Type 2 diabetes in China
Exercise Therapy Guidelines (2024 Edition)
Source: National Geriatrics Center, Chinese Society of Diabetes, Chinese Society of Sports Science. Guidelines for exercise therapy of type 2 diabetes mellitus in China (2024 edition)[J]. Chinese Journal of General Practice. DOI: 10.12114/j.issn.1007-9572.2024.A0019 👈
In the comprehensive management of patients with type 2 diabetes mellitus (T2DM), exercise is one of the main forms of lifestyle intervention. At present, there is still a lack of exercise treatment guidelines for T2DM in mainland China that are in line with China's national conditions and incorporate the latest research evidence. To this end, the National Geriatrics Center, the Diabetes Branch of the Chinese Medical Association and the Chinese Sports Science Society jointly organized a team of domestic experts in endocrinology and metabolic diseases, sports medicine, rehabilitation medicine, medical nutrition, geriatrics and other related fields to systematically sort out high-quality literature at home and abroad in recent years, and compiled the "Chinese Guidelines for Exercise Treatment of Type 2 Diabetes (2024 Edition)", aiming to provide safe and effective T2DM exercise guidance for clinicians, diabetes education nurses and other diabetes prevention and control personnel. The guidelines include the basic principles of exercise therapy for T2DM, acute and chronic complications, comorbidities, commonly used drugs, exercise timing, intra-exercise blood glucose monitoring, sports nutrition, sports injuries, exercise adherence, and digital health, with a total of 76 recommendations. The guidelines are highly practical and operable, and it is expected to provide scientific and standardized exercise treatment options for Chinese patients with T2DM.
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Common terms used in this guide
Swipe up to see 22 common terms used in this guide
(1) Physical activity (PA) and exercise: Physical activity and exercise are often used interchangeably, but the two terms are not synonymous. Physical activity is any physical movement produced by the contraction of skeletal muscles that increases energy expenditure above the basal metabolic level, usually referring to physical activity that enhances health in the physical activity classification. Physical activity can be divided into four categories: occupation, transportation, housework, and leisure. Exercise is a type of recreational physical activity that is planned, organized, and repeatable to improve or maintain physically healthy physical performance or healthy physical activity.
(2) Level of physical activity: It is a concept that describes the level of regular aerobic exercise performed by an individual, which is related to muscle development, weight, work intensity, time and frequency. The classification of physical activity levels and the health benefits that individuals receive at a specific level of physical activity are classified into the following 4 levels: (1) Inactive: not doing any moderate or large intensity physical activity outside of the basic activities of daily living. (2) Insufficiently active: Perform some moderate-intensity or large-intensity physical activity, but do not reach 150 minutes (min) of moderate-intensity physical activity or 75 minutes of large-intensity physical activity or equivalent combination per week. This level of physical activity is below the target range for meeting physical activity guidelines for adults. (3) Active: Moderate intensity physical activity equivalent to 150~300 min per week, or 75~150 min of large-intensity physical activity or equivalent combination. This level of physical activity meets the target range of the physical activity guidelines for adults. (4) Highly active physical activity: more than 300 min of moderate-intensity physical activity, 150 min of large-intensity physical activity or equivalent combination of physical activity per week. This level of physical activity exceeds the target range of physical activity guidelines for adults.
(3) Regular exercise: refers to moderate-intensity exercise for at least 3 consecutive months, 3 times a week, and more than 30 minutes each time.
(4) Physical fitness: refers to the ability to perform daily tasks energetically, without excessive fatigue, and have sufficient energy to enjoy leisure time and respond to emergencies. Physical fitness includes: cardiorespiratory or aerobic capacity, muscle strength, muscular endurance, body composition, flexibility, flexibility, coordination, balance, ability to do work, reaction time, and movement speed. Physical fitness can be divided into two categories: health-related and performance-related, with the first 5 items (cardiorespiratory endurance or aerobic capacity, muscle strength, muscular endurance, body composition, flexibility) listed as health-related fitness, and the last 6 items (flexibility, coordination, balance, ability to do functions, reaction time, exercise speed) listed as fitness-related to sports performance.
