Exercise Guidelines for People with Diabetes and Prediabetes

It’s not unusual news that being active helps manage diabetes and prevent type 2 diabetes. Yet the majority of Americans are simply not active. Even in light of the fact that the third leading cause of preventable death is inactivity! It follows smoking, the number one leading preventable cause of death, and obesity, the second leading preventable cause of death.

The American Diabetes Association (ADA) is dedicated to help people with diabetes and pre-diabetes. Last year, the ADA and American College of Sports Medicine issued a joint position statement addressing exercise guidelines for people with diabetes and prediabetes.

New to the lineup of recommendations is the guideline to break up prolonged sedentary activities with 3 minutes of light activity every 30 minutes. So if you have a desk job or are settling in for an evening of TV binge watching, get up every half hour for 3 minutes to walk  around, stretch, do toe raises, push ups on the floor or against the wall or any activity that interests you. Why? Studies show that people have better blood sugar management don’t sit so much!

All adults, and particularly people with type 2 diabetes, should decrease the amount of time spent in daily sedentary activity, such as desk work, and watching television. In addition to light activity every 30-minutes to minimize sedentary behavior, the ADA has set guidelines on structured exercise, encouraging aerobic endurance, muscle strength, balance, and flexibility exercises. The position paper also outlines precautions for people with various health conditions and provides guidance for pre-exercise carbohydrate consumption for people with type 1 diabetes and others who are at risk for low blood sugar during or after exercise. These precautions should be reviewed with either your doctor, endocrinologist, or Registered Dietitian.

The following provides a few general recommendations for adults to include structured exercise:

  • Aim to exercise daily for a total of at least 150 minutes per week of moderate to vigorous intensity exercise. To enhance insulin action, do not allow more than two days between exercise sessions.
  • Most people benefit from both aerobic and strength training exercises. Ideally, adults with diabetes should engage in two to three sessions of resistance training weekly on non-consecutive days.
  • Adults should also engage in flexibility and balance training two to three times per week. Balance training can be used during a warm-up, while flexibility training can be used as part of your cool down.
  • Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental (activities for daily living) physical activities to gain additional health benefits. Daily incidental activities include for example gardening, climbing stairs, making your bed, doing laundry or other household chores.
  • Supervised exercise programs generally lead to greater health benefits. So, consult with a fitness expert.
  • Pregnant women with diabetes should exercise regularly. Ideally, the best time to start physical activity is prior to pregnancy to reduce gestational diabetes mellitus risk, but it is safe to initiate during pregnancy with very few contraindications. If you have gestational diabetes or are at risk for it, aim to exercise at a moderate intensity for 20 – 30 minutes daily. Pregnant women using insulin should be aware of the insulin-sensitizing effects of exercise and increased risk of hypoglycemia, particularly during the first trimester.

To minimize exercise-related adverse events in people with diabetes, the ADA recommends talking with your health care specialist to change your insulin regimen and carbohydrate intake to prevent exercise-related hypoglycemia. Other strategies include the following:

  • Include short sprints or resistance exercise before aerobic exercise when in the same training session. Also, include activity timing.
  • Reduce risk of nocturnal hypoglycemia following physical activity by adjusting basal insulin doses, inclusion of a bedtime snack, and/or use of continuous glucose monitoring.
  • Besides insulin, other medications could increase the risks of exercise-related hypoglycemia and their prescription may need to be adjusted based on your training and blood sugar levels.
  • Exercise-induced hyperglycemia is more common in type 1 diabetes but can be modulated with insulin and/or a low intensity aerobic cool down. Note: Exercising with hyperglycemia and elevated blood ketones is not recommended.

Physical activity and exercise should be used to manage glycemic control and overall health in all individuals, especially those with diabetes. Specific recommendations and precautions should be tailored depending on the type and treatment of diabetes, a person's age, exercise type and intensity, as well as any additional co-existing health complications.

It is important to be active to manage your blood sugar and weight, as well as your risk for heart disease and several types of cancers. Behavior-change strategies can be used to promote good nutrition and the adoption and maintenance of lifetime physical activity. To discuss precautions specific to your needs, and learn more about how to form new habits in order to live a healthier lifestyle, adopt an exercise program, and plan meals full of whole foods that heal, nurture, and maintain a healthy mind, body, and soul, contact me at B3yond Nutrition LLC 973.852.3335.

Source:

  • Sheri R. Colberg, Ronald J. Sigal, Jane E. Yardley, Michael C. Riddell, David W. Dunstan, Paddy C. Dempsey, Edward S. Horton, Kristin Castorino, Deborah F. Tate, Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes AssociationDiabetes Care Nov 2016, 39 (11) 2065-2079; DOI: 10.2337/dc16-1728

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