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Physical Activity

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Physical activity benefits almost everyone. Depending on the type of activity, benefits include improved cardiovascular health, lower blood pressure, increased bone mineral density and improved energy levels. 

For people with type 2 diabetes, activity helps to decrease insulin resistance, and contributes to improved glycemic control. People with type 1 diabetes receive general health benefits noted above, but may not see any improvement in blood glucose.

The following activity guidelines are provided for clinician information and guidance. When talking with patients, remember to use client-centered counselling skills. Many people are unable to follow all exercise recommendations.

Safety

  • Encourage exercise at an appropriate intensity for your patients' fitness level.
  • Consider complications. For more details please refer to the Diabetes Canada handouts here and here. Advice needs to take into consideration:
    • Cardiovascular fitness
    • Peripheral and autonomic neuropathy
    • Foot concerns
    • Preproliferative or proliferative retinopathy
    • Kidney disease
  • Insulin and secretagogues carry a risk of hypoglycemia. For people with type 1 diabetes, more details are available on our patient handout. Consider the following advice for patients who are at risk of hypoglycemia: 
    • Cut the total meal dose of rapid-acting insulin (correction and meal dose) by 50% if your patient is going to be active within 2 h of the meal insulin dose. 
    • Consider reducing the bedtime long-acting insulin dose by 10 to 20% if your patient:
      • was active in the afternoon or evening
      • was active for a long time during the day
      • did an intense activity for a short time, but is not usually active
      • is planning an activity before noon the next day
    • Check blood glucose often enough to determine patterns associated with physical activity. Effects of activity on glucose levels might be delayed. Once patterns are identified, use blood glucose monitoring to help minimize the risk of hypoglycemia.
    • Wear a Medic Alert bracelet or alternative.
    • Carry treatment for low blood glucose.

Exercise goals

  • Goals are individualized. Depending on the limitations noted above, consider advising to eventually achieve the following activity goals:

  • Aerobic exercise

    • For example, walking, cyclling swimming or running
    • 150 minutes or more of moderate to vigorous intensity exercise per week

  • Resistance exercise

  • Limit sitting

    • Try to interrupt sitting time by getting up briefly every 20 to 30 minutes.