Type 2 Diabetes and Physical Activity
Being regularly active is quite possibly the most important factor for health in people who have diabetes. 1People with poorly controlled diabetes have three to four times’ higher risk of cardiovascular disease, such as heart disease or stroke, than those who do not. 2 Regular physical activity not only improves the body’s ability to control blood sugar but it has a strong positive effect on the ‘risk factors’, such as high blood pressure, obesity and high cholesterol, for cardiovascular disease.
Working muscles, compared to resting ones, use more sugar which then leads to lower sugar in the blood. Doing both aerobic activity (which is any sustained movement that makes your heart and lungs work harder) and muscle strengthening exercise improves blood glucose control more than doing either type alone. 3
Your doctor may prescribe you medications for diabetes but it should be used in addition, not as a replacement, to physical activity and a balanced diet.
Regular physical activity also gives you more energy, builds confidence and can help you to sleep more soundly at night. You can combine your activity time with family and friends or use it as an opportunity to reflect on things and listen to your favourite music.
Physical Activity Recommendations for inactive adults with Type 2 DiabetesAim to do the following three types of activity:
- Aerobic activity at relative moderate intensity for at least 150 minutes (2 hours and 30 minutes) a week – one way to approach this is to do 30 minutes on at least five days each week.
- Muscle strengthening activity on two or more days a week which work all major muscles groups (legs, hips, back, abdomen, chest, shoulder and arms)
- Flexibility exercises on a daily basis
The Three Types of Activity and Type 2 Diabetes
You may find the following weekly approach useful if you have been inactive for a while.
Aerobic activity, also known as endurance activity, is when large muscle movements, maintained over a period of time, make the heart and lungs work harder.
Activity? – Any type that you can maintain comfortably is ideal. Choose exercises that you enjoy, such as walking, cycling or group fitness classes. Make sure you use appropriate footwear with supportive midsoles and socks to avoid blisters. Starting off with walking, static cycling or swimming will avoid too much joint overload if you are overweight and have joint pain.
How long (duration)? – One approach to meet the recommendations is to do at least 30 minutes per day. You can split your sessions to a minimum of 10 minutes to reach your total. If you have been inactive for a long time, start with short sessions and increase the time as your body allows and you feel more confident. Remember not to sit for hours. A regular break from sitting every hour is healthy.
How hard (intensity)? – Try to progress gradually over time to a relatively moderate-intensity activity. Doing moderate intensity activity means that you feel warm, mildly out of breath and mildly sweaty. The ‘talk test’ is a simple way to measure moderate intensity. Whilst you are working, you can still talk, but not sing, during the activity.
How often (frequency)? – if you aim to do 30 minutes per day then do this at least 5 times per week so that you can reach a total of 150 mins a week. Distribute sessions over the week and aim to have no more than 2 consecutive days without physical activity. When you start any new activity make sure you give your body enough time to recover and adapt between sessions
Simple strength training on at least 2 days a week is important in type 2 diabetes. It helps to control blood sugar and improves the action of the body’s own insulin. Stronger, larger muscles use up more calories for energy so it can help maintain your body fat. Some activities, such as climbing stairs, digging the garden or walking up hill, combine aerobic and muscle strengthening types.
These activities should work all the major muscle groups in your body such as legs, hips, back, chest, abdomen, shoulders and arms. When strengthening a muscle group, begin by familiarising the movement with little or no load.
If you are using weights such as dumbbells, try to do at least 1 set of 8-12 repetitions per activity. The correct weight choice is the one which is hard to complete by the end of the set. A repetition is one complete movement of an activity, like doing a sit up or bicep curl.
Daily flexibility exercises can prevent pain, stiffness, and injury of muscles and joints. People often experience a sense of wellbeing and relaxation during flexibility exercises. Some quick and simple movements can be found in our separate exercise sheet. Yoga, Tai Chi and Pilates are examples of some activities which combine strength and flexibility as well as balance training.
