Warning: routine physical activity is an important part of the diabetic care plan. Any change in physical activity will effect glycemic control. The attending physician and registered dietician must be notified of alterations in activity so that appropriate adjustment to diet and medication can be made to compensate for changed activity level. Changes in physical activity will also require increased vigilance and glucose testing until the effects of the new routine are known.

While exercise is recommended for everyone, the benefits of exercise for people with diabetes are even more favorable than for non-diabetics. Aerobic exercise provides the greatest benefits for people with diabetes to achieve blood glucose control and to improve cardiovascular status. The current American Diabetes Association recommendations are:

• "People with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50-70% of maximum heart rate)".
• "In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance training three times per week"

Aerobic exercise promotes cardio-pulmonary distribution of oxygen throughout the body. Aerobic exercise involves repetitive contraction of major muscle groups at a rate and intensity that does not result in rapid oxygen depletion. Optimum aerobic exercise occurs between 70-80% of maximun effort. Continuous moderate intensity swimming, cycling, walking or jogging are examples of aerobic exercise.

Anaerobic exercise is high intensity, short duration exercise that exceeds the body's ability to supply oxygen. Anaerobic exercise results in oxygen deficit and lactic acid production. Anaerobic exercise occurs between 80-90% of maximium effort. Examples of anaerobic exercise include: resistance training, heavy weight-lifting, any type of sprint, isometrics, etc. Anaerobic exercise does not confer the same health benefits as an aerobic program. In addition, anaerobic exercise and certain types and intensity levels of aerobic exercise may produce excessive rises in blood pressure, cardiac workload, and pressure within the eye (intraocular pressure). These reactions can be potential problems in persons with diabetes who have eye disease or cardiovascular disease.

Exercise was first recommended as a therapy for lowering blood glucose levels in the 20th century. Regular exercise is now a primary component of diabetes management. Much of the morbidity and mortality associated with diabetes is due to cardiovascular disease. Research studies have consistently demonstrated that regular exercise and physical fitness are associated with decreased cardiovascular disease in the population at large and a decrease in the incidence of type 2 diabetes.
Although regular exercise is beneficial for everyone, here are some specific benefits of exercise for people with diabetes:

• Improved glucose control
• Reduced risk of progression from pre-diabetes to type 2 diabetes
• Decreased risk of diabetes associated coronary artery disease, including a reduction in triglycerides, and low-density lipoproteins (LDLs), and an increase in high-density lipoproteins (HDLs)
• Increased sensitivity to insulin is greatest with a combined program of aerobic and resistance training
• Reduced hyperinsulinemia (excessive insulin secretion), a potential risk factor for atherosclerosis
• Increased fibrinolysis (breakdown of clots in the circulatory system)
• Reduced A1c in type 2
  

Recent Evidence Base

Guelfi, Ratnam et al. demonstrated that continuous moderate intensity exercise resulted in a greater reduction of blood glucose than high intensity exercise in type 1 diabetics. They attribute the effect to an increased rate of glucose production during high-intensity exercise as well as a decreased utilization of glucose during exercise and early recovery.

Thomas D, Elliott E, Naughton G. conducted a meta-analysis of fourteen randomized controlled studies comparing exercise against no exercise in type 2 diabetes involving a total of 377 participants. The analysis revealed:

• exercise significantly improved glycemic control as measured by HbA1c levels
• visceral and subcutaneous adipose tissue was decreased
• insulin response was improved
• plasma triglycerides but not plasma cholesterol were decreased
• no significant weight loss
• no diabetic complications were attributed to exercise

O'Gorman, D; Karlsson, H.; et al. found that exercise training (7-days) increased insulin mediated glucose reduction in obese type 2 diabetics but not obese non-diabetics. Changes were related to increased GLUT4 content.

Thompson, A.; Church, T.; et al. concluded that in men with pre-diabetes and diabetes, higher levels of cardiorespiratory fitness were associated with lower risk of cancer mortality, particularly as a result of cancers of the gastrointestinal tract, compared with those who had low levels of fitness.

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