Recommendations Summary

DM: Physical Activity (2015)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  DM: Encourage Individualized Physical Activity Plan

  The registered dietitian nutritionist (RDN) should encourage an individualized physical activity plan for adults with diabetes, unless medically contraindicated, to gradually achieve the following:

  • Accumulating 150 minutes or more of physical activity per week
  • Moderate-intensity aerobic exercise (50% to 70% of maximum heart rate) spread over at least three days per week with no more than two consecutive days without exercise
  • Resistance training at least twice per week
  • Reduce sedentary time by breaking up extended amounts of time (more than 90 minutes) spent sitting.

  Adults with diabetes should be advised to perform at least 150 minutes per week of moderate-intensity aerobic physical activity (50% to 70% of maximum heart rate), spread over at least three days per week with no more than two consecutive days without exercise.

  Rating: Strong
  Imperative

  DM: Educate on Prevention and Treatment of Exercise-Related Hypoglycemia

  The registered dietitian nutritionist (RDN) should educate adults with diabetes taking insulin or insulin secretagogues that physical activity may cause hypoglycemia if medication doses or carbohydrate consumption is not altered. Individual glycemic response patterns can differ markedly with exercise; therefore, persons with diabetes taking insulin or insulin secretagogues must use glucose monitoring and recognition of glucose patterns to make decisions to exercise safely.
  
  
  
   

  Rating: Consensus
  Conditional

  • Risks/Harms of Implementing This Recommendation

    Intense physical activity in some overweight and obese individuals may contribute to disability or death; thus, consultation with a physician prior to beginning an exercise program should be recommended.

  • Conditions of Application

    The recommendation, DM: Encourage Individualized Physical Activity Plan, applies to adults with type 1 diabetes and type 2 diabetes unless medically contraindicated.
    
    The recommendation, DM: Educate on Prevention and Treatment of Exercise-Related Hypoglycemia, applies to adults with diabetes taking insulin or insulin secretagogues.
    
     

  • Potential Costs Associated with Application

    Costs of medical nutrition therapy (MNT) sessions and reimbursement vary. However, MNT sessions are essential for improved outcomes.

  • Recommendation Narrative

    From the 2015 American Diabetes Association Standards of Medical Care in Diabetes
    
    Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care and Immunization

    • Children with diabetes or pre-diabetes should be encouraged to engage in at least 60 minutes of physical activity each day. Grade B
    • Adults with diabetes should be advised to perform at least 150 minutes per week of moderate-intensity aerobic physical activity (50% to 70% of maximum heart rate), spread over at least three days per week with no more than two consecutive days without exercise. Grade A
    • Evidence supports that all individuals, including those with diabetes, should be encouraged to reduce sedentary time, particularly by breaking up extended amounts of time (more than 90 minutes) spent sitting. Grade B
    • In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week. Grade A

  • Recommendation Strength Rationale

    • The 2015 American Diabetes Association Standards of Medical Care in Diabetes received Grades A and B.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    A Physical Activity Toolkit for Registered Dietitians: Utilizing Resources of Exercise is Medicine. Academy of Nutrition and Dietetics, 2013. 

    American Diabetes Association. Standards of medical care in diabetes - 2015. Diabetes Care 2015;38(1):S1-S94.

    Kaufman FR, ed. American Diabetes Association. Medical Management of Type 1 Diabetes. Sixth Edition. American Diabetes Association, Alexandria, VA, 2012.