Evidence‐based Exercise Progression on the Diabetic Patient

Abstract

It is estimated that the worldwide prevalence of Type 2 Diabetes Mellitus by 2030 will be 522 million people, which generates a negative impact on the well‐being of the individual and population health. Within the fundamental pillars of the treatment are the changes in the lifestyle that includes physical exercise. Organizations such as the ADA (American Diabetes Association) and the ACSM (American College of Sports Medicine) suggest strength training 2 to 3 times per week, using weights, bands or machines at moderate to vigorous intensity and aerobic training 3 to 7 days, minimum 150 minutes a week with the same intensity. However, these recommendations are widespread and do not take into account the progression of the load. This work summarizes the progression of training that diabetic patients should have in order to optimize the results. It is suggested to combine the work of strength with resistance, which is related to better body composition. Training intensity should be progressively increased whenever possible, which is related to increased muscle sensitivity to insulin. The training volume should be progressively increased as well, which allows for a higher concentration of GLUT4 transporters, improving intracellular insulin signaling, and generating a reduction in plasma and intramyocellular free fatty acids that lead to better insulin sensitivity. Based on the preceding, the physiological proposal of progression includes: Performing resistance work during the first weeks of training and subsequently including endurance training until a concurrent type of training is achieved. Also, there should be an increase the training volume (total weight lifted and total covered distance ), and then increased the intensity, High‐Intensity Interval training can only be done until several weeks of adaptation are completed. Finally, the training frequency should also be increased progressively until ideally reaching seven days a week. Given the rapid physiological adaptation, the loads must be undulated, alternating the training variables, intensity, volume, time, and type of exercise, until reaching the objective. Therefore, based on the evidence, we propose in this article a dynamic training model for diabetic patients that could be implemented by physicians and corresponding health personnel. Dynamic training model for diabetic patients