Exercise and blood sugar levels in metabolic syndrome -
PHYSICAL ACTIVITY AND TYPE 1 DIABETES. PHYSICAL ACTIVITY AND PREGNANCY WITH DIABETES. Article Information. Article Navigation. Position Statement October 11 Colberg ; Sheri R. Corresponding author: Sheri R. Colberg, scolberg odu.
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toolbar search search input Search input auto suggest. B Prolonged sitting should be interrupted with bouts of light activity every 30 min for blood glucose benefits, at least in adults with type 2 diabetes.
C The above two recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement. B Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes.
C Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general.
B Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods.
C Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests. Table 1 Suggested carbohydrate intake or other actions based on blood glucose levels at the start of exercise.
Pre-exercise blood glucose. Carbohydrate intake or other action. Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease.
View Large. Table 2 Suggested initial pre-exercise meal insulin bolus reduction for activity started within 90 min after insulin administration. Exercise intensity. Exercise duration.
C Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental nonexercise physical activity to gain additional health benefits. C To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs.
Table 3 Exercise training recommendations: types of exercise, intensity, duration, frequency, and progression. Flexibility and Balance. Type of exercise Prolonged, rhythmic activities using large muscle groups e.
C Pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20—30 min of moderate-intensity exercise on most or all days of the week. C Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cooldown.
C Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training. C Exercise training should progress appropriately to minimize risk of injury. Table 4 Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments.
Exercise considerations. B Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. B The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity.
C Vigorous aerobic or resistance exercise; jumping, jarring, head-down activities; and breath holding should be avoided in anyone with severe nonproliferative and unstable proliferative diabetic retinopathy.
E Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions. C Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations.
Table 5 Physical activity consideration, precautions, and recommended activities for exercising with health-related complications. Health complication. All activities okay. Consider exercising in a supervised cardiac rehabilitation program, at least initially.
Exertional angina Onset of chest pain on exertion, but exercise-induced ischemia may be silent in some with diabetes. Hypertension Both aerobic and resistance training may lower resting blood pressure and should be encouraged.
Some blood pressure medications can cause exercise-related hypotension. Ensure adequate hydration during exercise. Avoid Valsalva maneuver during resistance training. Myocardial infarction Stop exercise immediately should symptoms of myocardial infarction such as chest pain, radiating pain, shortness of breath, and others occur during physical activity and seek medical attention.
Restart exercise after myocardial infarction in a supervised cardiac rehabilitation program. Start at a low intensity and progress as able to more moderate activities.
Both aerobic and resistance exercise are okay. Stroke Diabetes increases the risk of ischemic stroke. Restart exercise after stroke in a supervised cardiac rehabilitation program.
Congestive heart failure Most common cause is coronary artery disease and frequently follows a myocardial infarction. Avoid activities that cause an excessive rise in heart rate.
Focus more on doing low- or moderate-intensity activities. Peripheral artery disease Lower-extremity resistance training improves functional performance All other activities okay.
Consider inclusion of more non—weight-bearing activities, particularly if gait altered. Local foot deformity Manage with appropriate footwear and choice of activities to reduce plantar pressure and ulcer risk Focus more on non—weight-bearing activities to reduce undue plantar pressures.
Examine feet daily to detect and treat blisters, sores, or ulcers early. Weight-bearing activity should be avoided with unhealed ulcers. Amputation sites should be properly cared for daily. Avoid jogging. Autonomic neuropathy May cause postural hypotension, chronotropic incompetence, delayed gastric emptying, altered thermoregulation, and dehydration during exercise 6.
Exercise-related hypoglycemia may be harder to treat in those with gastroparesis. With autonomic neuropathy, avoid exercise in hot environments and hydrate well. All activities okay with mild, but annual eye exam should be performed to monitor progression. Severe nonproliferative and unstable proliferative retinopathy Individuals with unstable diabetic retinopathy are at risk for vitreous hemorrhage and retinal detachment.
