Exercise as Medicine for Diabetes: Prescribing Appropriate Activities and Avoiding Potential Pitfalls: Preface

In this issue, I have the pleasure of further reinforcing for you the benefits of engaging in regular exercise, along with the more expansive realm of appropriate physical activities for people with diabetes. Although physical activity is a cornerstone in the management of diabetes, and the health benefits of exercise are widely touted as “medicine” for diabetes, many individuals with this chronic disease fail to become or remain regularly active (1). One barrier to being active is that exercise potentially has a large impact on the body’s metabolism, which, in some cases, can complicate the management of blood glucose levels. For example, a number of factors influence the exact contribution of various fuels to exercise metabolism, including (but not limited to) nutritional status, age, type of activity, physical fitness level, and glycemic balance. However, the most important influences on fuel utilization—and the resulting glycemic balance—are the intensity and duration of physical activity (2–10). This Diabetes Spectrum From Research to Practice section on exercise covers the latest trends, practices, suggestions, recommendations, and concerns regarding getting people with all types of diabetes more physically active to improve their health and, hopefully, their glycemic balance. The goal is to allow you to think more broadly about being active and how that can become a reality for each and every one of your patients, one way or another. Before you begin prescribing exercise to everyone, I need to add a word of caution related to advising sedentary individuals, in particular, to become more active. Before embarking on a new exercise program or even increasing their usual patterns of physical activity, people with diabetes are advised to undergo a detailed medical evaluation with appropriate screening for the presence of diabetes-related health complications that could potentially be worsened by exercise, including poor glycemic control, joint issues, and various macrovascular and microvascular complications (11). Generally, for individuals planning to participate in low-intensity physical activity such as walking, health care providers should use their clinical judgment in deciding whether to recommend additional pre-exercise testing (11). At present, the need for exercise stress testing before engaging in all physical activity is controversial. Before undertaking exercise more vigorous than brisk walking or that exceeds the demands of everyday living, however, previously sedentary individuals with diabetes are advised to be assessed for cardiovascular disease risks or other conditions that might contraindicate specific types of exercise or predispose them to injuries (12). The benefit of conducting diagnostic exercise stress testing for asymptomatic, low-risk individuals has not been established and is not Old Dominion University and Eastern Virginia Medical School, Norfolk, VA