Physical Activity and Diabetes

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Ronald J. Sigal MD, MPH, FRCPC Marni J. Armstrong CEP, PhD candidate Pam Colby BSc, RD Glen P. Kenny PhD Ronald C. Plotnikoff PhD Sonja M. Reichert MD, MSc, CCFP Michael C. Riddell PhD

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • Moderate to high levels of physical activity and cardiorespiratory fitness are associated with substantially lower morbidity and mortality in men and women with and without diabetes.
  • For most people, being sedentary has far greater adverse health consequences than exercise would. However, before beginning a program of physical activity more vigorous than walking, people with diabetes should be assessed for conditions that might place the individual at increased risk for an adverse event associated with certain types of exercise.
  • For people with type 2 diabetes, supervised exercise programs have been particularly effective in improving glycemic control, reducing the need for antihyperglycemic agents and insulin, and producing modest but sustained weight loss.
  • Both aerobic and resistance exercise are beneficial for patients with diabetes, and it is optimal to do both types of exercise. At least 150 minutes per week of aerobic exercise, plus at least two sessions per week of resistance exercise, is recommended.

Highlights of Revisions

  • New recommendations suggest people with diabetes should set specific physical activity goals and that structured exercise programs supervised by qualified trainers should be implemented, when possible, for people with type 2 diabetes in order to improve glycemic control.
  • In 2008, an electrocardiographic (ECG) stress test was recommended for individuals at high risk for cardiovascular disease who wished to undertake exercise more vigorous than brisk walking. In 2013, the recommendation has changed to suggest a more thorough evaluation, one that includes history, physical examination and resting ECG and may or may not include an exercise ECG stress test.


  1. 1.People with diabetes should accumulate a minimum of 150 minutes of moderate- to vigorous-intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise [Grade B, Level 2, for type 2 diabetes (1-3) ; Grade C, Level 3, for type 1 diabetes (4)].
  2. 2.People with diabetes (including elderly people) should perform resistance exercise at least twice a week (23) and preferably 3 times per week [Grade B, Level 2 (6)] in addition to aerobic exercise [Grade B, Level 2 (5,7,8)]. Initial instruction and periodic supervision by an exercise specialist are recommended [Grade C, Level 3 (6)].
  3. 3.People with diabetes should set specific physical activity goals, anticipate likely barriers to physical activity (e.g. weather, competing commitments), develop strategies to overcome these barriers [Grade B, Level 2 (9)] and keep records of their physical activity [Grade B, Level 2 (10)].
  4. 4.Structured exercise programs supervised by qualified trainers should be implemented when feasible for people with type 2 diabetes to improve glycemic control, CVD risk factors and physical fitness [Grade B, Level 2 (3,5)].
  5. 5.People with diabetes with possible CVD or microvascular complications of diabetes who wish to undertake exercise that is substantially more vigorous than brisk walking should have medical evaluation for conditions that might increase exercise-associated risk. The evaluation would include history, physical examination (including funduscopic exam, foot exam, and neuropathy screening), resting ECG and, possibly, exercise ECG stress testing [Grade D, Consensus].

CVD, cardiovascular disease; ECG, electrocardiogram.


  1. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011;34:1228-37.
  2. Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 2006;29:2518-27.
  3. Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011;305:1790-9.
  4. Moy CS, Songer TJ, LaPorte RE, et al. Insulin-dependent diabetes mellitus, physical activity, and death. Am J Epidemiol 1993;137:74-81.
  5. Balducci S, Zanuso S, Nicolucci A, et al. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Arch Intern Med 2010;170:1794-803.
  6. Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2009;83:157-75.
  7. Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA 2010;304:2253-62.>
  8. Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-69.
  9. DeWalt DA, Davis TC, Wallace AS, et al. Goal setting in diabetes self-management: taking the baby steps to success. Patient Educ Couns 2009;77:218-23.
  10. Gleeson-Kreig JM. Self-monitoring of physical activity: effects on selfefficacy and behavior in people with type 2 diabetes. Diabetes Educ 2006; 32:69-77.


Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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