What exercise is best for type 2 diabetes?

Exercise can be classed as aerobic (or cardiovascular) and resistance (or strength). Aerobic exercise has widely been considered the most appropriate exercise for those with type 2 diabetes, but is this correct for the most effective management of diabetes and how much should you do?

More recent research has found that both aerobic and resistance exercise improve glycaemic control, and that improvement is greatest when both forms of exercise are combined.

Aerobic Exercise

There are lots of definitions of 'aerobic' exercise, but I use it to refer to any activity involving movement of large muscle groups for 10 consecutive minutes or more. This could be walking, cycling, swimming, kayaking, etc.

Moderate intensity aerobic exercise would generally be at around 50-70% of maximum heart rate. An approximation of maximum heart rate can be established by deducting your age from 220. Therefore a 40 year old would have a maximum heart rate of 180 and this would give them a target heart rate of 90-126 bpm. Please note that certain medications have a lowering effect on heart and that this is just an average. Some people may have a naturally higher or lower heart rate. The important thing is that you are working at a level where you are having to breathe a little deeper, though should still be able to hold a conversation without being out of breath.

Vigorous cardiovascular activity - also known as huffy puffy exercise - would generally take the heart rate above 70% of maximum. It is important to have medical clearance before attempting vigorous activity and always build up to this gradually through more moderate intensity activity.

Resistance Exercise

This is anything using the application of a force to increase muscle strength. The resistance can be anything from medicine balls to kettlebells, dumbells to powerbags. Basically anything you pick up and put down again. Resistance can also be from bodyweight, suspension trainers like TRX and resistance bands.

Current Guidelines for exercise and diabetes (ADA Guidelines)

• At least 150 minutes a week of moderate to vigorous cardiovascular activity spread over at least three days.
• No more than two days without exercise
• Resistance exercise three times a week progressing to 3 sets of 8-10 reps

My opinion is that 150 minutes of cardiovascular exercise a week is not enough. To be beneficial to health at least 30 minutes of activity a day is recommended. For most people this can be easily achieved by walking or cycling as a means of transport, taking a brisk walk on before or after work or even on a lunchtime - this will also make you much more energised and productive in the afternoon. Structured exercise is a great way to include additional exercise and by making a regular commitment to an activity you are more likely to keep doing it. Things like aqua aerobics, Nordic Walking classes or spinning classes (though make sure you build intensity up gradually) are great ways to get regular exercise into your life. Also, don't just think of exercise as being something you need to do. Think of activities that you would like to do. This could be going for a cycle ride with family, learning to kayak. Think of activities you'd like to have a go at and go for it, even if it means enlisting the help of others to give you the confidence to get started.

Not going more than two days without exercise is important for everyone's health, but particularly important when using exercise to manage type 2 diabetes. The benefits of exercise in improving glycaemic control last for between 24 and 72 hours, depending mainly on the intensity of the exercise.

Many of the studies into diabetes and resistance training have been based on completing 8-10 repetitions. Other studies have shown that 10-15 or 20-25 repetitions have a beneficial effect. Higher intensity resistance training activities can be considered safe provided there are no underlying heart conditions or high blood pressure. As with any exercise, it is important to build up intensity gradually. With the appropriate supervision there is no reason why activities such as kettlebell training, boxing and other high intensity activities can not be enjoyed. As insulin resistant individuals often have lower aerobic capacity and less slow twitch (endurance type) muscle fibres, activities working the fast twitch (strength/power) muscle fibres can be an effective way to train.

Look out for next weeks blog when I'll explain the safety considerations of exercising with type 2 diabetes.