The Role of Exercise in Diabetes

Exercise is a key component to lifestyle therapy for prevention and treatment of diabetes. These recommendations are based on positive associations between physical activity and type 2 diabetes (T2D) prevention, treatment, and disease-associated morbidity and mortality. For type 1 diabetes (T1D), there is evidence to support that exercise can reduce diabetes-associated complications. However, there are physiological and behavioral barriers to exercise that people with both T2D and T1D must overcome to achieve these benefits. Physiological barriers include diabetes-mediated impairment in functional exercise capacity, increased rates of perceived exertion at lower workloads, and decision-making regarding glycemic management. There are additional social and psychological stressors, including depression and reduced self-efficacy. Interestingly, there is variability in the response to exercise by sex, genetics, and environment, further complicating the expectations for individual benefit from physical activity. Defining the optimal dose, duration, timing, and type of exercise remains uncertain for achieving individual health benefits from physical activity. In this chapter, we will discuss the preventative value of exercise for T2D development, the therapeutic impact of exercise on diabetes metabolic and cardiovascular outcomes, the barriers to exercise, including hypoglycemia, and the impact of sex and gender on cardiorespiratory fitness and adaptive training response in people with and without diabetes. There are still many unknowns regarding the diabetes-mediated impairment in cardiorespiratory fitness, the variability and individual response to exercise training, and the impact of sex and gender. However, there is no debate that exercise provides a health benefit for people with and at risk for diabetes. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.