The Role of Physical Activity in Diabetes Management: Benefits, Risks, and Recommendations - review
DOI:
https://doi.org/10.12775/QS.2025.40.59722Keywords
Physical activity, Diabetes type 2, Hb1Ac Levels, Hypoglycemia, Aerobic exercise, Resistance trainingAbstract
Regular physical activity plays a key role in managing type 1 (T1D) and type 2 diabetes (T2D), improving insulin sensitivity, glycemic control, and metabolic health. Exercise helps maintain a healthy body weight, reduces the risk of cardiovascular diseases, and enhances mental well-being. For individuals with T2D, physical activity decreases insulin resistance, while for those with T1D, it increases the risk of hypoglycemia, requiring adjustments in insulin doses and carbohydrate intake. Continuous glucose monitoring (CGM) systems facilitate the detection of hypoglycemia, especially at night. A combination of aerobic and resistance training
is recommended for optimal glycemic control and HbA1c reduction. In individuals at risk of T2D, such as those with prediabetes, regular exercise can delay or prevent disease onset. Tailored exercise programs and education on glucose management are essential for safe and effective implementation. Future research should focus on individualized exercise plans and long-term effects of physical activity on diabetes progression and complications. In conclusion, integrating regular physical activity into diabetes management significantly improves health outcomes and quality of life for patients with T1D and T2D, though challenges like hypoglycemia must be carefully managed.
References
1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, Pavkov ME, Ramachandaran A, Wild SH, James S, Herman WH, Zhang P, Bommer C, Kuo S, Boyko EJ, Magliano DJ. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022 Jan;183:109119. doi: 10.1016/j.diabres.2021.109119. Epub 2021 Dec 6. Erratum in: Diabetes Res Clin Pract. 2023 Oct;204:110945. doi: 10.1016/j.diabres.2023.110945. PMID: 34879977; PMCID: PMC11057359.
2. Tiinamaija Tuomi; Type 1 and Type 2 Diabetes: What Do They Have in Common?. Diabetes 1 December 2005; 54 (suppl_2): S40–S45.
3. Pouya Saeedi, Inga Petersohn, Paraskevi Salpea, Belma Malanda, Suvi Karuranga, Nigel Unwin, Stephen Colagiuri, Leonor Guariguata, Ayesha A. Motala, Katherine Ogurtsova, Jonathan E. Shaw, Dominic Bright, Rhys Williams, On behalf of the IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.
4. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014 Jan 4;383(9911):69-82. doi: 10.1016/S0140-6736(13)60591-7. Epub 2013 Jul 26. PMID: 23890997; PMCID: PMC4380133.
5. Shugart C, Jackson J, Fields KB. Diabetes in Sports. Sports Health. 2010;2(1):29-38. doi:10.1177/1941738109347974.
6. Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, Myers V, Nauta M, Rodarte RQ, Sparks L, Thompson A, Earnest CP. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010 Nov 24;304(20):2253-62. doi: 10.1001/jama.2010.1710. Erratum in: JAMA. 2011 Mar 2;305(9):892. PMID: 21098771; PMCID: PMC3174102.
7. Hordern MD, Dunstan DW, Prins JB, Baker MK, Singh MA, Coombes JS. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. J Sci Med Sport. 2012 Jan;15(1):25-31. doi: 10.1016/j.jsams.2011.04.005. Epub 2011 May 28. PMID: 21621458.
8. Yurkewicz M, Cordas M Jr, Zellers A, Sweger M. Diabetes and Sports: Managing Your Athlete With Type 1 Diabetes. Am J Lifestyle Med. 2016 Jul 8;11(1):58-63. doi: 10.1177/1559827615583648. PMID: 30202314; PMCID: PMC6124849.
9. Katherine E. Iscoe, Matthew Corcoran, Michael C. Riddell. High Rates of Nocturnal Hypoglycemia in a Unique Sports Camp for Athletes with Type 1 Diabetes: Lessons Learned from Continuous Glucose Monitoring Systems. Canadian Journal of Diabetes. 2008;32(3):182-189.
10. Nadella S, Indyk JA, Kamboj MK. Management of diabetes mellitus in children and adolescents: engaging in physical activity. Transl Pediatr. 2017 Jul;6(3):215-224. doi: 10.21037/tp.2017.05.01. PMID: 28795013; PMCID: PMC5532192.
11. Hamasaki H. Daily physical activity and type 2 diabetes: A review. World J Diabetes. 2016 Jun 25;7(12):243-51. doi: 10.4239/wjd.v7.i12.243. PMID: 27350847; PMCID: PMC4914832.
