Too much screen time is associated with higher blood sugar levels, while physical activity is linked to lower A1Cs and healthier hearts.
ADA's Standards of Medical Care in Diabetes recommend breaking up time sitting by walking, leg extensions, or overhead arm stretches every 30 minutes. Will your child come home from school today and do homework for an hour or want to bike with friends for an hour? No matter the age, you can help children stay active.
For example, encouraging infants in active play to explore movement and their surroundings supports physical and mental development. For toddlers, 30 minutes or more of physical activity a day with no more than 60 minutes of sitting at a time will help promote motor skills and muscular development. Your health care team can help you find the balance between activity, food and insulin.
When testing on your own to learn about your reaction to different activities, keep a record of your activity and your numbers. Your healthcare team can use that data to suggest adjustments and refine your plan. If you are having chronic lows or highs, they may need to alter your insulin dose or make a change in your meal plan.
Log in menu Manage Account Search. Donate now. Exercise and Type 1. To meet its energy needs under these circumstances, skeletal muscle uses, at a greatly increased rate, its own stores of glycogen and triglycerides, as well as free fatty acids FFAs derived from the breakdown of adipose tissue triglycerides and glucose released from the liver. To preserve central nervous system function, blood glucose levels are remarkably well maintained during exercise.
Hypoglycemia during exercise rarely occurs in nondiabetic individuals. The metabolic adjustments that preserve normoglycemia during exercise are in large part hormonally mediated. A decrease in plasma insulin and the presence of glucagon appear to be necessary for the early increase in hepatic glucose production during exercise, and during prolonged exercise, increases in plasma glucagon and catecholamines appear to play a key role.
These hormonal adaptations are essentially lost in Sign In or Create an Account. Advanced Search. User Tools. Sign In. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Some CV and BG benefits may be gained from lower exercise volumes a minimum dose has not been established , whereas further benefit likely results from engaging in durations beyond recommended amounts. Any form of aerobic exercise including brisk walking that uses large muscle groups and causes sustained increases in HR is likely to be beneficial , and undertaking a variety of modes of PA is recommended At present, no study on individuals with type 2 diabetes has compared rates of progression in exercise intensity or volume.
Gradual progression of both is advisable to minimize the risk of injury, particularly if health complications are present, and to enhance compliance. The most successful weight control programs involve combinations of exercise, diet, and behavior modification.
ADA B level recommendation. Resistance exercise should be undertaken at least twice weekly on nonconsecutive days 1 , , , , , , but more ideally three times a week 65 , , as part of a PA program for individuals with type 2 diabetes, along with regular aerobic activities. Home-based resistance training following supervised, gym-based training may be less effective for maintaining BG control but adequate for maintaining muscle mass and strength Each training session should minimally include 5—10 exercises involving the major muscle groups in the upper body, lower body, and core and involve completion of 10—15 repetitions to near fatigue per set early in training 1 , 97 , , , , progressing over time to heavier weights or resistance that can be lifted only 8—10 times.
A minimum of one set of repetitions to near fatigue, but as many as three to four sets, is recommended for optimal strength gains. Resistance machines and free weights e. Heavier weights or resistance may be needed for optimization of insulin action and BG control To avoid injury, progression of intensity, frequency, and duration of training sessions should occur slowly. In most progressive training, increases in weight or resistance are undertaken first and only once when the target number of repetitions per set can consistently be exceeded, followed by a greater number of sets and lastly by increased training frequency.
Initial instruction and periodic supervision by a qualified exercise trainer is recommended for most persons with type 2 diabetes, particularly if they undertake resistance exercise training, to ensure optimal benefits to BG control, BP, lipids, and CV risk and to minimize injury risk Inclusion of both aerobic and resistance exercise training is recommended. Combined training thrice weekly in individuals with type 2 diabetes may be of greater benefit to BG control than either aerobic or resistance exercise alone However, the total duration of exercise and caloric expenditure was greatest with combined training in all studies done to date 51 , , , and both types of training were undertaken together on the same days.
