Best Exercises for People with Diabetes: Benefits, Challenges, and Strategies
Discover the best exercises for people with diabetes. Learn about the benefits of physical activity, common challenges, and practical strategies to overcome them. Improve your blood sugar control, reduce the risk of complications, and enhance your overall well-being.
DR T S DIDWAL MD(Internal Medicine)
10/27/202410 min read
According to a review in American journal of medicine Open, exercise is a cornerstone of diabetes management, offering numerous benefits for both prevention and control. It improves insulin sensitivity, reduces cardiovascular risk, enhances fitness, and improves mental health. While exercise is crucial, people with diabetes often face barriers such as reduced exercise capacity, hypoglycemia risk, and psychological challenges. To overcome these obstacles, starting small and building gradually, managing hypoglycemia risk, choosing appropriate exercise types, prioritizing safety, and addressing women's unique needs are essential. Technology plays a significant role in supporting exercise efforts. Making exercise sustainable involves finding enjoyable activities, setting realistic goals, creating support systems, and planning for obstacles. Research continues to advance our understanding of exercise and diabetes, leading to personalized exercise prescriptions and innovative technologies. By addressing challenges and utilizing available resources, people with diabetes can incorporate exercise into their lives, improving their overall health and well-being.
Key Points
Exercise and Diabetes: Exercise is a powerful tool for both preventing and managing diabetes. It improves insulin sensitivity, reduces cardiovascular risk, enhances fitness, and improves mental health.
Barriers to Exercise: People with diabetes often face barriers such as reduced exercise capacity, hypoglycemia risk, and psychological challenges.
Overcoming Barriers: To overcome these obstacles, start small and build gradually, manage hypoglycemia risk, choose appropriate exercise types, prioritize safety, and address women's unique needs.
Technology and Exercise: Technology plays a significant role in supporting exercise efforts, including activity trackers, continuous glucose monitoring systems, and exercise apps.
Making Exercise Sustainable: To make exercise sustainable, find enjoyable activities, set realistic goals, create support systems, and plan for obstacles.
Future of Exercise and Diabetes: Research continues to advance our understanding of exercise and diabetes, leading to personalized exercise prescriptions and innovative technologies.
Conclusion: By addressing challenges and utilizing available resources, people with diabetes can incorporate exercise into their lives, improving their overall health and well-being.
Exercise and Diabetes: Breaking Down Barriers and Maximizing Benefits
Exercise is often called a cornerstone of diabetes management, alongside proper nutrition. But for many people living with diabetes, maintaining a consistent exercise routine can feel like climbing a mountain. In this comprehensive guide, we'll explore why exercise is so crucial for diabetes management, the challenges that often get in the way, and practical strategies for overcoming them.
The Power of Exercise in Diabetes Prevention and Management
The relationship between exercise and diabetes is compelling. Research shows that regular physical activity can reduce the risk of developing type 2 diabetes by up to 42%. Even more impressive, this benefit follows a dose-response relationship – meaning that even small increases in physical activity can lead to significant reductions in diabetes risk.
For those who already have diabetes, exercise offers multiple benefits:
Improved insulin sensitivity
Better blood glucose control
Reduced cardiovascular risk
Enhanced overall fitness
Lower blood pressure
Better lipid profiles
Reduced inflammation
Improved mental health
These benefits aren't just short-term. Studies have shown that meeting physical activity guidelines is associated with a remarkable 40% decrease in cardiovascular mortality, with an even greater impact on all-cause mortality. This is particularly significant since people with diabetes have a two to six-fold increase in risk for cardiovascular disease.
Current Exercise Guidelines
The American Diabetes Association recommends that adults with diabetes should:
Perform at least 150 minutes of moderate-to-vigorous aerobic activity per week
Spread this activity over at least three days to avoid consecutive inactive days
Include two to three sessions of resistance exercise on non-consecutive days
Understanding Exercise Intensity
To put exercise intensity in perspective, here's what different activities look like in terms of metabolic equivalents (METs):
Slow walking (3 km/h): 3 METs
Walking up stairs: 4.7 METs
Brisk walking (6 km/h): 5.4 METs
Bicycling (20 km/h): 7.1 METs
Running (8 km/h): 8.2 METs
Hockey: 12.9 METs
Boxing: 13.4 METs
One MET represents the energy expended while sitting at rest. Higher MET values indicate more intense activities.
Aerobic compared with resistance exercise for Diabetes
Aerobic Exercise and Glycemic Control: Aerobic exercise, like walking, running, or cycling, is a cornerstone of diabetes management. It improves insulin sensitivity, reducing the body's need for insulin to utilize glucose. Regular aerobic activity can lower blood sugar levels, especially in the fasting state.
Resistance Training and Glycemic Control: Resistance training, such as weightlifting or using resistance bands, builds muscle mass and improves insulin sensitivity, particularly in the post-meal state. This can help regulate blood sugar spikes after eating.
Combined Approach: Concurrent Training: A combination of aerobic and resistance training, known as concurrent training, offers the most significant benefits for glycemic control. It enhances both insulin sensitivity and muscle mass, leading to improved blood sugar management.