(5) Cardiorespiratory fitness/aerobic fitness: also known as aerobic capacity, refers to the ability of continuous physical activity to breathe, supply oxygen to the circulatory system and use oxygen by skeletal muscles. The objective measure of cardiorespiratory endurance is maximal oxygen uptake (VO2max), which refers to the amount of oxygen that can be ingested (utilized) per unit of time (usually calculated per minute) when the heart, lung function and muscle ability to use oxygen reach the limit level of the person during long-term vigorous exercise with a large number of muscle groups. Peak oxgen uptake (VO2Peak) is commonly used to describe cardiorespiratory endurance in people with chronic diseases and health problems. Cardiorespiratory endurance is a core element of health-related physical fitness, and higher levels of cardiorespiratory endurance can significantly reduce CVD and all-cause mortality.
(6) Aerobic exercise: also known as endurance exercise, refers to the rhythmic and long-term continuous movement of large muscle groups of the body, and the energy required for this type of exercise is produced through aerobic oxidation. Aerobic exercise can improve cardiorespiratory endurance and optimize the body's metabolic functions (such as blood sugar, blood lipids, etc.). Common forms of aerobic exercise include brisk walking, running, square dancing, tai chi, cycling, and swimming.
(7) Interval exercise: In a broad sense, it refers to the interval time between strenuous exercise for rest, which is the current research hotspot of exercise prescription (ExRx). Interval exercise with a lower total exercise still produces a physiological adaptation similar to that of traditional endurance exercise, and the physiological adaptation produced by intermittent exercise is better when the total exercise volume is the same. Intermittent exercise is usually a short period of time (20~240 s) of large to sub-maximum intensity exercise and the same amount or longer (60~360 s) of low to moderate intensity exercise, intermittent ExRx mainly considers the intensity, duration and number of intervals of exercise and intervals. For individuals with low levels of physical activity or chronic medical conditions, high intensity interval exercise (HIIE) should be used sparingly, and walking can simply be incorporated into the interval pattern, where brisk and slow walking alternate.
(8) Vigorous intermittent lifestyle physical activity (VILPA): refers to short, strenuous exercise (up to 1 or 2 min) performed in daily life, such as rapid walking or stair climbing on the way to and from work or from one place to another.
(9) Anaerobic exercise: refers to a form of exercise in which skeletal muscles carry out energy metabolism without sufficient oxygen in the state of high-intensity exercise. Anaerobic exercise relies primarily on glycogen in muscles to produce energy through anaerobic metabolism and is mainly provided by the adenosine triphosphate-phosphocreatine (ATP-PC) system and glycolysis. This type of exercise usually lasts for a short period of time (10~30 s) and has a high intensity (all-out exercise), such as weightlifting, sprinting, short track speed skating, jumping, etc.
(10) Resistance exercise: also known as strength exercise, including physical activity or exercise that increases skeletal muscle strength, endurance, explosive power and volume, refers to the way in which the human body mobilizes the body's skeletal muscle contraction to resist external resistance. Resistance exercises can be performed with your own weights or with training equipment such as elastic bands, barbells, dumbbells, or immobilization equipment. Muscle power refers to the speed at which an action is completed. As we age, muscle power declines faster than muscle strength or endurance, and power training plays an increasingly important role in maintaining balance and preventing falls.
(11) Flexibility exercises: Also commonly known as stretching exercises or stretching exercises, it is a form of exercise designed to increase the extensibility of muscles and the range of motion of joints. Flexibility is an important part of physical health and athletic performance, helping to increase exercise efficiency, reduce the risk of injury, and can improve the body's overall athletic capacity. Range of motion is closely related to the elasticity and stretchability of ligaments, tendons, muscles, skin, and other tissues.
(12) maximum heart rate (HRmax): the center rate of exercise increases with the increase of exercise intensity, when the exercise intensity increases to a certain level, the heart rate no longer increases with the exercise intensity, and reaches a stable state, which is called the maximum heart rate. In the setting of exercise intensity, the maximum heart rate is often used, and when conditions permit, the maximum heart rate can be directly measured by exercise stress test, and when conditions are not allowed, the formula (HRmax=207-0.7×age) can also be used to estimate HRmax, which is suitable for adult men and women of all ages and fitness levels.
(13) Heart rate reserve (HRR): refers to the difference between the actual measured or predicted maximum heart rate and resting heart rate (HRR = maximum heart rate - resting heart rate), which is a method to establish target heart rate and evaluate exercise intensity. The formula for calculating the target heart rate based on HRR is target heart rate = (HRR × target intensity %) + resting heart rate. HRR reflects the potential capacity of the body to have a possible increase in heart rate during labor or exercise.
