2022: Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes

Abstract

Introduction For individuals diagnosed with diabetes mellitus, the practice of properly oriented physical exercises brings significant benefits to the individual's health and is considered an indispensable tool for metabolic management. The individualization of exercise routines is an essential aspect for therapeutic success, despite the need to consider some general recommendations. This review is an authorized literal translation of the Brazilian Society of Diabetes (SBD) Guidelines 2021–2022, which is based on scientific evidence and provides guidance on physical activities and exercises aimed at individuals with type 1 and 2 diabetes. Methods SBD designated 9 specialists from its “Department of Diabetes, Exercise & Sports” to author chapters on physical activities and exercises directed to individuals with type 1 and 2 diabetes. The aim of these chapters was to highlight recommendations in accordance with Evidence Levels, based on what is described in the literature. These chapters were analyzed by the SBD Central Committee, which is also responsible for the SBD 2021–2022 guidelines. Main clinical inquiries were selected to perform a narrated review by using MEDLINE via PubMed. Top available evidence, such as high-quality clinical trials, large observational studies and meta-analyses related to physical activity and exercise advisory, were analyzed. The adopted MeSh terms were [diabetes], [type 1 diabetes], [type 2 diabetes], [physical activity] [physical exercise]. Results 17 recommendations were defined by the members. For this review, it was considered different Evidence Levels, as well as different Classes of Recommendations. As to Evidence Levels, the following levels were contemplated: Level A) More than one randomized clinical trial or a randomized clinical trial meta-analysis with low heterogeneity. Level B) Meta analysis with observational studies, one randomized clinical trial, sizeable observational studies and sub-groups analysis. Level C) Small non-randomized studies, cross-sectional studies, case control studies, guidelines or experts’ opinions. In respect to Recommendation Classes, the following criteria were adopted: I. “Recommended”: Meaning there was a consent of more than 90% of the panel; IIa. “Must be considered”: meaning there is a general preference of the panel which 70–90% agrees; IIb. “Can be considered”. 50–70% agrees; III Not recommended: There is a consensus that the intervention should not be performed. Conclusion Physical exercise aids on the glycemic control of type 2 diabetes individuals while also decreasing cardiovascular risk in individuals with type 1 and 2 diabetes. Individuals diagnosed with diabetes should perform combined aerobic and resistance exercises in order to manage the disease. In addition, exercises focusing on flexibility and balance should be specially addressed on elderly individuals. Diabetes individuals using insulin as therapeutic treatment should properly monitor glycemia levels before, during and after exercise sessions to minimize health incidents, such as hypoglycemia.

Physical exercise as treatment for adults with type 2 diabetes: a rapid review

“…This study aimed to produce a literature synthesis, through a rapid review, on the effects of aerobic, resistance, and combined physical training variables on glycemic control in adults with type 2 Diabetes Mellitus. There is a strong body of evidence on the therapeutic effect of physical exercise on the prevention and treatment of T2DM ( 13 , 16 , 21 , 42 ). However, previous studies have reported important heterogeneity in adherence rates and a low rate of patients with diabetes meeting the minimum amount of exercise recommended by guidelines ( 43 , 44 ).…”

“…Physical exercise should be tailored to meet the specific personal and clinical needs of each patient ( 11 ). An individualized exercise program is crucial for therapeutic success, although there are general guidelines ( 9 , 12 – 16 ). Properly prescribed and executed physical exercise offers significant benefits to individuals with T2DM, serving as an effective tool for metabolic management and a non-pharmacological strategy for the prevention and treatment of T2DM in adults and older adults ( 9 , 13 ).…”

Ejercicio físico y diabetes mellitus tipo 1: Una revisión narrativa (Physical exercise and type 1 diabetes mellitus: An narrative review)

“…(Jauregui y López, 2015). Así, abogamos también por la recomendación de la Sociedad Brasileña de Diabetes, (2022) (Pereira et al, 2023) en relación al ejercicio en individuos con DMT1, sugiriendo que aquellos sujetos dependientes de insulina como tratamiento terapéutico deben controlar adecuadamente los niveles de glucemia antes, durante y después de las sesiones de ejercicio para minimizar los incidentes como la hipoglucemia.…”

“…Si el ejercicio se torna muy intenso, >85% de la frecuencia cardíaca máxima (FC máx), el metabolismo anaeróbico es el que suministra la mayor parte de la energía (Yardley et al, 2013), en éste sentido, se ha propuesto que los sprints están asociados con aumentos de hormonas contrarreguladoras (catecolaminas, glucagón, hormona del crecimiento) que pueden actuar para aumentar los niveles de glucosa (Cockcroft et al, 2020), de manera que esfuerzos predominantemente anaeróbicos, a menudo conducen a situaciones de hiperglucemia durante el ejercicio y poco después de su culminación (Campbell et al, 2015), precisamente por su efecto hiperglucemiante se sugiere que incluir alguna actividad breve de alta intensidad (5-15 s) en una sesión de EA podría ser un enfoque eficaz para contrarrestar la hipoglucemia (French et al, 2007). Al mismo tiempo, el ER genera incremento de estas hormonas contrarreguladoras (Cockcroft et al, 2020;Petschnig et al, 2020), que de manera similar a la inclusión de sprints, podría ayudar a estabilizar la glucosa en sangre, quedando demostrado que realizar ER antes (Yardley et al, 2013) o después de una sesión de EA tiene efectos protectores (Cockcroft et al, 2020).…”

Diabetes and co-occurring osteoarthritis, and yoga 2023

“…While critically ill patients may need intravenous insulin infusion therapy, and pharmacotherapy is both marketed intently and popular, 20 these approaches do not truly change the underlying modifiable or behavioral causes or contributors to the condition at all effectively. 21 Safer and available to all adults even in low income countries, the adoption of moderate exercise appears highly justified in this regard if one considers its value for both diabetes and osteoarthritis care, its wide ranging approaches, its simplicity, low cost, and the observation most cases of Type 2 diabetes can be managed by blood glucose monitoring, diet, and moderate exercise, 3,10,22 with exercise as the most promising approach. It is also the preferred approach for countering osteoarthritis pain and for possible sustained weight control.…”