[acb-diabetics] Exercise

[Patricia LaFrance-Wolf]

 <http://www.diabetesincontrol.com/diabetes-in-control-newsletters/552>
Issue 552 

 



New Guidelines for Exercise in Type 2 Diabetes


New guidelines stress the crucial role that physical activity plays in the
management of Type 2 diabetes: physicians should prescribe exercise.... 


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They replace recommendations made in the American College of Sports Medicine
Position Stand, "Exercise and Type 2 Diabetes," issued in 2000.

Developed by a panel of 9 experts, the new guidelines are published
concurrently in the December issue of Medicine & Science in Sports &
Exercise and Diabetes Care.

"High-quality studies establishing the importance of exercise and fitness in
diabetes were lacking until recently," the expert panel writes, "but it is
now well established that participation in regular physical activity
improves blood glucose control and can prevent or delay Type 2 diabetes
mellitus, along with positively affecting lipids, blood pressure,
cardiovascular events, mortality, and quality of life."

Most of the benefits of exercise are realized through acute and long-term
improvements in insulin action, accomplished with both aerobic and
resistance training, the experts write.

For people who already have Type 2 diabetes, the new guidelines recommend at
least 150 minutes per week of moderate to vigorous aerobic exercise spread
out at least 3 days during the week, with no more than 2 consecutive days
between bouts of aerobic activity. These recommendations take into account
the needs of those whose diabetes may limit vigorous exercise.

Sheri R. Colberg, PhD, writing chair, professor of exercise science at Old
Dominion University, adjunct professor of internal medicine at Eastern
Virginia Medical School, Norfolk, Virginia, and regular Diabetes In Control
contributor, stated that, "Most people with Type 2 diabetes do not have
sufficient aerobic capacity to undertake sustained vigorous activity for
that weekly duration, and they may have orthopedic or other health
limitations." "For this reason, the ADA [American Diabetes Association] and
ACSM [American College of Sports Medicine] call for a regimen of
moderate-to-vigorous activity and make no recommendation for a lesser amount
of vigorous activity."

The panel specifically recommends that such moderate exercise correspond to
approximately 40% to 60% of maximal aerobic capacity and states that for
most people with Type 2 diabetes, brisk walking is a moderate-intensity
exercise.

The expert panel also recommends that resistance training be part of the
exercise regimen. This should be done at least twice a week -- ideally 3
times a week -- on nonconsecutive days. The panel also recommends that
people just beginning to do weight training be supervised by a qualified
exercise trainer "to ensure optimal benefits to blood glucose control, blood
pressure, lipids, and cardiovascular risk and to minimize injury risk."

Regular use of a pedometer is also encouraged. In a meta-analysis of 8
randomized controlled trials and 18 observational studies, people who used
pedometers increased their physical activity by 27% over baseline. Having a
goal, such as taking 10,000 steps per day, was an important predictor of
increased physical activity, according to the expert panel.

Finally, the new guidelines emphasize that exercise must be done regularly
to have continued benefits and should include regular training of varying
types.

Physicians should prescribe exercise, Dr. Colberg said in a statement. "Many
physicians appear unwilling or cautious about prescribing exercise to
individuals with Type 2 diabetes for a variety of reasons, such as excessive
body weight or the presence of health-related complications. However, the
majority of people with Type 2 diabetes can exercise safely, as long as
certain precautions are taken. The presence of diabetes complications should
not be used as an excuse to avoid participation in physical activity."

Med Sci Sports Exerc. 2010;2282-2303.

 

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