New exercise update for type two diabetics

Adapted from Update on Advice for Physical Activity in Type 2 Diabetes by Marlene Busko http://www.medscape.com 11 Feb 2022

The American College of Sports Medicine has updated advice from The ACSM/ADA joint statement in 2010 for type two diabetics. Their recommendations have been published in full in the February issue of Medicine and Science in Sports and Exercise.

The key information is that everyone with type two diabetes should engage in regular physical activity, reduce sedentary time, and break up sitting with frequent activity breaks. Workouts can be modified if necessary. Anyone who wants to lose weight should consider workouts of moderately high volume 4 or 5 times a week.

Regular aerobic exercise improve glycaemic management. Blood sugar spikes are reduced and you can expect a reduction in A1c between 0.5-0.7%.

High intensity resistance exercise, when performed safely, is better than low to moderate intensity resistance exercise for glucose management and to reduce the amount of insulin you need to take. You can expect to an improvement in strength of 10-15%, improved bone mineral density, lower blood pressure, improved lipid profile, higher skeletal muscle mass and improved insulin sensitivity.

Exercise after meals, such as taking an after dinner walk, at an easy pace, helps stabilise blood sugar levels.

You should reduce sedentary time by taking regular activity breaks. These will result in small improvements in post meal blood sugars particularly in those who have more insulin resistance or who are overweight.

To prevent low blood sugars during or after exercise, people who take insulin, or drugs that promote insulin release, should reduce the amount injected if they can, reduce the medication, or if necessary increase carbohydrate intake.

If you are on beta blockers, you can’t rely on a heart monitor to measure your workout intensity. You can use a perceived exertion scale instead, eg Borg. Be guided as to the required intensity by a certified exercise professional.

Weight loss of more than 5% can improve A1c, lipids, and blood pressure. Visceral fat can be reduced by moderate exercise 4 or 5 days a week.

In young people who have type two diabetes, intensive lifestyle interventions plus metformin were no better than metformin alone for blood sugar control. Their physical activity goals should be the same as non diabetic individuals.

Those who did regular exercise before and after bariatric surgery, got better surgical outcomes.