ADA issues new diabetes guidelines for physical activity and exercise

 

Table 4. Physical activity participation for people with diabetes

Pre-exercise medical clearance is generally unnecessary for asymptomatic individuals prior to beginning low-intensity or moderate-intensity physical activity not exceeding the demands of brisk walking or everyday living. Grade B

Most adults with diabetes should engage in 150 minutes or more of moderate-to-vigorous intensity activity weekly, spread over at least 3 days/week, with no more than 2 consecutive days without activity. Shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. Grade B for type 2 diabetes, Grade C for type 1 diabetes

Children and adolescents with type 1 or type 2 diabetes should engage in 60 min/day or more of moderate or vigorous intensity aerobic activity, with vigorous, muscle-strengthening, and bone-strengthening activities included at least 3 days/week. Grade C

Adults with diabetes should engage in 2 to 3 sessions per week of resistance exercise on nonconsecutive days. Grade B for type 2 diabetes, Grade C for type 1 diabetes

Flexibility training and balance training are recommended 2 to 3 times per week for older adults with diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance. Grade C

Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental (nonexercise) physical activity to gain additional health benefits. Grade C

To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs. Grade B

Table 5. Physical activity and pregnancy with diabetes

Women with preexisting diabetes of any type should be advised to engage in regular physical activity prior to and during pregnancy. Grade C

Pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20 to 30 minutes of moderate-intensity exercise on most or all days of the week. Grade B

Table 6. Minimizing exercise-related adverse events in people with diabetes

Insulin regimen and carbohydrate intake changes should be used to prevent exercise-related hypoglycemia. Other strategies involve including short sprints, performing resistance exercise before aerobic exercise in the same session, and activity timing. Grade B

Risk of nocturnal hypoglycemia following physical activity may be mitigated with reductions in basal insulin doses, inclusion of bedtime snacks, and/or use of continuous glucose monitoring. Grade C

Exercise-induced hyperglycemia is more common in type 1 diabetes but may be modulated with insulin administration or a lower-intensity aerobic cool down. Exercising with hyperglycemia and elevated blood ketones is not recommended. Grade C

Some medications besides insulin may increase the risks of exercise-related hypoglycemia and doses may need to be adjusted based on exercise training. Grade C

Older adults with diabetes or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary disease should avoid exercising outdoors on very hot and/or humid days to prevent heat-related illnesses. Grade C

Exercise training should progress appropriately to minimize risk of injury. Grade C

Table 7. Managing physical activity with health complications

Physical activity with vascular diseases can be undertaken safely but with appropriate precautions. Grade B

Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation. Grade B

The presence of autonomic neuropathy may complicate being active; certain precautions are warranted to prevent problems during activity. Grade C

Vigorous aerobic or resistance exercise; jumping, jarring, head-down activities; and breath holding should be avoided in anyone with severe nonproliferative and unstable proliferative diabetic retinopathy. Grade E

Exercise does not accelerate progression of kidney disease and can be undertaken safely, even during dialysis sessions. Grade C

Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations. Grade C

Table 8. Promoting physical activity

Targeted behavior-change strategies should be used to increase physical activity in adults with type 2 diabetes. Grade B

When using step counters, adults with type 2 diabetes should initially set tolerable targets for steps per day before progressing toward higher goals. Grade C

For adults with type 2 diabetes, Internet-delivered interventions for physical activity promotion may be used to improve outcomes. Grade C

Reference

1. Colberg, SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39(11): 2065-2079. doi:10.2337/dc16-1728.

From the December 01, 2016 Issue of Clinical Advisor