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AHA statement: Exercise training recommended in patients with type 2 diabetes

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Patients with type 2 diabetes should be engaging in up to two and a half hours of physical activity per week, according to a scientific statement from the American Heart Association.

According to researchers on the writing committee, the economic burden of type 2 diabetes in the United States was estimated at $172 billion in 2007 (up from $132 billion in 2002) and will likely continue to increase with rising obesity levels in the general population. Commitment to an exercise program can be effective in controlling some of the complications related to diabetes and can also stem some of the risks for cardiovascular disease.

“Briefly, exercise has favorable metabolic effects (glycemic control, weight loss), effects on other risk factors (lipids, hypertension) and direct vascular effects,” the researchers wrote. “However, despite a number of studies suggesting favorable effects on metabolic control and CVD risk factors, the net effect of these on clinical outcomes in type 2 diabetes mellitus is yet to be defined.”

The researchers recommended that patients with type 2 diabetes who are considering initiating an exercise program first talk to their physicians for evaluation of their risk profile and physical condition to determine their optimum individualized options. They indicated that physicians and patients should consider assessment of hypoglycemia, potential cardiac risks during exercise, microvascular disease and foot conditions.

The researchers also recommended that previously sedentary patients with type 2 diabetes engage in a minimum of 30 minutes of accumulated moderate-intensity physical activity for at least five days during the week (or a minimum energy expenditure of 1,000 kcal/week). For the improvement of CV risk, they also suggested accumulating either a minimum of 150 minutes per week of at least moderate-intensity physical activity and/or 90 minutes per week of at least vigorous-intensity cardiorespiratory exercise.

“Exercise training in patients with type 2 diabetes mellitus is feasible, well tolerated and beneficial,” they concluded. “Individualized exercise prescription offers an ideal opportunity to account for both cardiac and noncardiac considerations in type 2 diabetes mellitus.”

Marwick TH. Circulation. 2009;doi:10.1161/CIRCULATIONAHA.109.192521.