“You need to improve your diet and exercise more.”
If you’ve recently been diagnosed with type 2 diabetes, there’s a good chance you’ve heard some version of this from your GP.
The problem is that “exercise more” isn’t really a prescription.
How much exercise? What type? How hard should you work? Should you walk, lift weights, swim, cycle or join a gym? What if you haven’t exercised in 20 years? And what happens if you’re taking medication that can affect your blood sugar?
Exercise isn’t simply a lifestyle suggestion for people with type 2 diabetes. It is an important part of the treatment of the condition, with measurable effects on blood glucose, insulin sensitivity, cardiovascular health, physical function and overall wellbeing.
The challenge is turning the general advice to “exercise more” into something that is safe, realistic and specific to you.
That is where an Accredited Exercise Physiologist (AEP) can help.
What’s the best exercise for type 2 diabetes?
There isn’t one single exercise that is “best” for everyone with type 2 diabetes.
The strongest evidence supports a combination of aerobic exercise and resistance training, alongside reducing the amount of time spent sitting throughout the day.
That might sound like a lot if you’re starting from scratch. It doesn’t have to mean suddenly spending five days a week in a gym.
An exercise physiologist can take the recommendations and turn them into a programme that actually fits your current fitness, health, preferences and lifestyle.
Think about the difference between being told:
“You should exercise more.”
and being told:
“Let’s start with two supervised strength sessions each week, three 20-minute walks on the days in between, and gradually build from there.”
The second is a prescription.
Based off the current research, regular aerobic and resistance exercise is recommended, with at least three exercise days per week and no more than two consecutive days without training where possible. Programmes should also be adapted around a person’s health conditions, complications, preferences and access to equipment.
And importantly, if you aren’t currently able to meet the full recommendation, doing what you can is still beneficial.
You don’t need to be fit before you start.
You start where you are.
How does exercise lower blood sugar?
Your muscles are one of the biggest places in the body where glucose is used and stored.
When you eat carbohydrates, glucose enters your bloodstream. Insulin helps move that glucose from the blood into your cells, where it can be used for energy or stored.
In type 2 diabetes, the body becomes less responsive to insulin. This is known as insulin resistance.
Exercise provides another way for your muscles to take up glucose.
When your muscles contract during exercise, they can increase glucose uptake through pathways that don’t rely entirely on insulin. In simple terms, contracting muscle creates another “door” through which glucose can enter the muscle.
This is one reason physical activity can lower blood glucose even when insulin isn’t working as effectively as it should.
Improvements in insulin sensitivity and insulin-dependent glucose uptake are important mechanisms behind the improvements in glycaemic control seen with exercise. Exercise also produces changes such as increased GLUT4 activity, blood flow and muscle adaptations that contribute to better glucose handling.
And the effect doesn’t necessarily stop when you finish exercising.
Insulin sensitivity can remain improved following exercise, although the duration and size of the effect varies between individuals and depends on the exercise performed. Insulin sensitivity can decline substantially again by around 48 hours, which is one reason regular exercise throughout the week is preferable to doing everything in one or two sessions.
There is another reason strength training matters.
Building or maintaining muscle gives you more metabolically active tissue capable of taking up and storing glucose. Resistance exercise can also help counter the loss of muscle mass that can occur with ageing and inactivity.
So exercise isn’t just about burning calories.
It directly changes the way your body handles glucose.
Can you reverse type 2 diabetes with exercise?
You may see claims online that exercise can “reverse” or “cure” type 2 diabetes. Those statements can be misleading.
Exercise can significantly improve blood glucose control and insulin sensitivity, but it should not be presented as a guaranteed cure for type 2 diabetes.
For some people, substantial lifestyle changes can contribute to diabetes remission. However, remission is different from saying that diabetes has been permanently cured, and it doesn’t happen for everyone.
What we do know is that structured exercise has a meaningful role in managing type 2 diabetes.
Research shows that aerobic exercise, resistance exercise and combined training can all improve glycaemic control. Combining aerobic and resistance exercise may provide complementary or potentially synergistic benefits.
