The American College of Sports Medicine and the American Diabetes Association: joint position statement

Summary of ACSM evidence and ADA clinical practice recommendation statements ACSM evidence and ADA clinical practice recommendation statementsACSM evidence category(A, highest; D, lowest)/ADA level of evidence(A, highest; E, lowest)Acute effects of exercise •PA causes increased glucose uptake into active muscles balanced by hepatic glucoseproduction, with a greater reliance on carbohydrate to fuel muscular activity as intensityincreases.A/*•Insulin-stimulated BG uptake into skeletal muscle predominates at rest and is impairedin type 2 diabetes, while muscular contractions stimulate BG transport via a separate,additive mechanism not impaired by insulin resistance or type 2 diabetes.A/*•Although moderate aerobic exercise improves BG and insulin action acutely, the risk ofexercise-induced hypoglycemia is minimal without use of exogenous insulin or insulinsecretagogues. Transient hyperglycemia can follow intense PA.C/*•The acute effects of resistance exercise in type 2 diabetes have not been reported, butresult in lower fasting BG levels for at least 24 h postexercise in individuals with IFG.C/*•A combination of aerobic and resistance exercise training may be more effective inimproving BG control than either alone; however, more studies are needed todetermine whether total caloric expenditure, exercise duration, or exercise mode isresponsible.B/*•Milder forms of exercise (e.g., tai chi, yoga) have shown mixed results. C/*•PA can result in acute improvements in systemic insulin action lasting from 2 to 72 h. A/*Chronic effects ofexercise training•Both aerobic and resistance training improve insulin action, BG control, and fatoxidation and storage in muscle.B/*•Resistance exercise enhances skeletal muscle mass. A/*•Blood lipid responses to training are mixed but may result in a small reduction in LDLcholesterol with no change in HDL cholesterol or triglycerides. Combined weight lossand PA may be more effective than aerobic exercise training alone on lipids.C/*•Aerobic training may slightly reduce systolic BP, but reductions in diastolic BP are lesscommon, in individuals with type 2 diabetes.C/*•Observational studies suggest that greater PA and ﬁtness are associated with a lowerrisk of all-cause and CV mortality.C/*•Recommended levels of PA may help produce weight loss. However, up to 60 min/daymay be required when relying on exercise alone for weight loss.C/*•Individuals with type 2 diabetes engaged in supervised training exhibit greatercompliance and BG control than those undertaking exercise training withoutsupervision.B/*•Increased PA and physical ﬁtness can reduce symptoms of depression and improvehealth-related QOL in those with type 2 diabetes.B/*PA and prevention oftype 2 diabetes•At least 2.5 h/week of moderate to vigorous PA should be undertaken as part oflifestyle changes to prevent type 2 diabetes onset in high-risk adults.A/APA in prevention andcontrol of GDM•Epidemiological studies suggest that higher levels of PA may reduce risk of developingGDM during pregnancy.C/*•RCTs suggest that moderate exercise may lower maternal BG levels in GDM. B/*Preexercise evaluation •Before undertaking exercise more intense than brisk walking, sedentary persons withtype 2 diabetes will likely beneﬁt from an evaluation by a physician. ECG exercisestress testing for asymptomatic individuals at low risk of CAD is not recommended butmay be indicated for higher risk.C/CRecommended PAparticipation forpersons with type 2diabetes•Persons with type 2 diabetes should undertake at least 150 min/week of moderate tovigorous aerobic exercise spread out during at least 3 days during the week, with nomore than 2 consecutive days between bouts of aerobic activity.B/B•In addition to aerobic training, persons with type 2 diabetes should undertakemoderate to vigorous resistance training at least 2–3 days/week.B/B•Supervised and combined aerobic and resistance training may confer additional healthbeneﬁts, although milder forms of PA (such as yoga) have shown mixed results.Persons with type 2 diabetes are encouraged to increase their total daily unstructuredPA. Flexibility training may be included but should not be undertaken in place ofother recommended types of PA.B/C