If you've recently been diagnosed with type 2 diabetes, your doctor has likely told you that you'll need to make some lifestyle changes. Chiefly among these is adopting a new diet that carefully limits sugar consumption. However, regular exercise can also play a vital role in keeping your blood sugar levels in a safe zone.
In this article, we'll discuss how exercise improves blood sugar processing in the body and which exercise programs might be ideal for people with diabetes.
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When you have type 2 diabetes, your body can't process insulin as well as it should. Since insulin is responsible for regulating glucose uptake, your body has more blood sugar than it should. Medicines such as metformin can help increase insulin sensitivity, meaning your body cells will better use insulin to pick up glucose from your bloodstream.
If that doesn't work, insulin injections may be required to make up for what your body isn't processing.
However, physical exercise can also significantly benefit blood sugar levels through several mechanisms. Consequently, you will reduce medication dependence and the risk of health-related complications.
The American College of Sports Medicine and the American Diabetes Association worked to create an extensive overview¹ of how physical exercise impacts those with type 2 diabetes. Here are some acute and chronic effects of physical activity on the health of people with type 2 diabetes:
As your muscles work during physical activity, they increase glucose uptake to get the energy they need. This is possible because exercise activates non-insulin-dependent molecular pathways. This mechanism is essential since insulin release is decreased during exercise.
Because your body needs glucose for fuel, it produces its own when you begin to work out, releasing it into the bloodstream. As we'll discuss later, it's relevant to be aware that your glucose levels may increase during exercise.
With prolonged physical activity, your body won't be able to keep up with the glucose production needs, causing an increase in energy production from fat and protein.
Although insulin action during exercise might not be as efficient in type 2 diabetics, exercise does increase insulin sensitivity acutely. The effects of exercise on your body's ability to use insulin can last from 2 to 72 hours. Many of the benefits of physical exercise for type 2 diabetics come from this improvement in insulin processing in the long term.
In both obesity and type 2 diabetes, it's common for the liver to have increased fat content. This excess fat has a detrimental effect on the liver's ability to process insulin. Exercise can help reduce weight and shed some of that fat content from the liver, boosting your body's ability to process insulin.
But don't worry if you don't notice the pounds dropping from your exercise efforts. Even when there's no visible weight loss in the body, the fat content may have been reduced in the liver.
Although not directly related to type 2 diabetes, high blood pressure afflicts many people with the condition. If your diabetes is accompanied by hypertension, regular exercise may positively affect systolic blood pressure.
Like high blood pressure, depression is more common among people with type 2 diabetes. Exercise can help to alleviate those symptoms as well. The effects of exercise on improving depressive symptoms were found to be substantial in both short and long-term exercise programs. The effects of exercise on depression for those working out to manage illnesses were stronger in those with fewer existing complications.
Most people with type 2 diabetes are not physically active. As exercise aids the body in controlling blood sugar levels naturally and reduces dependence on medication, it consequently decreases the appearance of complications, such as heart and kidney diseases, nerve damage, and other problems with feet, oral health, and vision.
During their position statement, the American College of Sports Medicine and the American Diabetes Association examined several studies about the effects of exercise on the prevention of type 2 diabetes.
One study showed that 20 minutes of mild or moderate exercise per day could decrease the risk of type 2 diabetes by 46%. Among middle-aged and overweight individuals, another study found a reduction in diabetes incidence of 58%.
Several types of exercise can benefit those with type 2 diabetes. The most important thing is that you get more active and create situations where your muscles need to burn glucose. This is typically achieved through either aerobic-style exercise or a resistance training program.
However, other exercise types, such as yoga and tai chi, have also been studied for their effects on diabetes. Let's take a look at each exercise and see what the science says about them:
The most commonly recommended type of exercise for those with type 2 diabetes is aerobics. After just one week of moderate to vigorous-intensity aerobic training, insulin sensitivity improves throughout the body.
Aerobic exercise also comes in several forms, making it easy for almost anyone to find a method they can enjoy and stick with. Some common forms of aerobic exercise are listed below.
Swimming - For those who enjoy the water, swimming is an excellent way to get aerobic exercise. The activity is the fourth most popular sports activity in the country. Because people report² greater enjoyment from exercising in water than on land, swimming might also be an easier exercise to stick with.
Cycling - Riding a bike or a stationary cycle is also a great way to get aerobic exercise and build muscle mass in your lower body. Cycling is a versatile hobby. There are bikes for those who like riding in the city or enjoy rougher terrain. Remember to ride safely and wear a helmet if you choose to cycle.
Walking - You might not have access to water to swim in or have a bicycle to ride, but anyone who can walk can get in a great workout by doing so. Remember to walk briskly to keep your heart rate up and achieve a suitable exercise intensity. However, if you can't walk briskly in the beginning, feel free to take your time and build up to it. The important part is that you get moving.
