ACSM consensus statement on physical activity in patients with type 2 diabetes
USA: A recent study published in the journal Medicine & Science in Sports & Exercise, reports a consensus statement from the American College of Sports Medicine on exercise/physical activity in individuals with type 2 diabetes.
The consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The updated version has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed.
Following are the consensus statements and recommendations:
- Regular aerobic exercise training improves glycemic management in adults with type 2 diabetes, with less daily time in hyperglycemia and 0.5%–0.7% reductions in overall glycemia (as measured by A1C).
- High-intensity resistance exercise training has greater beneficial effects than low-to-moderate-intensity resistance training in terms of overall glucose management and attenuation of insulin levels.
- Greater energy expenditure postprandially reduces glucose levels regardless of exercise intensity or type, and durations ≥45 min provide the most consistent benefits.
- Small "doses" of PA throughout the day to break up sitting modestly attenuate postprandial glucose and insulin levels, particularly in individuals with insulin resistance and a higher body mass index.
- Weight loss (accomplished through lifestyle changes in diet and PA) of >5% seems to be necessary for beneficial effects on A1C, blood lipids, and blood pressure.
- For reductions in visceral fat in individuals with type 2 diabetes, a moderately high volume of exercise (~500 kcal) done 4–5 d·wk1 is needed.
- In youth with type 2 diabetes, intensive lifestyle interventions plus metformin have not been superior to metformin alone in managing glycemia.
- Despite the limited data, it is still recommended that youth and adolescents with type 2 diabetes meet the same PA goals set for youth in the general population.
- Pregnant women with and without diabetes should participate in at least 20–30 min of moderate-intensity exercise most days of the week.
- Individuals with type 2 diabetes using insulin or insulin secretagogues are advised to supplement with carbohydrate (or reduce insulin, if possible) as needed to prevent hypoglycemia during and after exercise.
- Participation in an exercise program before bariatric surgery may enhance surgical outcomes, and after surgery, participation confers additional benefits.
To conclude, various physical activity types, conclusive of but not limited to planned exercise, can greatly enhance the health and glycemic management of patients of all ages with T2D, including balance and exercise in adults. These guidelines are applicable to most people with diabetes, including youth, with a few exceptions and modifications.
"All individuals should engage in regular PA, reduce sedentary time, and break up sitting time with frequent activity breaks," wrote the authors. "
PA undertaken with health complications can be made safe and efficacious, and exercise training undertaken before and after bariatric surgery is warranted and may enhance its health benefits. Finally, barriers to, and inequities in, PA and exercise adoption and maintenance need to be addressed to maximize participation."
Reference:
KANALEY, JILL A.1; COLBERG, SHERI R.2; CORCORAN, MATTHEW H.3; MALIN, STEVEN K.4; RODRIGUEZ, NANCY R.5; CRESPO, CARLOS J.6; KIRWAN, JOHN P.7; ZIERATH, JULEEN R.8 Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine, Medicine & Science in Sports & Exercise: February 2022 - Volume 54 - Issue 2 - p 353-368 doi: 10.1249/MSS.0000000000002800
