Key Points from the Updated Guidelines on Exercise and Diabetes

No doubt remains that the adoption and maintenance of physical activity is important for overall health and blood glucose management in individuals with diabetes and prediabetes.Recently, the American Diabetes Association (ADA) published updated recommendations and precautions about physical activity and exercise in people with type 1 diabetes, type 2 diabetes, and gestational diabetes (1).Given the importance of these topics, it is worth discussing the key changes and updates included in this ADA position statement (PS). pre-Exercise Health Screening and EvaluationThis PS reiterates that "pre-exercise medical clearance is not necessary for asymptomatic, sedentary individuals who wish to begin low-or moderate-intensity physical activity not exceeding the demands of brisk walking or everyday living" (1).This stance directly opposes a recent recommendation from the American College of Sports Medicine (ACSM) (2) that requires anyone with a metabolic disease (in this case, diabetes) who desires to begin exercising at any level-even doing light activities-to obtain medical clearance from a health-care provider first.The authors of the ADA PS did not agree with this restriction and took the same stance as the prior ADA PS on type 2 diabetes and exercise (3), which I believe is a much better recommendation.Making adults obtain any type of medical clearance prior to starting walking, for example, is an unnecessary barrier that will not necessarily make exercising any safer for them.However, ADA agrees with ACSM that adults with diabetes who plan to exercise at higher intensities than currently undertaken or who would be considered at high risk for cardiovascular disease (e.g., have elevated blood cholesterol, smoke, have a strong family history, etc.) or other health complications from doing such activities are recommended to obtain a pre-training examination from a health-care provider who may or may not recommend exercise stress testing (3). RECOMMEnDED pHYSiCAL ACTiViTY/EXERCiSEAll physical movement has the potential to improve physical and mental health (4-6).Since blood glucose management varies with a number of factors, it is critical for recommendations to be tailored for activity type and health complications to be effective (3, 7).In the PS, physical activity is defined as any movement that increases energy use, and exercise is a subset of physical activity that is more planned or structured (1), which is an important distinction. Aerobic Exercise TrainingAs previously recommended, most adults with type 1 or type 2 diabetes should undertake at least 150 min or more of moderate-to vigorous-intensity activity weekly; it is also recommended that these activities occur on at least 3 or more days during the week and that individuals should not allow more than 2 days to elapse between activity sessions to maintain higher levels of insulin sensitivity