No exercise should be undertaken during a vitreous hemorrhage. Cataracts Cataracts do not impact the ability to exercise, only the safety of doing so due to loss of visual acuity.
Avoid activities that are more dangerous due to limited vision, such as outdoor cycling. Consider supervision for certain activities. Overt nephropathy Both aerobic and resistance training improve physical function and quality of life in individuals with kidney disease. Individuals should be encouraged to be active.
End-stage renal disease Doing supervised, moderate aerobic physical activity undertaken during dialysis sessions may be beneficial and increase compliance Electrolytes should be monitored when activity done during dialysis sessions.
Strengthen muscles around affected joints with resistance training. Avoid activities that increase plantar pressures with Charcot foot changes. Arthritis Common in lower-extremity joints, particularly in older adults who are overweight or obese.
Participation in regular physical activity is possible and should be encouraged. Moderate activity may improve joint symptoms and alleviate pain. C For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes.
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Aerobic exercise like walking, bicycling, swimming or jogging involves continuous, rhythmic movements of large muscle groups, normally at least 10 minutes at a time.
Resistance exercise involves brief repetitive exercises with weights, weight machines, resistance bands or one's own body weight e. Flexibility exercise like lower back or hamstring stretching aims to enhance the ability to move through fuller ranges of motion.
Some types of exercise, such as yoga, can incorporate elements of both resistance and flexibility exercise. Physical activity can help people with diabetes achieve a variety of goals, including increased cardiorespiratory fitness, increased vigour, improved glycemic control, decreased insulin resistance, improved lipid profile, blood pressure BP reduction and maintenance of weight loss 2—5.
Randomized trials have found that supervised exercise interventions improve glycated hemoglobin A1C 6—8 , triglycerides TG and cholesterol 9 in people with type 2 diabetes when compared to no exercise comparison groups Randomized trials have also demonstrated that aerobic exercise training increases cardiorespiratory fitness in both type 1 and type 2 diabetes 17 , and slows the development of peripheral neuropathy A meta-analysis 6 found that supervised exercise interventions improved A1C in people with type 2 diabetes when compared to no exercise comparison groups.
A meta-analysis of head-to-head trials comparing the effects on A1C of aerobic exercise at higher vs. It was unclear whether the greater benefits of higher-intensity exercise were limited to studies using high-intensity interval training see next section on interval training.
In contrast to trials in type 2 diabetes, most clinical trials evaluating exercise interventions in adults with type 1 diabetes have not demonstrated a beneficial effect of exercise on glycemic control 19 , but 2 recent meta-analyses found that aerobic training lowered A1C in children and youth with type 1 diabetes by 0.
A recent large cross-sectional study of 18, adults with type 1 diabetes reported an inverse association between physical activity levels and A1C, diabetic ketoacidosis DKA , BMI and a number of diabetes-related complications, including dyslipidemia, hypertension, retinopathy and microalbuminuria There are no published trials evaluating the effects of exercise training on quality of life in type 1 diabetes.
High-intensity interval training involves alternating between short periods of higher and lower-intensity exercise see Exercise Prescription Examples. High-intensity interval training leads to greater gains in cardiorespiratory fitness in people with or without diabetes 23,24 , and improves glycemic control in some studies of people with type 2 diabetes compared to continuous moderate-intensity exercise 24— In people with type 1 diabetes, high-intensity interval exercise appears to be associated with less risk for hypoglycemia than continuous aerobic exercise, at least during the time of the activity 27,28, To date, the risks of high-intensity interval training seem comparable to moderate-intensity continuous exercise in previously screened participants with relatively good glycemic control; however, most studies have been small and underpowered 8.
Resistance training in adults with type 2 diabetes improves glycemic control as reflected by reduced A1C , decreases insulin resistance and increases muscular strength 30 , lean muscle mass 31 and bone mineral density 32,33 , leading to enhanced functional status and prevention of sarcopenia and osteoporosis.
