The practical experience of exercise and diabetes: position statement

ABSTRACT

Diabetes health care professionals are often frustrated with results of their efforts to increase physical activity in patients with type 2 diabetes. Motivation is difficult and drop out rate are high. It is especially disappointing when the diabetes management team is successful in getting patients to exercise and find that improvements in physical fitness, weight management and glucose control are not as expected. Although our results often tempt us to throw up our hand and claim our patients are just "too fat and lazy" for an exercise program to do them any good, we should know better. Patients with type 2 diabetes are different and their prescriptions for exercise must account for these differences. Most type 2 patients do have very low initial VO2max values and typically do not improve much with physical training. We must be carefully planned to meet their specific needs and abilities. Fifteen years of practical experience have shown me that successful exercise programs are possible if the initial exercise experiences are well tolerated. Appropriate intensities and durations for aerobic activity should be based on tests of functional capacity. For most patients, resistance exercise should be slowly added to improve total fitness. Many patients take as long as 6 to 12 months before they are able to perform enough total exercise to see even modest changes in functional capacity and weight loss. Reasonable goals and appropriate feedback can enhance compliance.(AU)