D iabetes mellitus is a large and growing health problem in the United States, and as such constitutes a target for many health initiatives. Exercise provides beneficial effects on excess weight, insulin resistance, and atherosclerosis, making it an important tool to mitigate diabetes symptoms and sequelae. The need to increase physical activity is frequently mentioned in the text.
Exercise acutely lowers plasma glucose levels and tissue energy stores.
More important, it improves insulin sensitivity and glycemic control, even without any weight loss. Although most patients with diabetes will still require pharmacologic agents for adequate glycemic control, every regimen should emphasize diet modification and exercise. Since most patients with diabetes die from sequelae of vascular disease, exercise-induced improvements in blood pressure, lipid levels, and cardiopulmonary fitness are especially desirable. It may be that the greatest benefit to patients who exercise is reduced cardiac risk, rather than improved glycemic control. A great place to start is by having patients conscientiously increase their everyday activity, such as using stairs instead of elevators, walking a few extra yards, or doing a few minutes of housework.