Individuals with all types of diabetes frequently are deconditioned and live a sedentary lifestyle.
Therefore, the first major step in assisting them to exercise more regularly is to focus on incorporating more activities of daily living and other less-structured physical activity into their lifestyles1,2. The U.S. Physical Activity Guidelines (2008) refer to such activities as "baseline activity," defined as the light-intensity activities of daily life like standing, walking slowly, and lifting lightweight objects. Although individuals vary in how much baseline activity they do, those only engaging in baseline activity are considered to be inactive.
Significant health benefits, such as a reduction in coronary risk factors, can be obtained by incorporating frequent bouts of moderate-intensity activity on most, if not all, days of the week, even if this activity is not a traditional, planned (or structured) one3,4. A single bout of low-intensity, as opposed to high-intensity, exercise has been shown to substantially reduce the prevalence of hyperglycemia throughout the subsequent 24 h postexercise period in individuals with type 2 diabetes (T2D), demonstrating that activities of daily living also can have a positive effect on blood glucose management5. Although lifestyle physical activity does not entirely take the place of a traditional structured exercise program, in most cases, it can be highly effective in helping individuals increase their daily activity level and build a fitness base that will allow them to participate in other, more intense or structured physical activities and exercise programs.
Engaging in frequent and daily physical activity is an essential part of self-care for all individuals with T2D. For anyone with type 1 diabetes (T1D), however, appropriate medication and dietary regimen changes likely will be needed to maintain control over blood glucose levels. All insulin users (regardless of type of diabetes) need to follow hypoglycemia prevention strategies. In many cases, the success of a physical activity should not simply be gauged by how much blood glucose levels decrease during participation. For insulin users, large drops in the blood glucose are more likely to lead to rapid-onset hypoglycemia and worsened control. The focus instead should be on keeping the blood glucose level from interfering with the ability to continue the physical activity.
Although physical activity of any type — including activities of daily living — is not guaranteed to improve acute blood glucose control in insulin users, it is still equally important. For instance, one study recently investigated the influence of computer use on glycemic control in 115 patients with T1D. Their A1C levels were not related to age, diabetes duration, television watching, or computer use, but rather were independently and negatively associated with the weekly hours that individuals spent doing any physical exercise6. Table 3.1 gives some suggestions on how to get individuals started doing more daily physical movement.
Table 3.1. Recommendations for Getting Started with More Daily Movement
Here are some suggestions on how to get individuals with any type of diabetes more physically active on a daily basis:
Breaking Up Sedentary Time
Use of physical activity accelerometers has brought a better estimation of total daily movement, along with the time spent doing activities of varying intensities or nothing at all (like sitting or sleeping). In overweight and obese adults, interrupting sitting time with 2 min bouts of light- or moderate-intensity walking lowered their postprandial glucose and insulin levels7. Along the same lines, an individual would theoretically expend an additional 24, 59, or 132 kilocalories per day, on average, if he or she chose to stand up and walk around at a normal, self-selected pace for 1, 2, or 5 min every hour, respectively, compared with sitting continuously during an 8 h period8. Making small changes like taking a 5 min walking break every hour could yield beneficial weight control or weight loss results.
In adults with newly diagnosed T2D (ages 30–80 years), each hour of sedentary time during waking hours was associated with a larger waist circumference and lower levels of HDL-C, suggesting that a higher sedentary time is associated with a worse metabolic profile9. Using similar techniques with accelerometer measurements, others have confirmed that the proportion of time spent in sedentary pursuits on a daily basis is strongly related to metabolic risk, independent of how much physical activity an individual otherwise does10. Thus, people with diabetes in particular may benefit from reducing their total sedentary time and avoiding prolonged periods of sedentary behavior, which they can do simply by increasing the number of breaks from sitting that they take during the day.
- Johannsen, D. L., G. J. Welk, R. L. Sharp, and P. J. Flakoll: Differences in daily energy expenditure in lean and obese women: the role of posture allocation. Obesity (Silver Spring) 16 (1):34–39, 2008
- Levine, J. A., L. M. Lanningham-Foster, S. K. McCrady, A. C. Krizan, L. R. Olson, P. H. Kane, M. D. Jensen, and M. M. Clark: Interindividual variation in posture allocation: possible role in human obesity. Science 307 (5709):584–586, 2005
- McBride, P. E., J. A. Einerson, H. Grant, C. Sargent, G. Underbakke, M. Vitcenda, L. Zeller, and J. H. Stein: Putting the Diabetes Prevention Program into practice: a program for weight loss and cardiovascular risk reduction for patients with metabolic syndrome or type 2 diabetes mellitus. J Nutr Health Aging 12 (10):745s–749s, 2008
- Loimaala, A., K. Groundstroem, M. Rinne, A. Nenonen, H. Huhtala, J. Parkkari, and I. Vuori: Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol 103 (7):972–977, 2009
- Manders, R. J., J. W. Van Dijk, and L. J. van Loon: Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sports Exerc 42 (2):219–225, 2010
- Benevento, D., C. Bizzarri, D. Pitocco, A. Crino, C. Moretti, S. Spera, C. Tubili, F. Costanza, A. Maurizi, L. Cipolloni, M. Cappa, P. Pozzilli, and Imdiab Group: Computer use, free time activities and metabolic control in patients with type 1 diabetes. Diabetes Res Clin Pract 88 (3):e32–e34, 2010
- Dunstan, D. W., B. A. Kingwell, R. Larsen, G. N. Healy, E. Cerin, M. T. Hamilton, J. E. Shaw, D. A. Bertovic, P. Z. Zimmet, J. Salmon, and N. Owen: Breaking Up Prolonged Sitting Reduces Postprandial Glucose and Insulin Responses. Diabetes Care 35 (5):976–983, 2012
- Swartz, A. M., L. Squires, and S. J. Strath: Energy expenditure of interruptions to sedentary behavior. Int J Behav Nutr Phys Act 8:69, 2011
- Cooper, A. R., S. Sebire, A. A. Montgomery, T. J. Peters, D. J. Sharp, N. Jackson, K. Fitzsimons, C. M. Dayan, and R. C. Andrews: Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia 55 (3):589–599, 2012
- Bankoski, A., T. B. Harris, J. J. McClain, R. J. Brychta, P. Caserotti, K. Y. Chen, D. Berrigan, R. P. Troiano, and A. Koster: Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes Care 34 (2):497–503, 2011
This article is excerpted from Chapter 3 of Exercise and Diabetes: A Clinician’s Guide to Prescribing Physical Activity, a case-study based book that will be released by the American Diabetes Association in June 2013 and was written by Dr. Sheri Colberg (find more information about the book online at www.shericolberg.com/exercise-diabetes.asp).
In addition, anyone wishing to earn free CME credits through the ADA for completing a new self-assessment program on exercise and diabetes may do so now through the ADA’s web site at http://professional.diabetes.org/ce.
Copyright © 2013 Diabetes In Control, Inc.