Movement Matters: The Many Benefits of Exercise for Diabetes

Exercise's health and quality-of-life benefits cannot be overstated for people with diabetes. Not only does physical activity empower the body and promote better blood glucose regulation, but it also lowers the risk of several diabetes complications.

Beyond diabetes-specific advantages, consistently active improves vascular function, cholesterol levels, and blood pressure. It also boosts your immune system and reduces anxiety.

This combination of optimized blood sugar control and whole-body improvements is why exercise is considered essential, not optional, for individuals with diabetes.

Aerobic exercises are the ones that involve the repeated movement of large muscle groups. Good examples include cycling, jogging, and swimming.

Some of the benefits of aerobic exercises for diabetes include:

• A position stand by the American College of Sports Medicine indicates that aerobic training increases insulin sensitivity, oxidative enzymes, and mitochondrial density. It also improves lung and immune function, as well as cardiac output and reactivity of blood vessels.
• Aerobic training can decrease insulin resistance in type 2 diabetes. On top of that, it can improve lipid levels, endothelial function, and cardiorespiratory fitness.
• People living with type 2 diabetes can expect lower A1C levels, triglycerides, and blood pressure. They can also expect lower insulin resistance, as with type 1 diabetes.
• A JAMA Network prospective study and meta-analysis shows that aerobic exercise is associated with lower cardiovascular and mortality risks in people living with type 1 and type 2 diabetes.
• High-intensity interval training (HIIT), which fits into both aerobic and anaerobic exercise categories, can improve insulin sensitivity, glycemic control, and skeletal muscle oxidative capacity in type 2 diabetes. As far as type 1 diabetes, high-intensity interval training can be performed without glycemic control deterioration.

Exercises that fall under this category offer the following benefits:

• Improving the body composition, muscle mass, and overall strength of adults living with diabetes. It also improves bone mineral density, lipid profiles, cardiovascular health, and blood pressure, as per the above-mentioned position stand by the ACSM.
• While the effect of strength training on type 1 glycemic control is unclear, studies show that it can reduce the risk of exercise-induced hypoglycemia.

Note: If you combine strength training with aerobic exercise in one session, it’s recommended to do your strength training first to minimize the chance of hypoglycemia.

• For type 2 diabetes, resistance exercise can improve overall metabolic health. More specifically, it can boost glycemic control, insulin resistance, blood pressure, fat mass, and lean body mass.

It’s crucial to note that diabetes is an independent risk factor for lower muscle strength and function. In other words, diabetes can directly lead to weaker muscles and faster strength deterioration over the years. This underlines the importance of engaging in resistance training to help mitigate these complications.

Flexibility exercise or stretching is important for older adults living with diabetes—type 2, in particular—because they often struggle with limited joint mobility, which makes them prone to issues such as frozen shoulder, carpal tunnel syndrome, and arthritis.

This lack of mobility is attributed, at least in part, to the formation of advanced glycation end products (AGEs), which accumulate over the years and can be accelerated by hyperglycemia.

Engaging in flexibility or stretching exercises improves the range of motion around the joints, addressing the issues related to the formation of AGEs.

Further, some studies show that stretching can improve blood sugar levels in people with type 2 diabetes and improve circulation in the small blood vessels within the joints and muscles, allowing for easy glucose uptake.

Among the recommendations of the American Diabetes Association is for older adults living with diabetes (50 years of age and older) to engage in balance exercises. It’s especially recommended for those with peripheral neuropathy.

Balance training may help improve loss of stability and reduce the risk of falls by counteracting the loss of feeling in the feet. It also improves gait, even in the presence of peripheral neuropathy.

The health benefits of alternative training like tai chi and yoga for diabetes aren’t as established as more common types of exercise. Still, the results of some meta-analyses seem to be promising.

For instance:

• In the case of yoga, a growing body of evidence suggests that adults with type 2 diabetes may benefit from yoga practice about glycemic control, body composition, and lipid levels.
• In the case of tai chi, the practice seems to improve neuropathic symptoms, balance, and glycemic control, according to the Journal of Alternative and Complementary Medicine.

There isn’t one specific type of activity that’s best for everyone living with diabetes. It’s all about finding what works best for you. After all, what works or appeals to one person may not do the same for another.

That said, a combination of different types of exercise will likely give you the best results. After all, each type of exercise offers different benefits and engages different body parts.

For adults, it’s recommended to engage in at least 150 minutes of moderate-to-intense exercise every week, ideally spread over at least three days a week and with no more than two consecutive days without activity.

For younger, more physically fit adults, shorter exercise durations (at least 75 minutes per week) of high-intensity or interval training should be sufficient.

Adults with diabetes should also engage in 2-3 sessions of resistance exercise training on nonconsecutive days per week, in addition to flexibility and balance training 2-3 times a week.

