Diabetes & Exercise Safety

Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

“…This risk stratification is based on a number of well-established risk factors for CVD and micro-or macrovacular disease in persons with diabetes and the finding that exercise can be a trigger for cardiovascular symptoms-events and (or) damage to the microvasculature in patients with diabetes. Our recommendations, which focus on prediabetes and diabetes, align closely with others who have voiced concerns about the importance of screening and safety issues related to exercise in persons with these conditions (Constantini et al 2005;Flood and Constance 2002;Chipkin et al 2001;Albert and Bernbaum 1995;Draznin 2000;Gaudet-Savard et al 2007;Graham and Lasko-McCarthey 1990;Bernbaum et al 1989;Kanade et al 2006).…”

“…An extensive review of the beneficial effects of PA in persons with a metabolic disease can be found in a recent report by the Physical Activity Guidelines Advisory Committee published by the United States Department of Health and Human Services (Physical Activity Guidelines Advisory Committee 2008). While several authors have commented previously on the CVD event risks associated with exercise in diabetes (Constantini et al 2005;Flood and Constance 2002;Chipkin et al 2001;Albert and Bernbaum 1995;Draznin 2000;Gaudet-Savard et al 2007;Graham and Lasko-McCarthey 1990;Bernbaum et al 1989;Kanade et al 2006), no attempt has been made to systematically document the adverse events in persons with metabolic disease. As such, several questions remain with respect to PA and metabolic disease: (i) what are the risks associated with increased PA for each type of metabolic disease-condition; (ii) what are the absolute and relative contraindications of exercise that should be considered in screening individuals with a metabolic condition; and (iii) who is qualified to screen and prescribe such an exercise program?…”

“…For those already diagnosed with diabetes (either type 1 or type 2), there are considerable benefits from being physically active. In the past, several authors, professional associations, and expert consensus panels have presented guidelines and (or) recommendations for physical activity (PA) for patients with diabetes (Sigal et al 2004(Sigal et al , 2006(Sigal et al , 2008Albright et al 2000;Constantini et al 2005;Flood and Constance 2002;Chipkin et al 2001;Albert and Bernbaum 1995;Draznin 2000; Physical Activity Guidelines Advisory Committee 2008; Thomas et al 2006). While these important documents highlight the numerous benefits of PA, they generally fail to provide clear evidenced-based guidelines on risk stratification or on the absolute and relative contraindications to exercise in these seemingly high-risk individuals.…”

Primary Prevention and Risk Reduction for Cardiovascular/Pulmonary Disorders—Preferred Practice Pattern 6A

“…2,13 Long-term impairments that result from poorly controlled type 2 diabetes are both microvascular and macrovascular. 2,13 Long-term impairments that result from poorly controlled type 2 diabetes are both microvascular and macrovascular.…”

Exercise for Primary Care

“…However, even for those with co-occurring conditions, many risks can be sidestepped by the gradual introduction of low-intensity movement that fits comfortably within each patient's existing routine. 4,6,7,[10][11][12][13][14][15][16][17][18][19] To optimize the risk-benefit ratio, lifestyle changes should represent just-noticeable differences from previous levels of functioning. As the old adage goes, substitute sitting for lying down, standing for sitting, and walking for standing.…”