(14) Metabolic equivalent (MET): It is the ratio of the metabolic rate at activity to the metabolic rate at rest. 1 MET corresponds to the rate of energy metabolism in a quiet, sitting position, which is ≈ oxygen uptake of 3.5 mL/kg per minute. MET is a valid, convenient, and standard method for quantitatively describing the absolute intensity of multiple behaviors and physical activity. In adults, low-intensity physical activity is 1.6~2.9 MET, moderate-intensity physical activity is 3.0~5.9 MET, and large-intensity physical activity is ≥6 MET. MET-h/wk or MET-min/wk are standard units for estimating the amount of exercise, which is equivalent to how many hours of exercise at 1 MET intensity in a week and how many minutes at 1 MET intensity in a week, respectively.
(15) 1-RM (one-repetition maximum): the maximum repetition resistance, which is the standard evaluation method of dynamic muscle strength, and the maximum resistance resistance or maximum strength achieved by the whole joint range of motion under the correct posture and certain rules. is a standard method for assessing an individual's maximum strength in a particular sport and is widely used in the field of strength training. A 1-RM percentage is commonly used to set the intensity of resistance movement.
(16) 6-RM (six-repetition maximum): 6-repetition maximum, which is a kind of multiple repetition maximal strength test, which can be used to predict 1-RM and can also be used as an indicator of muscle strength over time. This is the maximum that an individual can complete 6 times in a row without being able to move on to the next one
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(17) Rate of perceived exertion (RPE): The most commonly used is the Borg Subjective Exertion Scale, which has two forms: 6~20 points and 0~10 points, 6 points and 0 points indicate "effortless" in the two scales, and 20 points and 10 points indicate "maximum exertion" in the two scales. In recent years, the subjective exertion sensory classification scale of 0~10 points is mostly used, with 5~6 points indicating moderate intensity and 7~8 points indicating greater intensity.
(18) Physical activity readiness questionnaire for everyone (PAR-Q+): It is currently internationally recognized as a questionnaire that must be surveyed before exercise testing and exercise, and is applicable to all populations. It can be used as a pre-exercise self-health screening tool, or as an aid for professionals to screen information outside of the process. Questionnaires can be used to determine whether it is necessary to consult a relevant professional (e.g., a physician) before exercise testing and exercise. It should be noted that the questionnaire must be in full form when used and must not be changed or excerpted at will. The questionnaire is valid for 12 months after completing the questionnaire, and if there is a change in physical condition and there is a "yes" question, the previous questionnaire result will be invalid and you will need to answer the questionnaire again.
(19) Structured exercise: refers to a planned, organized and targeted mode of exercise. It formulates a set of scientific and reasonable exercise plans according to the individual's health status, physical fitness level, exercise purpose and time arrangement, so that athletes can form a series of exercise actions within the specified time, according to a certain process and intensity, in order to achieve the expected exercise effect.
(20) Cool-down: Also known as the relaxation phase, it is the part after exercise that aims to gradually reduce the intensity of exercise and heart rate, helping the body smoothly transition from a higher intensity exercise state to a resting state. Finishing exercises are important for recovery, and it can bring a variety of health benefits, including reducing the risk of muscle pain and injury, promoting muscle recovery and rebuilding, improving flexibility, reducing stress on the cardiovascular system, and more.
(21) Exercise prescription: According to the patient's age, gender, general medical examination, exercise test, physical fitness/physical fitness test, cardiovascular/motor organ function status, combined with subjective and objective conditions, the appropriate exercise content, exercise intensity, exercise time and frequency for the patient are formulated in the form of prescription, and the precautions in exercise are pointed out, so as to achieve the purpose of scientific and planned rehabilitation treatment or fitness.
(22) Exercise fever: also known as exercise fever, refers to the abnormal rise in body temperature due to the body's heat production exceeding the heat dissipation capacity during strenuous or long-term exercise. This usually happens when exercising in a hot environment, especially when the humidity is high, because high humidity can reduce the efficiency of sweat evaporation, reduce the heat dissipation of the body, and can also be caused by dehydration, etc. Exercise fever is a medical emergency that can lead to organ damage or even death.