For children and adolescents with type 1 or type 2 diabetes, a minimum of 60 minutes per day of moderate or vigorous aerobic activity is recommended. Muscle and bone-strengthening activities should also be included at least three days a week.

It’s also worth noting that pre-exercise medical clearance isn’t usually necessary for asymptomatic individuals in the case of low or even moderate-intensity physical activity that doesn’t exceed the demands of everyday living.

If you spend a lot of time at home, you may find it challenging to get your much-needed exercise. The good news is that you don’t even have to step outside to exercise.

You can do a lot as a form of exercise from the comfort of your home. For example, you can do some on-the-spot walking while watching TV.

You can also use cans of food as weights for some resistance training.

Other things you can do include:

• Stretching your arms and legs
• Washing your car
• Doing some gardening
• Vacuuming your home
• Dancing to some music

It’s important for people with diabetes who work desk jobs that involve sitting in front of a computer for extended periods of time to stay active as much as possible.

You can do chair/sitting exercises like seated backbends, chair squats, and simple arm and leg stretches. Also, consider a standing desk or walking around when you’re on the phone.

Other things you can do include:

• Going for a short walk on your breaks
• Replacing your office chair with an exercise ball
• Keeping some exercise equipment at work

If you’re constantly on the move, there are slight changes that you can make in your daily routine to increase your physical activity and make the most out of your time outdoors.

Some of the things you can do include:

• Walking or cycling to work
• Using your grocery shopping as weights
• Getting off the bus a stop earlier
• Parking a few miles away from the destination
• Using the stairs as much as possible

Since people living with diabetes are prone to heart and blood vessel disease, as well as foot problems, they must take the necessary precautions to reap the benefits of exercise without compromising their health.

Here are some general guidelines to adhere to:

• Check your blood sugar levels before, during, and after physical activity
• Refer to an exercise physiologist for an individualized exercise program.
• Start with low-impact exercises like walking if you’ve never exercised before.
• Make sure you have an individualized diabetes management plan.
• Drink plenty of fluids while you’re physically active to prevent dehydration
• Wear well-fitting shoes and comfortable, soft socks
• Check your feet for sores, blisters, or other injuries after exercising

For people taking insulin or glucose-lowering medication (like sulphonylurea), there’s a risk of blood glucose levels getting too low (4.0 mmol/L or less), referred to as hypoglycemia.

If you belong to this group, you must monitor your BGLs before, during, and after exercise to assess how each exercise affects your body.

To reduce the risk of hypoglycemia, you can:

• Ensure your blood glucose levels are at between 5.0 and 13.9 mmol/L (90 and 250 mg/dL) before you start exercising
• Increase your intake of carbs as necessary for the type, intensity, and duration of exercise
• Decrease your insulin or diabetes medication as necessary after referring to your doctor
• Always carry hypoglycemia treatments with you and wear a medic alert bracelet

On the other hand, if your BGLs are too high (over 13 mmol/L), which is referred to as hyperglycemia, exercising can help lower your levels. Just be sure to increase your fluid intake, as people with BGLs above the normal range are more prone to dehydration.

That said, if your BGLs are too high to the point that you feel unwell, it’s best not to engage in physical exercise until your BGLs return to normal.

If you’ve had diabetes for a long time or if your BGLs are consistently high, you should take into consideration that you’re prone to developing foot problems before engaging in physical activities. This is especially important if you have nerve damage (peripheral neuropathy).

Here’s what you can do to prevent foot injuries and infections:

• Have your feet checked by a podiatrist on a regular basis to ensure you’re safe to exercise
• Always wear well-fitting socks and shoes that are commodious and comfortable enough
• Make sure to wear the right pair of shoes for the activity in which you’re looking to engage
• Inspect your feet on a daily basis and report to your doctor immediately upon detecting changes

If you have type 1 diabetes and you feel unwell, you should avoid exercise until you feel better so that you don’t run the risk of ketoacidosis, which is basically the build-up of ketones.

If you have positive blood or urine ketones and your BGLs are above 15 mmol/L, you should make sure the ketones are cleared from your blood before you engage in physical activity.

Doing so will likely involve extra insulin, but it’s important not to make any decisions before consulting your diabetes healthcare provider.

If you have type 2 diabetes, you don’t have to worry about developing dangerous levels of ketones unless you’re taking a Sodium-Glucose Transport Protein 2 (SGLT2) inhibitor.

Regular exercise offers tremendous benefits for people with diabetes, from better blood sugar control and reduced risk of complications to improved cardiovascular health and overall well-being.

Aerobic, strength training, flexibility, and balance exercises each offer unique advantages that promote optimal health when dealing with diabetes.

What’s important is that you opt for activities that you enjoy and that fit your lifestyle and physical ability. Equally important is working with your healthcare provider to develop a safe, personalized exercise regimen.

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