TABLE 4.
Key Recommendations for Physical Activity Prescription for People With Diabetes and Diabetes-Related Complications4,6,9,27,66,84,105
| Patient Characteristic | Recommendation for Physical Activity Prescription |
|---|---|
| Diabetes: general | • Customize program for patient goals, comorbidities, and complication risk • Prescription of physical activity must take into account baseline activity level in order to avoid injury and maximize long-term compliance • Activity monitors are a useful tool to determine baseline activity and to monitor and encourage activity prescription compliance • Physical activity should be progressed gradually, with the goal to achieve 150 min/wk of moderate- to vigorous-intensity aerobic activity6 • Monitor blood pressure and glucose during and after performing new aerobic and/or resistance exercises • Exercise equipment must accommodate the size and weight of the patient • Decrease sedentary time by getting up and out of the chair every 30 min69 |
| Lower extremity musculoskeletal impairments, neuropathy, and/or a history of foot ulcers/fractures | • Weight-bearing exercise is not contraindicated; however, patients may be more at risk for skin breakdown when there is foot deformity or a history of foot wounds74 • Select activities that minimize lower extremity load, including - Pool-based exercise - Stationary cycling - Elliptical - Seated aerobic activities • If patients have an open sore or injury on their foot, non–weight-bearing exercise is preferred6 |
| Autonomic neuropathy or medication (eg, beta blockers, nitrates, calcium-channel blockers, digoxin, diuretics, ACE inhibitors) that blunts heart rate and blood pressure response to physical activity | • Use rate of perceived exertion in addition to heart rate and blood pressure to monitor exercise response |
| Proliferative and severe nonproliferative diabetic retinopathy | • High-intensity aerobic exercise may be contraindicated due to the potential to exacerbate eye damage6 |
| Obesity | • Resistance training has many of the same benefits as aerobic exercise84 and is often better tolerated by those who are obese or untrained |
Abbreviation: ACE, angiotensin-converting enzyme.