises with completion of 1—3 sets of 10—15 repetitions to near fatigue per set on every exercise early in training. 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. Increase in resistance can be followed by a greater number of sets and finally by increased training frequency. Youth with type 1 or type 2 diabetes should follow general recommendations for children and adolescents.
Low-volume HIIT, which involves short bursts of very intense activity interspersed with longer periods of recovery at low to moderate intensity, is an alternative approach to continuous aerobic activity 16 , However, its safety and efficacy remain unclear for some adults with diabetes , Those who wish to perform HIIT should be clinically stable, have been participating at least in regular moderate-intensity exercise, and likely be supervised at least initially The risks with advanced disease are unclear , and continuous, moderate-intensity exercise may be safer The optimal HIIT training protocol has yet to be determined.
Although heavier resistance training with free weights and weight machines may improve glycemic control and strength more , doing resistance training of any intensity is recommended to improve strength, balance, and ability to engage in activities of daily living throughout the life span.
Although flexibility training may be desirable for individuals with all types of diabetes, it should not substitute for other recommended activities i.
Many lower-body and core-strengthening exercises concomitantly improve balance and may be included. Yoga and tai chi can be included based on individual preferences to increase flexibility, strength, and balance.
Increasing unstructured physical activity e. Unstructured activity also reduces total daily sitting time. Supervised aerobic or resistance training reduces A1C in adults with type 2 diabetes whether or not they include dietary cointervention, but unsupervised exercise only reduces A1C with a concomitant dietary intervention Similarly, individuals undertaking supervised aerobic and resistance exercise achieve greater improvements in A1C, BMI, waist circumference, blood pressure, fitness, muscular strength, and HDL cholesterol Thus, supervised training is recommended when feasible, at least for adults with type 2 diabetes.
Women with preexisting diabetes of any type should be advised to engage in regular physical activity prior to and during pregnancy. 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.
Physical activity and exercise during pregnancy have been shown to benefit most women by improving cardiovascular health and general fitness while reducing the risk of complications like preeclampsia and cesarean delivery Regular physical activity during pregnancy also lowers the risk of developing gestational diabetes mellitus , Once gestational diabetes mellitus is diagnosed, either aerobic or resistance training can improve insulin action and glycemic control In women with gestational diabetes mellitus, particularly those who are overweight and obese, vigorous-intensity exercise during pregnancy may reduce the odds of excess gestational weight gain Ideally, the best time to start physical activity is prior to pregnancy to reduce gestational diabetes mellitus risk , but it is safe to initiate during pregnancy with very few contraindications Any pregnant women using insulin should be aware of the insulin-sensitizing effects of exercise and increased risk of hypoglycemia, particularly during the first trimester Insulin regimen and carbohydrate intake changes should be used to prevent exercise-related hypoglycemia.
Other strategies involve including short sprints, performing resistance exercise before aerobic exercise in the same session, and activity timing. Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cooldown.
Exercising with hyperglycemia and elevated blood ketones is not recommended. Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training.
Exercise-induced hypoglycemia is common in people with type 1 diabetes and, to a lesser extent, people with type 2 diabetes using insulin or insulin secretagogues. In addition to insulin regimen and carbohydrate intake changes, a brief 10 s maximal intensity sprint performed before or after a moderate-intensity exercise session may protect against hypoglycemia Performing high-intensity bouts intermittently during moderate aerobic exercise also slows blood glucose declines 81 , , , as can resistance exercise done immediately prior to aerobic Exercise-induced nocturnal hypoglycemia is a major concern Exercise-induced hyperglycemia is more common in type 1 diabetes.
Purposeful insulin omission before exercise can promote a rise in glycemia, as can malfunctioning infusion sets Individuals with type 2 diabetes may also experience increases in blood glucose after aerobic or resistance exercise, particularly if they are insulin users and administer too little insulin for meals before activity Overconsumption of carbohydrates before or during exercise, along with aggressive insulin reduction, can promote hyperglycemia during any exercise Very intense exercise such as sprinting , brief but intense aerobic exercise , and heavy powerlifting , may promote hyperglycemia, especially if starting blood glucose levels are elevated Hyperglycemia risk is mitigated if intense activities are interspersed between moderate-intensity aerobic ones 82 , Similarly, combining resistance training done first with aerobic training second optimizes glucose stability in type 1 diabetes Millán, personal communication.