The optimal resistance training program has not been clearly established in terms of frequency, intensity, type and volume The greatest impact on A1C is typically seen in studies that had participants progress to 3 sets with approximately 8 repetitions per set of resistance-type exercises at moderate to high intensity i.
the maximum weight that can be lifted 8 times while maintaining proper form , 3 times per week 35,36 or more 37, However, significant reductions in A1C and body fat have been achieved with twice-weekly resistance exercise in combination with regular aerobic exercise 39— The effects of resistance exercise and aerobic exercise on glycemic control are additive For example, a recent meta-analysis found that exercise training with resistance bands in people with type 2 diabetes increased strength but had no significant effect on A1C The benefits of resistance exercise in type 1 diabetes are less clear, but small clinical trials suggest improved body composition and strength, enhanced insulin sensitivity and possibly modest reductions in A1C Compared to aerobic exercise, resistance exercise is associated with less hypoglycemia risk for individuals with type 1 diabetes 45, To date, evidence for the beneficial effects of other types of exercise is not as extensive or as supportive as the evidence for aerobic and resistance exercise.
Two systematic reviews found that tai chi had no effect on A1C, compared to either sham exercise or usual care in people with diabetes 47, Systematic reviews of yoga as an intervention for type 2 diabetes 49—51 have reported reductions in A1C.
However, the quality of the studies was generally low and results were highly heterogeneous, limiting any conclusions that may be drawn see Complementary and Alternative Medicine for Diabetes chapter, p.
No published study has demonstrated any impact of a pure flexibility program on metabolic control, injury risk or any diabetes-related outcome. Since osteoarthritis can be a barrier to physical activity 52 , water-based physical activities, such as swimming, walking or running in a pool, or aquatic fitness classes have been encouraged for people with such comorbidities 53, While few high-quality trials exist, a recent meta-analysis suggests aquatic exercise improves A1C compared to no exercise comparison groups and that the improvements are comparable to those obtained with land-based exercise A systematic review and meta-analysis found that supervised programs involving aerobic or resistance exercise improved glycemic control in adults with type 2 diabetes, whether or not they included dietary co-intervention 6.
The same meta-analysis found that unsupervised exercise improved glycemic control only if there was concomitant dietary intervention. A meta-analysis found that trials evaluating resistance exercise with less supervision showed less beneficial impact on glycemic control, insulin resistance and body composition than studies with greater supervision A 1-year randomized trial compared exercise counselling plus twice-weekly supervised aerobic and resistance exercise vs.
exercise counselling alone in people with type 2 diabetes and the metabolic syndrome Although self-reported total physical activity increased substantially in both groups, the group receiving the supervised aerobic and resistance exercise training had significantly better results, including greater reductions in A1C, blood pressure BP , BMI, waist circumference and estimated year CV risk, and greater increases in aerobic fitness, muscle strength and high-density lipoprotein cholesterol HDL-C Major CV event rates were not significantly different in the 2 groups However, the ILI group achieved significantly greater and more sustained improvements in many important secondary outcomes, including weight loss; improved cardiorespiratory fitness; improved glycemic control, BP and lipids with fewer medications; as well as decreased rate of sleep apnea, severe diabetic chronic kidney disease and retinopathy, depression, sexual dysfunction, urinary incontinence and knee pain; as well as better physical mobility maintenance and quality of life, with lower overall health-care costs For most people with and without diabetes, being sedentary is associated with far greater health risks than exercise would be.
Most people with diabetes who have no symptoms of coronary ischemia do not require medical clearance before starting a low-to-moderate intensity exercise program. However, middle-aged and older individuals with diabetes who wish to undertake very vigorous or prolonged exercise, such as competitive racing, high-intensity interval training with intervals at maximal effort, or long-distance running should be assessed for conditions that may place them at increased risk for an adverse event.
Preproliferative or proliferative retinopathy should be treated and stabilized prior to commencement of vigorous exercise. People with severe peripheral neuropathy should be instructed to inspect their feet daily, especially on days they are physically active, and to wear appropriate footwear.