12. Charles D, Sabouret P, Moll A, Plisson M, Nasir K, Biondi-Zoccai G, Gulati M, Bhatt DL, Fysekidis M. The relationship between mortality and daily number of steps in type 2 diabetes. Panminerva Med. 2023 Sep;65(3):335-342. doi: 10.23736/S0031-0808.22.04732-2. Epub 2022 May 30. PMID: 35638241.
13. Balducci, S., et al. (2012). Effect of an Intensive Exercise Intervention Strategy on Modifiable Cardiovascular Risk Factors in Subjects with Type 2 Diabetes Mellitus: A Randomized Controlled Trial. Archives of Internal Medicine, 172(5), 414-424.
14. Lazarevic G, Antic S, Vlahovic P, Djordjevic V, Zvezdanovic L, Stefanovic V. Effects of aerobic exercise on microalbuminuria and enzymuria in type 2 diabetic patients. Ren Fail. 2007;29(2):199-205. doi: 10.1080/08860220601098870. PMID: 17365936.
15. Reddy R, Wittenberg A, Castle JR, El Youssef J, Winters-Stone K, Gillingham M, Jacobs PG. Effect of Aerobic and Resistance Exercise on Glycemic Control in Adults With Type 1 Diabetes. Can J Diabetes. 2019 Aug;43(6):406-414.e1. doi: 10.1016/j.jcjd.2018.08.193. Epub 2018 Aug 30. PMID: 30414785; PMCID: PMC6591112.
16. Yan X, Han X, Wu C, Shang X, Zhang L, He M. Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study. PLoS One. 2021 Jan 14;16(1):e0239214. doi: 10.1371/journal.pone.0239214. PMID: 33444338; PMCID: PMC7808642.
17. Sheri R. Colberg, Ronald J. Sigal, Jane E. Yardley, Michael C. Riddell, David W. Dunstan, Paddy C. Dempsey, Edward S. Horton, Kristin Castorino, Deborah F. Tate; Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 1 November 2016; 39 (11): 2065–2079. https://doi.org/10.2337/dc16-1728
18. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B; American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010 Dec;33(12):e147-67. doi: 10.2337/dc10-9990. PMID: 21115758; PMCID: PMC2992225.
19. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec;25 Suppl 3:1-72. doi: 10.1111/sms.12581. PMID: 26606383.
20. Messina G, Alioto A, Parisi MC, Mingrino O, Di Corrado D, Crescimanno C, Kuliś S, Nese Sahin F, Padua E, Canzone A, Francavilla VC. Experimental study on physical exercise in diabetes: pathophysiology and therapeutic effects. Eur J Transl Myol. 2023 Oct 10;33(4):11560. doi: 10.4081/ejtm.2023.11560. PMID: 37817671; PMCID: PMC10811642.
21. Benham JL, Booth JE, Dunbar MJ, Doucette S, Boulé NG, Kenny GP, Prud'homme D, Sigal RJ. Significant Dose-Response between Exercise Adherence and Hemoglobin A1c Change. Med Sci Sports Exerc. 2020 Sep;52(9):1960-1965. doi: 10.1249/MSS.0000000000002339. PMID: 32175973.
22. Kulzer B, Freckmann G, Ziegler R, Schnell O, Glatzer T, Heinemann L. Nocturnal Hypoglycemia in the Era of Continuous Glucose Monitoring. Journal of Diabetes Science and Technology. 2024;18(5):1052-1060. doi:10.1177/1932296824126782.
23. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011 May 4;305(17):1790-9. doi: 10.1001/jama.2011.576. PMID: 21540423.American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S62-9. doi: 10.2337/dc10-S062. Erratum in: Diabetes Care. 2010 Apr;33(4):e57. PMID: 20042775; PMCID: PMC2797383.
24. Massimo F Piepoli, Arno W Hoes, Stefan Agewall, Christian Albus, Carlos Brotons, Alberico L Catapano, Marie-Therese Cooney, Ugo Corrà, Bernard Cosyns, Christi Deaton, Ian Graham, Michael Stephen Hall, F D Richard Hobbs, Maja-Lisa Løchen, Herbert Löllgen, Pedro Marques-Vidal, Joep Perk, Eva Prescott, Josep Redon, Dimitrios J Richter, Naveed Sattar, Yvo Smulders, Monica Tiberi, H Bart van der Worp, Ineke van Dis, W M Monique Verschuren, Simone Binno, ESC Scientific Document Group , 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)
Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Heart Journal, Volume 37, Issue 29, 1 August 2016, Pages 2315–2381, https://doi.org/10.1093/eurheartj/ehw106
25. Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of Diabetes 2017. J Diabetes Res. 2018 Mar 11;2018:3086167. doi: 10.1155/2018/3086167. PMID: 29713648; PMCID: PMC5866895.
