Greater improvement in glucose homeostasis can usually be obtained by weight loss. Despite the relatively small impact of exercise demonstrated to date, regular physical exercise may be a therapeutic component supplementing diet in selected patients. Furthermore, the consensus panel seeks to emphasize that the possible benefits of body fat reduction outweigh putative exercise effects.
Vigorous exercise appears to blunt the rise in blood glucose that follows carbohydrate ingestion.
In addition, exercise training may increase insulin sensitivity, but this change appears to be an acute effect associated with recent exercise and is reversed within 2 to 3 days by physical inactivity. Physical activity may assist in reducing body fat, but exercise without caloric restriction appears ineffective. Patients who exercise regularly may negate its weight-reducing effects by curtailing their usual activities and by increasing caloric intake. The incidence of these complications with exercise has not been defined. The components of the evaluation will vary depending on the severity and duration of the diabetes, the presence of complications, the likelihood of asymptomatic CHD, and the intensity of the activity.