American Diabetes Association Issues Recommendations for Physical Activity, Exercise

People with diabetes should interrupt long periods of sitting every half hour with light activity, such as walking, leg extensions, or overhead arm movements, according to new recommendations from the American Diabetes Association (ADA).

The recommendation to move at least every 30 minutes represents a shift for the ADA, which previously called for moving every 90 minutes during long periods of sedentary activity, according to a statement. The full guideline appears in the November issue of Diabetes Care.

Three minutes or more of light activity “improves blood sugar management in people who have sedentary jobs and in people who are overweight, obese, and who have difficulty maintaining blood sugars in a healthy range,” the group said. ADA’s updated position, which applies not only when people with diabetes are at work but also when they are at home, comes after a wave of new research connecting long periods of sitting with poor health outcomes:

· A March 2016 study in the American Journal of Preventive Medicine found that sitting was responsible for 3.8% of all-cause mortality.

· Watching TV for extended periods was particularly unhealthy, compared with working at a computer or reading, according to a June 2014 study in the Journal of the American Heart Association.

· A January 2015 study in the British Journal of Cancer found that prolonged TV watching was not only associated with diabetes and obesity, but also with higher rates of colorectal cancer.

According to the ADA’s statement, the recommendation to boost light activity during sedentary activity is especially important for those with type 2 diabetes (T2D); this group accounts for more than 27.5 of the 29.1 million people diagnosed with the disease. People with diabetes can also break up the workday with short bursts of torso twists, walking in place, or desk chair swivels, according to ADA.

“These updated guidelines are intended to ensure everyone continues to physically move around throughout the day—at least every 30 minutes—to improve blood glucose management,” said Sheri R. Colberg-Ochs, PhD, FACSM, in a press release. Colberg-Ochs, who is the lead author on the statement and ADA’s director of physical fitness, said that these short bursts of activity should come on top of longer stretches of exercise.

The Diabetes Care statement distinguishes between physical activity, which “includes all movement that increases energy use,” and exercise, which is defined as a planned, structured physical activity.

For all adults, the CDC currently recommends 150 minutes per week of moderate exercise, such as brisk walking, or 75 minutes per week of rigorous activity, such as running. Adults are also advised to take part in “muscle building activities,” such as lifting weights, at least 2 days a week. Last year, the US Surgeon General called on all Americans to walk at least 22 minutes per day to combat chronic disease.

The statement in Diabetes Care features separate physical activity guidelines for those with type 1 diabetes (T1D), T2D, women with gestational diabetes, and prediabetes. An estimated 86 million Americans have prediabetes. Managing blood glucose will vary with each type of disease and each person, “Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual,” the authors write.

Besides aerobic activity, older adults with T2D are advised to take part in exercise that encourages flexibility and improves balance. Those with T1D benefit from both aerobic activity and resistance training, which the ADA says can improve insulin sensitivity and muscle strength.

Reference

Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39(11): 2065-2079. http://dx.doi.org/10.2337/dc16-1728.