CLINICAL DIABETES COMMENTARY Diabetes Mellitus and Exercise William H. Herman, MD, MPH An ideal treatment for type 2 diabetes would lower blood glucose concentrations acutely, improve long-term glycemic control, and enhance insulin sensitivity. It would improve mild to moderate hypertension, reduce low-density lipoprotein cholesterol and triglycerides, increase high-density lipoprotein cholesterol, and serve as an adjunct to caloric restriction for weight reduction. Finally, it would increase patients' sense of well-being and improve their quality of life. As a drug, such an agent would be a blockbuster, with >$1 billion per year sales potential. Yet, such a treatment exists and has been recognized for centuries. It is regular physical activity—that is, exercise. The American Diabetes Association position statement on Diabetes Mellitus and Exercise, reprinted on the following pages, reviews the role of regular physical activity in type 2 diabetes and highlights some of the challenges created by intermittent physical activity of varied intensity and duration in type 1 diabetes. The statement highlights the potential risks of exercise, including precipitation of sustained hyperglycemia or life-threatening hypoglycemia as well as worsening of long-term microvascular and neuropathic complications of diabetes, increased risk of complications of preexisting cardiovascular disease, and risks of soft tissue injuries and degenerative joint disease. It further provides a guide whereby patients with type 2 diabetes may safely enjoy the myriad health benefits of exercise, and those with type 1 diabetes may participate safely in and enjoy physical and sport activities. As is true for any treatment, it is imperative that providers be aware of benefits and risks and clearly communicate them to patients. Involvement of a multidisciplinary treatment team with individuals with knowledge and training in exercise physiology is appropriate. Most important, however, is that exercise, especially regular, low-intensity forms of aerobic exercise, such as walking, not be overlooked in the armamentarium of treatments for diabetes. William H. Herman, MD, MPH, is an associate professor of internal medicine in the Division of Endocrinology and Metabolism at the University of Michigan in Ann Arbor. He is an associate editor of Clinical Diabetes. Copyright © 1999 American Diabetes
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