Diabetes Type 1 and 2

DM: Physical Activity (2007)

• Intervention
  What is the effect of physical activity (for at least 3 months) combined with MNT on metabolic outcomes in persons with type 2 diabetes?

  • Conclusion

    In people with type 2 diabetes, 90 - 150 minutes of weekly physical activity (both aerobic exercise and resistance/strength training) reduces A1C, improves insulin sensitivity, and decreases relative risk for all-cause mortality. 

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of physical activity (for at least 3 months) combined with MNT on metabolic outcomes in persons with type 2 diabetes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus. A meta-analysis of controlled clinical trials. JAMA. 2001;286:1218-1227.
      • Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME.  A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes.  Diabetes Care 2002; 25(12): 2335-2341. 
      • Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Metz-Schimmerl S, Pacini G, Wagner O, Georg P, Prager R, Kostner K, Dunky A, Haber P.  The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus.  Arch Phys Med Rehabil 2005; 86:1527-1533.
      • Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL, Blair SN.  Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 2004; 27:83-88.
      • Clark M, Hampson SE, Avery L, Simpson R.  Effects of a tailored lifestyle self-management intervention in patients with Type 2 diabetes.  British Journal of Health Psychology 2004; 9: 365-379.
      • Di Loreto C, Ranchelli A, Fanelli C, Fatone C, Lucidi P, Taglioni C, Murdolo G, Santeusanio F, De Cicco A, De Feo F, Parlanti N.  Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes.  Diabetes Care 2005; 28:1295-1302.
      • Dunstan DW, De Courten M, Daly RM, Shaw J, Owen N, Zimmet P, Jolley D.  High-intensity resistance training improves glycemic control in older patients with type 2 diabetes.  Diabetes Care 2002;25:1729-1736.
      • Dunstan DW, Daly RM, Owen N, Jolley D, Vulikh E, Shaw J, Zimmet P.  Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes.  Diabetes Care 2005: 28:3-9.
      • Goldhaber-Fiebert JD, Goldhaber-Fiebert SN, Tristan ML, Nathan DM. Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care 2003; 26:24-29.
      • Kirk A, MacIntyre P, Mutrie N, Fisher M. Increasing physical activity in people with type 2 diabetes. Diabetes Care 2003;26:1186-1192.
      • Kirk A, Mutrie N, MacIntyre P, Fisher M. Effects of a 12-month physical activity counseling intervention on glycemic control and on the the status of cardiovascular risk factors in people with Type 2 diabetes. Diabetologia 2004;47:821-832.
      • Mayer-Davis EJ, D'Agostino R, Karter AJ, Haffner SM, Rewers MJ, Saad M, Bergman RN. Intensity and amount of physical activity in relation to insulin sensitivity. The Insulin Resistance and Atherosclerosis Study (IRAS). JAMA. 1998;279:669-674.
      • Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C.  Physical activity/exercise and type 2 diabetes.  Diabetes Care 2004; 27(10):2518-2539.
      • Van Rooijen AJ, Rheeder P, Eales CJ, Becker PJ.  Effect of exercise versus relaxation on haemoglobin A_1C in Black females with type 2 diabetes mellitus.  QJ Med 2004: 97:343-351.
      • Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN.  Low cardiorespiratory fitness and physical inactivity in men with type 2 diabetes.  Annals of Intern Med 2000;132:605-611.
  • Search Plan and Results: Physical Activity - Type 2 2006
     
  What is the effect of physical activity combined with Medical Nutrition Therapy (MNT) on metabolic outcomes in persons with type 1 diabetes?

  • Conclusion
    In persons with type 1 diabetes, the incidence of hypoglycemia during exercise depends on baseline glucose levels, and exercise often results in overnight hypoglycemia.  Glycemic control generally does not improve in response to ongoing participation in physical activity alone.  One study reported possible gender differences in A1C; further research is needed in this area.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of physical activity combined with MNT on metabolic outcomes in persons with type 1 diabetes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Roberts L, Jones TW, Fournier PA.  Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus.  J Pediatr Endocrinol Metab 2002;15(5):621-7.
      • Sarnblad S, Ekelund U, Aman J.  Physical activity and energy intake in adolescent girls with Type 1 diabetes.  Diabet Med 2005;22(7):893-9. 
      • Tansey MJ, Tsalikian E, Beck RW, Mauras N, Buckingham BA, Weinzimer SA, Janz KF, Kollman C, Xing D, Ruedy KJ, Steffes MW, Borland TM, Singh RJ, Tamborlane WV, The Diabetes Research in Children Network (DirecNet) Study Group.  The effects of aerobic exercise on glucose and counterregulatory hormone concentrations in children with type 1 diabetes.  Diabetes Care 2006;29(1):20-5. 
      • Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, Wysocki T, Weinzimer SA, Buckingham BA, Kollman C, Xing D, Ruedy KJ; Diabetes Research in Children Network Direcnet Study Group.  Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus.  J Pediatr 2005;147(4):528-34.
      • Waden J, Tikkanen H, Forsblom C, Fagerudd J, Pettersson-Fernholm K, Lakka T, Riska M, Groop PH, FinnDiane Study Group.  Leisure time physical activity is associated with poor glycemic control in type 1 diabetic women:  the FinnDiane study.  Diabetes Care 2005;28(4):777-82.
  • Search Plan and Results: Physical Activity - Type 1 2006