How Much Should You Exercise with Type 2 Diabetes?

Get Enough Exercise for Blood Sugar Control

Walking on Boardwalk
Walking on Boardwalk. Daniel Allan/Creative RF/Getty Images

Physical exercise is good medicine for people with Type 2 diabetes, and for those who want to prevent developing it, according to the position paper issued jointly by the American College of Sports Medicine and the American Diabetes Association. The recommended level of exercise is 150 minutes per week, or two and a half hours total, of moderate to vigorous physical activity.

"Participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes, along with positively impacting lipids, blood pressure, cardiovascular events, mortality, and quality of life," says the extract published in Diabetes Care.

  The full position paper supports each of those claims with links to medical studies.

  • Keep it Regular: Aerobic exercise, such as brisk walking, should be done at least 3 times a week, with no more than 2 days between bouts of exercise. The improvements to blood insulin levels need regular exercise, not "weekend warrior" bouts done only once a week.
  • Exercise Intensity: A little heavy breathing is good for the insulin levels. The paper recommends moderate to vigorous exercise of at least 40-60% of maximum. What does that mean for you? Use our target heart rate calculator. Most people can achieve this level with brisk walking. For those who like more intense exercise, the paper says that is even better.
    What Exercises are Moderate Intensity?
    What Exercises are Vigorous Intensity?
  • How Long to Exercise at One Time? Exercise should be for at least 10 minutes at a time.  Most recommendations are for either 30 minutes at a time, 5 days a week of moderate intensity exercise such as brisk walking, or for vigorous intensity exercise such as running for 20 minutes at a time at least 3 days a week. More: 30-Minute Walking Workout for Diabetes
  • What Kind of Exercise? The paper recommends any kind of exercise that activates the large muscle groups, including brisk walking. They also point to a variety of exercise being beneficial. A meta-study of previous studies of over 8000 subjects found that 150 minutes of exercise a week helped control diabetes, reducing hemoglobin A1c levels, when used in addition to dietary measures. The researchers found that moderately intense aerobic exercise, such as brisk walking was slightly more effective than structured resistance training or a combination of both. In the final analysis, each lowered HbA1c levels by -.67 percent. No running is required: high intensity exercise showed no greater results than moderate intensity exercise. Getting more than 150 minutes a week of moderate intensity exercise saw greater improvements, while getting less than the recommended amount saw less improvement.
    More: Walking Shape-Up Plan
  • Use a Pedometer to Increase Daily Activity: The paper pointed out the benefits of setting a daily step goal of 10,000 steps as a marker of increasing lifestyle activity. People with Type 2 Diabetes generally sit 2.5 hours a day more than lean people and put in 3.5 miles fewer lifestyle steps. Most of the extra steps that lean people took were in short walks of under five minutes, and at a low speed. Using a pedometer with a daily step goal has been shown to work well to increase daily activity.
  • Exercise is Safe for Most Persons with Type 2 Diabetes: It you aren't using insulin or insulin secretagogues, you  are unlikely to experience hypoglycemia related to physical activity. If you are on those medications, you should take in carbohydrates as needed while exercising and after exercise.
  • Walking still recommended even with peripheral neuropathy: Walking doesn't increase the risk of foot ulcers or repeat ulceration in peripheral neuropathy. Foot care and daily checking of your feet are important, as well as selecting the right shoes.

Walk 30 Minutes Per Day to Live Longer

Walking two hours or more a week reduces the death rate in people with diabetes. A CDC study  followed 3000 people with diabetes for over ten years.

They found death rates from all causes lowered by 39% and death rates from cardiac events lowered by 34% in those who walked at least 2 hours per week. Death rates were lowest in those who walked 3-4 hours per week. If you have diabetes - get out there and walk at least 30 minutes per day.
More: 30 Minute Lunch Time Walk

Take a 15-Minute Walk After Meals

Don't sit after that meal! A small study showed that taking short 15-minute walks after each meal helped seniors control their blood sugar. The worst thing to do was to eat an evening meal and settle onto the couch. A post-meal stroll helped prevent blood sugar spikes that may lead to diabetes.

Sources:
Sheri R. Colberg, PHD, FACSM, et al. SPECIAL COMMUNICATIONS: Joint Position Statement. Medicine & Science in Sports & Exercise. December 2010 - Volume 42 - Issue 12 - pp 2282-2303 doi: 10.1249/MSS.0b013e3181eeb61c

Daniel Umpierre, 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]1790-1799.

Study abstract: Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes, "Annals of Internal Medicine."

Edward W. Gregg, PhD; Robert B. Gerzoff, MS; Carl J. Caspersen, PhD; David F. Williamson, PhD; K. M. Venkat Narayan, MD. "Relationship of Walking to Mortality Among US Adults With Diabetes." JAMA Internal Medicine June 23, 2003, Vol 163, No. 12.

Loretta DiPietro, Andrei Gribok, Michelle S. Stevens, Larry F. Hamm, and William Rumpler; "Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose Tolerance"; Diabetes Care, published ahead of print 11 June 2013; DOI: 10.2337/dc13-0084.

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