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5.2 Physical Activity

Supplemental Information

The positive benefits of physical activity include improved glycemic control, blood pressure values, lipid profile, depression management and cardiac status, as well as increased insulin sensitivity and effective weight management.

Hypoglycemia is a risk in individuals who participate in physical activity and are taking insulin and/or insulin secretagogues. Depending on the level of physical activity, the medication dosage or the amount of carbohydrate ingested, hypoglycemia can occur.  For patients on these drug classes and pre-exercise glucose monitor results are less than 100 mg/dL, additional carbohydrate should be ingested for prevention of hypoglycemia.

Strategies for initiation of increased physical activity

  • Start by incorporating 10 minutes of increased activity into each day
    • Use stairs instead of elevator
    • Park car away from building entrance and walk
    • Walk to do errands
  • Overcome barriers
    • Self-monitor activity performed using pedometer, time record and/or journal
    • Be consistent
    • Have alternative activities for inclement weather
    • Find enjoyable activities
    • Be active at the time of day that is best for the individual
    • Doing a physical activity with a partner and/or being accountable to someone regarding your progress greatly improves the ability to be successful
  • Reinforce the ongoing need and benefits of physical activity at each visit

Medical evaluation to assess safety of exercise program

Clinicians should use clinical judgment and assess for conditions that might contraindicate certain types of exercises or be predisposed to injury (e.g., uncontrolled hypertension, severe autonomic neuropathy, severe peripheral autonomic neuropathy or history of foot lesions). High-risk patients should be encouraged to start with short periods of low-intensity exercise, and increase intensity and duration slowly (American Diabetes Association, 2014).

  • Assess physical condition and limitations of the patient
  • Cardiac stress testing should be considered for the previously sedentary individual at moderate to high risk for cardiovascular disease or other patients who are clinically indicated who want to undertake vigorous aerobic exercise that exceeds the demands of everyday living (American Diabetes Association, 2014).  Cardiac stress testing is not routinely necessary in asymptomatic patients before beginning a moderate-intensity exercise program such as walking.
  • Assess glucose control
  • Assess knowledge of physical activity in relation to glucose control
  • When making a referral, make other health care clinicians aware of limitations for exercise