Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-41

Activity/Exercise BENEFITS OF EXERCISE

The many health benefits of exercise for the general population (154) apply equally to people with diabetes. Both aerobic and resistance types of exercise are beneficial. Physical activity can help increase cardiorespiratory fitness, increase vigour, improve glycemic control, decrease insulin resistance, improve lipid profile and blood pressure (BP), and promote weight loss and maintenance of weight loss (155-158). Moderate to high levels of aerobic activity and higher levels of cardiorespiratory fitness are associated with substantial reductions in morbidity and mortality in men and women with diabetes. In people with type 2 diabetes, regular physical activity (150-161) and/or moderate to high cardiorespiratory fitness (162) are associated with reductions in cardiovascular and overall mortality of 39 to 70% over 15 to 20 years of follow-up (160,163). In people with type 1 diabetes, a cohort study found that 7 year mortality was 50% lower in those reporting ≥2 , 000 kcal of weekly exercise (equivalent to ≥7 hours/week of brisk walking), compared to those reporting <1,000 kcal of physical activity per week (164). For people with type 2 diabetes, physical activity can increase insulin sensitivity, thereby improving glycemic control (165); this may decrease the amount of medication required, or even eliminate the need for it altogether. Exercise durations of more than 150 minutes per week were associated with greater A1C reductions compared to durations 150 minutes or less of exercise per week (166). Activity has not been proven to improve glycemic control for people living with type 1 diabetes (167). However aerobic exercise has been shown to lower A1C in children and youth with type 1 diabetes (168,169), while also lowering body mass index (BMI), TG and total cholesterol levels. In adults with type 1 diabetes, an inverse association has been seen between physical activity levels and A1C, diabetic ketoacidosis (DKA), BMI and diabetes related complications, including dyslipidemia, hypertension, retinopathy and microalbuminuria (170). Aerobic exercise has been shown to limit the development of peripheral neuropathy (171). Resistance exercise may provide benefits for people with type 2 diabetes, including increased strength and vigour, reduced body fat and increased resting metabolic rate (172,173). A systematic review found that resistance training may lead to improvements in glycemic control, decreases in insulin resistance and increased muscular strength in adults with type 2 diabetes (174). The greatest impact on A1C is seen when people progress to three sets, with approximately eight repetitions per set, of resistance-type exercises at moderate to high intensity (i.e. the maximum weight that can be lifted eight times while maintaining proper form), three or more times per week (175-178). However, reductions in