I recently co-chaired a new consensus statement from the American College of Sports Medicine (ACSM) that is an update from the 2010 joint ACSM/American Diabetes Association position statement on physical activity/exercise for individuals with type 2 diabetes (T2D) (1). A lot more research has been conducted in the ensuing decade since the joint position statement was published, and this new consensus statement (2) provides a summary of the current evidence.
In short, it recommends that people with T2D (or prediabetes) engage in physical activity regularly and reduce their sedentary time. Various types of physical activity and planned exercise can greatly enhance the health and glycemic management of individuals of all ages with T2D, however, including flexibility and balance exercise in adults. The greater emphasis on these latter two types is the result of many studies showing their importance in preventing loss of range of motion around joints while aging with diabetes. They also lower the incidence of falls and injuries, even in people with peripheral nerve damage from long-standing diabetes in their feet and lower extremities.
The new topics covered this time around include a discussion of the importance of physical activity around bariatric surgery, the impact of the timing of a bout of exercise, the merits (and potential detriments) of high intensity interval training, how being regularly active affects mental health and cognitive function, nutritional concerns around activity, and disparities in access and barriers to physical activity. Lifestyle interventions that include physical activity, dietary changes, and possible weight loss remain important approaches in the management of T2D and cardiovascular disease risks.
What else is important to know? Almost all of the conclusions from the 2010 joint position statement are still valid. The following is a synopsis of the findings of the consensus statement and its current physical activity recommendations:
Regular aerobic exercise training improves glycemic management in adults with T2D. Adults who exercise regularly spend less daily time with hyperglycemia (elevated blood glucose) and experience a 0.5 to 0.7 percent drop in A1C.
When resistance training is high-intensity, it bestows greater beneficial effects than low-to-moderate-intensity training when it comes to lowering A1C and insulin levels. (However, doing any resistance training is always better than none.)
Exercising after meals reduces blood glucose levels regardless of the intensity of activity or the type done and doing 45 minutes or more provides the most consistent benefits.
Small “doses” of any type of physical movement done throughout the day to break up sitting time help lower glucose and insulin levels after meals, albeit modestly, particularly in individuals with insulin resistance and a higher body mass index (BMI).
Weight loss—when accomplished through lifestyle changes in diet and activity—of more than 5 percent of total body weight seems to be necessary for the most beneficial effects on A1C, blood lipids, and blood pressure in adults with T2D.
To reduce visceral (deep abdominal) fat, a moderately high volume of exercise, i.e., using up ~500 calories per day through activity, done 4 to 5 days per week may be needed.
In youth with T2D, following intensive lifestyle changes while taking metformin is about as effective as metformin by itself for managing overall blood glucose levels. (However, lifestyle improvements are still recommended for a variety of reasons.)
Although research on this topic is limited, it is still recommended that youth and adolescents with T2D diabetes meet the same physical activity goals set for youth in the general population.
Pregnant women with and without diabetes should participate in at least 20 to 30 minutes of moderate-intensity exercise most days of the week.
Individuals with T2D using insulin or insulin secretagogues are advised to supplement with carbohydrate (or reduce insulin, if possible) as needed to prevent hypoglycemia (low blood glucose) during and after exercise.
Participating in an exercise program before undergoing bariatric surgery may enhance surgical outcomes, and after surgery, regular exercise confers additional benefits.
While much more new and relevant information is available in this consensus statement, you will have to read the rest for yourself! Find the statement online: https://journals.lww.com/acsm-msse/Fulltext/2022/02000/Exercise_Physical_Activity_in_Individuals_with.18.aspx.
1. Colberg SR, Albright AL, Blissmer BJ, Braun B, Chasan-Taber L, Fernhall B, et al. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc. 2010;42(12):2282-303. doi: 10.1249/MSS.0b013e3181eeb61c.
2. Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, et al. Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Med Sci Sports Exerc. 2022;54(2):353-68. doi: 10.1249/mss.0000000000002800. PubMed PMID: 35029593.