This consensus statement is an update of the 2010 American College of Sports Medicine position stand on exercise and type 2 diabetes. Since then, a substantial amount of research on select topics in exercise in individuals of various ages with type 2 diabetes has been published while diabetes prevalence has continued to expand worldwide. This consensus statement provides a brief summary of the current evidence and extends and updates the prior recommendations. The document has been expanded to include physical activity, a broader, more comprehensive definition of human movement than planned exercise, and reducing sedentary time. Various types of physical activity enhance health and glycemic management in people with type 2 diabetes, including flexibility and balance exercise, and the importance of each recommended type or mode are discussed. In general, the 2018 Physical Activity Guidelines for Americans apply to all individuals with type 2 diabetes, with a few exceptions and modifications. People with type 2 diabetes should engage in physical activity regularly and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks. Any activities undertaken with acute and chronic health complications related to diabetes may require accommodations to ensure safe and effective participation. Other topics addressed are exercise timing to maximize its glucose-lowering effects and barriers to and inequities in physical activity adoption and maintenance.

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Our data indicate that subjects with T1DM oxidize fat at a higher rate and carbohydrates at a lower rate when compared with age- and sex-matched controls at the same relative intensity of exercise, despite the elevated pre-exercise blood glucose of subjects with T1DM.

The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.

Introduction: Physical activity (PA) has many health benefits in people with type 1 diabetes (T1D), yet adolescents with T1D engage in less PA than their peers and may struggle to employ strategies that allow them to participate fully and maintain glucose levels in target range. Diabetes Training Camp Teen Boot Camp (DTC-TBC) is an intensive 3-day program that includes education and workouts geared for teens with T1D and their parents/guardians. We aimed to determine if indicators of psychosocial (confidence in glucose management during PA, positive experience, barriers to PA) and health (HbA1c) changed after attending DTC-TBC in summer 2022. Methods: DTC-TBC participants included 16 adolescents aged 13-18 years (HbA1c=7.3±1.4%; 25% female). Most used a continuous glucose monitor (93%) and insulin pump (69%) to manage T1D. Participants completed questionnaires on the first day of camp (baseline), last day of camp and 1 month after camp. Paired t-tests were used to compare 1) mean 7-point Likert scale scores for confidence in managing T1D (1 = not confident, 7= very confident) before and immediately post camp and 2) mean scores on the Barriers to PA in T1D and reported HbA1c before and 1-month post camp (n=11). Results: Both parents and teens reported high satisfaction with the DTC-TBC experience; 100% of participants said they would recommend DTC-TBC. Confidence in managing T1D significantly increased (baseline 4.9±1.2 vs post-camp 6.0±0.6; p<0.0001). Teens reported lower barriers to PA 1-month post-camp (baseline 25.0±14.3, 1 month 21.5±8.0; p=0.170). HbA1c decreased by 0.26% 1 month after camp (95% CI −0.18, 0.70; p=0.106). Conclusions: Barriers to PA and HbA1c both trended towards significant reductions even with a small sample size, whereas confidence significantly increased. Follow-up at regular intervals and inclusion of future camp participants will help determine if DTC-TBC has a statistically significant positive impact on psychosocial and health outcomes. Disclosure K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. J.D.Hall: None. H.K.O'donnell: None. J.P.Deblois: None. B.Tanner: None. C.Ferri: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. R.Powell: None. M.H.Corcoran: Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk.

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