Exercise Patterns – Diabetes Daily

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We all know that exercise confers tremendous health benefits on everyone, and people with diabetes are no exception. As part of our first-ever data-driven journalism effort, we asked the question:

Are people who achieve optimal A1c levels more likely to engage in exercise on a regular basis? 

Hundreds of survey participants with type 1 and type 2 diabetes responded to detailed questions about their exercise patterns. After collecting the data, we analyzed the differences in the proportion of people who engage in regular exercise among those who reported an A1c of <6.5% as compared to those with a reported A1c of >8%. Here is what we found:

Exercise Habits and A1c: Type 1 Diabetes

The survey results revealed that those with lower self-reported A1c levels were more likely to report exercising at least 4 times per week as compared to those with higher A1c levels among those with type 1 diabetes. Those with a higher A1c level were significantly more likely to report very low exercise frequencies (less than once per week). There were no significant differences in the proportion of people who reported exercising 1-3 times per week between the two A1c groups.

Self-reported exercise habits among patients with type 1 diabetes. Those with lower self-reported A1c levels (<6.5%) are significantly more likely to report exercising more frequently that those with higher (>8%) A1c levels.

Exercise Habits and A1c: Type 2 Diabetes

Among patients with type 2 diabetes, a similar trend was observed as for those with type 1 diabetes. Those with lower self-reported A1c levels were more likely to report exercising at least 4 times per week as compared to those with higher A1c levels, while there were no significant differences in the proportion of people who reported exercising 1-3 times per week between the two groups. Those with a higher self-reported A1c level were significantly more likely to report very low exercise frequencies (less than once per week).

Self-reported exercise habits among patients with type 2 diabetes. Those with lower self-reported A1c levels (<6.5%) are significantly more likely to report exercising more frequently that those with higher (>8%) A1c levels.

Discussion

Exercise is known to improve insulin sensitivity in healthy people, as well as in those with type 1 and type 2 diabetes. In fact, regular physical activity is a clinically-accepted strategy in improving the health of children and adults with diabetes, and has been demonstrated as effective in helping to optimize glycemic management. Our survey results are consistent with this knowledge, and underscore exercise as an important tenet of health for people with diabetes.

Although we cannot infer a causal relationship between exercise patterns and glycemic management in this analysis, it can be hypothesized that the association of regular exercise with more optimal diabetes control may be directly related, as improved glycemic control, likely as a direct result of improved insulin sensitivity, is well-documented in the scientific literature. As per the 2018 American Diabetes Association (ADA) consensus statement:

Children and adolescents with type 1 or type 2 diabetes or prediabetes should engage in 60 min/day or more of moderate- or vigorous-intensity aerobic activity, with vigorous muscle-strengthening and bone-strengthening activities at least 3 days/week.

Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes. 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.

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.

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.

It is important to consult with your healthcare team prior to beginning a new exercise program or changing your exercise habits. Blood glucose-lowering medications, like insulin, will likely need to be adjusted and hypoglycemia during exercise may be of particular concern for patients with type 1 diabetes.

Do you use exercise as part of your diabetes management strategy? Please share your thoughts in the comments below.

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