Updated Federal Physical Activity Guidelines: Do They Apply to People with Diabetes?
In mid-November 2018, the U.S. Department of Health and Human Services finally released new physical activity guidelines (as a 2nd edition) to update their previous set from a decade before (1,2). Various activity guidelines for adults with diabetes have been updated several times in the interim, including a 2010 position statement on exercising with type 2 diabetes (3) published jointly by the American College of Sports Medicine and the American Diabetes Association; a 2016 ADA position statement on exercise and physical activity for all types of diabetes (4); and a consensus statement on being active with type 1 diabetes published in The Lancet in 2017 (5).
In those three sets of recommendations specific to diabetes, it was clear that everyone with diabetes can benefit from being more regularly active. Adults with diabetes should undertake a variety of activities, including aerobic, resistance, flexibility, and balance training (the last one particularly for adults over 40 or anyone with neuropathy), as well as stay more active on a daily basis just doing lifestyle activities or sitting less for better blood glucose management and weight control. The activity recommendations for adults and youth with diabetes have essentially been the same for everyone else of a similar age without diabetes.
So, what do the new federal guidelines add to the mix, if anything? Based on a review of the current research, the biggest change from the previous set of guidelines is likely that you don’t need to be active for a minimum of 10 minutes at a time for it to be beneficial to fitness and well-being. Given that many studies in the past decade have shown that breaking up sedentary behavior with short (3-minute) breaks can alter metabolism for the better, these recommendations are not surprising. They also recommend that people should sit less overall, again not a shocking guideline at this point. Studies done with people with diabetes have reached the same conclusions, so these updates certainly apply to everyone.
Another change in the federal guidelines applies to the weekend warriors: they now state that adults can derive similar health benefits if they perform all their weekly recommended physical activity in a single day or two rather than over the course of multiple days. However, whether this guideline applies as directly to people with diabetes is questionable. Past guidelines (3,4,5) have recommended that adults with diabetes not go more than two days without doing some physical activity, and many have recommended doing daily or near daily exercise for better blood glucose management. Given that the enhancing effects of your last bout of physical activity on insulin sensitivity may only last 2 to 72 hours, it seems unlikely that people with diabetes will gain all the same benefits by being a weekend warrior only—at least not when it comes to blood glucose management through reduced insulin resistance. For now, the recommendations for people with diabetes to do some type of exercise at least every other day will likely remain in place for that reason.
Finally, the new guidelines expanded out recommendations for all adults to get 150 minutes of moderate aerobic activity or 75 minutes of intense activity (or a combination thereof) each week to include up to double that amount—300 minutes moderate or 150 minutes intense aerobic training—and beyond for additional benefits. As if the bar weren’t set high enough already, you now have to find even more time to be active to gain optimal health benefits. While we already knew this was true, apparently the federal government also now recognizes how important it is for all of us to be the anti-couch potato and get as much as activity as possible to optimize our collective health! Luckily, the guidelines for doing resistance training at least two days a week are still unchanged, although we all know that doing three nonconsecutive resistance workouts a week is a preferable goal to maximize muscle gains and prevent losses of muscle (where we store carbohydrates) from aging and disuse.
In summary, these new federal physical activity guidelines really did not change what we should be doing already: getting at least 75 to 150 minutes of aerobic exercise weekly depending on its intensity (but closer to double that amount for optimal health), doing resistance training at least twice a week (but preferably three), stretching regularly, working on our balance ability if we’re older, moving more, sitting less, getting up more often, and taking the stairs instead of the elevator. So, go get active!
Physical Activity Guidelines for Americans, 2nd Edition, 2018. Accessed at https://health.gov/paguidelines/second-edition/.
Executive Summary: Physical Activity Guidelines for Americans, 2nd Edition, 2018. Accessed at https://health.gov/paguidelines/second-edition/pdf/PAG_ExecutiveSummary.pdf.
Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer B, Rubin RR, Chasan-Taber L, Albright AL, and Braun B. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Diabetes Care, 33(12): e147–e167, 2010.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, and Tate DF. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11); 2065–2079, 2016.
Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, and Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinology, 5:377–390, 2017.