Type diabetes exercise -
People with diabetes-related eye complications severe retinopathy may be advised to avoid vigorous or high-impact activities and strenuous weightlifting, which can increase blood pressure and cause bleeding in the eye.
People with neurologic complications peripheral neuropathy are usually advised to avoid traumatic weightbearing exercises such as running, which can lead to foot ulcers and stress fractures, although this depends on the severity of the neuropathy. Non-weightbearing exercises eg, cycling, chair exercises, swimming may be more appropriate.
See "Patient education: Diabetic neuropathy Beyond the Basics ". Intensity — Exercise does not have to be intense to be beneficial, and the intensity depends on both the type of activity and a person's level of fitness.
Light-intensity physical activities include light housework or slow walking. Moderate-intensity activities include brisk walking or bicycling.
In general, a person doing a moderate-intensity activity can talk but not sing during the activity. Finally, vigorous-intensity activities include running or hiking uphill, and typically a person doing vigorous physical activity will not be able to say more than a few words without pausing for a breath.
If you want to increase the intensity of your exercise, it's important to do so gradually and always stop if you experience worrisome symptoms, such as chest discomfort or nausea. Duration and frequency — Any amount of physical activity is beneficial compared with being sedentary. To optimize the benefits of exercise, we suggest a goal of minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week, which can be done through any combination of duration and frequency for example, 30 minutes of moderate-intensity activity five days a week.
In general, a longer duration of lower-intensity physical activity is required to gain similar benefits to those from higher-intensity activity. Increase the intensity, frequency, and duration of exercise gradually.
QUITTING SMOKING. Over 25 percent of people newly diagnosed with diabetes actively smoke. Quitting smoking is one of the most important things people can do to improve their health.
See "Patient education: Quitting smoking Beyond the Basics ". People with diabetes who quit smoking can decrease these risks.
Most people who smoke find it difficult to quit; assistance is available from a number of sources. Health care providers have access to self-help materials and can help select a quit date, provide contact information for local support groups, and prescribe nicotine replacement treatment or other medicines if needed.
DIET AND TYPE 2 DIABETES. Changing the type and amount of food eaten can help people with diabetes to lose weight, improve blood sugar levels, and lower blood cholesterol levels and blood pressure. A separate topic discusses the role of diet including meal planning, carbohydrate counting, and alcohol intake in more detail.
See "Patient education: Type 2 diabetes and diet Beyond the Basics ". The day-to-day management of blood sugar levels can be complicated.
Planning and performing these activities take time. Make sure to talk to your health care provider about how to prioritize these activities and fit them into your daily life. Setting a routine — Successful management of diabetes should not take the enjoyment out of life.
At first, it can be difficult to establish a routine that incorporates all aspects of diabetes care, although many people find that the routine becomes second nature over time.
Written schedules may help some patients to remember the details of a routine until they are committed to memory. Some people may find that making too many changes at once is overwhelming and prefer to gradually incorporate various aspects of diabetes care into their life.
Aside from day-to-day routine, it is also important to carefully manage situations that can complicate blood sugar control, such as sick days and vacations. You and your health care team should reevaluate your management plan periodically to make sure it seems appropriate and reasonable to you and fits into your daily life.
Medication regimens — People with diabetes may need to take several medications throughout the day. Medications to lower elevated blood pressure and cholesterol levels, as well as low-dose aspirin may be used to manage and prevent complications. Your health care provider should talk with you about the benefits and risks of your medications, and you should jointly decide which ones are right for you.
Any medication is most effective when it is taken exactly as prescribed. If the medication schedule is complex, a pill organizer or written outline may be helpful for remembering to take specific medications at specific times.
Medical costs — Medications and diabetes supplies can be expensive, particularly if insulin is required. Many people with diabetes ration their insulin because of the cost.
It is a good idea to share any concerns about medication-related and other costs with your health care provider so they can help find ways to reduce these costs. A few strategies to reduce costs include switching to a similar medication that is covered by insurance; taking advantage of a specific low-cost program, coupon, or discount card; or applying for financial assistance.
ROUTINE MEDICAL CARE IN TYPE 2 DIABETES. Making changes in diet and exercise are an important step in diabetes management. However, routine medical care is also important for long-term health in people with diabetes, particularly for preventing, detecting, and slowing the progression of complications.
A health care provider can recommend a regular schedule for visits and screening and monitoring tests based upon the duration of diabetes, any diabetes-related complications, and other medical problems.
People with diabetes also should receive routine vaccinations to help prevent common infections. See "Patient education: Vaccines for adults Beyond the Basics ". Your health care team can also recommend screenings to detect health problems that do not cause symptoms in the early stages.
These screenings include eye examinations, foot examinations, blood and urine tests, dental examinations, and electrocardiograms, if needed. See "Patient education: Cervical cancer screening Beyond the Basics " and "Patient education: Breast cancer screening Beyond the Basics " and "Patient education: Bone density testing Beyond the Basics ".
See "Patient education: Prostate cancer screening Beyond the Basics " and "Patient education: Bone density testing Beyond the Basics ". See "Patient education: Screening for colorectal cancer Beyond the Basics ". DIABETES DISTRESS. People with diabetes have to perform many daily tasks to manage their blood sugar and optimize their health.
In addition to these daily demands, diabetes often gives rise to concerns including medical costs and long-term health. These obligations and concerns often cause feelings of frustration, burnout, and stress. If these feelings become overwhelming and make the daily management of diabetes difficult or impossible, they are described as "diabetes distress.
Many people with diabetes experience diabetes distress. It is important to tell your health care provider if you feel overwhelmed by diabetes and its management for any more than a week or two at a time. Your provider can help find strategies to reduce your stressors and ease your concerns.
They may also suggest that you speak with a health care provider who specializes in helping people with diabetes distress. Sharing your feelings with family, friends, or other people in your support network can help reduce diabetes distress. Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.
These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Treatment for type 2 diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Lowering your risk of prediabetes and type 2 diabetes The Basics.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Foot care for people with diabetes Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Diabetic neuropathy Beyond the Basics Patient education: Quitting smoking Beyond the Basics Patient education: Peripheral artery disease and claudication Beyond the Basics Patient education: Type 2 diabetes and diet Beyond the Basics Patient education: Cervical cancer screening Beyond the Basics Patient education: Breast cancer screening Beyond the Basics Patient education: Bone density testing Beyond the Basics Patient education: Prostate cancer screening Beyond the Basics Patient education: Screening for colorectal cancer Beyond the Basics.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.
Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Exercise guidance in adults with diabetes mellitus Nutritional considerations in type 1 diabetes mellitus Nutritional considerations in type 2 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus.
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. Paddy C. Dempsey ; Paddy C. Edward S. Horton ; Edward S. Kristin Castorino ; Kristin Castorino. Deborah F. Tate Deborah F.
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. 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.
New research shows diabetws risk of infection ezercise prostate biopsies. Discrimination exerciee work is linked to high Flavonoids and antioxidants pressure. Icy fingers and Thermogenic supplements for cutting Poor circulation or Raynaud's phenomenon? For people who have diabetes—or almost any other disease, for that matter—the benefits of exercise can't be overstated. Exercise helps control weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being. Foods are Flavonoids and antioxidants of carbohydrates, protein, and fat — or a mixture of these. Diabetee Flavonoids and antioxidants into sugar in your body. When you eat carbohydrates you must take an insulin injection. Carbohydrates come from starch and sugar in food. Carbohydrates can be found in the following food groups:.
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