Physical activity is one of the cornerstones of diabetes management. Regular physical activity of any kind can have a favourable impact on glycaemic control, CVD risk and overall mortality.6 However, more structured, specialised and individualised exercise prescription can achieve superior benefits.10
The goal is for patients with diabetes, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) to accumulate a minimum of 210 minutes per week of moderate-intensity exercise (or 125 minutes per week of vigorous-intensity exercise), with no more than two consecutive days without training. This weekly total should include at least two moderate-to-vigorous resistance training sessions for a total of at least 60 minutes. These exercise amounts will establish and maintain muscular fitness and aerobic capacity.4
It is recommended to refer patients with type 2 diabetes to an accredited exercise physiologist for the prescription of a safe and effective exercise intervention.
In people with type 2 diabetes, aerobic exercise (eg walking, cycling, swimming) reduces HbA1c, triglycerides, blood pressure and insulin resistance.10
Aerobic exercise intensity can be set as a percentage of estimated maximal heart rate (HRmax) using the equation 208 – 0.7 x age [years].11,12 For moderate intensity, 55–69% of HRmax and for vigorous intensity 70–89% of HRmax can be used.4
Alternatively, ‘moderate’-intensity aerobic exercise is defined on rate of perceived exertion (RPE) scales as ‘somewhat hard’, and ‘vigorous’ as ‘hard’. Using the talk/sing test, a person is doing moderate-intensity exercise when they can comfortably talk but can’t sing, and vigorous is when they are unable to talk comfortably.
Resistance, or strength, training involves activity such as using free weights, resistance machines or body weight. ‘Moderate-to-vigorous’ resistance training can be defined as 2–4 sets of 8–10 repetitions of 8–10 exercises, with rest intervals of 1–2 minutes.4
Resistance training reduces HbA1c, although to a lesser degree than aerobic exercise.13 However, combining aerobic and resistance training appears to be superior compared with either alone.14 Both types reduce CVD markers similarly,13 and a single bout of either may have a similar acute effect.15