Position statement advocates physical activity for patients with type 2 diabetes

The American College of Sports Medicine and the American Diabetes Association have issued a joint position statement encouraging patients with type 2 diabetes and those at high risk for developing the disease to exercise.

“Diet and [physical activity] are central to the management and prevention of type 2 diabetes because they help treat the associated glucose, lipid, [blood pressure] control abnormalities, as well as aid in weight loss and maintenance,” the position statement’s writing committee wrote.

The statement, published in Diabetes Care, developed from a desire to update previous recommendations generated by the American College of Sports Medicine (ACSM) alone.

“The ACSM had a position stand on this topic published in 2000, but it was seriously outdated and was not done jointly with the ADA,” writing group member Sheri R. Colberg, PhD, told Endocrine Today. “I suggested the idea of updating it to the ACSM in 2008 and then I approached the ADA about doing it jointly. It was not easy to coordinate, but I think it is the strongest, evidence-based position statement to date for both of these reasons.”

Duration, intensity of required physical activity

The position statement recommends that people with type 2 diabetes engage in at least 150 minutes of moderate-to-vigorous aerobic exercise per week spread out during at least 3 days, with no more than 2 days passing between periods of aerobic activity.

Colberg, who is also a professor of exercise science in the human movement sciences department at Old Dominion University in Norfolk, Va., noted that this recommendation differs from federal guidelines or those offered by the ACSM.

“The statement does not recommend a lesser duration of vigorous exercise because most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may also have orthopedic or other health limitations,” she said.

Because of these problems, the lower exercise volumes suggested in the statement are adequate to help patients achieve optimal CV risk reduction, according to Colberg. Lower volumes of exercise, however, may confer some benefits, including improved blood glucose management, but additional activity will likely lead to further advantages.

Importance of mixing modes of exercise

Resistance training should also not be overlooked. The statement recommends that people with type 2 diabetes engage in moderate-to-vigorous sessions at least 2 or 3 days per week.

“[The position statement] reiterates that recent studies have shown resistance training to be as important as, or perhaps even more important than, aerobic activity in diabetes management,” Colberg said. “In fact, combining aerobic and resistance training may bestow additional glycemic benefits.”

The writing group also noted that flexibility training, such as yoga and tai chi, may be particularly valuable for older people with type 2 diabetes who need to improve balance, but should not serve as a substitute for aerobic and resistance training.

Increasing daily movement is also beneficial.

“Based on the latest research, the position statement also encourages all individuals with type 2 diabetes or prediabetes to increase their total daily unstructured physical activity, such as gardening, housework and walking,” Colberg said.

Physicians’ roles

When it comes to prescribing exercise, many physicians are cautious about prescribing physical activity for patients with type 2 diabetes because of the comorbidities associated with the disease.

The majority of these patients, however, can engage in brisk walking without physician approval, according to Colberg. “Therefore, the position statement states that the presence of diabetes complications should not be used as an excuse to avoid participation in physical activity.”

Furthermore, the document offers robust data supporting this notion, she said. “The position statement gives a lot of evidence that regular activity can not only prevent or delay the onset of type 2 diabetes but also many of the complications associated with it.”

Dr. Colberg has no direct financial interest in any of the products mentioned in this article nor is she a paid consultant for any companies mentioned.

For more information:

• Colberg SR. Diabetes Care. 2010;33:e147-e167.

This is an interesting and very complete summary of the effects of exercise on glucose homeostasis and the role of exercise in treatment. Of some importance is the realization that formal CV testing is not required of all diabetic patients prior to beginning an exercise program, and rather that clinical judgement can be used in separating those who may (or do) have CVD, for whom supervised exercise is required, and others who should not be required to see a cardiologist, as this often becomes a barrier to this important self-care activity.

– Zachary T. Bloomgarden, MD
Endocrine Today Editorial Board Member

Dr. Bloomgarden has no direct financial interest in any of the products mentioned in this article nor is he a paid consultant for any companies mentioned.

This consensus statement is a helpful blend of opinions from the American College of Sports Medicine and the American Diabetes Association to address a critical area of diabetes care. It is important to increase awareness among all health care providers about the importance of promoting physical activity in patients with diabetes, and this statement provides tangible goals and details that will enable providers to counsel patients effectively. Unfortunately, the lack of access to and reimbursement for trained exercise physiologists and organized exercise programs tailored to patients with diabetes remains a large barrier, despite the demonstrated efficacy of these programs in promoting sustained participation.

– Dawn Belt Davis, MD, PhD
Endocrine Today Editorial Board Member

Dr. Davis has no direct financial interest in any of the products mentioned in this article nor is he a paid consultant for any companies mentioned.

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