Exercise for people with type 2 diabetes (Part 1)

Exercise for people with type 2 diabetes (Part 1)

by Shirley Archer, J.D., M.A.


More than 17 million Americans suffer from diabetes, a metabolic disease in which the body has difficulty converting food into fuel. “People with diabetes have a shortage of insulin or a decreased ability to use insulin, a hormone that allows glucose (sugar) to enter cells and be converted to energy,” explains a publication by the Centers for Disease Control and Prevention (CDC).


One in three people with diabetes, or 5.9 million people, do not know they have the disease, increasing the risk for serious complications. Diabetes can lead to heart disease, stroke, vision loss or eye damage, kidney disease and kidney failure, nerve damage, amputations, frozen shoulder and gum disease. Diabetes also raises the risk threefold of dying from complications related to influenza or pneumonia. In America, diabetes is currently the sixth leading cause of death and a leading cause of blindness and amputations.


Among adults ages 65 and older, diabetes is one of the most common chronic health conditions. Seven million individuals—one in five people in this age group—have the disease, according to the American Diabetes Association (ADA). And the number of recognized new cases among older adults is growing. For instance, in the years 1980–94, new cases among women in this age group rose from 97,000 to 181,000, an increase of 45.7%. Today, about 4.5 million women ages 60-plus have diabetes, with 1.2 million unaware they have the disease.


In addition, approximately one million people are diagnosed with diabetes annually. That number will soar in the coming decades. According to a study by CDC, “[t]he number of Americans with diagnosed diabetes is projected to increase 165%, from 11 million in 2000 (prevalence of 4.0%) to 29 million in 2050 (prevalence of 7.2%).” The largest percent increase will be among people ages 75-plus years. Minority racial and ethnic populations are particularly at risk of developing the disease.


Different types of diabetes

Although several categories of diabetes exist, the disease has two main types. In type 1, or insulin-dependent diabetes mellitus, the body is either completely unable to produce insulin, which controls blood glucose levels, or is able to produce such a tiny amount that insulin injections are necessary. In type 2 diabetes, also known as non-insulin-dependent diabetes mellitus, the body cannot produce enough insulin or the cells cannot absorb the insulin. This results in high levels of glucose remaining in the bloodstream. Type 2 diabetes affects 90–95% of people with the disease, most commonly after age 40, and is linked with unhealthy lifestyle behaviors, such as obesity and physical inactivity. In fact, almost 90% of people with type 2 diabetes are overweight or obese, according to ADA.


This article focuses on exercise program needs for people with type 2 diabetes. Those with type 1 diabetes have specialized needs beyond the scope of this article. References to people with diabetes in this article include only those with the type 2 disease.


What kinds of exercise and why?

Approximately 60% of people with diabetes have hypertension (high blood pressure), according to ADA, while nearly all have one or more lipid abnormalities. Regular exercise helps individuals with diabetes manage these chronic conditions or lessens the likelihood of developing coronary artery disease, hypertension and hyperlipidemia (high cholesterol). “While the management of blood sugar has always been and remains a cornerstone of diabetes care,” says ADA, “diabetes requires a comprehensive program that includes management of blood glucose, management of blood pressure and management of cholesterol.”


Cardiovascular exercise is a key component in helping people with diabetes to manage blood sugar levels and improve the body’s ability to use insulin. This exercise helps maintain healthy blood sugar levels by burning fuels and by helping people to achieve and maintain a healthy weight and body composition. However, improvements in glucose tolerance and insulin sensitivity are usually short-lived, deterioriating within three days of the individual’s last workout. This factor makes regular aerobic exercise vital.


The American College of Sports Medicine’s (ACSM) position stand on exercise and type 2 diabetes cautions that participants in some studies have had no improvement in glucose control from mild to moderate aerobic exercise. In addition, adults ages 55 and older may not show “the same exercise induced blood glucose changes as usually occur in younger counterparts.”


“Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity,” according to ACSM. Resistance training can also increase the resting metabolic rate to assist in weight control.


Although not individually studied in relationship with diabetes, range of motion exercise contributes to an individual’s ease of movement and functional ability. In addition, individuals with diabetes have a much higher likelihood of adhesive capsulitis, more commonly known as frozen shoulder, than the general population. And they are less likely to make a full recovery—even with physical therapy. About 20% of people with type 2 diabetes are affected by frozen shoulder and may face a permanent loss of as much as 50% of shoulder mobility. The first line of treatment for this condition is usually stretching and moving the shoulder in physical therapy, plus exercise.


Regular exercise also has important emotional health benefits for those living with diabetes, says ACSM, including reduced stress, heightened psychological well-being and enhanced quality of life.


This article is provided courtesy of the International Council on Active Aging www.icaa.cc