Exercise is one of the most important non-drug strategies for managing type 2 diabetes. Regular physical activity can improve insulin sensitivity, help control blood sugar, reduce visceral fat, and support overall cardiovascular health.
For some people with type 2 diabetes, sustained lifestyle changes may even contribute to remission. However, remission does not mean that diabetes has been permanently cured, and exercise should be viewed as part of a broader treatment strategy that may also include dietary changes, weight management, medication, and blood sugar monitoring.
The health risks of too little physical activity
Insufficient physical activity is one of the factors associated with the accumulation of visceral fat, which is closely linked to insulin resistance and metabolic disease. For people who spend much of the day sitting, getting up and moving at least every 30 minutes can help improve glucose metabolism.
A lack of regular exercise is also associated with chronic inflammation, worsening insulin resistance, and a greater risk of atherosclerosis. Physical activity, by contrast, stimulates muscles to release substances known as myokines, some of which have anti-inflammatory effects. Exercise can also improve blood vessel function and help reduce visceral fat.
Exercise recommendations for adults with diabetes
Most adults with diabetes are advised to get at least 150 minutes of moderate-to-vigorous aerobic activity per week, spread over several days. Brisk walking, jogging, swimming, and cycling are common examples.
For people who are already physically fit, shorter periods of vigorous or interval exercise may provide similar benefits, with about 75 minutes per week sometimes being sufficient.
Resistance training is also important. Adults with diabetes are generally encouraged to perform strength exercises two to three times per week on nonconsecutive days. These may include dumbbells, resistance bands, weight machines, or bodyweight exercises such as push-ups and squats.
Older adults can also benefit from flexibility and balance exercises two to three times per week. Yoga and tai chi are two options that may help improve flexibility, strength, balance, and mobility.
Combining different types of exercise
Aerobic and resistance exercise work in different ways, which is why combining them can be particularly helpful.
Aerobic activity increases the amount of glucose used by working muscles and improves cardiovascular fitness. Resistance training builds and preserves skeletal muscle, giving the body more metabolically active tissue that can take up glucose.
Research has found that combining aerobic and resistance exercise can provide additional benefits for blood sugar control compared with relying on either form of exercise alone.
Lifestyle changes can also substantially reduce the risk of developing type 2 diabetes among people at high risk. In the landmark Diabetes Prevention Program, a structured lifestyle intervention that included at least 150 minutes of weekly physical activity, dietary changes, and a goal of losing about 5 to 7 percent of body weight reduced the risk of developing type 2 diabetes by 58 percent.
How aerobic exercise affects blood sugar
During aerobic exercise, working muscles increase their uptake of glucose. As exercise intensity rises, the muscles rely increasingly on carbohydrates for energy, while the liver releases glucose to help maintain a stable supply in the bloodstream.
Brisk walking, jogging, swimming, and cycling are all forms of aerobic activity that can improve glucose metabolism.
Studies of people with type 2 diabetes have found that regular aerobic exercise can lower HbA1c, a measure of average blood sugar over the previous two to three months. Longer-term participation generally produces greater benefits than exercising only occasionally.
Aerobic exercise can also improve insulin sensitivity and fasting blood glucose while contributing to cardiovascular fitness and weight management.
The benefits of strength training
Strength training offers a different set of benefits. It increases skeletal muscle mass and strength while also improving the body’s ability to regulate glucose.
Research involving people with type 2 diabetes has found that regular resistance training can reduce HbA1c and improve blood sugar control. It may be particularly useful for managing the rise in blood sugar that occurs after meals.
Building and preserving muscle becomes increasingly important with age, when people naturally tend to lose muscle mass. For people with diabetes, resistance training can therefore support both glucose management and physical function.
Why combining aerobic and strength training can help
Aerobic exercise, resistance exercise, and programs that combine the two can all improve insulin sensitivity and blood sugar control.
Combined training, however, may offer broader benefits because it develops both cardiovascular fitness and muscular strength. Studies have found improvements in measures such as HbA1c, fasting blood glucose, body composition, cholesterol, and blood pressure.
Aerobic activity increases energy use and improves cardiovascular fitness, while resistance exercise helps maintain or increase muscle mass. Together, they can support weight management and provide a more balanced approach to long-term metabolic health.
The most important factor, however, is consistency. An exercise program that can be maintained over the long term is generally more useful than an ambitious routine that is quickly abandoned.
Making exercise part of daily life
Finding an uninterrupted hour for exercise can be difficult, particularly for people balancing work and family responsibilities. Fortunately, physical activity does not always have to be completed in one long session.
Short periods of exercise throughout the day can make it easier to accumulate meaningful amounts of physical activity.
Make walking more effective
Walking is one of the simplest forms of exercise, particularly for middle-aged and older adults.
For people who are able to do so safely, increasing the pace can make a shorter walk more challenging and improve its aerobic benefits. The original recommendation of walking about 5 to 6 kilometers per hour — roughly 3 to 3.7 mph — may provide a useful target for some people.
However, exercise intensity should be appropriate for the individual’s age, fitness level, and health. A slower pace can still provide meaningful benefits, particularly for someone who has previously been sedentary. Increasing activity above one’s usual level is itself a worthwhile goal.
Use short periods after meals
Another practical strategy is to exercise briefly after meals.
Instead of trying to find one long period for exercise, consider spending five to 10 minutes moving after breakfast, lunch, and dinner. Three short sessions can add up to 15 to 30 minutes of activity during the day.
Options can include walking, climbing stairs, or light resistance exercises such as squats, half-squats, curls, lateral raises, and other simple movements that can be performed safely. Post-meal activity can help reduce the rise in blood glucose that typically follows eating.
Breaking exercise into shorter sessions can also make physical activity easier to incorporate into a busy schedule and may help people establish a habit they can maintain over time.
People who take insulin or medications that increase insulin secretion should be more cautious, however, because exercise can sometimes cause blood sugar to fall too low during or even several hours after activity. Glucose monitoring, carbohydrate intake, or medication adjustments may be necessary depending on the individual and should be discussed with a health care professional.
Rather than assuming that exercise requires a full hour at the gym, look for opportunities to add movement to the natural rhythm of the day. Regular aerobic activity, strength training, and even brief periods of movement can all play a meaningful role in improving blood sugar control and long-term health.
(This article is excerpted and adapted with permission from Reversing Diabetes!: The Five Elements of Blood Sugar Control — Food, Exercise, Weight (Fat) Loss, Medication, and Monitoring Devices + The Four Principles of Dietary Control — Total Amount, Type, Order, and Speed, published by New Naturalism Press. Author: Dr. Chen Cheng-qin.)
Translated by Eva
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