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Pre-exercise evaluation in patients with type 2 diabetes
Testimonials
Recommendation 1: Patients with T2DM should undergo a medical evaluation and exercise assessment prior to exercise (A)Recommendation 2: For most low-risk patients who plan to participate in low- to moderate-intensity exercise (e.g., brisk walking), there is no need for a pre-exercise medical evaluation in the absence of cardiovascular or microvascular complications (A)Recommendation 3: Medical evaluation is recommended for adults with T2DM who are sedentary or have multiple chronic conditions prior to moderate and high-intensity exercise (A)
Recommendation 4: Suspend exercise in the case of severe hypoglycemia, acute metabolic complications such as diabetic ketoacidosis, acute infection, proliferative retinopathy, severe cardiovascular and cerebrovascular diseases (unstable angina, severe arrhythmia, transient ischemic attack), etc., and gradually resume exercise only after the condition is stable (A)
The health status of patients with T2DM varies greatly depending on age, course of disease, complications, comorbidities, medications, and physical activity habits. Before exercising, the content of the assessment should be based on previous exercise habits, CVD risk, and target exercise intensity. This usually includes a pre-exercise medical assessment, exercise risk assessment, and exercise capacity assessment.
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2.1
Pre-exercise medical evaluation
(1) Disease control: including medical history, vital signs, physical examination, drug treatment, blood glucose control, risk of hypoglycemia, liver function, kidney function, etc., as well as relevant examinations deemed necessary by clinicians.
(2) Screening for acute complications of diabetes mellitus and complications of chronic diseases: generally including blood glucose, urinalysis, urine microalbumin/creatinine ratio, fundus photography, peripheral neuropathy examination, dorsalis pedis artery pulse and other examinations.
(3) Cardiovascular risk assessment: The Chinese Atherosclerotic Cardiovascular Disease Risk Prediction Study (China-PAR) model is based on the large sample cohort data of the follow-up of the China-PAR study, which is suitable for the 10-year risk and lifetime risk assessment of Chinese cardiovascular disease, and can be used to assess the risk of atherosclerotic cardiovascular disease in a simple and rapid way. Further exercise stress testing or exercise cardiopulmonary testing in symptomatic or high-risk patients for CVD is required to assess cardiorespiratory endurance and CVD risk during exercise.
Risk groups need to be assessed before exercise, and the escalating exercise stress test is indicated for adults who meet one or more criteria, as shown in Table 1.
2.2
Exercise risk assessment
Exercise risk assessment can be performed in patients with diabetes mellitus with PAR-Q+. Fall risk assessment can be performed in older patients using the self-rated FRQ.
2.3
Exercise capacity assessment
(1) Cardiopulmonary endurance or aerobic exercise capacity evaluation: exercise stress test or exercise cardiopulmonary test is used for evaluation, usually using sports plate or power car test scheme, and site test schemes such as 2 min step test can also be used when the venue and equipment are limited. Cardiorespiratory endurance reflects the overall mobility of the human body and is closely related to the state of health. Patients with low cardiorespiratory endurance have decreased physical functions, and the risk of CVD and all-cause mortality is significantly increased, which is more harmful than smoking, hypertension, high cholesterol and diabetes, and low cardiorespiratory endurance has been identified as one of the risk factors for CVD, which is closely related to the 10-year CVD risk. Long-term regular aerobic exercise is an effective way to improve cardiorespiratory endurance. Cardiopulmonary endurance assessment can not only be used for CVD risk screening, but also for individualized exercise guidance, making exercise more scientific, safe and effective.
(2) Muscle fitness assessment: T2DM patients can use grip strength or 6-RM to test or predict the maximum muscle strength, and according to the test conditions, force plates, accelerometers, etc. can be selected to evaluate other muscle fitness such as explosive strength.
(3) Balance ability: It can be assessed by standing on one foot with eyes closed/eyes open.
(4) Flexibility: It can be assessed by the back grasp test and (modified) sitting forward bending.
(5) Physical activity: For low-weight elderly patients, physical activity ability can be assessed by the Simplified Physical Performance Function Scale (SPPB) if necessary.
(6) Body composition: Body composition can be evaluated by skinfold thickness, bioelectrical impedance or dual-energy X-ray absorptiometry according to the test conditions.
