Consensus Statements and Recommendations

Recommended types of exercise training for all adults with T2D

Indications for preparticipation exercise stress testing

General exercise training considerations and precautions

PA precautions for common comorbid health complications

Document Overview

Design and created by Guideline Central in participation with the American College of Sports Medicine.

Exercise and Physical Activity in Individuals with Type 2 Diabetes

American College of Sports Medicine

Publication Date: Jan 24, 2022

Page Last Updated: May 5, 2026

Recommended types of exercise training for all adults with T2D

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.

PA precautions for common comorbid health complications

Health Complication	Precaution
Autonomic neuropathy	• Be aware of an increased likelihood of hypoglycemia, abnormal blood pressure responses, and impaired thermoregulation, as well as elevated resting and blunted maximal heart rate.
	• Use of ratings of perceived exertion (RPE) is suggested to monitor exercise intensity.
	• Take steps to prevent dehydration and hyperthermia or hypothermia.
Peripheral neuropathy	• Limit exercise participation that may cause foot trauma, such as prolonged hiking, jogging, or walking on uneven surfaces.
	• Non–weight-bearing exercises (e.g., cycling, chair exercises, swimming) may be more appropriate, but avoid aquatic exercise with unhealed plantar surface ulcers.
	• Check feet daily for signs of trauma and redness.
	• Choose shoes and socks carefully for proper fit and wear socks that keep feet dry.
	• Avoid activities requiring excessive balance ability.
Diabetic retinopathy	• With unstable proliferative and severe retinopathy, avoid vigorous, high-intensity activities that involve breath holding (e.g., weight lifting and isometrics) or overhead lifting.
	• Avoid activities that lower the head (e.g., yoga, gymnastics) or that jar the head.
	• In the absence of a stress test measured maximal heart rate, use RPE to monitor exercise intensity (10 to 12 on a 6–20 scale).
	• Exercise is contraindicated for anyone with unstable or untreated proliferative retinopathy, recent panretinal photocoagulation, or other recent surgical eye treatment.
	• Consult an ophthalmologist for specific restrictions and limitations.
Diabetic kidney disease	• Avoid exercise that causes excessive increases in blood pressure (e.g., weight lifting, high-intensity aerobic exercise) and refrain from breath holding during activities.
	• High blood pressure is common, and lower-intensity exercise may be necessary to manage blood pressure responses and fatigue.
	• Light to moderate exercise is possible during dialysis treatments if electrolytes are managed.
Hypertension	• Avoid heavy weight lifting or breath holding.
	• Perform dynamic exercises using large muscle groups, such as walking and cycling at a low to moderate intensity.
	• Follow blood pressure guidelines for activity levels.
	• In the absence of a measured maximal heart rate, use of RPE is recommended (10 to 12 on a 6–20 scale).

Document Overview

Document Title: Exercise and Physical Activity in Individuals with Type 2 Diabetes

Authoring Society: American College of Sports Medicine

Document Publication Date: Jan 24, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/acsm-msse/fulltext/2022/02000/exercise_physical_activity_in_individuals_with.18.aspx

Source Citation: Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, Kirwan JP, Zierath JR. Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Med Sci Sports Exerc. 2022 Feb 1;54(2):353-368. doi: 10.1249/MSS.0000000000002800. PMID: 35029593.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The objective of this consensus statement is to provide readers with a summary of the current evidence and extend and update the prior recommendations from 2010. The writing group used a consensus approach to synthesize available evidence from clinical trials and case reports, narrative and systematic reviews, and meta-analyses, and the recommendations represent the consensus of the writing panel and ACSM and incorporate guidance from other professional organizations with expertise in this area, such as the ADA.

Scope: Counseling, Management

Diseases/Conditions (MeSH)

D003924 - Diabetes Mellitus, Type 2

D010809 - Physical Fitness

D015444 - Exercise

D003924 - Diabetes Mellitus, Type 2

D010809 - Physical Fitness

D015444 - Exercise

Keywords: Type 2 Diabetes , diabetes, exercise, nutrition, physical activity, type 2 diabetes mellitus

Target Patient Population: Children and adults with type 2 diabetes

Target Provider Population: All providers and caregivers who care for individuals with type 2 diabetes, and those individuals themselves

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory, Childcare Center, Long Term Care, School

Intended Users: Athletics/Coaching, Nurse, Nurse Practitioner, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 236

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: No

Grades quality of strength of recommendation?: No

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No