No studies have yet reported whether daily, but alternating, training is more effective or the BG effect of isocaloric combinations of training. Milder forms of PA, such as yoga and tai chi, may benefit control of BG 98 , , , , , although their inclusion is not supported conclusively at this time.
Individuals with type 2 diabetes are encouraged to increase their total daily, unstructured PA to gain additional health benefits. Nonexercise activity thermogenesis i. In an observational study, obese individuals sat for about 2. Moreover, use of objective measures such as step counters may enhance reaching daily goals. A meta-analysis of 26 studies with a total of 2, primarily nondiabetic participants 8 RCTs and 18 observational studies found that pedometer users increased PA by An important predictor of increased PA was the use of a goal, such as to take 10, steps per day Flexibility training may be included as part of a PA program, although it should not substitute for other training.
Older adults are advised to undertake exercises that maintain or improve balance , , which may include some flexibility training, particularly for many older individuals with type 2 diabetes with a higher risk of falling Although flexibility exercise stretching has frequently been recommended as a means of increasing joint range of motion ROM and reducing risk of injury, two systematic reviews found that flexibility exercise does not reduce risk of exercise-induced injury , A small RCT found that ROM exercises modestly decreased peak plantar pressures 94 , but no study has directly evaluated whether such training reduces risk of ulceration or injury in type 2 diabetes.
However, flexibility exercise combined with resistance training can increase ROM in individuals with type 2 diabetes and allow individuals to more easily engage in activities that require greater ROM around joints. Supervised and combined aerobic and resistance training may confer health additional benefits, although milder forms of PA such as yoga have shown mixed results.
Persons with type 2 diabetes are encouraged to increase their total daily unstructured PA. Flexibility training may be included but should not be undertaken in place of other recommended types of PA. While hyperglycemia can be worsened by exercise in type 1 diabetic individuals who are insulin deficient and ketotic due to missed or insufficient insulin , very few persons with type 2 diabetes develop such a profound degree of insulin deficiency.
Therefore, individuals with type 2 diabetes generally do not need to postpone exercise because of high BG, provided that they are feeling well.
If hyperglycemic after a meal, individuals with type 2 diabetes will still likely experience a reduction in BG during aerobic work because endogenous insulin levels will likely be higher at that time ADA E level recommendation. Of greatest concern to many exercisers is the risk of hypoglycemia.
In individuals whose diabetes is being controlled by lifestyle alone, the risk of developing hypoglycemia during exercise is minimal, making stringent measures unnecessary to maintain BG Glucose monitoring can be performed before and after PA to assess its unique effect.
Activities of longer duration and lower intensity generally cause a decline in BG levels but not to the level of hypoglycemia 9 , 29 , 75 , , While very intense activities can cause transient elevations in BG , , , intermittent high-intensity exercise done immediately after breakfast in individuals treated with diet only reduces BG levels and insulin secretion In insulin or insulin secretagogue users, who frequently have the effects of both exercise and insulin to increase glucose uptake, PA can complicate diabetes management , , , If controlled with diet or other oral medications, most individuals will not need carbohydrate supplements for exercise lasting less than an hour.
Intense, short exercise requires lesser or no carbohydrate intake Later-onset hypoglycemia is a greater concern when carbohydrate stores i. In particular, high-intensity exercise e. In such cases, the consumption of 5—30 g of carbohydrate during and within 30 min after exhaustive, glycogen-depleting exercise will lower hypoglycemia risk and allow for more efficient restoration of muscle glycogen 31 , Persons with type 2 diabetes not using insulin or insulin secretagogues are unlikely to experience hypoglycemia related to PA.
Users of insulin and insulin secretagogues are advised to supplement with carbohydrate as needed to prevent hypoglycemia during and after exercise. Current treatment strategies promote combination therapies to address the three major defects in type 2 diabetes: impaired peripheral glucose uptake liver, fat, and muscle , excessive hepatic glucose release with glucagon excess , and insufficient insulin secretion.