Exercise behavior is related to the execution and adherence of exercise prescriptions and is influenced by behavioral, mental, and personal motor skills. It can be evaluated by the motor change stage questionnaire, the motor change process questionnaire, the exercise decision balance questionnaire, and the exercise self-efficacy questionnaire.
People with prediabetes (impaired fasting glucose, impaired glucose tolerance, impaired fasting glucose + impaired glucose tolerance), people at high risk of diabetes, and patients with T2DM who are stable under control can exercise appropriately after appropriate exercise assessment. It is recommended that patients with T2DM communicate with clinicians before exercise therapy to rule out contraindications to exercise and develop a safe and feasible exercise regimen.
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Principles for the development of exercise prescription in patients with type 2 diabetes
Testimonials
Recommendation 5: The exercise prescription of T2DM patients should include exercise plans in several categories of aerobic, resistance, flexibility and balance exercises (A) Recommendation 6: The purpose, timeliness and special precautions of each patient should be considered when formulating exercise prescriptions, and the exercise plan for each category should include frequency, intensity, time, mode and total amount, progression and precautions (A) Recommendation 7: Patients with T2DM should maintain an exercise frequency of not less than 3~5 days/week, and in the case of equal amount of exerciseThe frequency of exercise for 1~2 days/week can also obtain health benefits. Exercise with low frequency-long exercise durations increases the risk of sports injuries (A) Recommendation 8: Patients with T2DM should aim for moderate- to high-intensity exercise (A) Recommendation 9: Patients with T2DM should achieve at least 150 min/week of moderate-intensity aerobic exercise (A) Recommendation 10: Patients with T2DM should achieve at least 1 000 kcal/week of energy expenditure on physical activity (A)
Recommendation 11: In the process of progression, start with low intensity and slowly progress to the target exercise intensity and volume (A)
Exercise therapy for patients with T2DM should follow a reasonable exercise prescription. The ideal exercise prescription or exercise training plan should meet the health and fitness requirements of the exerciser as far as their health status, functional capacity, and natural and social environment allow. Exercise prescriptions for patients with T2DM should include exercise programs in the following categories, i.e., aerobic, resistance, flexibility, and balance exercises. The purpose of exercise therapy, the timeliness and the special considerations of each patient should be taken into account when formulating exercise prescriptions, and each category of exercise plan should include frequency (several times per week), intensity (intensity), time (duration), type (type or type), as well as total volume and progression (progression) per week. That is, ExRx's FITT-VP principle.
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3.1
Frequency of exercise
Exercise frequency, which refers to the number of days per week when an exercise program is performed, plays an important role in promoting health and improving healthy physical fitness. The World Health Organization recommends that the frequency of aerobic exercise should not be less than 3 days/week, and for most adults, it is a favorable strategy to achieve the recommended amount of physical activity by distributing the exercise time in 3~5 days per week. During resistance exercise, the frequency of exercise of the same muscle group should be spaced at least 1 d, 2~3 d/week. The frequency of flexibility exercises is best done every day. Patients are encouraged to exercise 3~5 times/week with an interval of no more than 2 days to achieve the recommended amount of exercise. However, due to a variety of factors, only 1~2 times a week can still obtain health benefits, such as reducing the risk of all-cause mortality, CVD and cancer, etc., but by increasing the amount of single exercise and reducing the frequency of exercise to achieve the recommended amount of exercise, such as only 1~2 times a week, it may increase the risk of sports injuries and cardiovascular events in sports.
3.2
Exercise intensity
It refers to the degree of exertion during exercise, which is the core indicator that determines the amount of exercise. Aerobic exercise intensity depends on speed, incline, power, etc., and is usually calculated by VO2max, HRmax, HRR, etc., and can also be expressed as absolute exercise intensity by energy expenditure per minute (e.g., kcal/min) or MET. The strength of resistance exercise depends on how much resistance the local muscle group is holding against resistance or bearing weight. Increasing the intensity of exercise will result in a positive dose response of health/fitness benefits, and exercise below the minimum intensity threshold will not adequately obtain changes in physiological indicators. When prescribing exercise in patients with T2DM, relative intensity is recommended. Physiological indicators of exercise are directly measured by the Increasing Exercise Load Cardiopulmonary Endurance Test (CPR) and are the preferred method for determining exercise intensity. Determine the starting exercise intensity according to exercise habits and health status. It is recommended to start with low-intensity aerobic exercise (30%~39% HRR) and gradually increase to moderate-intensity (40%~59% HRR) to high-intensity (60%~69% HRR) aerobic exercise. Subjective exertion can adjust or refine the intensity of exercise. The talk test is a valid and reliable method of assessing exercise intensity, which can replace the lactate threshold, ventilation threshold, and respiratory compensation point as a primary method for developing and monitoring exercise intensity. A common way to determine the intensity of aerobic exercise is to scan the QR code at the end of the article to view.