Importantly, you don’t necessarily need to lose weight to improve your blood glucose.
Exercise can improve metabolic health even when the number on the scales doesn’t change.
Improvements in glycaemic control do not necessarily require reductions in body weight or body fat, with metabolic improvements potentially relating more closely to changes in visceral fat and other metabolic adaptations.
This is important because exercise for diabetes shouldn’t become another conversation about weight.
The goal isn’t simply to make you smaller.
The goal is to help your body work better.
That can mean better blood glucose control, improved strength, better cardiovascular fitness, greater physical capacity and more confidence doing everyday activities.
Is weight training or cardio better for diabetes?
The short answer is: both have a role.
Aerobic exercise
Aerobic exercise includes activities such as:
- Brisk walking
- Cycling
- Swimming
- Water-based exercise
- Jogging, if appropriate
- Cardio machines such as treadmills, bikes or cross-trainers
A commonly recommended target is around 150 minutes of moderate-intensity aerobic activity per week, although the exact prescription should be individualised.
That could look like:
30 minutes of brisk walking, five days per week.
But it doesn’t have to.
If 30 minutes feels unrealistic, shorter bouts can be useful. Research has shown that breaking activity into shorter, manageable periods can be an effective way of accumulating exercise and can make a programme more achievable and sustainable.
For someone who has been inactive for years, starting with 10 minutes may be much more appropriate than attempting 30 minutes straight.
Resistance training
Resistance training means making your muscles work against a load.
That could involve:
- Gym machines
- Dumbbells
- Resistance bands
- Bodyweight exercises
- Sit-to-stands
- Step-ups
- Squats
- Rows or presses
We recommend resistance training on at least two days per week, involving the major muscle groups.
You don’t need to be a “gym person” to benefit from strength training.
An exercise physiologist can start with movements that match your current ability and progressively increase the challenge as your strength and confidence improve.
And don’t forget the rest of the day
Exercise sessions aren’t the whole picture.
Long periods of uninterrupted sitting are associated with poorer glycaemic control, and research supports reducing prolonged sedentary time through regular light activity and standing or movement breaks. These activities are an addition to, rather than a replacement for, moderate-to-vigorous exercise.
In practical terms, that might mean getting up regularly during a long period at your desk, walking around the house during television advertisements, or taking a short walk after a meal.
The most effective programme isn’t necessarily the hardest one.
It is the one you can consistently do.
How often should someone with diabetes exercise?
According to research, a useful target is at least 210 minutes of moderate-intensity activity per week, or approximately 125 minutes of vigorous activity, alongside resistance training on at least two days per week. It recommends exercising on at least three days per week and avoiding more than two consecutive days without exercise.
For someone reading that and thinking, “There is absolutely no way I’m doing 210 minutes a week,” don’t panic.
That is a target, not a starting point.
If you’re currently doing almost nothing, the first goal might simply be to establish a routine.
For example:
Weeks 1–2
- 10–15 minute walks, three to five days per week
- One or two short strength sessions
Weeks 3–6
- Gradually increase walking duration
- Progress strength exercises
- Build towards more regular weekly activity
Longer term
- Work towards the recommended weekly volume
- Maintain at least two resistance sessions
- Avoid long stretches of completely inactive days
The exact programme will depend on your health, fitness, medications, injuries, complications and goals.
According to research moderate-intensity exercise can often be more appropriate and better tolerated than higher-intensity exercise, particularly when adherence is the priority.
You don’t need to destroy yourself in a workout to improve your diabetes.
Consistency beats intensity when intensity stops you from coming back.
Is exercise safe if I’m taking diabetes medication?
For most people with type 2 diabetes, exercise is safe and beneficial when appropriately prescribed.
However, medication is one reason why your exercise programme shouldn’t simply be copied from someone else’s.
Some diabetes medications, particularly insulin and sulfonylureas, can increase the risk of hypoglycaemia (low blood glucose) around exercise.
If you’re taking these medications, your healthcare team may recommend specific strategies around exercise timing, meals, medication and blood glucose monitoring.
