Type 2 diabetes

Type 2 diabetes is a condition involving insulin resistance in body tissues and a shortfall in insulin secretion by the pancreas.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 551.} The NSCA puts it at about 90% of diabetes cases and links it closely to family history, older age, obesity, poor diet and inactivity.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 551.} IPTA gives a share of 90% to 95% and notes that most clients are overweight or obese when symptoms appear.^{2International Personal Trainer Academy, Certified Personal Trainer Textbook, p. 436.} Treatment usually combines dietary changes, weight control, regular exercise and oral medication.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 551.}

ACSM reports that regular exercise reduces daily time in hyperglycemia and lowers A1C by 0.5% to 0.7% in clients with type 2 diabetes.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 656.} The main exercise risk is hypoglycemia, which the NSCA says is a greater concern in type 1 than type 2.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 552.}

In practice

• Clients with diabetes should have a medical evaluation before starting exercise.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 552.} The NSCA generally also recommends a cardiac stress test by a medical professional before moderate-intensity exercise for at-risk clients, including those older than 35 and those with type 2 diabetes for more than 10 years.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 552.}
• ACSM encourages aerobic and resistance exercise.^{5Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 659.} It says most clients with type 2 diabetes need at least 150 minutes of moderate-to-vigorous aerobic exercise per week for the best cardiovascular risk reduction and fitness gains.^{6Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 660.}
• Schedule sessions 1 to 2 hours after a meal or when medication isn’t at its peak.^{7Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 553.} Advice on insulin or meal timing falls outside a trainer’s scope of practice; refer clients with regular lapses in glucose control to their physician.^{7Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 553.}
• For clients with nerve damage in the feet (peripheral neuropathy), swimming and biking may be preferable to walking and jogging, and well-fitted shoes matter.^{4Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 552.}