Diabetes Association upgrades activity recommendations

The American Diabetes Association this week said it now recommends more daily exercise for everyone with diabetes, while recommending less overall sedentary time every day.

The most notable recommendation calls for three or more minutes of light activity, such as walking, leg extensions or overhead arm stretches, every 30 minutes during prolonged sedentary activities for improved blood sugar management, particularly for people with type 2 diabetes.

This is a shift from the Association's previous recommendation of physical movement every 90 minutes of sedentary time.

All types of diabetes are addressed in "Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association," to be published in the November 2016 issue of Diabetes Care, which is nowavailable online.

Sedentary behavior—awake time that involves prolonged sitting, such as at a desk on the computer, in a meeting or watching TV—has a negative effect on preventing or managing health problems, including diabetes. Studies have shown improved blood sugar management when prolonged sitting is interrupted every 30 minutes—with three minutes or more of standing or light-intensity activities, such as:

• leg lifts or extensions;
• overhead arm stretches;
• desk chair swivels;
• torso twists;
• side lunges; and
• walking in place.

Physical movement improves blood sugar management in people who have sedentary jobs and in people who are overweight, obese and who have difficulty maintaining blood sugars in a healthy range.

"These updated guidelines are intended to ensure everyone continues to physically move around throughout the day—at least every 30 minutes—to improve blood glucose management," said lead author Sheri R. Colberg-Ochs, PhD, FACSM, consultant/director of physical fitness for the American Diabetes Association. "This movement should be in addition to regular exercise, as it is highly recommended for people with diabetes to be active. Since incorporating more daily physical activity can mean different things to different people with diabetes, these guidelines offer excellent suggestions on what to do, why to do it and how to do it safely."

This is the first time the Association has issued independent, comprehensive guidelines on physical activity and exercise for all people with diabetes, including type 1, type 2 and gestational diabetes, and prediabetes. Additionally, there is emphasis on various categories of physical activity—aerobic exercise, resistance training, flexibility and balance training, and general lifestyle activity—and the benefits of each for people with diabetes. The new report is based upon an extensive review of more than 180 papers of the latest diabetes research and includes the expertise of leaders in the field of diabetes and exercise physiology from top research institutions in the U.S., Canada and Australia.

Specific recommendations are outlined for people with type 1 or type 2 diabetes. Aerobic activity benefits patients with type 2 diabetes by improving blood sugar management, as well as encouraging weight loss and reducing cardiovascular risks. Movement that encourages flexibility and balance are helpful for people with type 2 diabetes, especially older adults. Regular exercise that incorporates aerobic and resistance training activities also offers health benefits for people with type 1 diabetes, including improvements in insulin sensitivity, cardiovascular fitness and muscle strength.

Additionally, activity guidelines are suggested for women with gestational diabetes and for people with prediabetes. Women who are at-risk or diagnosed with gestational diabetes are encouraged to incorporate aerobic and resistance exercise into their lives most days of the week to improve the effects of insulin and help maintain consistent blood sugar levels.

People with prediabetes—a condition that is detected when blood sugar levels are above the normal range, yet not high enough for a diabetes diagnosis—are urged to combine physical activity and healthy lifestyle changes to delay or prevent a type 2 diabetes diagnosis.

The statement clarifies that recommendations and precautions for physical activity and exercise will vary based on a patient's type of diabetes, age, overall health and the presence of diabetes-related complications. Additionally, specific guidelines are outlined for monitoring blood sugar levels during activity. The statement also suggests positive behavior-change strategies that clinicians can utilize to promote physical activity programs with patients and indicates that supervised, structured exercise programs are more beneficial for people with diabetes.

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