KEYSTONE, COLO. – Contemporary exercise guidelines for type 2 diabetes patients take a kinder, gentler approach than previous versions did.
This stance is based partly on scientific advances, but there’s also a greater common-sense recognition among health care providers that type 2 diabetes patients find it tough to embark on an exercise program and even harder to stick with it. Current guidelines aim to remove barriers to doing so, Judith G. Regensteiner, Ph.D., said at a conference on practical ways to achieve targets in diabetes care.
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Developing a contemporary exercise program that works for type 2 diabetes patients requires a gentle touch.
"Once you get them started, a minority will love it and will continue to exercise for life, but the majority will struggle. If you can’t make it fun for them, they’re not going to persist with it. Exercising with a group, with your family, your children or grandchildren – we have to keep working on this behavioral piece," explained Dr. Regensteiner, professor of medicine and director of the center for women’s health at the University of Colorado at Denver.
One of the major barriers to exercising is a still-widespread misconception that physical activity must be vigorous to provide health benefits. It’s an idea that dates back to the pre-1995 American Heart Association and American College of Sports Medicine exercise guidelines, which called for at least 20 minutes of vigorous exercise continuously three or more times per week.
"This was the ‘no pain/no gain’ era, and it did us a lot of damage, I think. That’s where people got the idea that if they weren’t running a marathon or a 10-K or doing something equally vigorous, they weren’t helping themselves. I still hear this all the time. It’s certainly not true and we did ourselves harm by saying it because we scared people off in droves," she said at the meeting, which was sponsored by the Children’s Diabetes Foundation at Denver and the university.
"We know very well from reams of data that walking – simple walking – is effective for the aerobic component of an exercise program. We want people to walk because it’s the easiest exercise to do," Dr. Regensteiner added.
That core message is contained in two recent sets of exercise guidelines that she coauthored. One is the comprehensive Physical Activity Guidelines Advisory Committee Report 2008 to the Secretary of Health and Human Services. The report reviews in detail the strong evidence for all of the medical conditions in which exercise has been shown to be beneficial, including colon and breast cancer, depression, and numerous other diseases in addition to type 2 diabetes. Dr. Regensteiner summed up the 683-page tome in three words: "Exercise is medicine."
The HHS guidelines state that even though any amount of physical activity provides some health benefit, 150 minutes per week of moderate-intensity aerobic activity – such as brisk walking – substantially reduce the risk of many chronic diseases. Moving up to 5 hours per week provides additional health benefits. A 20-minute session devoted to strengthening all the major muscle groups is recommended on 2 or more days per week.
Dr. Judith Regensteiner
More recently, Dr. Regensteiner coauthored an American College of Sports Medicine/American Diabetes Association joint position statement on exercise and type 2 diabetes (Med. Sci. Sports Exerc. 2010;42;2282-303; Diabetes Care 2010;33:e147-67). The detailed document knocks down another major barrier to exercise that was a fixture in older exercise guidelines: the recommendation that everybody who has type 2 diabetes or who is at least 40 years old, with multiple cardiovascular risk factors, should get an exercise stress test before starting an exercise program.
"This is completely unrealistic. It’s not going to happen. What it did was provide people with another reason not to exercise," she said.
The joint position statement declares, "Before undertaking exercise more intensive than brisk walking, sedentary persons with type 2 diabetes will likely benefit from an evaluation by a physician. Electrocardiogram exercise stress testing for asymptomatic individuals at low risk for [coronary artery disease] is not recommended but may be indicated for higher risk."
What that means, Dr. Regensteiner explained, is that many sedentary patients with type 2 diabetes don’t need a stress test if they simply want to start a walking program rather than a more vigorous running regimen.
"We want people to get out there and walk, so don’t put a barrier up," she said.
Dr. Regensteiner reported having no financial conflicts of interest.