4.5.0.0 Phys­i­cal Ac­tiv­i­ty and Glycemic Con­trol

Clin­i­cal tri­als have pro­vided strong ev­i­dence for the A1C-‍low­er­ing value of re­sis­tance train­ing in older adults with type 2 di­a­betes (154) and for an ad­di­tive benefit of com­bined aer­o­bic and re­sis­tance ex­er­cise in adults with type 2 di­a­betes (155). If not contrain­di­cated, pa­tients with type 2 di­a­betes should be en­cour­aged to do at least two week­ly ses­sions of re­sis­tance ex­er­cise (ex­er­cise with free weights or weight ma­chines), with each ses­sion con­sist­ing of at least one set (group of con­sec­u­tive repet­i­tive ex­er­cise mo­tions) of five or more dif­fer­ent re­sis­tance ex­er­cises in­volv­ing the large mus­cle groups (154).

For type 1 di­a­betes, al­though ex­er­cise in gen­er­al is as­so­ci­at­ed with im­provement in dis­ease sta­tus, care needs to be taken in titrat­ing ex­er­cise with re­spect to glycemic man­age­ment. Each in­di­vid­u­al with type 1 di­a­betes has a vari­able glycemic re­sponse to ex­er­cise. This variabil­i­ty should be taken into con­sid­eration when rec­om­mend­ing the type and du­ra­tion of ex­er­cise for a given in­di­vid­u­al (138).

Women with pre­ex­ist­ing di­a­betes, par­tic­u­lar­ly type 2 di­a­betes, and those at risk for or pre­sent­ing with ges­ta­tion­al di­a­betes mel­li­tus should be ad­vised to en­gage in reg­u­lar mod­er­ate phys­i­cal ac­tiv­i­ty prior to and dur­ing their preg­nan­cies as tol­er­at­ed (142).