Exercise Guidelines Emphasize Reduction of Sedentary Time in Diabetes Management

Synopsis

This consensus statement is an update to the 2010 position on exercise and type 2 diabetes (T2D) published jointly by the American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA). In the following decade, published a considerable amount of research on select topics related to exercise in people of different ages with T2D, while the prevalence of diabetes continued to expand worldwide.

The goal of this consensus statement is to provide readers with a summary of the current evidence and to expand and update previous recommendations from 2010. The writing group used a consensus approach to synthesize available evidence from clinical trials and case reports, narrative and systematic reviews, and meta-analyses, and the recommendations represent the consensus of the writing panel and the ACSM and incorporate guidance from other professional organizations with expertise in this area, such as the ADA.

Current science, new discussion topics, and clinical experience in making recommendations for the participation of people with T2D of all ages are highlighted. Additionally, the title of the consensus statement and the text itself have been expanded to include physical activity (PA), a broader and more comprehensive definition of human movement of which structured or planned exercise is a subset.

People with type 2 diabetes should engage in regular physical activity and should be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activity performed with acute and chronic diabetes-related health complications may require accommodations to ensure safe and effective participation. Other topics addressed include exercise time to maximize its glucose-lowering effects and barriers and inequalities in the adoption and maintenance of physical activity.

Diabetes currently affects more than 463 million people worldwide (3), and its prevalence in the United States is 10.5% (4). T2D accounts for 90% to 95% of all cases. The goal of treatment for T2D is to facilitate an individualized treatment plan, which may include education, glycemic control, cardiovascular disease (CVD) risk reduction, and ongoing screening for microvascular complications, to achieve and maintain optimal blood glucose levels. blood, lipids and blood pressure levels that prevent or delay chronic complications.

Lifestyle interventions and/or medications are typically prescribed for the treatment of type 2 diabetes, and more recently, bariatric surgery has also become part of a potential treatment plan.

During any type of physical activity (PA), glucose uptake into active skeletal muscles increases through insulin-independent pathways.

Blood glucose levels are maintained by glucoregulatory hormone-derived increases in hepatic glucose production and free fatty acid mobilization, which can be affected by insulin resistance or diabetes. Improvements in systemic, and possibly hepatic, insulin sensitivity after any PA can last from 2 to 72 h, with reductions in blood glucose closely associated with the duration and intensity of PA.

Additionally, regular PA improves β-cell function, insulin sensitivity, vascular function, and gut microbiota, all of which can lead to better diabetes control as well as risk reduction.

Consensus statements and recommendations

Regular aerobic exercise training improves glycemic control in adults with type 2 diabetes, with less daily time in hyperglycemia and 0.5% to 0.7% reductions in overall blood glucose (as measured by A1C).
High-intensity resistance exercise training has greater beneficial effects than low-to-moderate intensity resistance training in terms of overall glucose control and attenuation of insulin levels.
Greater postprandial energy expenditure reduces glucose levels regardless of exercise intensity or type, with durations ≥45 min providing the most consistent benefits.
Small “doses” of PA throughout the day to break sitting moderately attenuate postprandial glucose and insulin levels, particularly in people with insulin resistance and a higher body mass index.
Weight loss ( achieved through lifestyle changes in diet and physical activity) of >5% appears to be necessary for beneficial effects on A1C, blood lipids, and blood pressure.
To reduce visceral fat in people with type 2 diabetes, a moderately high volume of exercise (~500 kcal) performed 4–5 d·wk−1 is needed.
In youth with type 2 diabetes, intensive lifestyle interventions plus metformin have not been superior to metformin alone in controlling glycemia.
Despite limited data, it is still recommended that youth and adolescents with type 2 diabetes achieve the same physical activity goals established for youth in the general population.
Pregnant women with and without diabetes should participate in at least 20 to 30 minutes of moderate-intensity exercise most days of the week.
People with type 2 diabetes who use insulin or insulin secretagogues are recommended to supplement with carbohydrates (or reduce insulin, if possible) as needed to prevent hypoglycemia during and after exercise.
Participation in an exercise program before bariatric surgery may improve surgical outcomes, and after surgery, participation confers additional benefits.

Exercise Guidelines Emphasize Reduction of Sedentary Time in Diabetes Management

Guidelines for exercise and physical activity in diabetes management prioritize the reduction of sedentary time, highlighting the importance of incorporating regular physical activity and minimizing prolonged sitting to optimize glycemic control and cardiovascular health.