Although previous guidelines stated that persons with severe peripheral neuropathy should avoid weight-bearing activity, more recent studies indicate that individuals with peripheral neuropathy may safely participate in moderate weight-bearing exercise provided they do not have active foot ulcers 58— Studies also suggest that people with peripheral neuropathy in the feet, who participate in daily weight-bearing activity, are at decreased risk of foot ulceration compared with those who are less active A resting ECG should be performed, and an exercise ECG stress test should be considered, for individuals with typical or atypical chest discomfort, unexplained dyspnea, peripheral arterial disease, carotid bruits or history of angina, myocardial infarction MI , stroke or transient ischemic attacks see Screening for the Presence of Cardiovascular Disease chapter, p.
S who wish to undertake exercise more intense than brisk walking, especially if considering very intense, prolonged aerobic exercise. The value and utility of medical screening procedures prior to exercise, such as resting ECG and exercise stress testing in asymptomatic individuals has been the subject of much debate There is now an increased appreciation that exercise testing is a poor predictor of future cardiovascular disease CVD events because such testing detects flow-limiting coronary lesions while sudden cardiac arrest is usually produced by the rapid progression of a previously non-obstructive lesion Nevertheless, identifying individuals who are symptomatic remains very important.
People who are symptomatic, either before or during exercise, should be referred for ECG stress testing and further cardiac evaluation prior to participating or continuing in an exercise program see Screening for the Presence of Cardiovascular Disease chapter, p.
Performing physical activity, especially in the heat, places individuals at risk for heat-related injuries. The increase in metabolic heat production augments the rate at which heat must be dissipated to the environment to prevent dangerous increases in core temperature.
Reduced physical fitness 70 and the presence of metabolic, CV and neurologic dysfunctions, which are often associated with diabetes 71 , further exacerbate an already compromised ability to dissipate heat.
People with diabetes should be aware that heat stress is associated with a reduction in exercise capacity and an increase in disease-related symptoms an air-conditioned training centre, room with fans if it is very hot outdoors. If activities e. gardening, cycling, etc.
must be performed outdoors when the weather is hot, the activities should be conducted in the early or later hours of the day when the temperatures are cooler and the sun is not at its peak. Middle-aged and older people with diabetes should try to avoid performing exercise in hot humid conditions as these conditions restrict the evaporation of sweat which is necessary to cool the body.
Staying well hydrated will help ensure that the body can maintain an adequate cooling capacity during exercise by maintaining sweat production at normal levels especially in the heat, and prevent fluctuations in blood glucose levels 71,72 , and is likely to reduce the risk for heat-related complications, such as heat exhaustion or heat stroke.
Prolonged aerobic exercise increases insulin sensitivity in recovery for up to 48 hours In type 1 diabetes, there is little or no endogenous insulin secretion, and achieving the appropriate balance of exogenous insulin and carbohydrate intake for the different forms and intensities of exercise can be challenging Fear of hypoglycemia is an important barrier to exercise in people with type 1 diabetes 75 and advice on physical activity to people with type 1 diabetes should include strategies to reduce risk of hypoglycemia.
Several small studies have explored several types of strategies for the prevention of hypoglycemia in type 1 diabetes, including the consumption of extra carbohydrates for exercise 76 , limiting preprandial bolus insulin doses 77—79 or reducing the basal insulin rate for continuous subcutaneous insulin infusion CSII insulin pump users These strategies can be used alone or in combination 81, Increasing carbohydrate intake just before, during and immediately after exercise is a simple and effective way to prevent hypoglycemia, although the optimal carbohydrate intake rate varies based on the duration and intensity of the activity and the amount of insulin in the circulation at the time of exercise 78,83, Basal insulin reduction before exercise may also offer some protection for children 86 and for those people on CSII 79, A more aggressive basal rate reduction, such as basal rate suspension at exercise onset is somewhat effective, although blood glucose levels may still drop markedly at the start of exercise As such, additional carbohydrates may still be needed even following basal rate reductions.
