Physical activity and exercise in the management of type 2 diabetes: where to start?

Physical activity is a fundamental therapeutic aid in the management of type 2 diabetes (T2D). Regular engagement elicits a plethora of adaptations which leads to improvements in clinical outcomes, such as HbA1c, lipids and blood pressure as well as whole body health and physical function benefits. Those with T2D are encouraged to engage in a minimum of 150 minutes/week of moderate-intensity physical activity (or 75 minutes/week of vigorous activity). Current recommendations also suggest that this should be supplemented with two-to-three resistance, flexibility and/or balance training sessions/week. The latter is particularly encouraged for older individuals or those with limited mobility/poor physical function. Those with T2D are also encouraged to break up prolonged bouts of sitting.

However, a large proportion of the general population do not meet current physical activity guidelines, with the figure even lower in those with T2D. Getting started and sustaining a physically active lifestyle is challenging. Therefore, this article aims to provide health care professionals with the information required to tailor guidance to individuals with T2D by: presenting an overview of current guidelines, terminology and benefits; discussing the risk of adverse events; precautions when exercising with complications; practical options for getting started and how to tailor advice in primary care.

Where appropriate, individual preferences and motivations should inform decision making regarding exercise modality in order to maximise compliance. That said, the overarching message is that any physical activity is better that none, but more is better especially when combined with a reduction in sitting.