Exercise for the management of type 2 diabetes mellitus: factors to consider with current guidelines

It has long been established that exercise is powerful medicine for those with type 2 diabetes mellitus (T2DM), such that it should represent a priority in the treatment and management of that condition. In spite of this, exercise adherence among those with T2DM is low, with lack of time and fear of doing harm commonly cited as reasons for not being more active. Published guidelines for aerobic exercise in those with T2DM recommend only moderate intensity, due to the elevated risk of untoward outcomes with more vigorous exercise in persons with chronic disease. However, considerable research evidence has appeared in the literature since the publication of those guidelines in 2010 addressing the safety and efficacy of more vigorous forms of exercise (i.e., interval training) in those with T2DM. Many such studies have reported improvements in glucose control as great as or greater than those associated with moderate intensity exercise, with significantly reduced time requirements, and mechanisms of improved glucose control via interval training may be unique to this mode of exercise. Resistance training, too, appears to confer significant improvements in glucose control in those with T2DM through unique mechanisms. These recent findings may be of interest to physicians and exercise practitioners, as they may provide for greater adherence to more optimal exercise prescriptions that are better suited to each patient's time availability and motivational level.