In people with or at risk for developing type 2 diabetes, extended sedentary time is also associated with poorer glycemic control and clustered metabolic risk ( 36– 39). Higher amounts of sedentary time are associated with increased mortality and morbidity, mostly independent of moderate-to-vigorous physical activity participation ( 31– 35). Sedentary behavior-waking behaviors with low energy expenditure (TV viewing, desk work, etc.)-is a ubiquitous and significant population-wide influence on cardiometabolic health ( 29, 30). BENEFITS OF AND RECOMMENDATIONS FOR REDUCED SEDENTARY TIME Tai chi training may improve glycemic control, balance, neuropathic symptoms, and some dimensions of quality of life in adults with diabetes and neuropathy, although high-quality studies on this training are lacking ( 28). The benefits of alternative training like yoga and tai chi are less established, although yoga may promote improvement in glycemic control, lipid levels, and body composition in adults with type 2 diabetes ( 27). Group exercise interventions (resistance and balance training, tai chi classes) may reduce falls by 28%−29% ( 26). Balance training can reduce falls risk by improving balance and gait, even when peripheral neuropathy is present ( 11). Stretching increases range of motion around joints and flexibility ( 10) but does not affect glycemic control. Limited joint mobility is frequently present, resulting in part from the formation of advanced glycation end products, which accumulate during normal aging and are accelerated by hyperglycemia ( 25). Benefits of Other Types of Physical Activityįlexibility and balance exercises are likely important for older adults with diabetes. Resistance training benefits for individuals with type 2 diabetes include improvements in glycemic control, insulin resistance, fat mass, blood pressure, strength, and lean body mass ( 24). When resistance and aerobic exercise are undertaken in one exercise session, performing resistance exercise first results in less hypoglycemia than when aerobic exercise is performed first ( 23). However, resistance exercise can assist in minimizing risk of exercise-induced hypoglycemia in type 1 diabetes ( 22). The effect of resistance exercise on glycemic control in type 1 diabetes is unclear ( 19). The health benefits of resistance training for all adults include improvements in muscle mass, body composition, strength, physical function, mental health, bone mineral density, insulin sensitivity, blood pressure, lipid profiles, and cardiovascular health ( 12). TYPES OF EXERCISE AND PHYSICAL ACTIVITYĭiabetes is an independent risk factor for low muscular strength ( 20) and accelerated decline in muscle strength and functional status ( 21). Prediabetes is diagnosed when blood glucose levels are above the normal range but not high enough to be classified as diabetes affected individuals have a heightened risk of developing type 2 diabetes ( 7) but may prevent/delay its onset with physical activity and other lifestyle changes ( 8). Gestational diabetes mellitus occurs during pregnancy, with screening typically occurring at 24–28 weeks of gestation in pregnant women not previously known to have diabetes.
Type 2 diabetes (90%–95% of cases) results from a progressive loss of insulin secretion, usually also with insulin resistance. Although it can occur at any age, β-cell destruction rates vary, typically occurring more rapidly in youth than in adults.
Type 1 diabetes (5%–10% of cases) results from cellular-mediated autoimmune destruction of the pancreatic β-cells, producing insulin deficiency ( 7). The primary types of diabetes are type 1 and type 2. Physical activity recommendations and precautions may vary by diabetes type.
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