Tailoring the Dose of Exercise for Effective Glycemic Management in Type 2 Diabetes

Type 2 diabetes is one of the world’s most common long-term health conditions, affecting 1 in 11 of the adult population, and is responsible for 11% of deaths annually. Consequences and costs remain high, making type 2 diabetes a major public health concern.

Thus, with no cure on the near horizon, the American Diabetes Association (ADA) recommends focusing on optimizing healthy lifestyle behaviors, such as physical activity, to improve diabetes care and reduce the risk of associated complications, disability, and all-cause mortality. Physical activity has been shown to be effective in reducing mortality, comorbidities, and clinical parameters such as glycosylated hemoglobin (HbA1c).

The ADA and other institutions, such as the World Health Organization and the American College of Sports Medicine, recommend, in their physical activity guidelines for people living with diabetes, engaging in at least 150–300 min of moderate-intensity aerobic physical activity per week or 75–150 min of vigorous-intensity aerobic physical activity per week and in muscle-strengthening activities involving major muscle groups two or more times a week.

Investigators in several published meta-analyses have shown the effectiveness of different types of physical activities and exercise modalities; however, none found the optimal type or dose of physical activity to verify the validity and reliability of these recommendations, and consequently, determine whether the individuals are being sufficiently active.

Also, the potential impact of important clinical characteristics such as baseline HbA1c level at which participants enter into a physical activity program has not yet been meta-analyzed.

In a recently published high-quality evidence from 126 studies which had included 6,718 participants the dose- response relationship between physical activity and HbA1c (%) responses with adjustment for HbA1c baseline level of the participants was evaluated.

This study has found following important differences between the predicted optimal physical activity dose and the current guidelines’ recommendations,

This study has also showed that 1,100 MET min/week (i.e., the optimal dose) is equivalent on average to

In summary, this evidence suggests that people with diabetes may need to be more physically active than recommended to optimize their health outcomes.

Reference: 1.Daniel Gallardo-Gómez et al. Diabetes Care. 2024;47(2):295–303.
2. UK Chief Medical Officers’ Physical Activity Guidelines (2019), adapted from Netherlands Physical Activity Guidelines 2017 & Ainsworth et al 2017