Excessive insulin corrections after exercise increase nocturnal hypoglycemia risk, which can result in mortality Adults with diabetes are frequently treated with multiple medications for diabetes and other comorbid conditions.
Some medications other than insulin may increase exercise risk and doses may need to be adjusted , Although appropriate changes should be individualized, Table 4 lists general considerations and guidelines for medications.
Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments. If exercise-induced hypoglycemia has occurred, decrease dose on exercise days to reduce hypoglycemia risk.
May increase risk of hypoglycemia when used with insulin or sulfonylureas but not when used alone. Generally safe; no dose adjustment for exercise but may need to lower insulin or sulfonylurea dose.
Doses may need to be adjusted to accommodate the improvements from training and avoid dehydration. Physical activity increases bodily heat production and core temperature, leading to greater skin blood flow and sweating.
In relatively young adults with type 1 diabetes, temperature regulation is only impaired during high-intensity exercise , With increasing age, poor blood glucose control, and neuropathy, skin blood flow and sweating may be impaired in adults with type 1 , and type 2 diabetes, increasing the risk of heat-related illness.
Chronic hyperglycemia also increases risk through dehydration caused by osmotic diuresis, and some medications that lower blood pressure may also impact hydration and electrolyte balance. Active individuals with type 1 diabetes are not at increased risk of tendon injury , but this may not apply to sedentary or older individuals with diabetes.
Given that diabetes may lead to exercise-related overuse injuries due to changes in joint structures related to glycemic excursions , exercise training for anyone with diabetes should progress appropriately to avoid excessive aggravation to joint surfaces and structures, particularly when taking statin medications for lipid control Physical activity with vascular diseases can be undertaken safely but with appropriate precautions.
Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity.
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.
Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions. Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations.
Macrovascular and microvascular diabetes-related complications can develop and worsen with inadequate blood glucose control , Vascular and neural complications of diabetes often cause physical limitation and varying levels of disability requiring precautions during exercise, as recommended in Table 5.
Physical activity consideration, precautions, and recommended activities for exercising with health-related complications. Coronary perfusion may actually be enhanced during higher-intensity aerobic or resistance exercise. Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes.
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.
Stop exercise immediately if symptoms of a stroke occurring suddenly and often affecting only one side of the body happen during exercise. Lower-extremity resistance training improves functional performance Low- or moderate-intensity walking, arm ergometer, and leg ergometer preferred as aerobic activities Regular aerobic exercise may also prevent the onset or delay the progression of peripheral neuropathy in both type 1 and type 2 diabetes Proper care of the feet is needed to prevent foot ulcers and lower the risk of amputation 6.
Keep feet dry and use appropriate footwear, silica gel or air midsoles, and polyester or blend socks not pure cotton. Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Moderate walking is not likely to increase risk of foot ulcers or reulceration with peripheral neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
With postural hypotension, avoid activities with rapid postural or directional changes to avoid fainting or falling. With cardiac autonomic neuropathy, obtain physician approval and possibly undergo symptom-limited exercise testing before commencing exercise With blunted heart rate response, use heart rate reserve and ratings of perceived exertion to monitor exercise intensity Individuals with mild to moderate nonproliferative changes have limited or no risk for eye damage from physical activity.
With moderate nonproliferative retinopathy, avoid activities that dramatically elevate blood pressure, such as powerlifting.
Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment. Avoid activities that dramatically elevate blood pressure, such as vigorous activity of any type. Avoid vigorous exercise; jumping, jarring, and head-down activities; and breath holding 6.
Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity.