Another strategy to avoid hypoglycemia is to perform intermittent, brief 10 seconds , maximal-intensity sprints either at the beginning 90 or end 91 or intermittently during a moderate-intensity exercise session Performing resistance exercise immediately prior to aerobic exercise also helps reduce hypoglycemia risk, rather than performing aerobic exercise alone or aerobic exercise followed by resistance exercise Exercise performed late in the day or in the evening can be associated with increased risk of overnight hypoglycemia in people with type 1 diabetes Glucose levels can rise with brief intense exercise, such as sprinting 90—92 , resistance training 93 , 10 to 15 minutes of maximal-intensity aerobic exercise to exhaustion 94,95 or high-intensity interval training 96 in individuals with type 1 diabetes.
If this occurs, it can be addressed by giving a small bolus of a rapid-acting insulin in exercise recovery 97 , or by temporarily increasing the basal insulin infusion in CSII users. Individuals with type 2 diabetes generally do not need to postpone exercise because of high blood glucose, provided they feel well.
increased thirst, nausea, severe fatigue, blurred vision or headache , especially for exercise to be performed in the heat. In individuals with type 1 diabetes who are severely insulin deficient e. due to insulin omission or illness , hyperglycemia can worsen with exercise.
Sedentary behaviours involve prolonged sitting or reclining while awake, including television viewing, working on a computer and driving. Systematic reviews of observational studies 98,99 have demonstrated positive associations between the amount of sitting and the risk of premature mortality within the general population and in people with diabetes , even after adjusting for time spent in moderate-to-vigorous physical activity 98— Several recent studies in people with diabetes have documented harmful associations between objectively measured sedentary time and cardiometabolic risk factors, such as A1C, central adiposity, BMI, fasting TG, systolic BP, C-reactive protein, and hyperglycemia — Studies in people with and without type 2 diabetes have demonstrated that interrupting sitting by light walking or light resistance training can attenuate postprandial increases in BG, insulin and TG — Given the evidence that sedentary behaviour is associated with adverse health outcomes, even after statistically adjusting for levels of moderate-to-vigorous exercise, physical activity levels and sedentary behaviours should be considered distinct and potentially independent behaviours.
When discussing activity patterns with people with diabetes in clinical practice, it is reasonable, therefore, to promote both the reduction of prolonged sitting and the accumulation of moderate-to-vigorous physical activity in the person's daily routine. There are a number of barriers and facilitators to physical activity in people with diabetes — Interventions targeting these barriers and facilitators are needed to initially engage people with diabetes in, and then maintain, sufficient physical activity.
Behaviour-change focused interventions added to exercise-based interventions have tended to focus on increasing physical activity self-efficacy i. an individual's desire or willingness to do physical activity For example, a recent meta-analysis suggested that the use of motivational interviewing-based interventions see description below not only improved physical activity but also decreased A1C by about 0.
However, it should be noted that some other studies found this kind of intervention did not reduce A1C , The vast majority of the studies have examined motivational interviewing or motivational communication as the behaviour change intervention.
Motivational interviewing is a goal-oriented, client-centred counselling style, which helps to explore and resolve ambivalence and increase intrinsic motivation in individuals in order to change behaviour Motivational communication represents a collection of evidence-based strategies drawn from motivational interviewing, cognitive-behavioural techniques and behaviour change theories e.
self-determination theory, social-cognitive theory, theory of planned behaviour and the transtheoretical model that are used as a communication strategy to engage individuals in changing their behaviour For people with type 2 diabetes, evidence suggests that goal setting, problem solving, providing information on where and when to exercise, and self-monitoring e.
use of objective monitoring with pedometers have some efficacy to increase physical activity and improve A1C ,— Newer evidence is starting to accumulate on the potential benefits of other motivational tools and techniques.
