Get up and move your body, as often and as vigorously as you can – that's the rallying cry of the American Diabetes Association in a newly updated recommendation (published in Diabetes Care) on physical activity and exercise for people who have diabetes or are at risk for it.

In the interests of reducing daily sedentary time, one of the key recommendations is to intersperse periods of sitting with at least 3 minutes of light physical activity such as walking, leg lifts, torso twists, or overhead arm stretches, every 30 minutes. This is more frequent and more specific than the ADA's previous recommendation, which simply called for physical activity every 90 minutes.

"These updated guidelines are intended to ensure everyone continues to physically move around throughout the day -- at least every 30 minutes -- to improve blood glucose management," said lead author Sheri R. Colberg-Ochs, PhD, consultant and director of physical fitness for the ADA.

"This movement should be in addition to regular exercise, as it is highly recommended for people with diabetes to be active," she said. "Since incorporating more daily physical activity can mean different things to different people with diabetes, these guidelines offer excellent suggestions on what to do, why to do it, and how to do it safely."

The ADA's updated position statement provides practitioners with clinical recommendations based on a comprehensive review of more than 180 research papers regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes.



Recommendations cover key categories of physical activity including aerobic exercise, resistance training, flexibility and balance training, and general lifestyle activity, along with specific intervention parameters, benefits, risk precautions, and safety parameters for adults and youth with each type of diabetes.

The guidelines differentiate between physical activity, which includes all movement that increases energy use, and exercise, which involves planned, structured physical activity and which generally appears to have greater health benefits for people with diabetes.

Physically activity has numerous benefits that include greater insulin sensitivity, muscle strength, cardiovascular health, and improved mood, to name a few, Colberg-Ochs told MedPage Today in an email.

"The big differences from prior recommendations are the possibility of doing high intensity interval training for some adults, balance training for anyone age 40 or older or with neuropathy to lower falls risk, the inclusion of flexibility training for all, and frequent breaks from sedentary behavior," said Colberg-Ochs.

Shifting the main recommendation from movement every 90 minutes to every 30 minutes is based on the latest research in adults with type 2 diabetes, she explained, which showed glycemic benefits from more frequent interruption of sitting or sedentary behaviors. Walking -- even for just 10 minutes -- immediately after meals can help lower post-meal spikes in blood glucose.

At the other end of the activity spectrum, intensive lifestyle intervention with targeted weight loss of at least 7% and at least 175 min/week of unsupervised exercise achieved significantly greater sustained improvements in adults with type 2 diabetes, compared with controls receiving diabetes support and education, in the large randomized LOOK AHEAD trial. Adults with diabetes who wish to perform low-volume, high intensity interval training, which involves short bursts of very intense activity interspersed with longer periods of recovery at low to moderate intensity instead of continuous aerobic activity, should be clinically stable, have been participating at least in regular moderate intensity exercise, and likely be supervised at least initially.

Pregnant women with diabetes of any type should engage in regular physical activity both prior to and during pregnancy, and those at risk for gestational diabetes should aim for 20 to 30 minutes of moderate-intensity exercise on most or all days of the week.

The guidelines provide clinicians and patients with concrete guidance on insulin-dosing and precautions meant to lower the threshold for starting an exercise program and reducing sedentary behavior, Ronald Tamler, MD, of Mount Sinai Clinical Diabetes Institute, New York City, who was not involved with the guidelines, told MedPage Today.

But, he noted, "the fact that only one recommendation got an 'A' rating, structured exercise for more than 150 minutes per week as part of a program leading to 5% to 7% weight loss for diabetes prevention, shows how much work is left [to do] in studying lifestyle intervention in various diabetes populations."

Guideline authors stressed that recommendations and precautions for physical activity and exercise will vary based on a patient's type of diabetes, age, overall health, and the presence of diabetes-related complications – an individualized approach is needed.