Exercise does not accelerate progression of kidney disease even though protein excretion acutely increases afterward 6 , Greater participation in moderate-to-vigorous leisure time activity and higher physical activity levels may actually moderate the initiation and progression of diabetic nephropathy — All activities okay, but vigorous exercise should be avoided the day before urine protein tests are performed to prevent false positive readings.
Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease. All activities okay, but exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Exercise should begin at a low intensity and volume if aerobic capacity and muscle function are substantially reduced.
Individuals with diabetes are more prone to structural changes to joints that can limit movement, including shoulder adhesive capsulitis, carpal tunnel syndrome, metatarsal fractures, and neuropathy-related joint disorders Charcot foot In addition to engaging in other activities as able , do regular flexibility training to maintain greater joint range of motion 10 , Stretch within warm-ups or after an activity to increase joint range of motion best Most low- and moderate-intensity activities okay, but more non—weight-bearing or low-impact exercise may be undertaken to reduce stress on joints.
Do range-of-motion activities and light resistance exercise to increase strength of muscles surrounding affected joints.
Avoid activities with high risk of joint trauma, such as contact sports and ones with rapid directional changes. Targeted behavior-change strategies should be used to increase physical activity in adults with type 2 diabetes.
For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes. Behavioral interventions can significantly increase physical activity in adults with type 2 diabetes , and A1C reductions produced by such interventions have been sustained to 24 months However, motivational interviewing is not significantly better than usual care , and other intervention factors associated with weight loss, such as number and duration of contacts, have been inconsistent or not associated with greater participation Wearing the device may prompt activity, and it provides feedback for self-monitoring.
Pedometer use in adults with type 2 diabetes increased their daily steps by 1,, but did not improve A1C Using a daily steps goal e. The positive findings for pedometers are not universal , however, and some individuals may require greater support to realize benefits.
Longer-term efficacy and determination of which populations can benefit from pedometers and other wearable activity trackers require further evaluation. Given that the majority of individuals with type 2 diabetes have access to the Internet, technology-based support is appealing for extending clinical intervention reach.
For adults with type 2 diabetes, Internet-delivered physical activity promotion interventions may be more effective than usual care More evidence is needed regarding social media approaches, given the importance of social and peer support in diabetes self-management Physical activity and exercise should be recommended and prescribed to all individuals with diabetes as part of management of glycemic control and overall health.
Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications.
Recommendations should be tailored to meet the specific needs of each individual. In addition to engaging in regular physical activity, all adults should be encouraged to decrease the total amount of daily sedentary time and to break up sitting time with frequent bouts of activity.
Finally, behavior-change strategies can be used to promote the adoption and maintenance of lifetime physical activity. Duality of Interest. No potential conflicts of interest relevant to this article were reported.
This position statement was reviewed and approved by the American Diabetes Association Professional Practice Committee in June and ratified by the American Diabetes Association Board of Directors in September Sign In or Create an Account.
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TYPES OF EXERCISE AND PHYSICAL ACTIVITY. BENEFITS OF EXERCISE AND PHYSICAL ACTIVITY. PHYSICAL ACTIVITY AND TYPE 2 DIABETES. PHYSICAL ACTIVITY AND TYPE 1 DIABETES. PHYSICAL ACTIVITY AND PREGNANCY WITH DIABETES. Article Information. Article Navigation. Position Statement October 11 Colberg ; Sheri R.
Corresponding author: Sheri R. Colberg, scolberg odu. This Site. Google Scholar. Ronald J. Sigal ; Ronald J. Jane E. Yardley ; Jane E. Michael C. Riddell ; Michael C. David W. Dunstan ; David W.
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Diabetes Care ;39 11 — Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. 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.
This is how monitorign can help lower monitoriny glucose in the short term. And when Support optimal metabolism are active Exercise and blood sugar monitoring a regular monitoding, it can aand lower your A1C. Exercise and blood sugar monitoring effect physical activity has on your blood glucose will vary depending on how long you are active and many other factors. Physical activity can lower your blood glucose up to 24 hours or more after your workout by making your body more sensitive to insulin. Become familiar with how your blood glucose responds to exercise.
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