Mechanisms of Action: Exercise exerts its beneficial effects on glycemic control through various mechanisms, including:
Increased insulin sensitivity in muscles
Improved glucose uptake by muscles
Potential positive effects on pancreatic function
Reduced inflammation
Practical Implications: To optimize glycemic control, individuals with diabetes should aim for at least 150 minutes of moderate-intensity aerobic activity and strength training exercises two to three times per week. It's essential to consult with a healthcare provider to develop a personalized exercise plan that suits individual needs and health conditions.
High-intensity interval training for glycemic control
Consists of alternating 10 seconds to 4 minutes of high-intensity exercise (75-95% HRmax) with 12 seconds to 5 minutes of recovery periods
Provides similar or greater benefits to glycemic control compared to continuous exercise while requiring less total time
Studies show it can decrease average 24-hour blood glucose readings, improve mitochondrial capacity, and reduce HbA1c levels
A Good option for time-constrained individuals, though proper medical clearance is needed for vigorous exercise
Exercise timing relative to daytime and meals
Some research suggests afternoon/evening exercise may be more beneficial for glucose control and insulin sensitivity compared to morning exercise
However, morning exercise appears better for weight management and activity adherence
Post-meal exercise ("exercise desserts") shows particular benefit in reducing postprandial glucose spikes
The most practical approach is to exercise whenever it fits consistently in one's schedule, as regular activity is more important than timing
Breaking Up Sedentary Activity:
Extended sitting (≥8 hours/day) is associated with increased risk of cardiovascular mortality and Type 2 diabetes
Simple interventions like 3 minutes of light walking or basic resistance exercises (half-squats, calf raises) every 30 minutes can reduce postprandial glucose by about 14 mmol/h/L
Replacing sitting time with standing (2.5 hours/day) and light walking (2.2 hours/day) can improve 24-hour glucose levels and insulin sensitivity
Even basic household activities and "exercise snacks" (brief, vigorous activities) can provide benefits when performed regularly throughout the day
Exercise cardiometabolic benefit beyond weight loss
Beyond Weight Loss: While weight loss is often associated with exercise, it's important to recognize that exercise offers numerous health benefits beyond weight reduction. These benefits include improved body composition, reduced inflammation, enhanced mental health, and improved cardiovascular health.
Body Composition and Exercise: Exercise can help maintain or increase muscle mass while reducing body fat, particularly visceral fat. This shift in body composition is associated with improved insulin sensitivity and reduced risk of chronic diseases.
Inflammation and Exercise: Exercise can reduce systemic inflammation, a key contributor to insulin resistance and chronic diseases. By decreasing pro-inflammatory markers and increasing anti-inflammatory factors, exercise can improve overall health.
Liver Health and Exercise: Exercise can improve liver health by reducing liver fat accumulation and improving liver function. This is particularly important for individuals with non-alcoholic fatty liver disease (NAFLD), a common condition associated with obesity and type 2 diabetes.
Mental Health and Exercise: Exercise has positive effects on mental health, including reduced symptoms of depression and anxiety, improved mood, and enhanced cognitive function. Regular physical activity can help individuals with type 2 diabetes manage stress and improve their overall quality of life.
Cardiovascular Health and Exercise: Exercise is a powerful tool for improving cardiovascular health. It can lower blood pressure, reduce cholesterol levels, and decrease the risk of heart disease and stroke. Regular physical activity is essential for maintaining a healthy heart, especially for individuals with type 2 diabetes who are at increased risk of cardiovascular complications.
The Reality Check: Exercise Barriers in Diabetes
Despite the clear benefits, the statistics show a challenging reality. About 34.3% of Americans with diabetes are physically inactive (defined as less than 10 minutes of moderate or vigorous activity per week), and only 23.8% meet the recommended 150 minutes of weekly physical activity.