Examples of these include reinforcement, such as providing direct, instantaneous rewards monetary or token-based for goal completion , text-messaging , , mobile applications, social media and video games , However, further higher level evidence is needed to demonstrate their benefits for both physical activity and diabetes-related outcomes ,— A pedometer is a wearable device that detects and counts each step a person takes.
An accelerometer is a device that measures non-gravitational acceleration. Pedometers and accelerometers are well suited to measuring walking or jogging, but not bicycling or swimming. Pedometers measure steps but not speed, whereas accelerometers can measure both steps and speed. Large-scale cohort studies consistently demonstrate an inverse relationship between higher self-reported walking with CV events and both CV and all-cause mortality in type 2 diabetes, even with adjustments for other CV risk factors.
In a randomized controlled trial examining the effect of a pedometer-based prescription in people with type 2 diabetes, the change in A1C at the end of the 1-year step count prescription intervention was 0. Active arm participants reviewed step count logs with their physicians at each clinic visit over a 1-year period, set step targets and received a written step count prescription.
Those in the control arm were encouraged to be active 30 to 60 minutes daily. Smarter Step Count Prescription. In these trials, the active arms engaged in pedometer-based interventions with monitoring and recording of daily step counts often complemented by support from a facilitator with or without peers in a group.
Physical Activity in Children with Type 2 Diabetes: see Type 2 Diabetes in Children and Adolescents chapter, p. A1C, glycated hemoglobin ; BG , blood glucose; BP , blood pressure; BMI , body mass index; CV , cardiovascular; CVD , cardiovascular disease; ECG , electrocardiogram; FPG , fasting plasma glucose; HDL-C ; high-density lipoprotein cholesterol; LDL-C , low-density lipoprotein cholesterol.
Literature Review Flow Diagram for Chapter Physical Activity and Diabetes. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement.
PLoS Med 6 6 : e pmed For more information, visit www. Sigal reports grants from Amilyn Pharmaceuticals, Boehringer Ingelheim, Prometic, Population Health Research Institute PHRI , and Sanofi; and personal fees from Novo Nordisk, outside the submitted work.
Bacon reports personal fees from Kataka Medical Communications, Schering-Plough, Merck, and Sygesa; and grants from Abbive, outside the submitted work; also, he is Past-President of the Canadian Association of Cardiovascular Prevention and Rehabilitation. Riddell reports personal fees from Medtronic, Lilly Innovation, Insulet, and Ascencia Diabetes Care; grants and personal fees from Sanofi; and non-financial support from Dexcom, outside the submitted work.
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Key Messages Recommendations Figures Full Text References. Chapter Headings Types of Exercise Benefits of Physical Activity Benefits of Interval Training Benefits of Resistance Exercise Benefits of Other Types of Exercise Supervised vs.
Unsupervised Exercise The Look-AHEAD Trial Minimizing Risk of Exercise-Related Adverse Events Reduction of Sedentary Behaviour The Use of Adjunct Motivational Interventions to Improve Physical Activity Uptake Objective Monitoring of Physical Activity Exercise Prescription Examples Other Relevant Guidelines Relevant Appendix Author Disclosures.
Key Messages Moderate to high levels of physical activity and cardiorespiratory fitness are associated with substantially lower morbidity and mortality in people with diabetes.
Key Messages for People with Diabetes Physical activity often improves glucose control and facilitates weight loss, but has multiple other health benefits even if weight and glucose control do not change.
Types of Exercise Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure 1. Benefits of Physical Activity Physical activity can help people with diabetes achieve a variety of goals, including increased cardiorespiratory fitness, increased vigour, improved glycemic control, decreased insulin resistance, improved lipid profile, blood pressure BP reduction and maintenance of weight loss 2—5.
Benefits of Interval Training High-intensity interval training involves alternating between short periods of higher and lower-intensity exercise see Exercise Prescription Examples.
