To reduce their cardiovascular risk, people with type 2 diabetes should do at least two-and-a-half hours per week of moderate-intensity or one-and-a-half hours per week of vigorous-intensity aerobic exercises, plus some weight training, according to an American Heart Association scientific statement published in Circulation: Journal of the American Heart Association.
The global increase in overweight and obesity has led to an “unprecedented epidemic” in type 2 diabetes (when the body is unable to use insulin efficiently to help turn glucose, or blood sugar, into energy for the body’s cells). In 2007, type 2 diabetes in the United States cost an estimated $174 billion in direct medical costs and indirect costs such as disability, lost productivity and premature death. That amount represents a 30 percent increase from the $132 billion estimated in 2002, according to the statement.
Furthermore, heart and blood vessel disease is responsible for nearly 70 percent of deaths in people with type 2 diabetes.
“Given the observed increases in type 2 diabetes in adults over the last few decades in developed countries, and the increasing numbers of overweight and obese individuals throughout the world, we must look at ways to reduce the cardiovascular complications of diabetes, and exercise is one of those ways,” said Thomas H. Marwick, M.D., Ph.D., chair of the writing group and professor of medicine and director of the Centre of Clinical Research Excellence in Cardiovascular and Metabolic Disease at the University of Queensland School of Medicine in Brisbane, Australia.
Diet and exercise can prevent or slow the development of type 2 diabetes and produce clinically significant improvements in blood sugar control and cardiovascular risk factors in people with the condition, according to the statement. This benefit can reduce or eliminate some patients’ needs for medications to control risk factors.
The statement emphasizes the importance of exercise advice in the primary care environment. Patients are encouraged to work with their health care provider to establish an exercise regimen — basically, getting a prescription for exercise. Exercise, for the purpose of this statement, is defined as planned and structured activity that is aimed at improving cardiovascular health and metabolic control.
Physicians, physician assistants, nurses, diabetes counsellors and other health care providers are the most logical professionals to give advice about physical activity and should do so during every encounter with patients who have type 2 diabetes.
- To improve cardiovascular risk, type 2 diabetes patients should get at least 150 minutes per week of moderate-intensity exercise or 90 min/week of vigorous-intensity exercise, or some combination of the two.
- Patients should exercise on at least three non-consecutive days each week to maximize benefits. Individual sessions should be at least 10 minutes each or longer.
- Resistance training should be encouraged, and should be moderate- to high-intensity — 2–4 sets of 8–10 repetitions at a weight that can’t be lifted more than 8–10 times, with 1–2-minute rest periods between sets.
- Exercise counseling is needed to assess and adjust levels of physical activity and provide motivation and support. Telephone counseling is economical, practical and effective.
Co-authors of the statement are: Matthew D. Hordern, Ph.D.; Todd Miller, M.D.; Deborah A. Chyun, R.N., Ph.D.; Alain G. Bertoni, M.D., M.P.H.; Roger S. Blumenthal, M.D.; George Philippides, M.D.; and Albert Rocchini, M.D. Author disclosures are available on the manuscript.
- Bertoni, Roger S. Blumenthal, George Philippides, Albert Rocchini, on behalf of the Thomas H. Marwick, Matthew D. Hordern, Todd Miller, Deborah A. Chyun, Alain G. A Scientific Statement From the American Heart Association Exercise Training for Type 2 Diabetes Mellitus. Impact on Cardiovascular Risk. Circulation, Online Jun 8, 2009 DOI: 10.1161/CIRCULATIONAHA.109.192521
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