Additional Exercise Guidelines for Adults with Type 2 Diabetes
The following information is derived from the joint position statement released by The American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA).
These guidelines are for adults with type 2 diabetes, and focuses on exercise above and beyond what is done in the course of everyday life with the intent of getting physically fit.
The goal of treating type 2 diabetes is to achieve and maintain the best blood glucose, lipid and blood pressure levels possible in order to prevent or delay the complications of type 2 diabetes. One of the recommended courses of treatment, along with a healthy diet, is regular exercise with the purpose of losing any excess weight as well as achieving and/or maintaining physical health.
Before starting any exercise program, the ACSM and ADA recommend an evaluation by your healthcare provider.
Recommended physical activity for people with type 2 diabetes
- People with type 2 diabetes should undertake at least 150 min per week (2 hours and 30 minutes) of moderate to vigorous aerobic exercise spread out during at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity.
- In addition to aerobic training, persons with type 2 diabetes should undertake moderate to vigorous resistance training at least 2–3 days/week.
- Supervised and combined aerobic and resistance training may provide additional health benefits, although milder forms of physical activity (such as yoga) have shown mixed results. People with type 2 diabetes are encouraged to increase their total daily unstructured physical activity. Flexibility training may be included, but should not be take the place of other recommended types of physical activity.
Exercise with uncontrolled blood glucose levels
People with type 2 diabetes may engage in physical activity, using caution when exercising with BG levels exceeding 300 mg/dl (16.7 mmol/l) without ketosis, provided they are feeling well and are adequately hydrated.
People with type 2 diabetes not using insulin or insulin secretagogues are unlikely to experience hypoglycemia related to exercise. Users of insulin and insulin secretagogues are advised to supplement with carbohydrate as needed to prevent hypoglycemia during and after exercise.
Medication effects on exercise responses
People using insulin or certain insulin secretagogues may require an adjustment of their medication dosage in order to prevent exercise-associated hypoglycemia. Most other medications prescribed for common health problems do not affect exercise, with the exception of beta-blockers, some diuretics, and statins.
Exercise for people with complications of diabetes
- People with heart disease do not necessarily have to avoid exercise. Individuals with angina classified as moderate or high risk should likely begin exercise in a supervised cardiac rehabilitation program. Physical activity is advised for anyone with peripheral arterial disease (PAD).
- People 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.
- People with cardiovascular autonomic neuropathy (CAN) should be screened and receive physician approval and possibly an exercise stress test before starting exercise.
- People with uncontrolled proliferative retinopathy should avoid activities that greatly increase eye pressure and hemorrhage risk.
- Exercise training increases physical function and quality of life in people with kidney disease and may even be undertaken during dialysis sessions. The presence of microalbuminuria per se does not necessitate exercise restrictions.
Most forms of physical exercise are safe for people with type 2 diabetes provided they get the clearance from their healthcare provider first.
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This past weekend was my STAR TREK group's anniversary picnic. Our hostess was one of our chapter's newer members, though she's definitely a second-generation member (perhaps since birth!) of the larger organization. She's also dealing with a couple of agressive, quality-of-life-limiting autoimmune conditions, at least one of which has been somewhat mitigated by the effect of bariatric surgery. In the relaxed atmosphere of a group picnic, she was able to explain a bit more about...