Updated ADA Guidelines on Physical Activity for People With Diabetes

Though exercise is an essential component of a healthy lifestyle, it may be even more so for people with diabetes. In of the October 2016 issue of Diabetes Care, the American Diabetes Association issued guidelines on physical activity and exercise for people with diabetes and prediabetes.¹

The authors define physical activity as “all movement that increases energy use, whereas exercise is planned, structured physical activity.”¹

“New research is constantly emerging on the benefits of physical activity for people with diabetes and how to exercise safely and effectively,” said lead study author Sheri R. Colberg-Ochs, PhD, FACSM, consultant/director of physical fitness for the American Diabetes Association. “The Association issued joint guidelines back in 2010 on type 2 diabetes only, so there was a need for updated recommendations that covered all types of diabetes, including gestational, type 1 and type 2 diabetes, and prediabetes,” she told Endocrinology Advisor.

For individuals with type 2 diabetes, exercise has been shown to improve glucose control or even prevent the development of the disease, and to reduce risk factors for cardiovascular disease. Benefits for people with type 1 diabetes include improved heart functioning and insulin sensitivity. “The challenges related to blood glucose management vary with diabetes type, activity type, and presence of diabetes-related complications …. Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual,” wrote the authors.

Along with general benefits such as improving insulin sensitivity and immune function, aerobic exercise is linked with reduced cardiovascular and mortality risks in people with type 1 diabetes and type 2 diabetes. It “increases cardiorespiratory fitness, decreases insulin resistance, and improves lipid levels and endothelial function” in type 1 diabetes, and it lowers HbA1c and blood pressure in type 2 diabetes, as described in the guidelines.

Resistance exercise also confers many benefits for people with diabetes, as the disease is an independent risk factor for reduced muscular strength. General benefits, for example, include those pertaining to mental health, insulin sensitivity, blood pressure, and lipids. However, resistance exercise has also been found to improve glycemic control and reduce fat mass in people with type 2 diabetes. Evidence pertaining to type 1 diabetes and resistance exercise is less clear, although, in addition to general benefits, it can help reduce risk for exercise-induced hypoglycemia.

Findings suggest that flexibility and balance training may result in various improvements in people with diabetes as well as a reduction in the risk for falls and improvement in joint mobility in older age. For people with type 2 diabetes, studies have linked yoga with improved glycemic control, lipid profile, and body fat. There is some evidence that tai chi can improve glycemic control and neuropathic symptoms in adults with diabetes.

Below are general recommendations from the ADA on physical activity in people with diabetes and prediabetes.

A minimum of 150 minutes of moderate- to vigorous-intensity exercise per week, spread over at least 3 days with no more than 2 days between sessions, is recommended for most adults with type 1 diabetes and type 2 diabetes. The guidelines also recommend 2 to 3 sessions of resistance training on nonconsecutive days, as well as 2 to 3 sessions of flexibility and balance training, such as yoga or tai chi, for older adults with diabetes.

For younger individuals and those with a higher level of physical fitness, a minimum of 75 minutes per week may suffice if the activity is vigorous or involves interval training.

For children and adolescents with type 1 diabetes or type 2 diabetes, at least 60 minutes per day of moderate to vigorous aerobic exercise daily and 3 weekly sessions of strength-building exercises are recommended. These are the same guidelines that pertain to youth in general, as set forth by the Centers for Disease Control and Prevention (CDC).²