Benefits of Resistance Exercise Resistance training in adults with type 2 diabetes improves glycemic control as reflected by reduced A1C , decreases insulin resistance and increases muscular strength 30 , lean muscle mass 31 and bone mineral density 32,33 , leading to enhanced functional status and prevention of sarcopenia and osteoporosis.
Benefits of Other Types of Exercise To date, evidence for the beneficial effects of other types of exercise is not as extensive or as supportive as the evidence for aerobic and resistance exercise. Supervised vs. Unsupervised Exercise A systematic review and meta-analysis found that supervised programs involving aerobic or resistance exercise improved glycemic control in adults with type 2 diabetes, whether or not they included dietary co-intervention 6.
Minimizing Risk of Exercise-Related Adverse Events Identifying individuals for whom medical evaluation should be considered prior to initiating an exercise program For most people with and without diabetes, being sedentary is associated with far greater health risks than exercise would be.
Minimizing risk of heat-related illness Performing physical activity, especially in the heat, places individuals at risk for heat-related injuries.
Minimizing risk of exercise-induced hypoglycemia in type 1 diabetes Prolonged aerobic exercise increases insulin sensitivity in recovery for up to 48 hours Minimizing risks related to hyperglycemia Glucose levels can rise with brief intense exercise, such as sprinting 90—92 , resistance training 93 , 10 to 15 minutes of maximal-intensity aerobic exercise to exhaustion 94,95 or high-intensity interval training 96 in individuals with type 1 diabetes.
Reduction of Sedentary Behaviour Sedentary behaviours involve prolonged sitting or reclining while awake, including television viewing, working on a computer and driving. The Use of Adjunct Motivational Interventions to Improve Physical Activity Uptake There are a number of barriers and facilitators to physical activity in people with diabetes — Objective Monitoring of Physical Activity A pedometer is a wearable device that detects and counts each step a person takes.
Exercise Prescription Examples The following are practical examples illustrating how exercise can be prescribed: Aerobic exercise Start by walking at a comfortable pace for as little as 5 to 15 minutes at one time.
Gradually progress over 12 weeks to up to 50 minutes per session including warm-up and cool down of brisk walking. Alternatively, shorter exercise sessions in the course of a day, e. Resistance exercise Choose approximately 6 to 8 exercises that target the major muscle groups in the body.
Gradually increase the resistance until you can perform 3 sets of 8 to 12 repetitions for each exercise, with 1 to 2 minutes of rest between sets The best evidence supports strength training with weight machines or free weights. Resistance bands may not be as effective to improve glycemic control, but they can help increase strength and can be a starting point to progress to other forms of resistance training.
If you wish to begin resistance exercise, you should receive initial instruction and periodic supervision by a qualified exercise specialist to maximize benefits, while minimizing risk of injury, at least for the initial sessions Table 3.
Interval exercise Exercise performed in intervals, alternating between higher intensity and lower intensity, can be used by participants who have trouble sustaining continuous aerobic exercise, or can be used to shorten total exercise duration or increase variety.
Try alternating between 3 minutes of faster walking and 3 minutes of slower walking Another form of interval training, high-intensity interval training HIIT , can be performed through shorter intervals of higher-intensity exercise e.
Start with just a few intervals and progress to longer durations by adding additional intervals. Aquatic exercise can include walking briskly in the water, swimming or classes that include a variety of exercises.
Other types of exercise or exercise classes, such as yoga, may be appealing for reasons, such as stress management. Using pedometers or accelerometers Encourage people with diabetes to self-monitor physical activity with a pedometer or accelerometer.
Ask them to record values, review at visits, set step count targets and formalize recommendations with a written prescription see Appendix 4. Breaking up sedentary time It is best to avoid prolonged sitting. Recommendations People with diabetes should ideally accumulate a minimum of minutes of moderate- to vigorous-intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise, to improve glycemic control [Grade B, Level 2, for adults with type 2 diabetes 2,4,6 and children with type 1 diabetes 20 ]; and to reduce risk of CVD and overall mortality [Grade C, Level 3, for adults with type 1 diabetes 14 and type 2 diabetes 10 ].
