Best Exercises for People with Diabetes: Benefits, Challenges, and Strategies

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.