You should know what symptoms of low blood glucose feel like and have a plan provided by your healthcare professional for managing them.
This is particularly important when you’re starting a new exercise programme or significantly increasing your activity.
Other health considerations may also influence how exercise is prescribed.
For example, people with diabetes may also have cardiovascular disease, high blood pressure, peripheral neuropathy, foot problems, osteoarthritis or other complications that need to be considered. These issues generally do not mean someone cannot exercise, but the programme may need to be modified.
If you have reduced sensation in your feet, appropriate footwear and regular foot checks are particularly important.
And if you have cardiovascular risk factors or other complications, your GP or treating team may need to be involved before progressing certain types or intensities of exercise.
This is one of the advantages of seeing an exercise physiologist.
The assessment comes before the exercise prescription.
What does an Exercise Physiologist programme for diabetes actually look like?
An exercise physiology appointment isn’t simply someone handing you a gym programme and telling you to get started.
At VIBE, an initial assessment can be used to understand:
- Your diabetes history and current health
- Your medications and relevant medical considerations
- Your current activity levels
- Your strength and physical capacity
- Any injuries or other health conditions
- What you actually enjoy doing
- What you want to be able to do in your everyday life
From there, your exercise programme can be built around your starting point.
That might involve supervised gym sessions, walking, home-based exercise, resistance training, aerobic conditioning or a combination of these.
The programme can then progress as your capacity improves.
For someone who is nervous about gyms, that might mean learning a small number of exercises first rather than being thrown into a complicated workout.
For someone who is already active, the focus may be on making their training more structured and targeted towards improving metabolic health.
The important thing is that there isn’t one diabetes exercise programme.
There is your exercise programme.
Your progress can also be tracked beyond body weight.
Changes in strength, walking capacity, fitness, exercise tolerance and confidence can all demonstrate meaningful progress. Your GP can continue to monitor measures such as HbA1c and blood glucose as part of your medical management.
Exercise physiology doesn’t replace your GP or diabetes medication.
It works alongside them.
Does Medicare cover Exercise Physiology for diabetes?
This is one of the most common questions we hear.
For eligible people with a chronic condition such as type 2 diabetes, Medicare may provide subsidised allied health services through a GP Chronic Condition Management pathway, which can include exercise physiology where the relevant eligibility and referral requirements are met.
The exact Medicare rules, eligibility requirements and number of subsidised services can change, so it is important to confirm the current arrangements with your GP or healthcare provider.
There are also other potential funding pathways depending on your circumstances, including private health insurance extras and relevant DVA or NDIS arrangements.
If you’re interested in using Medicare for exercise physiology, a good place to start is your GP.
You can also speak with the VIBE team about the referral process and what options may be available to you.
For a more detailed explanation of Medicare and chronic disease management referrals, see our Medicare/CDM guide.
Exercise is treatment; but it needs a prescription
If you’ve recently been diagnosed with type 2 diabetes, being told to “exercise more” can feel overwhelming.
You may not know where to start.
You may be carrying an injury, haven’t exercised for years, feel uncomfortable in a gym, or simply have no idea what “exercise for diabetes” is supposed to look like.
The good news is that you don’t have to figure it out alone.
Exercise can directly improve the way your body handles glucose. Aerobic exercise can improve cardiovascular fitness and contribute to better glycaemic control. Resistance training can improve strength and insulin sensitivity. Combining the two can provide complementary benefits. Regular movement can also help reduce the negative effects of prolonged sitting.
And you don’t have to become an elite athlete to get those benefits.
You need a plan that is appropriate, progressive and sustainable.
That’s the difference between being told to “exercise more” and receiving an exercise prescription.
If you have type 2 diabetes or pre-diabetes and aren’t sure where to start, speak with your GP about whether an exercise physiologist referral is appropriate, or contact VIBE to discuss an assessment.
Exercise isn’t just something you do to be healthier. For type 2 diabetes, it can be part of the treatment. Book and appointment with the VIBE team to look at your individual prescription and treatment plan