Download PDF
Exp Clin Endocrinol Diabetes 2021; 129(S 01): S52-S59
DOI: 10.1055/a-1284-6097
German Diabetes Association: Clinical Practice Guidelines

Diabetes, Sports and Exercise

Katrin Esefeld
1   Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany
4   German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
,
Stephan Kress
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
7   Department of Internal Medicine I, Vinzentius Hospital Landau, Germany
,
Meinolf Behrens
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
8   Diabetes Center Minden, Minden, Germany
,
Peter Zimmer
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
,
Michael Stumvoll
3   Medical Department III - Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
,
Ulrike Thurm
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
,
Bernhard Gehr
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
9   m&i specialized clinic Bad Heilbrunn, Germany
,
Christian Brinkmann
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
5   Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
6   IST University of Applied Sciences Düsseldorf, Düsseldorf, Germany
,
Martin Halle
1   Department of Preventive Sports Medicine and Sports Cardiology, Technical University Munich, Munich, Germany
2   Diabetes, Sport and Physical Activity Working Group of the DDG, Germany
4   German Center for Cardiovascular Research (Deutsches Zentrum für Herzkreislaufforschung - DZHK), partner site Munich Heart Alliance (MHA), Munich, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

For all forms of diabetes mellitus, exercise is one of the most important measures for maintaining good health. Sport and exercise trigger adaptation and repair mechanisms in various organ systems and cells, such as the muscles, nerves, vessels, immune system or brain, which can help ward off diseases [1] [2] [3] [4].

There is no need for maximum physical exercise. Exertion according to the motto “running/walking without panting” already brings about good health benefits. According to the recommendations of the American Diabetes Association (ADA) from 2020, adults with diabetes should exercise for 150 minutes/week or more at moderate intensity. Younger and physically fit patients can also exercise more intensively (minimum recommendation: 75 minutes/week). Exercise should be performed on at least 3 days, with no more than 2 consecutive days of inactivity. Strength training 2–3 times a week is also recommended, but not on consecutive days. Periods of sitting should be interrupted every 30 minutes. For older people, flexibility and balance training is also recommended 2–3 times a week.

Alternative sports such as yoga and tai-chi may also be suitable. For the treatment of obesity, 200–300 minutes of exercise per week and an energy deficit of about 500–750 kcal/day should be aimed for [5].

This practice guideline is intended to outline therapeutic options for physical activity in the treatment of diabetes mellitus and to provide practical recommendations for implementation in type 1 and type 2 patients.



