From the Guidelines
Physical activity and medication management for patients with type 2 diabetes should be personalized and coordinated, with a focus on completing the Physical Activity Readiness Questionnaire (PARQ) to identify potential risks before starting an exercise program. Adults with type 2 diabetes should aim for 150 minutes of moderate-intensity aerobic activity weekly, spread over at least 3 days, with no more than 2 consecutive days without activity, as recommended by the most recent guidelines 1.
Key Recommendations
- Resistance training should be included 2-3 times weekly, with a focus on moderate to vigorous intensity 1.
- For medication management, metformin is typically the first-line agent, with additional medications including SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, or insulin depending on individual factors 1.
- Blood glucose monitoring is essential before, during, and after exercise, especially for those on insulin or sulfonylureas, as exercise can cause hypoglycemia 1.
- Patients should carry fast-acting carbohydrates during exercise and may need to reduce insulin doses or consume additional carbohydrates before activity, with proper hydration and appropriate footwear also important to prevent complications 1.
Rationale
The guidelines for physical activity and medication management in patients with type 2 diabetes are based on the latest evidence, which emphasizes the importance of personalized and coordinated care 1. The Physical Activity Readiness Questionnaire (PARQ) is a crucial tool for identifying potential risks before starting an exercise program, and the recommended 150 minutes of moderate-intensity aerobic activity weekly can help improve glycemic control and reduce cardiovascular risk factors 1.
Additional Considerations
- The exercise strategies must be adapted for each individual, based on their specific needs and health status 1.
- Combining aerobic and resistance exercise within the same exercise session is recommended by most guidelines, with flexibility exercises also complementing other types of exercise 1.
From the Research
Physical Activity Readiness Questionnaire (PARQ) for Type 2 Diabetes Mellitus
- The Physical Activity Readiness Questionnaire (PARQ) is a tool used to assess an individual's readiness to participate in physical activity, but there is limited information available on its specific use for patients with type 2 diabetes mellitus 2, 3, 4, 5, 6.
- However, studies have shown that regular physical activity can improve glycemic control in individuals with type 2 diabetes, with recommendations including at least 150 minutes of moderate aerobic exercise per week 4.
- The association between physical activity and blood glucose levels in individuals with type 2 diabetes has been investigated, with findings suggesting that moving from a sedentary to an active lifestyle can result in a mean weekly fasting blood glucose reduction of 13 mg/dL 5.
Guidelines for Physical Activity and Medication Management
- Guidelines for physical activity in adults with type 2 diabetes recommend engaging in at least 150 minutes of moderate aerobic exercise per week, with adaptations for disease-specific precautions such as glucose levels, diet, and foot care 4.
- The use of metformin, a common medication for type 2 diabetes, has been shown to have independent benefits on glucose control, but the impact of physical activity on HbA1c levels may be more apparent in those not taking metformin 3.
- Studies have also investigated the effect of exercise on glucose profiles in individuals with type 2 diabetes taking metformin, with findings suggesting that adding a bout of exercise to metformin can increase postprandial glucose levels without affecting mean glucose concentrations 2.
Assessment of Physical Activity in Patients with Type 2 Diabetes
- The International Physical Activity Questionnaire (IPAQ) has been evaluated as a potential tool for assessing physical activity in patients with type 2 diabetes, with findings suggesting that it may be a useful tool for measuring declared physical activity 6.
- However, further studies are needed to explore the relationship between physical activity and glycemic control in patients with type 2 diabetes, as well as the potential use of PARQ in this population 2, 3, 4, 5, 6.