Time to Get Moving: Helping Patients With Diabetes Adopt Exercise as Part of a Healthy Lifestyle

“Exercise in the days before insulin we regarded as useful, but by no means did we appreciate it as vital in the care of diabetes.... We should return to it to help us in the treatment of all of our cases....”

—Eliot P. Joslin, Treatment of Diabetes Mellitus, 1959

Eliot Joslin's appreciation for the importance of exercise in managing diabetes was visionary. In the decades since he made the observation quoted above, an impressive body of research has accumulated that demonstrates the varied benefits of regular physical activity for people with type 1 or type 2 diabetes. Notably, exercise has been shown to improve glycemic control, reduce the need for insulin and oral hypoglycemic agents, and improve body weight control. Moreover, exercise has myriad benefits for all people beyond those relating to diabetes alone. It can work wonders for the heart, improving the lipid profile, reducing risk for heart disease, restoring function after a heart attack, and moderating blood pressure. It helps in maintaining bone health regardless of age, it can significantly relieve depression and anxiety, and it appears to help maintain cognitive function in old age.^1-3 However, despite these and other benefits, many patients with diabetes do not include regular exercise as an integral part of their therapy.⁴

The reasons why this is true are not well understood, but certainly both patients and providers contribute to the failure of using regular exercise to improve diabetes outcomes. In surveys asking patients why they do not engage in regular exercise, the most common reasons cited are lack of time, health-related reasons, boredom, lack of convenient exercise locations, and expense.⁵ These answers suggest that our patients' perceptions may be the greatest barrier to adopting an exercise program.

Failure to exercise may also reflect a …