Most adults with type 2 diabetes would benefit from regular physical activity, as part of their treatment plan. It can improve glycemic control, facilitate desirable weight loss and help manage cardiovascular and other chronic health conditions. An ideal exercise regimen includes aerobic conditioning, strength workouts, stretching and balance training.

Skeletal muscle requires carbohydrates for energy to fuel both aerobic and resistance exercise. The body draws it from the blood, which lowers blood glucose levels via complex molecular processes that are independent of those stimulated by insulin. Glucose uptake by the muscle is proportional to the intensity and duration of exercise.

NOTE: Studies have shown that cardiovascular and strength training improve insulin sensitivity, lipid levels, blood pressure, body composition and glycosylated hemoglobin (HbA1C).

Resistance exercise strengthens muscles and bones that are important for individuals with type 2 diabetes. A person with diabetes is more susceptible to loss of muscular strength, osteoporosis and bone fractures than non-diabetic individuals. A person with diabetes is also more prone to developing cognitive impairments, and aerobic exercise has been found to reduce glucose uptake by the parts of the brain that may be affected, which helps preserve cognitive function.

Elevated glucose levels make individuals more likely to suffer from flexibility loss, related to glycation. Therefore, those with type 2 diabetes would benefit from participation in a routine stretching program. Stability training is important for preventing falls resulting from poor balance and ambulatory dysfunction due to peripheral neuropathy or hypoglycemia.

Working out is not without risk! For those with a more sedentary lifestyle, starting exercise at higher intensities is not advised.

A few risks of exercising with diabetes:
- Exercise-induced hypoglycemia may occur in those on insulin or insulin secretagogues.
- Exercise may require adjusted doses of these pharmaceutical treatments or increased carbohydrate intake prior to workouts.
- Although less common, short bouts of high intensity exercise may induce hyperglycemia. If someone with type 2 diabetes is already hyperglycemic, less vigorous exercise may be more appropriate.

NOTE: If blood glucose level is greater than 300 milligrams per deciliter (mg/dL), one should seek medical attention prior to engaging in any physical activity.

Type 2 diabetes is associated with an increased risk of heat-related illness during exercise, particularly in hotter climates or in absence of sufficient hydration. Inadequate blood flow and sweat production increase body temperature and pulse. Other chronic health conditions and medications to lower blood glucose levels may also contribute to heat stress. Hence, individuals with type 2 diabetes should be cautious when working out in the heat.

Workout timing with respect to one’s meal schedule should be considered, particularly because performing physical activity after eating will lower blood glucose levels more than exercising on an empty stomach.

NOTE: Fasting exercise has been associated with hyperglycemia in some studies.

Reactions to exercise will vary depending on multiple factors, including diet, medications, mode of exercise and duration of a workout. Those beginning an exercise program should be monitored and may require some “trial and error” to determine the ideal time to engage in physical activity.

To conclude, individuals with type 2 diabetes would most likely have improved health outcomes, if routine exercise is incorporated into a person's lifestyles. The safest way to initiate this is to discuss what would be appropriate with an endocrinologist, primary care physician or other certified diabetes specialist monitoring the results.

Next Steps:
* Seek advice from an endocrinologist, primary care physician and/or certified diabetes specialist for new exercise routines.
* Go slowly in the advance of types, amounts and duration of activities.
* Monitor blood glucose levels.
* Use this helpful download.

Important to remember!
* If blood glucose level is greater than 300 milligrams per deciliter (mg/dL), one should seek medical attention prior to engaging in any physical activity.
* Fasting exercise has been associated with hyperglycemia in some studies.