Evidence-Based Reasons How Exercise Can Improve Diabetes Type II Disease: A sample program

The metabolic disorder of type 2 diabetes mellitus (DM2) will be discussed for this post. DM2 affects over 27 million people in the USA and often can have sequalae of dyslipidemia, hypertension, heart disease, kidney disease, neuropathy and obesity comorbidities (Dunford & Doyle, 2019). DM2 is the resulting cascade of insulin resistance resulting in the body’s inability to transport and shuttle glucose into the cells which leads to proinflammatory proteins and fasting blood glucose of >125 mg/dl. Major risk factors are obesity and inactivity. Statistics reveal those with >35 BMI have a 30x greater risk than persons <23 BMI (Dunford & Doyle, 2019).

Since the essence of DM2 is acquired insulin resistance, one can manage it though a combination of diet, lifestyle, exercise, and drugs. The first three options can be effective and strategies we can directly partner together with the client. In fact, the “Physical Activity Guidelines for Americans” does not exclude people with DM2 as research demonstrates regular physical activities improves beta cell function (in pancreas), increases insulin sensitivity, improves vascular function, and gut microbiota health (Kanaley et al., 2022). Furthermore, regular resistance exercise in adults with DM2 improves strength, blood pressure, lipid profiles, and reduced A1C; recent data prefers high-intensity training to be more beneficial vs low-moderate intensity for glucose management (Kanaley et al., 2022). According to the text, aerobic exercise has some unique benefits like increasing the sensitivity of insulin receptors and upregulation of GLUT4 proteins which helps decrease hyperglycemia even for many hours after the cessation of aerobic training (Dunford & Doyle, 2019).

Therefore, to optimally manage DM2 then we should integrate various exercise modalities such as aerobic, resistance, and HIIT alongside diet and lifestyle modification. Specifically, training recommendations as follows according to Kanaley et al. (2022):

-        General Physical Activity Guidelines for All Americans:

• Aim to work up to 150-300min/ week of moderate-intensity aerobic training or 75-150min/ week of vigorous-intensity aerobic activity.

• Resistance training each major muscle groups 2x/ week with moderate or greater intensity.

• Balance and flexibility >2-3x/ week is also recommended.

So, an example weekly exercise program for a 45-year-old male with 33 BMI and DM2 without heart or kidney disease.

Sun	Mon	Tues	Weds	Thurs	Fri	Sat
15min walk AM	15min walk AM	15min walk AM	15min walk AM	15min walk AM	15min walk AM
	Upper body resistance training (push/ pull) at 60-80% 1RM 2-3 exercises per muscle group. 2-4 sets per exercise	Lower Body resistance Training at 60-80% 1RM 2-3 exercises per muscle group. 2-4 sets per exercise	Moderate intensity bike ride (30in)	Upper body resistance training (push/ pull) at 60-80% 1RM 2-3 exercises per muscle group. 2-4 sets per exercise	HIIT session on bike (20min)	Hike with family 1-2 hours
15 min walk PM	HIIT session on bike (20min)	15 min walk PM	15 min walk PM	15 min walk PM	15 min walk PM	15 min walk PM

Total moderate intensity aerobic (40-59% of HRR): 330min

Total high intensity aerobic (60-89% of HRR): 40min

Total resistance training: 2 upper body; 1 lower body

A great infographic from Kirwan, Sacks & Nieuwoudt (2017) on the beneficial modulatory effects of exercise and DM2:

Regarding networking, referral, co-management, and contraindications often we can partner with a general physician or PCP as the lead care provider and resource if prescription medications is necessary; referral to a diabetes specialist is not recommended in the initial stage of care (Ludinard, Chrusciel & Sanchez, 2025).

Lastly, precautions to be considered would be CVD, neuropathy, kidney, renal, and fasting blood glucose >300 (Dunford & Doyle, 2019). For adults who are currently sedentary, medical clearance is recommended before beginning moderate-to-high intensity physical activity. If the person is > 40 years old, a maximal graded exercise stress test may also be warranted even if the person has no know CVD risk factors (Kanaley et al. (2022). Lastly, caution is recommended when exercising in hot and humid conditions since thermoregulation mechanisms can be sub-optimal via abnormal cutaneous vasodilation, decreased sweat rate capacity and dehydration (Kanaley et al. (2022).

References:

Dunford, M., & Doyle, J. A. (2019). Nutrition for sport and exercise (4th ed.). Cengage.

Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., Kirwan, J. P., & Zierath, J. R. (2022). Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. Medicine and science in sports and exercise, 54(2), 353–368. https://doi.org/10.1249/MSS.0000000000002800

Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03

Ludinard, A., Chrusciel, J., & Sanchez, S. (2025). Referral reasons of type 2 diabetes patients from general practitioners to diabetes specialists: a cross-sectional observational study. BMC primary care, 26(1), 105. https://doi.org/10.1186/s12875-025-02809-x