- If you have led a very sedentary lifestyle, begin by doing low intensity exercise of short duration, e.g. 10 minutes. Increase your level of activity gradually to avoid injury.
- Stop exercising if you feel dizzy, sick, unwell or very tired.
- See a doctor if you are having chest pain, black outs or breathlessness on mild exertion.
The following specific precautions are designed to help you avoid problems when exercising:
- Hypoglycaemia (low blood sugar)
Hypoglycaemia usually occurs as a result of an excess of either insulin or sulphonylurea medications (e.g. Glicazide, Glimepiride) combined with reduced sugar intake or increase activity. The following advice can help you avoid such problems:
- Learn how your body responds to different types of exercise by monitoring blood sugar levels before and after activity (and every 60 minutes during if exercising for extended periods).
- Take a carbohydrate snack (e.g. fresh fruit, crackers, yoghurt) before beginning exercise if your blood sugar is less than 5.5mmol/l.
- If your level is above 5.5mmol/l before light exercise, a snack may not be necessary but check your blood level following the exercise to see if it dips below 4mmol/l
- An additional carbohydrate (e.g. fruit, carbohydrate drink) is suggested every 30-60 minutes for prolonged and intense exercise.
- Always carry fast-acting carbohydrate food such as glucose tablets which can be used to treat low sugars if needed.
- If you have been active before bedtime, have a snack to prevent night time ‘hypos’ and check glucose levels on waking.
- Avoid exercising alone and going into remote areas.
- Always wear a diabetes identification bracelet. Let others know that you are going out exercising and what time you expect to return.
- Try to avoid injecting insulin into exercising limbs as this can increase the risk of hypoglycaemia. The abdomen or an alternative injection site is advised.
- Hyperglycaemia (high blood sugar)
Good glucose control can be achieved with regular moderate activity but strenuous activity should be delayed if your blood glucose concentration levels are above 16.7mmol/l without ketones or 13.3 mmol/l with ketones detected in the urine. Moderate activities should be postponed if you feel dehydrated or generally unwell with a high temperature. If in any doubt, postpone exercise.
- Retinopathy (damage to the retina at the back of the eye)
Exercising is safe but you should discuss management options with your doctor if you develop advanced proliferative retinopathy (formation of new blood vessels in the back of the eye seen at screening).
- Peripheral Neuropathy (signs of damage to some of the nerves in the feet)
Good foot care should be practiced by wearing well fitted shoes and cotton socks, and inspecting feet every time after exercise. Keep feet dry. Walking is generally very safe in patients with nerve damage but you may find arm exercises, swimming or cycling more suitable alternatives if your balance is poor.
Please see the following safety considerations if you have other long term health conditions.
- Angina (Coronary Heart Disease)
- Previous Myocardial Infarction (Heart Attack)
- Cardiovascular Risk
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease (COPD)
- Type 2 Diabetes
- Rheumatoid Arthritis
DisclaimerThis leaflet has been provided for information only. ALWAYS check with your doctor if you have any concerns about your condition or treatment. Prescription4exercise.com is not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this information.
- Start Active, Stay Active – a report on physical activity for health from the four home countries ‘ Chief Medical Officers. UK Department of Health, July 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209
- ACSM’s Guidelines for Exercise Testing and Prescription, American College of Sports Medicine, 2009
- Swedish National Institute of Public Health. Physical Activity in the Prevention and Treatment of Disease. Professional Associations for Physical Activity, Sweden, 2010. Diabetes Mellitus. P345-355. www.fyss.se
- Church TS et al. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med 2005, 165:2114-20 ↩
- Sigal RJ et al. Effects of aerobic training, resistance training, or both on glycaemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007;147:357-69 ↩
- Exercise and Type 2 Diabetes. ACSM and ADA Joint position statement. Medicine and Science in Sports and Exercise 2010; 42 (12): 2282-2303 ↩