Dancing - Another fun way to get your heart rate up is dancing. Almost everyone enjoys dancing along to their favorite music. You take formal dance classes, and as long as they're high-energy, you'll get a good workout. If you're too shy to dance in public, it's easy to just turn on a playlist of fast songs and move in the privacy of your home.
Resistance training, or weightlifting, is another way to improve insulin action and control blood sugar. A study observed that twice-weekly resistance training improves insulin action by 56% and reduces blood sugar by over 7%.
Participants in that study showed a significant loss in visceral fat, which includes liver fat. In addition, by increasing muscle mass, more glucose is uptaken up to produce energy. This doesn't mean you need to try and look like a bodybuilder. Even modest increases in muscle mass will provide benefits.
Lower intensity forms of exercise are becoming more popular for their health benefits. Exercise modalities such as yoga and tai chi can improve flexibility, balance, and joint health. But what is their effect on blood glucose in diabetes patients?
Tai chi - This ancient Chinese art is about slow, controlled movements. According to the CDC,³ tai chi helps improve many common conditions, especially those aging-related. For type 2 diabetes, some studies have shown it to be beneficial in lowering fasting blood glucose levels, but not as much as aerobic activity.
Yoga - This ancient Indian practice has become a popular pastime due to its calming effect and benefits to flexibility and balance. Like tai chi, yoga has been shown⁴ to promote health benefits. Some studies have demonstrated it to be as effective at lowering blood glucose as other forms of physical activity. Nevertheless, researchers caution about concluding those studies due to study design problems such as low sample size.
As you can see, physical exercise can play an essential role in helping you manage your type 2 diabetes. However, like anything, you must do it correctly to benefit from it.
Thankfully, we have some guidelines to follow depending on the exercise routine you've decided to undertake. By following the recommendations below, you can be sure you're getting the best results.
Type - We've already seen a list of some of the common forms of aerobic exercise. But any activity that causes a sustained increase in heart rate and uses one or more of the body's large muscle groups is likely to have a positive benefit on blood glucose levels. What's important is finding an activity that you're most likely to stick with.
Frequency - In general, aerobic exercise should be performed at least three times per week.
Intensity - You don't need to go all out and exercise like you're training for the Olympics. Moderately intensive exercise is enough to see benefits in blood glucose. The lower end of this scale is a brisk walk. However, more intense exercise can increase the benefits. So don't be afraid to ramp it up as you gain endurance.
Duration - You need to perform the moderate-intensity exercise for at least 150 minutes per week for maximum benefit. This can include several daily bouts of exercise, but each should last for at least 10 minutes. The bout duration can be reduced if the intensity is increased to vigorous activity.
Type - There isn't much difference in strength and muscle mass gains between machines or free weights, so feel free to choose whichever you prefer.
Frequency - Due to its impact on the muscles, resistance training should be performed on non-consecutive days. Ideally, this will be three times per week. However, benefits can be achieved from two days per week of resistance training.
Duration - Rather than measure session duration in minutes, you should aim for several exercises, sets, and repetitions. Recommendations are for 5-10 movements covering the major muscle groups and 2-4 sets of 10-15 reps per exercise.
Progression - Without progression, you'll see minimal results from resistance training. Your 10-15 reps should always end with fatigue. When you can lift that much weight, add a little until the number of reps you can do goes back down. Repeat this process as you build strength.
The safety of an exercise program depends on the individual and the program in question. Before starting an exercise program, you should talk to your doctor about what risks might be involved. Individuals with complications from diabetes may be advised to undergo stress testing to ensure that performing the desired exercise can be done safely.
Some complications of diabetes may carry with them their own risks, but for type 2 diabetes alone, there are two concerns:
Hyperglycemia - As we've discussed, your body produces its own glucose when you exercise. However, this is rare in individuals with type 2 diabetes, and a high blood glucose level typically doesn't require you to postpone your exercise.
Hypoglycemia - Conversely, your body burns glucose as you exercise. If your diabetes is controlled through medication, the timing of your medication and workout may need to be adjusted to keep blood sugar levels in acceptable ranges.
Although most exercises are safe for people with diabetes, some complications may make strenuous exercise dangerous. As advised earlier, consult with your doctor before beginning an exercise program. If they tell you to avoid strenuous exercise, you should avoid weightlifting with heavy weights or vigorous aerobic activity.
Aerobic exercise is the most commonly recommended intervention for dealing with type 2 diabetes. The most important thing isn't the exercise you choose, but that you get moving and become more active than you have been. You can increase the intensity once you've developed the habit of moving.
There's no specific recommendation for an ideal time to exercise in the statement put out by the American Diabetes Association.
However, if you are on medication to control your type 2 diabetes, you may need to monitor your blood sugar before and after exercise and time your workouts and medication, so they don't interfere with one another.
Diet and exercise are two of the most important interventions to control type 2 diabetes without medication. Although monitoring your sugar intake is essential in diabetes management, a diet that helps you lose weight combined with moderate to intense exercise is the best strategy for lowering your blood sugar and reducing the risk of complications from type 2 diabetes.