Physical Activity/Exercise and Type 2 Diabetes
- Ronald J. Sigal, MD, MPH123,
- Glen P. Kenny, PHD23,
- David H. Wasserman, PHD4 and
- Carmen Castaneda-Sceppa, MD, PHD5
- 1Department of Medicine, University of Ottawa, Ottawa, Canada
- 2School of Human Kinetics, University of Ottawa, Ottawa, Canada
- 3Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada
- 4Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
- 5Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
- Address correspondence and reprint requests to Ronald J. Sigal, Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Ave., Ottawa, Ontario, Canada K1Y 4E9. E-mail:
- ACSM, American College of Sports Medicine
- ADA, American Diabetes Association
- CAD, coronary artery disease
- CVD, cardiovascular disease
- DPP, Diabetes Prevention Program
- ECG, electrocardiogram
- EGP, endogenous glucose production
- IGT, impaired glucose tolerance
- IRS, insulin receptor substrate
- MAP, mitogen-activated protein
- MET, metabolic equivalent
- NEFA, nonesterified fatty acid
- PI, phosphatidylinositol I
- RM, repetition maximum
For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years. The last American Diabetes Association (ADA) technical review of exercise and type 2 diabetes (formerly known as non–insulin dependent diabetes) was published in 1990. The present work emphasizes the advances that have occurred since the last technical review was published.
Major developments since the 1990 technical review include:
Advances in basic science, increasing our understanding of the effects of exercise on glucoregulation.
Large clinical trials demonstrating that lifestyle interventions (diet and exercise) reduce incidence of type 2 diabetes in people with impaired glucose tolerance (IGT).
Meta-analyses of structured exercise interventions in type 2 diabetes showing: 1) effectiveness of exercise in reducing HbA1c, independent of body weight; and 2) association between exercise training intensity and change in HbA1c.
Large cohort studies showing that low aerobic fitness and low physical activity level predict increased risk of overall and cardiovascular disease (CVD) mortality in people with diabetes.
Clinical trials showing effectiveness of resistance training (such as weight lifting) for improving glycemic control in type 2 diabetes.
New data on safety of resistance training in populations at high risk for CVD.
Based on this new evidence, we have refined the recommendations on the desired types, amounts, and intensities of aerobic physical activity for people with diabetes. Resistance training will now be recommended in a broader group of patients and at a broader range of intensity than done previously. There are other areas in which new evidence is lacking, but we feel that previous recommendations may have been more conservative than necessary. These areas include indications for exercise stress test before beginning an exercise program and precautions regarding …