Publication History

Article published online:
21 December 2020

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literature

  • 1 Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015; 25 Suppl. 3: 1-72
    CrossrefPubMedGoogle Scholar
  • 2 Kirchner H, Osler ME, Krook A. et al. Epigenetic flexibility in metabolic regulation: Disease cause and prevention?. Trends Cell Biol 2013; 23: 203-209
    CrossrefPubMedGoogle Scholar
  • 3 Benatti FB, Pedersen BK. Exercise as an anti-inflammatory therapy for rheumatic diseases-myokine regulation. Nat Rev Rheumatol 2015; 11: 86-97
    CrossrefPubMedGoogle Scholar
  • 4 Fiuza-Luces C, Garatachea N, Berger NA. et al. Exercise is the real polypill. Physiology 2013; 28: 330-358
    CrossrefPubMedGoogle Scholar
  • 5 American Diabetes Association. Standards in medical care in diabetes – 2020. Diabetes Care 2020; 43: S1
    CrossrefPubMedGoogle Scholar
  • 6 Stanford KI, Goodyear LJ. Exercise and type 2 diabetes: Molecular mechanisms regulating glucose uptake in skeletal muscle. Adv Physiol Educ 2014; 38: 308-314
    CrossrefPubMedGoogle Scholar
  • 7 Herbst A, Kordonouri O, Schwab KO. et al. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: A multicenter study of 23251 patients. Diabetes Care 2007; 30: 2098-2100
    CrossrefPubMedGoogle Scholar
  • 8 Tonoli C, Heyman E, Roelands B. et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: A meta-analysis. Sports Med 2012; 42: 1059-1080
    CrossrefPubMedGoogle Scholar
  • 9 Riddell MC, Gallen IW, Smart CE. et al. Exercise management in type 1 diabetes: A consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-390
    CrossrefPubMedGoogle Scholar
  • 10 Roberts AJ, Taplin CE. Exercise in youth with type 1 diabetes. Curr Pediatr Rev 2015; 11: 120-125
    CrossrefPubMedGoogle Scholar
  • 11 Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes. Pediatr Diabetes 2015; 16: 242-255
    CrossrefPubMedGoogle Scholar
  • 12 Bally L, Laimer M, Stettler C. Exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus. Curr Opin Clin Nutr Metab Care 2015; 18: 428-433
    CrossrefPubMedGoogle Scholar
  • 13 Garcia-Garcia F, Kumareswaran K, Hovorka R. et al. Quantifying the acute changes in glucose with exercise in type 1 diabetes: A systematic review and meta-analysis. Sports Med 2015; 45: 587-599
    CrossrefPubMedGoogle Scholar
  • 14 Lean ME, Leslie WS, Barnes AC. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster randomised trial. Lancet 2018; 391: 541-551
    CrossrefPubMedGoogle Scholar
  • 15 Lean MEJ, Leslie WS, Barnes AC. Durability of a primary care-led weightmanagement intervention for remission of type 2 diabetes: 2 year results of the DiRECT open-label, cluster randomised trial. Lancet Diabetes Endocrinol 2019; 7: 344-355
    CrossrefPubMedGoogle Scholar
  • 16 Röhling M, Herder C, Roden M. et al. Effects of long-term exercise interventions on glycaemic control in type 1 and type 2 diabetes: a Systematic Review. Exp Clin Endocrinol Diabetes 2016; 124: 487-494
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Umpierre D, Ribeiro PA, Kramer CK. et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis. JAMA 2011; 305: 1790-1799
    CrossrefPubMedGoogle Scholar
  • 18 Wing RR, Bolin P, Brancati FL. et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
    CrossrefPubMedGoogle Scholar
  • 19 Knowler WC, Fowler SE, Hamman RF. et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374: 1677-1686
    CrossrefPubMedGoogle Scholar
  • 20 Look AHEAD research group. et al. Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2014; 2: 801-809
    CrossrefPubMedGoogle Scholar
  • 21 Colberg SR, Laan R, Dassau E. et al. Physical activity and type 1 diabetes: time for a rewire?. J Diabetes Sci Technol 2015; 9: 609-618
    CrossrefPubMedGoogle Scholar
  • 22 Jayawardene DC, McAuley SA, Horsburgh JC. et al. Closed-loop insulin delivery for adults with type 1 diabetes undertaking high-intensity interval exercise versus moderate-intensity exercise: A randomized, crossover study. Diabetes Technol Ther 2017; 19: 340-348
    CrossrefPubMedGoogle Scholar
