Is Physical Exercise a Core Therapeutical Element for Most Patients With Type 2 Diabetes?

Abstract

Over the last decade, growing scientific evidence has demonstrated that exercise is an effective therapeutic strategy for type 2 diabetes (1–12). According to position statements published by the American Diabetes Association, American College of Sports Medicine, and American Heart Association, exercise therapy should be part of a structured lifestyle intervention and include both aerobic and resistance training (13,14). Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting expenditure. Exercise is a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement or maintenance of physical fitness is the objective. As with pharmacological therapy, for aerobic or resistance exercise therapy it is necessary to prescribe the right dose (intensity, volume, and frequency) and to carefully consider the potential side effects and contraindications. The aim of this review is to discuss a correct approach to exercise therapy and to underline the beneficial effects, precautions, and limitations of the use of exercise in type 2 diabetic subjects. Another crucial point that merits discussion is the profound gap between the exercise therapy suggested by scientific guidelines and the applicability of it in the management of type 2 diabetes. Full compliance with an exercise regimen requires high motivation and capability, both in the diabetes team operators/facilitators and in their patients, and is based on a strong therapeutic alliance. There are several obstacles in this virtuous process: lack of time and lack of confidence in the behavioral and motivation strategies of physicians and other diabetic team operators, unhealthy lifestyles of physicians who should advise exercise, and reluctance of sedentary diabetic patients to change their lifestyle, mainly due to poor self-efficacy or lack of time (15). The “no” side of this debate will discuss the evidence …