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Diabetes Care. 2010 December; 33(12): 2692–2696.
PMCID: PMC2992214

Exercise and Type 2 Diabetes

The American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary
Sheri R. Colberg, PHD, FACSM,1 Ronald J. Sigal, MD, MPH, FRCP(C),2 Bo Fernhall, PHD, FACSM,3 Judith G. Regensteiner, PHD,4 Bryan J. Blissmer, PHD,5 Richard R. Rubin, PHD,6 Lisa Chasan-Taber, SCD, FACSM,7 Ann L. Albright, PHD, RD,8 and Barry Braun, PHD, FACSM9

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively impacting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower risk of type 2 diabetes by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

Diabetes has become a widespread epidemic, primarily due to increasing prevalence and incidence of type 2 diabetes. According to the Centers for Disease Control and Prevention, in 2007 almost 24 million Americans had diabetes, with one-quarter of those, or six million, undiagnosed (1). Currently, it is estimated that almost 60 million U.S. residents also have prediabetes—a condition in which blood glucose levels are above normal—thus greatly increasing their risk of type 2 diabetes (1). Lifetime risk estimates suggest that one in three Americans born in 2000 or later will develop diabetes, but in high-risk ethnic populations, closer to 50% may develop it (2). Diabetes is a significant cause of premature mortality and morbidity related to cardiovascular disease, blindness, kidney and nerve disease, and amputation (1). Although regular PA may prevent or delay diabetes and its complications (310), the majority of people with type 2 diabetes are not active (11).

In this article, the broader term “physical activity” (defined as bodily movement produced by the contraction of skeletal muscle that substantially increases energy expenditure) is used interchangeably with “exercise,” which is defined as a subset of PA done with the intention of developing physical fitness (i.e., cardiovascular, strength, and flexibility training). The intent is to recognize that many types of physical movement may have a positive impact on physical fitness, morbidity, and mortality in individuals with type 2 diabetes.


Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, gestational diabetes mellitus, type 2 diabetes, and diabetes-related health complications. Both aerobic training and resistance training improve insulin action, at least acutely, and can assist with management of blood glucose levels, lipids, blood pressure, cardiovascular risk, mortality, and quality of life, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. Most people with type 2 diabetes can perform exercise safely, as long as certain precautions are taken. The inclusion of an exercise program or other means of increasing overall PA is critical for optimal health in individuals with type 2 diabetes.

Both the American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA) reviewed the relevant, published research and developed the recommendations that are defined in Table 1 and listed in Table 2. The entire position statement can be accessed online at

Table 1
Evidence categories for ACSM and evidence-grading system for clinical practice recommendations for ADA
Table 2
Summary of ACSM evidence and ADA clinical practice recommendation statements


No potential conflicts of interest relevant to this article were reported.


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

See accompanying article, p. e147.


1. U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. U.S. Department of Health and Human Services Centers for Disease Control and Prevention, Ed. Atlanta, GA, 2008
2. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF.: Lifetime risk for diabetes mellitus in the United States. JAMA 2003;290:1884–1890 [PubMed]
3. Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F.: Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications 2006;20:216–223 [PubMed]
4. Cohen ND, Dunstan DW, Robinson C, Vulikh E, Zimmet PZ, Shaw JE.: Improved endothelial function following a 14-month resistance exercise training program in adults with type 2 diabetes. Diabetes Res Clin Pract 2008;79:405–411 [PubMed]
5. Ghosh S, Khazaei M, Moien-Afshari F, Ang LS, Granville DJ, Verchere CB, Dunn SR, McCue P, Mizisin A, Sharma K, Laher I.: Moderate exercise attenuates caspase-3 activity, oxidative stress, and inhibits progression of diabetic renal disease in db/db mice. Am J Physiol Renal Physiol 2009;296:F700–F708 [PubMed]
6. Howorka K, Pumprla J, Haber P, Koller-Strametz J, Mondrzyk J, Schabmann A.: Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. Cardiovasc Res 1997;34:206–214 [PubMed]
7. Loimaala A, Huikuri HV, Kööbi T, Rinne M, Nenonen A, Vuori I.: Exercise training improves baroreflex sensitivity in type 2 diabetes. Diabetes 2003;52:1837–1842 [PubMed]
8. Pagkalos M, Koutlianos N, Kouidi E, Pagkalos E, Mandroukas K, Deligiannis A.: Heart rate variability modifications following exercise training in type 2 diabetic patients with definite cardiac autonomic neuropathy. Br J Sports Med 2008;42:47–54 [PubMed]
9. Tufescu A, Kanazawa M, Ishida A, Lu H, Sasaki Y, Ootaka T, Sato T, Kohzuki M.: Combination of exercise and losartan enhances renoprotective and peripheral effects in spontaneously type 2 diabetes mellitus rats with nephropathy. J Hypertens 2008;26:312–321 [PubMed]
10. Zoppini G, Targher G, Zamboni C, Venturi C, Cacciatori V, Moghetti P, Muggeo M.: Effects of moderate-intensity exercise training on plasma biomarkers of inflammation and endothelial dysfunction in older patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2006;16:543–549 [PubMed]
11. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW.: Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care 2007;30:203–209 [PubMed]

Articles from Diabetes Care are provided here courtesy of American Diabetes Association