  • 23 Breton MD, Chernavvsky DR, Forlenza GP. et al. Closed-loop control during intense prolonged outdoor exercise in adolescents with type 1 diabetes: the artificial pancreas ski study. Diabetes Care 2017; 40: 1644-1650
    CrossrefPubMedGoogle Scholar
  • 24 Dovc K, Macedoni M, Bratina N. et al. Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomised controlled crossover trial. Diabetologia 2017; 60: 2157-2167
    CrossrefPubMedGoogle Scholar
  • 25 Ding S, Schumacher M. Sensor monitoring of physical activity to improve glucose management in diabetic patients: A review. Sensors 2016; 16: 589
    Google Scholar
  • 26 Lunde P, Blakstad Nilsson B, Bergland A. et al. The effectiveness of smartphone apps for lifestyle improvement in noncommunicable diseases: systematic review and meta-analyses. J Med Internet Res 2018; 20: 1-12
    Google Scholar
  • 27 Wu X, Guo X, Zhang Z. The efficacy of mobile phone apps for lifestyle modification in diabetes: systematic review and meta-analysis. JMIR Mhealth and Uhealth 2019; 7: e12297
    CrossrefPubMedGoogle Scholar
  • 28 Yom-Tov E, Feraru G, Kozdoba M. et al. Encouraging physical activity in patients with diabetes: intervention using a reinforcement learning system. J Med Internet Res 2017; 19: e338
    Google Scholar
  • 29 Jimenez G, Lum E, Car J. Examining diabetes management apps recommended from a Google search: Content analysis. JMIR Mhealth and Uhealth 2019; 7: e11848
    CrossrefPubMedGoogle Scholar
  • 30 Pais S, Parry D, Petrova K. et al. Acceptance of using an ecosystem of mobile apps for use in diabetes clinic for self-management of gestational diabetes mellitus. Stud Health Technol Inform 2017; 245: 188-192
    Google Scholar
  • 31 Kordonouri O, Riddell MC. Use of apps for physical activity in type 1 diabetes: current status and requirements for future development. Ther Adv Endocrinol Metab 2019; 10: 1-7
    Google Scholar
  • 32 Thomas JG, Bond DS, Raynor HA. et al. Comparison of smartphone-based behavioral obesity treatment with gold standard group treatment and control: A randomized trial. Obesity 2019; 27: 572-580
    CrossrefPubMedGoogle Scholar
  • 33 Schütte L. Digital self-help. Digitalization and Technology Report Diabetes. 2019; https://www.dut-report.de/wp-content/uploads/2019/01/Selbsthilfe_Schuette.pdf. Access 26.05.2019
  • 34 Staiano AE, Beyl RA, Guan W. et al. Home-based exergaming among children with overweight/obesity: A randomized clinical trial. Pediatr Obes 2018; 13: 724-733
    CrossrefPubMedGoogle Scholar
  • 35 Cooper AR, Tibbitts B, England C. et al. Potential of electric bicycles to improve the health of people with type 2 diabetes: A feasibility study. Diabet Med 2018; 35: 1279-1282
    CrossrefPubMedGoogle Scholar
  • 36 Karstoft K, Winding K, Knudsen SH. et al. The effects of free-living intervalwalking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: A randomized, controlled trial. Diabetes Care 2013; 36: 228-236
    CrossrefPubMedGoogle Scholar
  • 37 Yang Z, Scott AC, Mao C. et al. Resistance exercise versus aerobic exercise for type 2 diabetes: A systematic review and meta-analysis. Sports Med 2014; 44: 487-499
    CrossrefPubMedGoogle Scholar
  • 38 van Buuren F, Horstkotte D, Mellwig KP. et al. Electrical myostimulation (EMS) improves glucose metabolism and oxygen uptake in type 2 diabetes mellitus patients – results from the EMS study. Diabetes Technol Ther 2015; 17: 413-419
    CrossrefPubMedGoogle Scholar
  • 39 Robinson CC, Barreto RP, Sbruzzi G. et al. The effects of whole body vibration in patients with type 2 diabetes: a systematic review and metaanalysis of randomized controlled trials. Braz J Phys Ther 2016; 20: 4-14
    CrossrefPubMedGoogle Scholar
  • 40 Kempf K, Martin S. Autonomous exercise game use improves metabolic control and quality of life in type 2 diabetes patients – a randomized controlled trial. BMC Endocr Disord 2013; 13: 57
    CrossrefPubMedGoogle Scholar
  • 41 Kemmler W, Weissenfels A, Willert S. et al. Recommended contraindications for the use of non-medical WB-electromyostimulation. German Journal for Sports Medicine 2019; 11: 278-281
    PubMedGoogle Scholar