Physical Barriers
People with diabetes face unique physical challenges when it comes to exercise:
1. Reduced Exercise Capacity
Lower cardiorespiratory fitness levels, even in uncomplicated diabetes
Increased perceived exertion during exercise
Impaired muscle oxygen utilization
Reduced mitochondrial function
2. Cardiovascular Considerations
Higher pulmonary capillary wedge pressure during exercise
Potential subclinical diastolic dysfunction
Increased cardiovascular risk during acute exercise
3. Diabetes Complications
Retinopathy affecting vision
Neuropathy affecting balance
Foot problems requiring special attention
Kidney disease potentially causing anemia
The Hypoglycemia Challenge
For people taking insulin or certain diabetes medications, exercise-induced hypoglycemia is a significant concern. Different types of exercise affect blood glucose differently:
Moderate aerobic exercise typically causes a gradual decline in blood glucose
Vigorous or resistance exercise may temporarily increase blood glucose
Effects can last up to 48 hours after exercise
Evening exercise can increase the risk of nocturnal hypoglycemia
Psychological and Social Barriers
The challenges aren't just physical:
Depression and diabetes distress
Reduced self-efficacy
Socioeconomic constraints
Safety concerns in certain neighborhoods
Limited access to exercise facilities
Time constraints
Breaking Through: Strategies for Success
1. Start Small and Build Gradually
Rather than jumping into an intensive exercise program, begin with manageable activities:
Short walks after meals
Simple resistance exercises at home
Gentle stretching routines
Building up duration and intensity over time
2. Managing Hypoglycemia Risk
For those on insulin or sulfonylureas:
Monitor blood glucose before, during, and after exercise
Reduce pre-exercise meal insulin by 30-50% for planned exercise
Consider consuming 30-60g of high-glycemic carbohydrates per hour of activity
For evening exercise, reduce nighttime insulin doses
Use continuous glucose monitoring when available
3. Safety Considerations
Consult healthcare providers before starting new exercise programs
Perform proper foot care and wear appropriate footwear
Start slowly and progress gradually
Listen to your body and watch for warning signs
Exercise with a partner when possible
Special Considerations for Women with Diabetes
Women face unique challenges when it comes to exercise and diabetes:
Lower overall physical activity levels across age groups
More pronounced exercise impairment in cardiorespiratory fitness
Additional barriers including safety concerns and access issues
greater impact of diabetes on cardiovascular risk
Strategies for women should include:
Finding activities that feel comfortable and enjoyable
Addressing safety concerns through group exercise or gym memberships
Building confidence through proper instruction and support
Creating sustainable routines that fit into daily life
The Role of Technology
Modern technology can help support exercise efforts:
Activity trackers and smartwatches
Continuous glucose monitoring systems
Hybrid closed-loop insulin delivery systems
Exercise apps and online communities
Virtual fitness classes and coaching
Making Exercise Sustainable
The key to long-term success with exercise is making it sustainable:
1. Find Activities You Enjoy
Try different types of exercise
Join group classes or sports teams
Experiment with both indoor and outdoor activities
Consider social aspects of exercise
2. Set Realistic Goals
Start with achievable targets
Focus on consistency over intensity
Track progress to stay motivated
Celebrate small wins
3. Create Support Systems
Join diabetes exercise groups
Work with diabetes educators
Find exercise buddies
Share goals with family and friends
Conclusion
Exercise remains a powerful tool in diabetes prevention and management, but it's important to acknowledge and address the real challenges that people with diabetes face. Success comes from finding the right balance of activities, proper precautions, and sustainable routines that work for each individual.
Remember that any movement is better than none, and small steps can lead to significant improvements in health outcomes. Work with healthcare providers to develop an appropriate exercise plan, and don't hesitate to adjust strategies as needed. With proper planning, support, and persistence, regular exercise can become an achievable and rewarding part of diabetes management.
FAQs about Exercise and Diabetes
1. Is exercise safe for people with diabetes?
Yes, exercise is generally safe for people with diabetes. However, it's essential to consult with your healthcare provider before starting a new exercise routine, especially if you have any diabetes-related complications.
2. How often should I exercise?
The American Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic activity per week, spread over at least three days.
3. What types of exercise are best for people with diabetes?
Both aerobic and resistance training are beneficial. Aerobic exercises like walking, swimming, and cycling improve cardiovascular health, while resistance training helps build muscle mass.
4. How can I manage hypoglycemia during exercise?
To manage hypoglycemia during exercise, monitor your blood glucose levels before, during, and after exercise. Adjust your insulin dose or carbohydrate intake as needed. It's also important to carry glucose tablets or a sugary drink with you during exercise.
5. Can exercise help prevent diabetes?
Yes, regular physical activity can significantly reduce the risk of developing type 2 diabetes, especially when combined with a healthy diet.
6. How can I stay motivated to exercise?
To stay motivated, find activities you enjoy, set realistic goals, and track your progress. Consider joining a fitness class or exercising with a friend or family member.
7. What if I have diabetes complications?
If you have diabetes complications like neuropathy or retinopathy, consult with your healthcare provider to determine safe and appropriate exercises. They can provide specific recommendations to minimize the risk of injury.
Related Article
Diabetes Prevention: Multiple Metabolic Factors Fuel Diabetes
Journal References
Zahalka SJ, Abushamat LA, Scalzo RL, et al. The Role of Exercise in Diabetes. [Updated 2023 Jan 6]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549946/
Susana R. Patton, Michael C. Riddell; Current Trends and Strategies for Exercise in Diabetes. Diabetes Spectr 1 May 2023; 36 (2): 100–103. https://doi.org/10.2337/dsi22-0019
Syeda, U. S. A., Battillo, D., Visaria, A., & Malin, S. K. (2023). The importance of exercise for glycemic control in type 2 diabetes. American journal of medicine open, 9, 100031. https://doi.org/10.1016/j.ajmo.2023.100031
Disclaimer
The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
About the Author:
Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.
With a commitment to improving patient outcomes, Dr. Didwal integrates the latest medical advancements with a compassionate approach. He believes in empowering patients to take control of their health and make informed decisions that support long-term wellness.