Physical Activity and Type 2 Diabetes
Statistics

In Ontario, over 600,000 people have diabetes.

Four out of ten people develop serious complications from diabetes: blindness,
limb amputations, kidney disease, nerve damage & stroke.
(MOHLTC, 1999)
Approximately 8%, or 2.5 million
Canadians, have type 2 diabetes, and if
present trends continue, by 2025, this
number will be about 4 million.
An estimated 13 billion is spent each
year in Canada treating people with
diabetes and its complications
(Canadian Diabetes Association, 2003)
(ALCOA, 2003, from Dr. N. W. Rodger)
Type 2 Diabetes – Recommendations for prevention
Follow the recommendations of Canada’s Physical Activity Guide for age
group. For adults:
At least:
 60 minutes of light activity daily OR
 30-60 minutes of moderate activity 4-7 days per week OR
 20-30 minutes of vigorous activity 4 days per week

Perform a mix of endurance, flexibility & strengthening activities
Funded by the Government of Ontario
General Recommendations for people with Type 2 Diabetes

People with type 2 diabetes should do 3-5 physical activity sessions each week. Those
with type 2 diabetes taking insulin and obese diabetic individuals should participate in daily
physical activity.
 Low to moderate intensity activity is recommended. Using Rate of Perceived Exertion
(RPE) is preferable to using Target Heart Rate because heart rate response to exercise
may be affected in individuals with autonomic neuropathy.
 Initially, daily sessions should be 10-15 minutes, gradually building to 30 minutes. When
weight loss is a primary goal, the duration needs to be incrementally increased to
approximately 60 minutes.
(American College of Sports Medicine, Position Stand on Exercise and Type 2 Diabetes)


A warm-up, stretching and cool-down are important components.
Wear good shoes and socks. Use silica gel or air mid-soles as well as polyester or cottonpolyester socks to prevent blisters and keep the feet dry to minimize trauma to the feet.
 Monitor closely for blisters and other damage to feet.
 Wear a clearly visible MedicAlert bracelet.
 Proper hydration is essential, before and during activity.
 Moderate weight training utilizing light weights and high repetitions can be used in nearly
all patients with diabetes.
(American Diabetes Association, Position Statement on Physical Activity and Diabetes)

Unless considerable hyperglycemia (i.e., >15
mmol/L) is present, low to moderate intensity
exercise lowers glucose levels both during and
after the activity, increasing the risk of a
hypoglycemic episode. Conversely, intense
exercise systematically raises glucose levels,
both during the activity and for variable duration
afterward, and can lead to progressive
hyperglycemia, particularly in those who are
hyperglycemic before exercising. Systematic
self-monitoring of glucose level before, during
and especially for many hours after exercise is
therefore important.
 A gradual increase in physical activity that is
integrated into the person’s lifestyle should be
part of the therapeutic plan for everyone with
type 2 diabetes who is able to increase activity.
(1998 Clinical Guidelines for the Management of
Diabetes in Canada. Canadian Medical Association
Journal.)
The contribution of physical
activity to the achievement of
treatment goals in type 2
diabetes has been well reviewed
in a meta-analysis of 504 patients
studied in 14 separate clinical
trials.
(Boule NG, Haddad E, Kenny
GP, et al. JAMA, 2001)
Recent reports of resistance
exercise training in controlled
studies indicate that in some
subjects, resistance training may
measurably contribute to the
control of high blood glucose
levels.
(Castaneda C, Foldvari M, Layne
JE: Diabetes Care 2002)
Type 2 Diabetes – Cautions

A physician may give additional contraindications if complications of the kidneys,
eyes or heart are present and should always be consulted prior to starting an
activity program.

High-resistance exercise using weights may be acceptable for young individuals
with diabetes but not for older individuals or those with long-standing diabetes.

The following exercises are contraindicated for patients with loss of protective
sensation: treadmill, prolonged walking, jogging, step exercises. In those cases,
appropriate exercise include swimming, bicycling, rowing, chair exercises, arm
exercises and other non-weight-bearing exercises.
(American Diabetes Association, Position Statement on Physical Activity and Diabetes)

Exercising late in the evening increases the risk of nocturnal hypoglycemia.

Certain medications tend to mask or exacerbate the effect of hypoglycemia with
exercise (beta-blockers, coumadin, calcium channel blockers, diuretics, nicotinic
acid).

Schedule exercise 1-2 hours after meals, not at peak insulin time.
(The Health Professional’s Guide to Diabetes and Exercise. Gordon NF, 1995)

Avoid exercise in extreme hot or cold conditions

Administer insulin into a site away from the most actively exercising extremities

Avoid exercising during any period of poor metabolic control

Ingest rapidly absorbed carbohydrate if pre-exercise glucose level is under 5 mmol/L
(1998 Clinical Guidelines for the Management of Diabetes in Canada. Canadian Medical
Association Journal.)
Organizations

Canadian Diabetes Association (www.diabetes.ca)

American Diabetes Association (www.diabetes.org) (U.S.)

National Aboriginal Diabetes Association (www.nada.ca)

Canadian Ethnocultural Council (www.ethnocultural.ca)

Canadian Centre for Activity and Aging (www.uwo.ca/actage)
Resources

American Diabetes Association. Health Professionals Guide to Diabetes and Exercise. N.
Rudermand and J. Devlin (Editors). (1995)

Active Living Coalition for Older Adults. Guide for Practitioners.
(http://www.alcoa.ca/e/diabetes/practitioners_guide_e.pdf)

Active Living Coalition for Older Adults. Prevent and Control Type 2 Diabetes – Guide for
Older Adults. (http://www.alcoa.ca/e/diabetes/olderadults_guide_e.pdf)

American Diabetes Association, Position Statement on physical activity and diabetes.
(http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s73)

1998 Clinical Guidelines for the Management of Diabetes in Canada. Canadian Medical
Association Journal. (http://www.diabetes.ca/Files/cpg98eng.pdf)

Position Stand on Exercise and Type 2 Diabetes. Journal of the American College of
Sports Medicine. (http://www.acsm-msse.org/)

Physical Activity and Type 2 Diabetes: a Guide for Older Adults from Asian, Black, and
Hispanic Populations. Canadian Ethnocultural Council. Available in 12 languages.
(http://www.ethnicaging.ca/pag.asp)
Successful Programs

First Step Program developed by Dr. Catrine Tudor-Locke at the Canadian Centre for
Activity and Aging and in the Lawson Diabetes Centre in London, Ontario. Using a fourweek adoption period in which patients are counseled by expert trainers, and measuring
walking accomplishment using pedometers, this program allows patients to set their own
goals, and assess their own performance. During the adherence phase (weeks 5-16)
there is less contact with the facilitator but continued self-monitoring.
(http://www.uwo.ca/actage/new/first_step.htm)
Content is provided as an information-sharing service and inclusion does not represent
endorsement by PARC, Ophea or their funders.
Funded by the Government of Ontario