4.0.0.0 Phys­i­cal Ac­tiv­i­ty

4.1.0.0 Overview

Phys­i­cal ac­tiv­i­ty is a gen­er­al term that in­cludes all move­ment that in­creases en­er­gy use and is an im­por­tant part of the di­a­betes man­age­ment plan. Ex­er­cise is a more specific form of phys­i­cal ac­tiv­i­ty that is struc­tured and de­signed to im­prove phys­i­cal fitness. Both phys­i­cal ac­tiv­i­ty and ex­er­cise are im­por­tant.

Ex­er­cise has been shown to im­prove blood glu­cose con­trol, re­duce car­dio­vas­cu­lar risk fac­tors, con­tribute to weight loss, and im­prove well-‍being (133). Phys­i­cal ac­tiv­i­ty is as im­por­tant for those with type 1 di­a­betes as it is for the gen­er­al pop­u­la­tion, but its specific role in the pre­ven­tion of di­a­betes com­pli­ca­tions and the man­age­ment of blood glu­cose is not as clear as it is for those with type 2 di­a­betes. A re­cent study sug­gest­ed that the per­cent­age of peo­ple with di­a­betes who achieved the rec­om­mend­ed ex­er­cise level per week (150 min) var­ied by race. Ob­jec­tive mea­sure­ment by ac­celerom­e­ter showed that 44.2%, 42.6%, and 65.1% of whites, African Amer­i­cans, and His­pan­ics, re­spectively, met the thresh­old (134). It is im­por­tant for di­a­betes care man­age­ment teams to un­der­stand the difficulty that many pa­tients have reach­ing rec­om­mend­ed treat­ment tar­gets and to iden­ti­fy in­di­vid­u­alized ap­proaches to im­prove goal achieve­ment.

Mod­er­ate to high vol­umes of aer­o­bic ac­tiv­i­ty are as­so­ci­at­ed with sub­stan­tial­ly lower car­dio­vas­cu­lar and over­all mor­tal­i­ty risks in both type 1 and type 2 di­a­betes (135). A re­cent prospec­tive ob­ser­va­tion­al study of adults with type 1 di­a­betes sug­gest­ed that high­er amounts of phys­i­cal ac­tiv­i­ty led to re­duced car­dio­vas­cu­lar mor­tal­i­ty after a mean fol­low-‍up time of 11.4 years for pa­tients with and with­out chron­ic kid­ney dis­ease (136). Ad­di­tion­al­ly, struc­tured ex­er­cise in­ter­ven­tions of at least 8 weeks’ du­ra­tion have been shown to lower A1C by an av­er­age of 0.66% in peo­ple with type 2 di­a­betes, even with­out a sig­nif­i­cant change in BMI (137). There are also con­sid­erable data for the health benefits (e.g., in­creased car­dio­vas­cu­lar fitness, greater mus­cle strength, im­proved in­sulin sen­si­tiv­i­ty, etc.) of reg­u­lar ex­er­cise for those with type 1 di­a­betes (138). A re­cent study sug­gest­ed that ex­er­cise train­ing in type 1 di­a­betes may also im­prove sev­er­al im­por­tant mark­ers such as triglyc­eride level, LDL, waist cir­cum­fer­ence, and body mass (139). High­er lev­els of ex­er­cise in­ten­si­ty are as­so­ci­at­ed with greater im­provements in A1C and in fitness (140). Other benefits in­clude slow­ing the de­cline in mo­bil­i­ty among over­weight pa­tients with di­a­betes (141). The ADA po­si­tion state­ment “Phys­i­cal Ac­tiv­i­ty/Ex­er­cise and Di­a­betes” re­views the ev­i­dence for the benefits of ex­er­cise in peo­ple with type 1 and type 2 di­a­betes and of­fers specific rec­om­men­da­tion (142).