The American Diabetes Association (ADA) has issued updated guidelines for all patients with diabetes regarding regular, structured physical exercise. The report, published in Diabetes Care, includes a recommendation of 3 or more minutes of light activity, such as walking, leg extensions, or overhead arm stretches, every 30 minutes during prolonged sedentary activities to improve blood sugar management, particularly for patients with type 2 diabetes.
The new guidelines are the first time that the ADA has issued independent, comprehensive recommendations on physical activity and exercise for all patients with diabetes, including type 1, type 2, and gestational diabetes, as well as prediabetes.
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“These updated guidelines are intended to ensure everyone continues to physically move around throughout the day—at least every 30 minutes—to improve blood glucose management,” stated Sheri R. Colberg-Ochs, PhD, FACSM, consultant/director of physical fitness for the ADA and lead author of the guidelines. “This movement should be in addition to regular exercise, as it is highly recommended for people with diabetes to be active. Since incorporating more daily physical activity can mean different things to different people with diabetes, these guidelines offer excellent suggestions on what to do, why to do it, and how to do it safely.”
The ADA’s position statement is based on a review of more than 180 papers of the most recent diabetes research and includes input from leaders in diabetes and exercise physiology from the United States, Canada, and Australia.
The recommendations, with the ADA’s grade for each, are as follows:
Table 1. Benefits of and recommendations for reduced sedentary time
| All adults, particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior.Grade B |
| Prolonged sitting should be interrupted with bouts of light activity every 30 minutes for blood glucose benefits, at least in adults with type 2 diabetes. Grade C |
| The above 2 recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement. Grade C |
Table 2. Physical activity and type 2 diabetes
| Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to enhance insulin action. Grade B |
| Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes. Grade C |
| Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general. Grade C |
| Structured lifestyle interventions that include at least 150 min/week of physical activity and dietary changes resulting in weight loss of 5% to 7% are recommended to prevent or delay the onset of type 2 diabetes in populations at high risk and with prediabetes. Grade A |
Table 3. Physical activity and type 1 diabetes
| Youth and adults with type 1 diabetes can benefit from being physically active, and activity should be recommended to all. Grade B |
| Blood glucose responses to physical activity in all people with type 1 diabetes are highly variable based on activity type or timing and require different adjustments. Grade B |
| Additional carbohydrate intake and/or insulin reductions are typically required to maintain glycemic balance during and after physical activity. Frequent blood glucose checks are required to implement carbohydrate intake and insulin dose adjustment strategies. Grade B |
| Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods. Grade C |
| Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests. Grade C |
