Spotlight on exercise

Multiple recent articles looked at physical activity in type 2 diabetes patients.

The American College of Sports Medicine updated its statement on exercise and type 2 diabetes for the first time since 2010. The update, published in the February Medicine & Science in Sports & Exercise, includes 11 consensus statements and recommendations based on current evidence. It was newly expanded to focus on physical activity, rather than just planned exercise. Among other advice, the statement said that regular aerobic exercise training improves glycemic management and that high-intensity resistance exercise training has greater beneficial effects on glucose management than low- to moderate-intensity resistance training. Greater energy expenditure postprandially reduces glucose levels regardless of exercise intensity or type, and exercise duration of at least 45 minutes provides the most consistent benefits, the statement said. It also noted that breaking up sedentary time with activity can modestly attenuate postprandial glucose and insulin levels and afternoon exercise sessions maybe more effective at decreasing postprandial glucose than morning sessions. In addition, it addressed the value of flexibility and balance exercises. “The latest Physical Activity Guidelines for Americans are applicable to most individuals with diabetes, including youth, with a few exceptions and modifications,” the statement said.

Regular physical activity is associated with lower risk for dementia among people with type 2 diabetes, according to a Korean study published by Diabetes Care on Feb. 22. The retrospective study looked at 133,751 patients ages 40 years or older who were newly diagnosed with type 2 diabetes. During the median follow-up of 4.8 years, 3,240 developed dementia, and this risk was significantly lower among those who engaged in regular physical activity (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.75 to 0.90), as were rates of Alzheimer disease (aHR, 0.85; 95% CI, 0.77 to 0.95) and vascular dementia (aHR, 0.78; 95% CI, 0.61 to 0.99), specifically. The protective effect was seen in both continuously active patients and those who had newly begun to be active, but it was greater in the former. “These findings suggest that regular [physical activity] should be encouraged to prevent dementia in high-risk populations and those with recent-onset type 2 diabetes,” the authors concluded.

Finally, a small study, published by Diabetes, Obesity and Metabolism on Feb. 24, looked at the optimal timing of physical activity in type 2 diabetes patients. It used accelerometer data to compare activity patterns in 74 patients. One study model found that moderate to vigorous physical activity was associated with better cardiorespiratory fitness (CRF) whether it was performed in the morning or afternoon, but only afternoon activity was associated with improvements in HbA1c and fat mass index. A second model found that only afternoon activity was associated with CRF. The authors concluded that being active in the afternoon may “yield more optimal benefits when it comes to glycemic control, CRF, and body composition in individuals with type 2 diabetes” but added that morning exercise has been associated with better adherence, decreased daily energy intake, and more total daily activity in other research. “It is important to note that any [moderate to vigorous physical activity] is better than none and it should still be stressed that the best time for individuals with type 2 diabetes to be physically active is when they are able and motivated to do so,” they wrote.