Medication adjustments for PA are generally necessary only with use of insulin and other insulin secretagogues , To prevent hypoglycemia, individuals may need to reduce their oral medications or insulin dosing before and possibly after exercise 83 , Before planned exercise, short-acting insulin doses will likely have to be reduced to prevent hypoglycemia.
Newer, synthetic, rapid-acting insulin analogs i. If only longer-acting insulins such as glargine, detemir, and NPH are being absorbed from subcutaneous depots during PA, exercise-induced hypoglycemia is not as likely , although doses may need to be reduced to accommodate regular participation in PA. Doses of select oral hypoglycemic agents glyburide, glipizide, glimepiride, nateglinide, and repaglinide may also need to be lowered in response to regular exercise training if the frequency of hypoglycemia increases , These medications generally do not affect exercise responses, with some notable exceptions.
They may also block adrenergic symptoms of hypoglycemia, increasing the risk of undetected hypoglycemia during exercise. Diuretics, however, may lower overall blood and fluid volumes resulting in dehydration and electrolyte imbalances, particularly during exercise in the heat.
Statin use has been associated with an elevated risk of myopathies myalgia and myositis , particularly when combined with use of fibrates and niacin An extended discussion on medications can be found in the Handbook of Exercise in Diabetes Medication dosage adjustments to prevent exercise-associated hypoglycemia may be required by individuals using insulin or certain insulin secretagogues.
Individuals with angina and type 2 diabetes classified as moderate or high risk should preferably exercise in a supervised cardiac rehabilitation program, at least initially Moreover, some individuals who have an acute myocardial infarction may not experience chest pain, and up to a third may have silent myocardial ischemia 45 , For individuals with PAD, with and without intermittent claudication and pain in the extremities during PA, low-to-moderate walking, arm-crank, and cycling exercise have all been shown to enhance mobility, functional capacity, exercise pain tolerance, and QOL , Lower extremity resistance training also improves functional performance measured by treadmill walking, stair climbing ability, and QOL measures Vascular alterations are common in diabetes, even in the absence of overt vascular disease.
Endothelial dysfunction may be an underlying cause of many associated vascular problems 45 , In addition to traditional risk factors, hyperglycemia, hyperinsulinemia, and oxidative stress contribute to endothelial damage, leading to poor arterial function and greater susceptibility to atherogenesis 45 , 82 , Both aerobic and resistance training can improve endothelial function 46 , , but not all studies have shown posttraining improvement Known CVD is not an absolute contraindication to exercise.
Individuals with angina classified as moderate or high risk should likely begin exercise in a supervised cardiac rehabilitation program. PA is advised for anyone with PAD. Mild to moderate exercise may help prevent the onset of peripheral neuropathy Individuals without acute foot ulcers can undertake moderate weight-bearing exercise, although anyone with a foot injury or open sore or ulcer should be restricted to non—weight-bearing PA.
All individuals should closely examine their feet on a daily basis to prevent and detect sores or ulcers early and follow recommendations for use of proper footwear. Previous guidelines stated that persons with severe peripheral neuropathy should avoid weight-bearing activities to reduce risk of foot ulcerations , However, recent studies indicated that moderate walking does not increase risk of foot ulcers or reulceration in those with peripheral neuropathy , Peripheral neuropathy affects the extremities, particularly the lower legs and feet.
Hyperglycemia causes nerve toxicity, leading to nerve damage and apoptosis , , which causes microvascular damage and loss of perfusion. Individuals with peripheral neuropathy and without acute ulceration may participate in moderate weight-bearing exercise. Comprehensive foot care including daily inspection of feet and use of proper footwear is recommended for prevention and early detection of sores or ulcers.
