Exercise and Physical Activity in Individuals with Type 2 Diabetes

Publication Date: January 24, 2022
Last Updated: March 14, 2022

Consensus Statements and Recommendations

  • Regular aerobic exercise training improves glycemic management in adults with type 2 diabetes, with less daily time in hyperglycemia and 0.5%–0.7% reductions in overall glycemia (as measured by A1C).
  • High-intensity resistance exercise training has greater beneficial effects than low-to-moderate-intensity resistance training in terms of overall glucose management and attenuation of insulin levels.
  • Greater energy expenditure postprandially reduces glucose levels regardless of exercise intensity or type, and durations ≥45 min provide the most consistent benefits.
  • Small “doses” of PA throughout the day to break up sitting modestly attenuate postprandial glucose and insulin levels, particularly in individuals with insulin resistance and a higher body mass index.
  • Weight loss (accomplished through lifestyle changes in diet and PA) of >5% seems to be necessary for beneficial effects on A1C, blood lipids, and blood pressure.
  • For reductions in visceral fat in individuals with type 2 diabetes, a moderately high volume of exercise (~500 kcal) done 4–5 d·wk−1 is needed.
  • In youth with type 2 diabetes, intensive lifestyle interventions plus metformin have not been superior to metformin alone in managing glycemia.
  • Despite the limited data, it is still recommended that youth and adolescents with type 2 diabetes meet the same PA goals set for youth in the general population.
  • Pregnant women with and without diabetes should participate in at least 20–30 min of moderate-intensity exercise most days of the week.
  • Individuals with type 2 diabetes using insulin or insulin secretagogues are advised to supplement with carbohydrate (or reduce insulin, if possible) as needed to prevent hypoglycemia during and after exercise.
  • Participation in an exercise program before bariatric surgery may enhance surgical outcomes, and after surgery, participation confers additional benefits.

Recommended types of exercise training for all adults with T2D

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Type of Training
Type Intensity Frequency Duration Progression
Aerobic Walking, jogging, cycling, swimming, aquatic activities, rowing, dancing, interval training 40%–59% of V˙O2R or HRR (moderate), RPE 11–12; or 60%–89% of V˙O2R or HRR (vigorous), RPE 14–17 3–7 d·wk−1, with no more than 2 consecutive days between bouts of activity Minimum of 150–300 min·wk−1 of moderate activity or 75–150 min of vigorous activity, or an equivalent combination thereof Rate of progression depends on baseline fitness, age, weight, health status, and individual goals; gradual progression of both intensity and volume is recommended
Resistance Free weights, machines, elastic bands, or body weight as resistance; undertake 8–10 exercises involving the major muscle groups Moderate at 50%–69% of 1RM, or vigorous at 70%–85% of 1RM 2–3 d·wk−1, but never on consecutive days 10–15 repetitions per set, 1–3 sets per type of specific exercise As tolerated; increase resistance first, followed by a greater number of sets, and then increased training frequency
Flexibility Static, dynamic, or PNF stretching; balance exercises; yoga and tai chi increase range of motion Stretch to the point of tightness or slight discomfort ≥2–3 d·wk−1 or more; usually done with when muscles and joints are warmed up 10–30 s per stretch (static or dynamic)group; 2–4 repetitions of each As tolerated; may increase range of stretch as long as not painful
Balance Balance exercises: lower body and core resistance exercises, yoga, and tai chi also improve balance No set intensity ≥2–3 d·wk−1 or more No set duration As tolerated; balance training should be done carefully to minimize the risk of falls
1RM, 1-repetition maximum; HRR, heart rate reserve; PNF, proprioceptive neuromotor facilitation; RPE, rating of perceived exertion; V˙O2R, V˙O2 reserve.

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Exercise and Physical Activity in Individuals with Type 2 Diabetes

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