exercise in the management of type 2 diabetes
Last edited 09/2020 and last reviewed 02/2022
- there is now wide acceptance of the importance of increasing physical activity
in the management of Type 2 diabetes
- exercise serves to reduce body weight and increase insulin sensitivity
- exercise such as a brisk walk of a mile every day confers some benefit
- however advanced age or physical disability often preclude this
- a meta-analysis by Boule et al reveals that three 45 minute moderate intensity
aerobic workouts per week (similar to the activity goals for the treatment
of obesity (2)) can reduce HbA1c concentrations to a degree sufficient to
reduce risk for myocardial infarction by 9% and microvascular complications
by 24%, according to the UK Prospective Diabetes Study Group data (3)
- in consideration of:
- aerobic exercise - reviewing the benefits of aerobic activity for patients with type 2 diabetes have repeatedly confirmed that compared with patients in sedentary control groups, aerobic exercise improves glycemic control, insulin sensitivity, oxidative capacity, and important related metabolic parameters (8). Aerobic exercise is a well-established way to improve HbA1c, and strong evidence exists with regard to the effects of aerobic activity on weight loss and the enhanced regulation of lipid and lipoprotein metabolism (8)
- high-intensity interval training (HIIT) - consists of very short
bursts of very high-intensity exercise interspersed with periods of recovery
- and type 2 Diabetes
- study evidence has shown that high-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes (4)
- resistance training - study evidence has shown a threefold greater reduction in HbA1c in patients with type 2 diabetes ages 60 to 80 compared with nonexercising patients in a control group - was also an increase in lean body mass in the resistance-training group, while those in the nonexercising control group lost lean mass after 6 months (9)
- blood pressure effects
- a systematic review and meta-analysis of randomized controlled
clinical trials (RCTs) was undertaken to determine the effects of
structured exercise training (aerobic [AER], resistance [RES], or
combined [COMB]) and physical activity (PA) advice only on BP changes
in patients with type 2 diabetes
- concluded that AER, RES, and high-intensity combined training
are associated with BP reduction in patients with type 2 diabetes,
especially in exercise programs lasting more than 150 min/week.
PA advice only is also associated with lower BP levels (5)
- concluded that AER, RES, and high-intensity combined training
are associated with BP reduction in patients with type 2 diabetes,
especially in exercise programs lasting more than 150 min/week.
PA advice only is also associated with lower BP levels (5)
- a systematic review and meta-analysis of randomized controlled
clinical trials (RCTs) was undertaken to determine the effects of
structured exercise training (aerobic [AER], resistance [RES], or
combined [COMB]) and physical activity (PA) advice only on BP changes
in patients with type 2 diabetes
- changes in HbA1c associated with exercise in type 2 Diabetes (6)
- evidence that exercise training is associated with a reduction in
glycated haemoglobin (HbA1c) of 0.67% in people with T2DM, with benefit
coming from aerobic or resistance exercise separately and both in
combination
- duration of the structured exercise programmes was also found
to be important
- programmes with an exercise duration of greater than 150
minutes per week were associated with an HbA1c reduction of
0.89%, whereas those with duration less than 150 minutes per
week were associated with a reduction of 0.36%. Physical activity
advice was also associated with a signifi cant reduction in
HbA1c, but only in combination with dietary advice
- programmes with an exercise duration of greater than 150
minutes per week were associated with an HbA1c reduction of
0.89%, whereas those with duration less than 150 minutes per
week were associated with a reduction of 0.36%. Physical activity
advice was also associated with a signifi cant reduction in
HbA1c, but only in combination with dietary advice
- duration of the structured exercise programmes was also found
to be important
- evidence that exercise training is associated with a reduction in
glycated haemoglobin (HbA1c) of 0.67% in people with T2DM, with benefit
coming from aerobic or resistance exercise separately and both in
combination
- changes in mortality data
- meta-analysis of cohort studies coupled with data from a prospective cohort study have suggested that there is a significant benefit, demonstrating an inverse relationship between physical activity and both cardiovascular disease and all-cause mortality (7)
A review notes that "Exercise training, whether aerobic or resistance training or a combination, facilitates improved glucose regulation. High-intensity interval training is also effective and has the added benefit of being very time-efficient.." (8)
Advice re: Medication, Exercise and Type 2 Diabetes is (9):
- "..the concern of blood glucose going low during exercise may be on
your mind. In reality, most of the diabetes medication used by people with
Type 2 diabetes tends not to cause hypoglycaemia. Diabetes medication which
requires extra caution is insulin and a class of drugs called insulin secretagogues
(common examples of this include Gliclazide, Glimepiride and Repaglinide).
These medications can cause hypoglycaemia during and after exercise (up to
24 hours after an exercise bout)...
- Insulin and exercise
- Strategies to prevent hypoglycaemia if using fast-acting insulin:
- If exercising within two hours of a meal where fast-acting insulin was taken, you may need to consider lowering the insulin dose. However, monitor the effects of exercise on your blood glucose and speak to your diabetes team for advice on appropriate insulin reduction, if this is necessary
- If exercising before a meal (e.g. exercise before breakfast) then consider reducing the fast-acting insulin dose at the meal eaten after exercise (in this case, breakfast).
- Strategies to prevent hypoglycaemia if using fast-acting insulin:
- if you use tablets such as Gliclazide and have experienced hypoglycaemia during exercise, have a discussion with your diabetes team as it may be an option to decrease the medication dose on exercise days..."
Reference:
- Prescribers' Journal (2000), 40 (1), 38-48.
- Boule NG et al (2001). Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus. A meta-analysis of controlled clinical trials. JAMA, 286, 1218-27.
- Stratton IM et al (2000). BMJ, 321, 405-12.
- Helal L et al. High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes: considerations regarding HbA1c starting levels and intervention design.Eur J Appl Physiol. 2017 Nov;117(11):2365-236
- Figueira FR et al. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis.Sports Med. 2014 Nov;44(11):1557-72.
- Umpierre D et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.JAMA. 2011 May 4;305(17):1790-9.
- Sluik D et al. Physical activity and mortality in individuals with diabetes mellitus: a prospective study and meta-analysis. Arch Intern Med 2012;172:1285-95.
- Kirwan JP et al. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med 2017 Jul;84(7 Suppl 1):S15-S21. doi: 10.3949/ccjm.84.s1.03.
- Diabetes UK. Sports nutrition and Type 2 diabetes (Accessed 16/5/20)
- Dunstan DW, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton KG. Effects of a short-term circuit weight training program on glycaemic control in NIDDM. Diabetes Res Clin Pract. 1998; 40:53–61.