Moderate walking likely does not increase risk of foot ulcers or reulceration with peripheral neuropathy. Moderate-intensity aerobic training can improve autonomic function in individuals with and without CV autonomic neuropathy CAN , , ; however, improvements may only be evident after an acute submaximal exercise Screening for CAN should include a battery of autonomic tests including HR variability that evaluate both branches of the autonomic nervous system.
Given the likelihood of silent ischemia, HR, and BP abnormalities, individuals with CAN should have physician approval and possibly undergo stress testing to screen for CV abnormalities before commencing exercise Exercise intensity may be accurately prescribed using the HR reserve method a percentage of the difference between maximal and resting HR, added to the resting value to approximate oxygen consumption during submaximal exercise with maximal HR directly measured, rather than estimated, for better accuracy 48 , The presence of CAN doubles the risk of mortality 48 , and indicates more frequency of silent myocardial ischemia , orthostatic hypotension, or resting tachycardia 76 , CAN also impairs exercise tolerance and lowers maximal HR , Although both sympathetic and parasympathetic dysfunctions can be present, vagal dysfunction usually occurs earlier.
Slower HR recovery after PA is associated with mortality risk 38 , Individuals with CAN should be screened and receive physician approval and possibly an exercise stress test before exercise initiation. Exercise intensity is best prescribed using the HR reserve method with direct measurement of maximal HR.
In diabetic individuals with proliferative or preproliferative retinopathy or macular degeneration, careful screening and physician approval are recommended before initiating an exercise program.
Activities that greatly increase intraocular pressure, such as high-intensity aerobic or resistance training with large increases in systolic BP and head-down activities, are not advised with uncontrolled proliferative disease, nor are jumping or jarring activities, all of which increase hemorrhage risk 1.
Diabetic retinopathy is the main cause of blindness in developed countries and is associated with increased CV mortality , Individuals with retinopathy may receive some benefits, such as improved work capacity, after low- to moderate-intensity exercise training 16 , While PA has been shown to be protective against development of age-related macular degeneration , very little research exists in type 2 diabetes.
Individuals with uncontrolled proliferative retinopathy should avoid activities that greatly increase intraocular pressure and hemorrhage risk. ACSM evidence category D. Both aerobic and resistance training improve physical function and QOL in individuals with kidney disease , , , although BP increases during PA may transiently elevate levels of microalbumin in urine.
Resistance exercise training is especially effective in improving muscle function and activities of daily living, which are normally severely affected by later-stage kidney disease Before initiation of PA, individuals with overt nephropathy should be carefully screened, have physician approval, and possibly undergo stress testing to detect CAD and abnormal HR and BP responses 1 , Exercise should be begun at a low intensity and volume because aerobic capacity and muscle function are substantially reduced, and avoidance of the Valsava maneuver or high-intensity exercise to prevent excessive increases in BP is advised 1.
Supervised, moderate aerobic exercise undertaken during dialysis sessions, however, has been shown to be effective as home-based exercise and may improve compliance , Microalbuminuria, or minute amounts of albumin in the urine, is common and a risk factor for overt nephropathy 45 and CV mortality Tight BG and BP control may delay progression of microalbuminuria , , along with exercise and dietary changes 81 , Exercise training delays the progression of diabetic nephropathy in animals 89 , , but few evidence is available in humans.
Exercise training increases physical function and QOL in individuals with kidney disease and may even be undertaken during dialysis sessions. The presence of microalbuminuria per se does not necessitate exercise restrictions.
Most American adults with type 2 diabetes or at highest risk for developing it do not engage in regular PA; their rate of participation is significantly below national norms Additional strategies are needed to increase the adoption and maintenance of PA.
