F. Physical activity - Diabetes Care

F. Physical activity

Recommendations

* To improve glycemic control, assist with weight maintenance, and reduce risk of CVD, at least 150 min/week of moderate-intensity aerobic physical activity (50??70% of maximum heart rate) is recommended and/or at least 90 min/week of vigorous aerobic exercise (>70% of maximum heart rate). The physical activity should be distributed over at least 3 days/week and with no more than 2 consecutive days without physical activity. (A)
* In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance exercise three times a week, targeting all major muscle groups, progressing to three sets of 8??10 repetitions at a weight that cannot be lifted more than 8??10 times. (A)

Indications for graded exercise test with electrocardiogram monitoring

* A graded exercise test with electrocardiogram (ECG) monitoring should be seriously considered before undertaking aerobic physical activity with intensity exceeding the demands of everyday living (more intense than brisk walking) in previously sedentary diabetic individuals whose 10-year risk of a coronary event is likely to be 10%.

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ADA technical reviews on exercise in patients with diabetes have summarized the value of exercise in the diabetes management plan. Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being. Furthermore, regular exercise may prevent type 2 diabetes in high-risk individuals.

Definitions

The following definitions are based on those outlined in “Physical Activity and Health,” the 1996 report of the Surgeon General. Physical activity is defined as bodily movement produced by the contraction of skeletal muscle that requires energy expenditure in excess of resting energy expenditure. Exercise is a subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness. Aerobic exercise consists of rhythmic, repeated, and continuous movements of the same large muscle groups for at least 10 min at a time. Examples include walking, bicycling, jogging, swimming, water aerobics, and many sports. Resistance exercise consists of activities that use muscular strength to move a weight or work against a resistive load. Examples include weight lifting and exercises using weight machines.

Effects of structured exercise interventions on glycemic control and body weight in type 2 diabetes

Boul? et al. undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of duration 8 weeks on HbA1c and body mass in people with type 2 diabetes. Twelve aerobic training studies and two resistance training studies were included (totaling 504 subjects), and the results were pooled using standard meta-analytic statistical methods. Postintervention HbA1c was significantly lower in exercise than control groups. Metaregression confirmed that the beneficial effect of exercise on HbA1c was independent of any effect on body weight. Therefore, structured exercise programs had a statistically and clinically significant beneficial effect on glycemic control, and this effect was not mediated primarily by weight loss.

Boul? et al. later undertook a meta-analysis of the interrelationships among exercise intensity, exercise volume, change in cardiorespiratory fitness, and change in HbA1c. This meta-analysis provides support for higher-intensity aerobic exercise in people with type 2 diabetes as a means of improving HbA1c. These results would provide support for encouraging type 2 diabetic individuals who are already exercising at moderate intensity to consider increasing the intensity of their exercise in order to obtain additional benefits in both aerobic fitness and glycemic control.

Frequency of exercise

The U.S. Surgeon General??s report recommended that most people accumulate 30 min of moderate intensity activity on most, ideally all, days of the week. The American College of Sports Medicine now recommends resistance training be included in fitness programs for adults with type 2 diabetes. Resistance exercise improves insulin sensitivity to about the same extent as aerobic exercise. Two clinical trials published in 2002 provided strong evidence for the value of resistance training in type 2 diabetes.

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AMERICAN DIABETES ASSOCIATION
DIABETES CARE, VOLUME 27, SUPPLEMENT 1, JANUARY 2004

References
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May 27, 10 • Diabetes mellitus