In the research, every exercise session was supervised; however, this is generally not available, affordable or practical for patients. Some patients are able to complete 150 minutes per week of aerobic training on their own, but evidence suggests that many will not adhere to the program without supervision. Lack of adherence can be through inadequate duration or inadequate intensity. The dose of exercise used in the trials was quite high; patients may need to start at a much lower level and work toward a more intensive exercise program over time.
In the community there are many options to achieve adequate duration and intensity of exercise, such as; these include active transport, walking for leisure and sports participation, as well as gym work that is more similar to the research environment.
The implementation challenge is to be able to ensure adequate duration and intensity, for which movement tracking devices such as pedometers or fitness monitors may have a role.
Ask patients about their preference for social support. Some like to do this alone while others prefer the social environment of exercising in a group. See the resources listed below.
Measurable repeatable exercise
For people exercising on a machine at home, it is helpful to have an objective and repeatable measure of work intensity such as power output in watts. This allows the doctor to prescribe a specific intensity and duration and for the patient to track their progress as they gain fitness.
For patients taking a beta blocker, heart rate does not reflect intensity. Therefore a subjective measure of exertion is used instead, such as a ‘walk and talk test’: moderate physical activity will cause a noticeable increase in breathing, however the exerciser should still be able to talk in sentences.
Patients need to be aware of the importance of good foot care and the need for comfortable and well-fitting footwear, especially if they have neuropathy, vascular disease or had previous foot problems.
Vascular disease considerations
Many people with type 2 diabetes have vascular disease and may need advice about the benefits of exercise for angina or intermittent claudication and how to exercise within their limitations to gradually increase their exercise capacity.
Impaired fasting glucose
Although the evidence was generated for people with diabetes, similar benefits are expected for people with IFG, and the same dose of exercise should be used.