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.

Abstract

Physical activity (PA) is one of the most powerful treatment options for persons with prediabetes or diabetes. However, some elevation in risk occurs with increased PA, at least initially, and certain precautions need to be made to lower these risks, particularly if these persons are unaccustomed to exercise. We conducted a standardized search of all adverse events associated with increased PA in persons with prediabetes or diabetes (type 1 or type 2) and provided evidencebased guidelines on PA screening in these apparently high-risk individuals. A systematic literature review was performed of all studies reporting on adverse events in persons with prediabetes or diabetes. Studies included were from all designs (retrospective and prospective including randomized controlled trials) and were assessed according to evaluation criteria adapted by a consensus panel. A total of 47 studies, involving >8000 individuals, were deemed eligible. A number of these studies identified a range of mild to severe acute risks with exercise (musculoskeletal injury, hypoglycemia, foot ulceration, proliferative retinopathy, hypotension, sudden death) but the overall prevalence was low. Based on several randomized controlled trials and prospective studies in which prescribed exercise was performed at a wide range of intensities, it appears that increased PA is a relatively safe procedure with no evidence of a loss of life. Based on our assessment of the available literature, we provide a new PA risk algorithm for persons with prediabetes and diabetes and comment on the role of the patient, the qualified exercise professional, and the patient's physician in the risk screening process.Key words: exercise, diabetes mellitus, prediabetes, adverse events, Par-Q.Résumé : L'activité physique (PA) est un des meilleurs traitements à l'intention des personnes prédiabétiques et diabéti-ques. Toutefois, avec l'intensification de la pratique de l'activité physique vient une augmentation du risque, du moins au début, et il est donc indiqué de prendre des précautions pour diminuer ce risque particulièrement chez les personnes non accoutumées à l'effort physique. Nous avons réalisé une recherche systématique de tous les événements indésirables se présen-tant avec l'intensification de la PA chez des personnes prédiabétiques et diabétiques (type 1 et type 2) et nous présentons des directives basées sur des données probantes pour le dépistage des patients apparemment à haut risque en matière de PA. On effectue une analyse documentaire systématique de toutes les études présentant des événements indésirables s'étant manifestés chez des personnes prédiabétiques et diabétiques. Les études incluent tous les devis expérimentaux (rétrospectifs et prospectifs y compris les essais cliniques aléatoires (RCTs)); on évalue ces études en fonction des critères adaptés par consensus d'experts. Au total, 47 études comprenant plus de 8000 personnes sont retenues. Un certain nombre d'études identifient des risques associés à PA allant de faibles à graves (blessu...

Social cognitive theory-based intervention to promote physical activity among prediabetic rural people: a cluster randomized controlled trial

“…At least 150–175 min/week of PA reduces the risk of developing type 2 diabetes by 40–70% in people with impaired glucose tolerance [29]. Limited RCT studies have recommended that patients with prediabetes should perform approximately 150 min/week of light-to-moderate PA to lower diabetes risk [30, 31]. Chen et al [32] reported that a 16-week empowerment program in three phases, including awareness raising, behavior building, and results checking for prediabetic patients, achieved a larger reduction in blood sugar and BMI and improved healthy lifestyle and self-efficacy significantly.…”

Iranian National Clinical Practice Guideline for Exercise in Patients with Diabetes

“…A short, few seconds, sprint after an exercise bout may somehow prevent post-exercise hypoglycemia (80). Proper measures should be taken to avoid hypoglycemia during exercise (26,32,50,52,80,85,(88)(89)(90)(91).…”

Type 2 diabetes and the medicine of exercise: The role of general practice in ensuring exercise is part of every patient’s plan

“…While the risk of an adverse event is elevated during exercise for patients with T2D, including those with comorbidities, the occurrence of adverse events is low with the benefits of regular exercise greatly outweighing the risks. 15 Additional common barriers to starting an exercise program include lack of interest and perceived lack of fitness and energy as well as ingrained sedentary behaviours. 16 The term 'exercise' itself may be a barrier to some individuals because of a lack of information from health professionals and a lack of knowledge surrounding exercise type and intensity that is safe and effective, as shown within cancer survivor populations.…”