Type 2 diabetics must have exercise prescriptions, study

Patients with type 2 diabetes should be given exercise “prescriptions” that specify the type, duration, intensity and frequency of workouts, adapted to the individual, according to a new review.

Although exercise improves blood sugar control, insulin sensitivity, blood pressure and cholesterol levels, most people with diabetes do not engage in regular exercise, the authors write.

“Exercise and physical activity can help to control type 2 diabetes,” said lead author Dr. Romeu Mendes of the Public Health Unit, ACES Douro I—Marao e Douro Norte in Vila Real, Portugal.

“There are many successful case-studies of patients who reversed metabolic dysfunction only with lifestyle strategies (exercise plus diet),” but the benefits disappear when healthy diet and regular exercise stop, he said.

“Diabetes is a chronic disease and must be managed for life,” Mendes said. “Regular exercise and a healthy nutritional pattern are the basis of the treatment.”

The researchers reviewed published recommendations or guidelines for exercise prescriptions for people with type 2 diabetes issued by international scientific organizations in the field of diabetology, endocrinology, cardiology, public health and sports medicine.

They included 11 publications from institutions like the European Association for the Study of Diabetes, American Diabetes Association, Francophone Diabetes Society and Swedish National Institute of Health.

“We were not aware that there were so many scientific organizations issuing specific recommendations for exercise prescription in this population,” Mendes told Reuters Health by email.

The guidelines agreed that people with type 2 diabetes should accumulate at least 150 minutes of moderate to vigorous aerobic exercise per week, spread over at least three days of the week, and also recommend resistance exercise at least twice weekly. Aerobic exercise can include brisk walking, running, cycling, swimming or other activities, and resistance exercise should target large muscle groups with machines or free weights. Some institutions also recommend some flexibility training, Mendes and colleagues reported in the British Journal of Sports Medicine.

“The ultimate and most important variable for people is quality of life,” Mendes said, noting that exercise particularly improves health-related quality of life. Exercise has indisputable life-saving benefits, but there is limited research on the benefits of exercise among people with diabetes, said Huseyin Naci, a health policy researcher at the London School of Economics who was not part of the new review.

“According to our previous research, there is a bias against testing exercise,” Naci told Reuters Health by email. “Medical research increasingly favors drug interventions over strategies to modify lifestyle.”

“The vast majority of patients with type 2 diabetes do not engage in regular exercise,” Mendes said. “This may be explained by insufficient awareness about the potential benefits of exercise and the lack of specific knowledge about current recommendations.”

Advising patients to increase their exercise levels is not enough, he said. Prescriptions should include specific information on the type, mode, duration, intensity and weekly frequency, and the exercise strategies must be adapted for each individual, based on other health conditions, contraindications and realistic personal goals.

“According to the U.S. Centers for Disease Control and Prevention, roughly one third of doctors prescribe exercise in primary care,” Naci said. “This is promising, but more doctors should discuss and give brief advice to their patients about the benefits of exercise and refer patients with diabetes to structured exercise programs.”