U.S. Department of Health and Human Services

Principle 5: Encourage Regular Physical Activity

For people with or at risk of diabetes, regular physical activity helps improve insulin sensitivity and glycemic control, positively affects lipids and blood pressure, assists with weight maintenance, and reduces the risk for cardiovascular disease (CVD). 1, 2 It also can improve psychological well-being, health-related quality of life, and depression in individuals with type 2 diabetes, among whom depression is more common than in the general population. 1 Muscle-strengthening activity can increase bone strength and muscular fitness and help maintain muscle mass during a program of weight loss. 1, 2

Physical activity (along with nutrition therapy) was a key component of the lifestyle interventions tested in the Diabetes Prevention Program (DPP) for prediabetes 3, 4 and in the Look AHEAD (Action for Health in Diabetes) study for type 2 diabetes. 5 These lifestyle interventions respectively achieved mean weight losses of 7 percent and 8 percent at 1 year and included 150 or 175 minutes per week of physical activity such as walking. 5 As detailed in Principle 4, the combination of increased physical activity and reduced caloric intake dramatically reduced development of diabetes in the DPP and improved fitness, quality of life, and mobility in Look AHEAD.

Encourage physical activity

​​

Adults with or at risk for diabetes, in consultation with their health care team and in the absence of contraindications, benefit from:

  • At least 150 minutes per week of moderate-intensity aerobic physical activity. Activity should be spread over at least 3 days per week, with no more than 2 consecutive days without exercise. Instead of 150 minutes, a person could substitute 75 minutes (1.25 hours) per week of vigorous aerobic exercise. 1, 2
    • Encourage adults who are unable to be active for 150 minutes per week to engage in regular physical activity according to their abilities. Inform them about the amounts and types of physical activity that are appropriate for their abilities.
    • Advise older adults with limited mobility about safe ways to be more active, such as chair exercises, exercise classes designed for seniors, or aquatic exercise.
  • Muscle-strengthening activity at least two to three times per week on nonconsecutive days, targeting all major muscle groups.

Although there is no specific ocular contraindication to moderate or intense physical activity for most people with diabetes or diabetic retinopathy, people with sight-threatening retinopathy should seek counsel from their eye care provider before initiating vigorous aerobic or muscle-strengthening exercises. 6 Mild to moderate nonproliferative diabetic retinopathy (NPDR) is not a contraindication to moderate or intense physical activity in the absence of diabetic macular edema.

People who engage in both aerobic and muscle-strengthening forms of exercise are likely to attain the greatest benefit. Adults with diabetes who exercise more than 150 minutes per week have even greater reductions in A1C than those who exercise less than 150 minutes per week. 7

Aerobic physical activity

​​

All types of aerobic activities are beneficial as long as they are of sufficient intensity and duration. Both moderate- and vigorous-intensity aerobic activity should be performed in episodes of at least 10 minutes.

As a rule of thumb, a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorous-intensity activity cannot say more than a few words without pausing for a breath.

Examples of different aerobic physical activities and intensities include:

Moderate intensity

  • Walking briskly (3 miles per hour or faster, but not race-walking)
  • Water aerobics
  • Bicycling slower than 10 miles per hour
  • Tennis (doubles)
  • Ballroom dancing
  • General gardening

Vigorous intensity

  • Race-walking, jogging, or running
  • Swimming laps
  • Tennis (singles)
  • Aerobic dancing
  • Bicycling 10 miles per hour or faster
  • Jumping rope
  • Heavy gardening (continuous digging or hoeing, with heart rate increases)
  • Hiking uphill or with a heavy backpack 1, 2

Muscle-strengthening activity

​​

Muscle-strengthening activities are beneficial if they work the major muscle groups of the body: the legs, hips, back, chest, abdomen, shoulders, and arms. Resistance training, including weight training, is a familiar example of muscle-strengthening activity. Other examples include working with resistance bands, doing calisthenics that use body weight for resistance (such as push-ups, pull-ups, and sit-ups), carrying heavy loads, and heavy gardening (such as digging or hoeing).

These activities should be done at least 2 days a week and performed to the point at which it would be difficult to do another repetition without help. When resistance training is used to enhance muscle strength, one set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more effective. Development of muscle strength and endurance is progressive over time. 1, 2

Goal setting

​​

Encourage people with or at risk for diabetes to set a modest initial physical activity goal. Physical activity should be increased gradually over time, regardless of the person’s current level of physical activity. Inactive people and those with low levels of physical activity should:

  • Generally start with relatively light- to moderate-intensity aerobic activity, such as 5 to 15 minutes of walking per session, two to three times a week.
  • First, gradually increase the number of minutes per session (duration) and the number of days per week (frequency) of moderate-intensity activity. Later, if desired, increase the intensity.
  • Consider the person’s age, level of fitness, and prior experience when individualizing the rate of increase.
  • Focus on developing self-efficacy and fostering social support from family, friends, and the health care team. 1, 2

Appropriate precautions

  • Evaluate people initially for contraindications and limitations to physical activity, and then, in consultation with them, develop an appropriate physical activity plan.
  • Gradual initiation of moderate-intensity activity is safe for most people with diabetes. Risk of CVD or injury should be assessed by their primary care provider before beginning a vigorous physical activity program.
  • Counsel people to pay special attention to blood glucose control and prevention of hypoglycemia when being active to help ensure that moderate-intensity activity is safe and beneficial. People taking medications that can cause hypoglycemia should be particularly cautious and test blood glucose before and after exercise to monitor for hypoglycemia.
  • Encourage use of the right gear and equipment, including proper footwear; choosing safe environments in which to be active; and making sensible choices about how, when, and where to be active. 1, 2

References

1. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33(12):2692–6.

2. U.S. Department of Health & Human Services. Physical Activity Guidelines for Americans. Rockville, MD: U.S. Department of Health and Human Services; 2008.

3. Diabetes Prevention Program Research Group. Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.

4. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

5. Rejeski WJ, Ip EH, Bertoni AG, et al. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366(13):1209–17.

6. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29(6):1433–8.

7. Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790–9.