Diabetes - Exercise and Physical Activity
Physical activity is an important part in maintaining the overall balance of energy expenditure. It plays a key role in maintaining glucose control and body weight. Other benefits include reduction in cardiovascular risk and improved psychological and physical wellbeing. Ideally physical activity should be a regular part of lifestyle as unaccustomed or erratic exertion can be problematic.
Declining trends in daily physical activity (reduced calorie expenditure) over last 50 years have contributed to current epidemic of obesity and diabetes especially in children.
Impact of Physical Activity on Glucose Control
Blood glucose is a key energy source that is used to maintain any physical activity or exercise, at least in short term. Therefore
Patients with diabetes should be advised that activity may cause changes in blood glucose: individual patterns may vary. Hypoglycaemia is the major risk and may occur up to 24 hours after the exercise.
Physical activity patterns should be considered when choosing diabetes treatments which may need to be flexible to accommodate the activity.
Factors that influence glucose control during and after exercise
Type of exercise & physical activity
Intensity and duration of exercise
Co-administration of insulin or sulphonylurea therapy
Current level of blood glucose control
General Principles for Safe Exercise
|Avoid unaccustomed moderate to severe physical activity|
Start with mild intensity physical activities for short periods
Progressively increase the duration
Progressively increase the intensity
For full health benefit use a range of physical activities
Blood glucose monitoring is advisable for patients who are at risk of hypoglycaemia (on insulin or Sulphonylurea treatment). Seeing the effects of regular exercise on blood glucose levels can be motivational.
Before Physical Activity
If activity is planned then it may be possible to reduce insulin or sulphonylurea doses or increase carbohydrate intake if experience suggests that it is likely to cause hypoglycaemia. Patients should be advised to check blood glucose level if possible before exercise. Type 1 patients should check for ketones if blood glucose is >14mmol/l.
Patients should carry diabetes identification and inform team members / opponents of their risk of hypoglycaemia and the appropriate action to take if it occurs or is suspected.
It may be necessary to take extra carbohydrate at intervals during extended exercise. Patients who are at risk should ensure they have ready access to quick acting glucose during exercise..
Some patients will require a reduction in dose of insulin or sulphonylurea or an increase in carbohydrate after exercise. It is important to be aware of the risk of hypoglycaemia for many hours after exercise.
Over enthusiastic use of carbohydrate should be avoided as this can negate the benefits of exercise on body weight! Individual response to exercise should be used to guide the optimum strategy. In general overweight patients should not be advised to increase carbohydrate unless experience suggests that they are at risk of hypoglycemia; in that case if on insulin or sulphonylureas they should reduce this first. Patients on metformin, glitazones or gliptins are at low risk of hypoglycaemia
Specific diabetes related issues with exercise
Activities that increase the intraocular pressures such as lifting heavy weights can make diabetic eye problems worse.
Peripheral neuropathy may make foot damage more likely in certain activities such as running or walking: swimming or aquarobics may be better. Good footwear and footcare is very important.
ABCD has produced a position statement on physical
activity and exercise in diabetes|
Exercise Prescription Schemes
Active Luton - See Useful External Resources for Referral Form.
Bedfordshire Exercise On Prescription - Referral Form
Useful External Resources / Links
ABCD position statement on physical activity and exercise in diabetes|
NICE | PH35 Preventing type 2 diabetes: population and
community - level interventions|
NICE| PH38 Preventing type 2 diabetes: risk identification and
intervention for individuals at high risk|
Bedfordshire Exercise On Prescription - Referral Form|
|Active Luton Exercise Referral Criteria|
Active Luton Exercise Referral Form|
|Declining Trends in Daily Physical Activity|
|Fact Sheet produced by the
Health and Social Care Information Centre.|
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