One of the most consistent predictors of greater levels of activity has been higher levels of self-efficacy 2 , 55 , 68 , which reflect confidence in the ability to exercise Social support has also been associated with greater levels of PA 93 , , , supporting the role of social networks in the spread of obesity Counseling delivered by health care professionals may be a meaningful source of support and effective source for delivery 7 , The availability of facilities or pleasant and safe places to walk may also be important predictors of regular PA When prescribing PA for the prevention or control of type 2 diabetes, the effects of the dose of the prescription on adherence are small Therefore, practitioners are encouraged to use factors such as choice and enjoyment in helping determine specifically how an individual would meet recommended participation.
Affective responses to exercise may be important predictors of adoption and maintenance, and encouraging activity at intensities below the ventilatory threshold may be most beneficial , , Many individuals with, or at risk of developing, type 2 diabetes prefer walking as an aerobic activity , and pedometer-based interventions can be effective for increasing aerobic activity 30 , , Finally, the emerging importance of sedentary behaviors in determining metabolic risk , suggests that future interventions may also benefit from attempting to decrease sitting time and periods of extended sedentary activity.
Large-scale trials such as the DPP and Look AHEAD provide some insight into successful lifestyle interventions that help promote PA by incorporating goal setting, self-monitoring, frequent contact, and stepped-care protocols 56 , 60 , 71 , Delivering these programs requires extensive access to resources, staff, and space, although they are cost-effective overall , These large studies are multifactorial, targeting several behaviors that include PA, but include multiple behavior interventions that also require changes in diet and focusing on weight loss or management Therefore, strategies for PA intervention in weight management are highly relevant to this population Fewer RCTs solely targeted PA behavior in individuals with or at risk of developing type 2 diabetes , , The results have been mixed, with some showing increased PA 67 , , , and others showing no effect , , Effective short-term programs have used print 67 , phone 44 , , , in-person , , or Internet 92 , delivery.
Long-term effectiveness of such interventions has not been assessed Efforts to promote PA should focus on developing self-efficacy and fostering social support from family, friends, and health care providers. Encouraging mild or moderate PA may be most beneficial to adoption and maintenance of regular PA participation.
Lifestyle interventions may have some efficacy in promoting PA behavior. Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types.
Most persons with type 2 diabetes can perform exercise safely as long as certain precautions are taken. The inclusion of an exercise program or other means of increasing overall PA is critical for optimal health in individuals with type 2 diabetes.
The authors have no financial support or professional conflicts of interest to disclose related to the article's content. ADA: Judith G. Regensteiner, PhD; Richard R.
Rubin, PhD; and Ronald J. Individual name recognition is stated in the acknowledgments at the end of the statement. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. See accompanying article, p. National Center for Biotechnology Information , U. Journal List Diabetes Care v. Diabetes Care. Sheri R. Ronald J. Judith G.
Bryan J. Richard R. Ann L. Find articles by Barry Braun. Author information Copyright and License information Disclaimer. Corresponding author: Sheri R. Colberg, ude. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See " Exercise and Type 2 Diabetes " on page This article has been cited by other articles in PMC.
Abstract Although physical activity PA is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. Introduction Diabetes has become a widespread epidemic, primarily because of the increasing prevalence and incidence of type 2 diabetes.
Diagnosis, classification, and etiology of diabetes Currently, the American Diabetes Association ADA recommends the use of any of the following four criteria for diagnosing diabetes: 1 glycated hemoglobin A1C value of 6. Treatment goals in type 2 diabetes The goal of treatment in type 2 diabetes is to achieve and maintain optimal BG, lipid, and blood pressure BP levels to prevent or delay chronic complications of diabetes 5. Evidence statement. Open in a separate window.
ADA evidence-grading system for clinical practice recommendations Level of evidence Description A Clear evidence from well-conducted, generalizable, randomized, controlled trials that are adequately powered, including the following: Evidence from a well-conducted multicenter trial Evidence from a meta-analysis that incorporated quality ratings in the analysis Compelling nonexperimental evidence, i.
Insulin-independent and insulin-dependent muscle glucose uptake during exercise. Resistance exercise effects. Combined aerobic and resistance and other types of training.
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