Interval training short periods of vigorous exercise alternating with short recovery periods at low-to-moderate intensity or rest from 30 seconds to 3 minute each can be recommended to people willing and able to perform it to increase gains in cardiorespiratory fitness in type 2 diabetes [Grade B, Level 2 ] and to reduce risk of hypoglycemia during exercise in type 1 diabetes [Grade C, Level 3 28,29 ].
People with diabetes including elderly people should perform resistance exercise at least twice a week 39 and preferably 3 times per week [Grade B, Level 2 30 ] in addition to aerobic exercise [Grade B, Level 2 39—42 ].
Initial instruction and periodic supervision by an exercise specialist can be recommended [Grade C, Level 3 30 ]. In addition to achieving physical activity goals, people with diabetes should minimize the amount of time spent in sedentary activities and periodically break up long periods of sitting [Grade C, Level 3 ].
Setting specific exercise goals, problem solving potential barriers to physical activity, providing information on where and when to exercise, and self-monitoring should be performed collaboratively between the person with diabetes and the health-care provider to increase physical activity and improve A1C [Grade B, Level 2 , ].
Step count monitoring with a pedometer or accelerometer can be considered in combination with physical activity counselling, support and goal-setting to support and reinforce increased physical activity [Grade B, Level 2 , ]. Structured exercise programs supervised by qualified trainers should be implemented when feasible for people with type 2 diabetes to improve glycemic control, CV risk factors and physical fitness [Grade B, Level 2 6,39 ].
Abbreviations: A1C, glycated hemoglobin ; BG , blood glucose; BP , blood pressure; BMI , body mass index; CV , cardiovascular; CVD , cardiovascular disease; ECG , electrocardiogram; FPG , fasting plasma glucose; HDL-C ; high-density lipoprotein cholesterol; LDL-C , low-density lipoprotein cholesterol.
Other Relevant Guidelines Monitoring Glycemic Control, p. S47 Glycemic Management in Adults with Type 1 Diabetes, p. S80 Hypoglycemia, p.
S Screening for the Presence of Cardiovascular Disease, p. S Type 2 Diabetes in Children and Adolescents, p.
Relevant Appendix Appendix 4. Author Disclosures Dr. References Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research.
Public Health Rep ;— Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: A meta-analysis.
Diabetes Care ;— Colberg SR, Sigal RJ, Yardley JE, et al. Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: A meta-analysis. Wing RR, Goldstein MG, Acton KJ, et al.
Behavioral science research in diabetes: Lifestyle changes related to obesity, eating behavior, and physical activity. Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or struc-tured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis.
JAMA ;—9. Umpierre D, Ribeiro PA, Schaan BD, et al. Volume of supervised exercise train-ing impacts glycaemic control in patients with type 2 diabetes: A systematic review with meta-regression analysis. Diabetologia ;— Liubaoerjijin Y, Terada T, Fletcher K, et al.
Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: A meta-analysis of head-to-head ran-domized trials.
Sheri R. ColbergRonald Mrtabolic. SigalJane E. YardleyMichael C. RiddellDavid W. Cardiovascular Eexrcise volume 16Article number: Cite Exercise and blood sugar levels in metabolic syndrome article. Metrics details. Purpose : to establish if exercise training improves syndroome outcomes Antifungal remedies for yeast overgrowth in the gut blod with metabolic syndrome Calisthenics and bodyweight movements. Data sources wnd studies were identified through a MEDLINE search strategy to Jan 12,Cochrane controlled trials registry, CINAHL and SPORTDiscus. Study selection : prospective randomized or controlled trials of exercise training in humans with metabolic syndrome, lasting 12 weeks or more. We included 16 studies with 23 intervention groups; 77, patient-hours of exercise training. We found no significant differences between outcome measures between the two exercise interventions.
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