Canadian Diabetes Association Clinical Practice Guidelines Physical Activity and Diabetes Chapter 10 Ronald J Sigal, Marni J Armstrong, Pam Colby, Glen

Canadian Diabetes Association Clinical Practice Guidelines

Physical Activity and Diabetes

Chapter 10

Ronald J Sigal, Marni J Armstrong, Pam Colby,

Glen P Kenny, Ronald C Plotnikoff, Sonja M Reichert, Michael C Riddell

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Physical Activity Checklist

DO a minimum of 150 minutes of moderate-to

vigorous-intensity aerobic exercise per week

INCLUDE resistance exercise ≥ 2 times a week

SET physical activity goals and INVOLVE a multi-

disciplinary team

ASSESS patient’s health before prescribing an

exercise regimen

2013


Physical Activity: Bridging the Gap

Problems Solutions

Lack of knowledge of resources

Increase awareness among health care professionals of community resources

Time constraints during physician-patient encounter

Involve a multi-disciplinary team of Physical Therapists, Diabetes Educators and Case Workers who can help motivate patients

Pre-existing or suspected heart disease

If patient wishes to take on activity more vigorous than walking, evaluate with a history and physical, resting ECG and possibly exercise ECG stress test.


Know your Community Resources and Advertise Them

Speak to your patients about community

resources:

Community pools, gyms, safe walking

trails, weight loss smart phone apps etc.


Pre-exercise Assessment

• Assess for conditions that can predispose to injury

before prescribing an exercise regimen:

– Neuropathy (autonomic and peripheral)

– Retinopathy

– Coronary artery disease – resting ECG +/-

exercise stress test (see CPG Chapter 23)

– Peripheral arterial disease


www.guidelines.diabetes.ca

http://www.guidelines.diabetes.ca/

http://www.guidelines.diabetes.ca/



Recommendation 1

1. People with diabetes should accumulate a minimum

of 150 minutes of moderate to vigorous intensity

aerobic exercise each week, spread over at least 3

days of the week, with no more than 2

consecutive days without exercise [Grade B, Level 2, for

T2DM; Grade C, Level 3 for T1DM]


Recommendation 2

2. People with diabetes (including elderly people)

should perform resistance exercise at least twice

a week, and preferably 3 times per week [Grade B, Level

2] in addition to aerobic exercise [Grade B, Level 2].

Initial instruction and periodic supervision by an

exercise specialist are recommended [Grade C, level 3]


Recommendations 3 and 4

3. People with diabetes should set specific physical

activity goals, anticipate likely barriers to physical

activity (e.g. weather, competing commitments),

develop strategies to overcome these barriers [Grade B,

Level 2], and keep records of their physical activity [Grade B, Level 2]

4. Structured exercise programs supervised by

qualified trainers should be implemented when

feasible for people with type 2 diabetes to improve

glycemic control, CVD risk factors, and physical

fitness [Grade B, Level 2]

2013

2013


Recommendation 5

5. People with diabetes with possible cardiovascular

disease or microvascular complications of

diabetes, who wish to undertake exercise that is

substantially more vigorous than brisk walking,

should have medical evaluation for conditions that

might increase exercise-associated risk. The

evaluation would include history, physical

examination (including fundoscopic exam, foot

exam, and neuropathy screening), resting ECG,

and, possibly, exercise ECG stress testing [Grade D,

consensus]

2013


CDA Clinical Practice Guidelines

http://guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

http://diabetes.ca – for patients

http://guidelines.diabetes.ca/

http://diabetes.ca/

Documents

Canadian Diabetes Association Clinical Practice Guidelines Physical Activity and Diabetes Chapter 10 Ronald J Sigal, Marni J Armstrong, Pam Colby, Glen