26. Fagour C, Gonzalez C, Pezzino S, Florenty S, Rosette-Narece M, Gin H, Rigalleau V. Low physical activity in patients with type 2 diabetes: the role of obesity. Diabetes Metab. 2013 Feb;39(1):85-7. doi: 10.1016/j.diabet.2012.09.003. Epub 2012 Nov 14. PMID: 23159129.
27. Yardley JE, Hay J, Abou-Setta AM, Marks SD, McGavock J. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014 Dec;106(3):393-400. doi: 10.1016/j.diabres.2014.09.038. Epub 2014 Oct 7. PMID: 25451913.
28. Gurneet Brar, Sean Carmody, Alistair Lumb, Andrew Shafik, Chris Bright, Robert C. Andrews. Practical considerations for continuous glucose monitoring in elite athletes with type 1 diabetes mellitus: A narrative review. The Journal of Physiology. 2024;602(10):2169-2177. doi:10.1113/JP285836.
29. Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World J Diabetes. 2015;6(6):850-867. doi:10.4239/wjd.v6.i6.850. PMID: 26131326.
30. Trojian, Thomas MD; Colberg, Sheri PhD; Harris, George MD; Oh, Robert MD; Dixit, Sameer MD; Gibson, Margaret MD; Corcoran, Matthew MD; Ramey, Lindsay MD; Berg, Philip V. MS. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clinical Journal of Sport Medicine. 2022;32(1):8-20. doi:10.1097/JSM.0000000000000906.
31. Kolka C. Treating Diabetes with Exercise - Focus on the Microvasculature. J Diabetes Metab. 2013 Nov 16;4:308. PMID: 24772374; PMCID: PMC4000229.
32. Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015 Jul;30(7):529-42. doi: 10.1007/s10654-015-0056-z. Epub 2015 Jun 20. PMID: 26092138.
33. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID: 11832527; PMCID: PMC1370926.
34. Ywh-Min Tzou, Sarah K. Bailey, Kaiyu Yuan, Ronald Shin, Wei Zhang, Yabing Chen, Raj K. Singh, Lalita A. Shevde, N. Rama Krishna, Identification of initial leads directed at the calmodulin-binding region on the Src-SH2 domain that exhibit anti-proliferation activity against pancreatic cancer,Bioorganic & Medicinal Chemistry Letters,Volume 26, Issue 4,2016,Pages 1237-1244,ISSN 0960-894X, https://doi.org/10.1016/j.bmcl.2016.01.027.
35. Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017 May;5(5):377-390. doi: 10.1016/S2213-8587(17)30014-1. Epub 2017 Jan 24. Erratum in: Lancet Diabetes Endocrinol. 2017 May;5(5):e3. doi: 10.1016/S2213-8587(17)30086-4. PMID: 28126459.
36. Smith, A.D., Crippa, A., Woodcock, J. et al. Physical activity and incident type 2 diabetes mellitus: a systematic review and dose–response meta-analysis of prospective cohort studies. Diabetologia 59, 2527–2545 (2016).
37. Sparks LM. Exercise training response heterogeneity: physiological and molecular insights. Diabetologia. 2017 Dec;60(12):2329-2336. doi: 10.1007/s00125-017-4461-6. Epub 2017 Oct 14. PMID: 29032385.
38. Zimmet, P., Alberti, K., Magliano, D. et al. Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nat Rev Endocrinol 12, 616–622 (2016). https://doi.org/10.1038/nrendo.2016.105
39. Hawley JA, Hargreaves M, Joyner MJ, Zierath JR. Integrative biology of exercise. Cell. 2014 Nov 6;159(4):738-49. doi: 10.1016/j.cell.2014.10.029. PMID: 25417152.
40. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA. 2017;317(4):371–378. doi:10.1001/jama.2016.19975
41. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future Kahn, Steven E et al.,The Lancet, Volume 383, Issue 9922, 1068 – 1083
42. Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016 Jun;4(6):537-47. doi: 10.1016/S2213-8587(16)30010-9. Epub 2016 May 4. PMID: 27156051
43. Diabetes Canada Clinical Practice Guidelines Expert Committee; Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes. 2018 Apr;42 Suppl 1:S54-S63. doi: 10.1016/j.jcjd.2017.10.008. PMID: 29650112.
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