Medicine & Science in Sports & Exercise®
Volume 32, Number 7
July 2000
Position Stand
Exercise and Type 2 Diabetes





This pronouncement was written for the American College of Sports Medicine by: Ann Albright, Ph.D., R.D.
(Chairperson); Marion Franz, M.S., R.D., C.D.E.; Guyton Hornsby, Ph.D., C.D.E.; Andrea Kriska, Ph.D., FACSM;
David Marrero, Ph.D.; Irma Ullrich, M.D.; and Larry S. Verity, Ph.D., FACSM.
SUMMARY
Physical activity, including appropriate endurance and resistance training, is a major therapeutic modality for type
2 diabetes. Unfortunately, too often physical activity is an underutilized therapy. Favorable changes in glucose
tolerance and insulin sensitivity usually deteriorate within 72 h of the last exercise session; consequently, regular
physical activity is imperative to sustain glucose-lowering effects and improved insulin sensitivity. Individuals
with type 2 diabetes should strive to achieve a minimum cumulative total of 1000 kcal·wk-1 from physical
activities. Those with type 2 diabetes generally have a lower level of fitness (|$$˙VO2max) than nondiabetic
individuals, and therefore exercise intensity should be at a comfortable level (RPE 10-12) in the initial periods of
training and should progress cautiously as tolerance for activity improves. Resistance training has the potential to
improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for
cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise
type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2
diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result,
ratings of perceived exertion rather than heart rate may need to be used for moderating intensity of physical
activity. Although walking may be the most convenient low-impact mode, some persons, because of peripheral
neuropathy and/or foot problems, may need to do non-weight-bearing activities. Outcome expectations may
contribute significantly to motivation to begin and maintain an exercise program. Interventions designed to
encourage adoption of an exercise regimen must be responsive to the individual's current stage of readiness and
focus efforts on moving the individual through the various "stages of change."
INTRODUCTION
Diabetes is one of the leading causes of death and disability in the United States with type 2 diabetes accounting
for 90-95% of all diabetic cases (77 ). Based on national data, there are about 10.3 million diagnosed cases of
diabetes in the United States with an estimated 5.4 million additional undiagnosed cases in the general population
(40 ). Unfortunately, the diagnosis of type 2 diabetes is often delayed for years after the onset of the disease. A
large portion of the burden of the disease falls upon the minority populations of the U.S., demonstrated by the fact
that the prevalence rates of diabetes are higher among Native Americans, African Americans, Hispanic Americans,
and Asian and Pacific Island Americans when compared with non-Hispanic whites (99 ). The long-term