3.3
Exercise time
It includes single exercise time and cumulative exercise time. The recommended exercise time can be completed consecutively or cumulatively, and the aerobic exercise time used to improve cardiorespiratory endurance should be more than 30 minutes per day.
3.4
Mode of exercise
According to the different ability to improve the body's exercise ability, it can be divided into aerobic exercise, resistance exercise, flexibility exercise and balance, coordination exercise, etc. The main forms of aerobic exercise include walking, water sports, running, cycling or power car, going up and down steps, mountaineering, swimming, skiing, skating, ball games, as well as traditional sports of mainland ethnic groups, such as Tai Chi, Wufowl Opera, Baduanjin, Yangge Twisting, etc. Walking is a generally accepted form of aerobic exercise. The main methods of resistance exercise are freehand exercises, instrument exercises, elastic band exercises, etc.
3.5
Amount of exercise per week
Exercise intensity, timing, and frequency are the factors that influence and determine the total amount of exercise. The amount of aerobic exercise is made up of the timing, frequency, and intensity of exercise; The amount of resistance exercise consists of the intensity and frequency of the exercise, the number of sets of exercises for each muscle group, and the number of repetitions per set. Physical activity plays an important role in achieving the health/fitness effect of exercise. It is recommended that patients with T2DM do at least 150~300 min of moderate-intensity or 75~150 min of large-intensity aerobic exercise per week, or an equivalent combination of moderate-intensity and high-intensity aerobic exercise, and more than 300 min of moderate-intensity or 150-minute maximum-intensity aerobic exercise per week will have more health benefits.
The standard units for estimating exercise can be expressed in MET-h/wk and kilocalories/week (kcal/wk), e.g., 0.5 hours per week for 5 days per week, 30 minutes per day, and 4 MET brisk walking× 4 METT×5=10 MET-h. The formula (kcal = 1.05×MET-h× kg body weight) can be used to calculate the energy expenditure during exercise. For most adults, 8.5~17.0 MET-h per week is a reasonable amount of exercise, which is equivalent to consuming 1 000~2 000 kcal/wk of energy, which can be achieved through 150~300 min/wk of moderate-intensity exercise. Exercising below this level can also provide health or fitness benefits for those who are beginning to exercise. Step count is an easy way to assess your amount of exercise, and a cadence of 100 steps/min is suitable for moderate-intensity exercise. 10 000 steps/d is often the goal of exercise, but the minimum amount of exercise per day related to obtaining health benefits is 6 000~8 000 steps/day, of which at least 3 000 steps should be brisk walking (cadence ≥ 100 steps/min).
3.6
Athletic progression
Progression depends on your body's health, age, personal athletic preferences and goals, and your body's ability to tolerate your current level of exercise. For healthy adults, the exercise progression should include three stages: adaptation stage, improvement stage and maintenance stage. Progression can be achieved by increasing the number of FITT principles that the individual can tolerate, usually by increasing the frequency and duration of exercise each day, and finally by increasing the intensity of exercise. At the beginning of an exercise program, especially in those with irregular exercise habits, adopting a "low start, slow plus" strategy can reduce the risk of exercise-related cardiovascular events and injuries, as well as increase the individual's fitness and adherence to exercise.
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Testimonials for different sports categories
4.1
aerobics
Recommendation 12: Regular aerobic exercise can reduce HbA1c by 0.5%~0.7% (A), and those with higher baseline HbA1c have a more obvious decline after exercise (B), and the effect of improving exercise intensity is better with the participation and supervision of medical personnel (B) Recommendation 13: It is recommended that patients with T2DM carry out aerobic exercise for 3~7 days a week with an interval of no more than 2 days each time (A) Recommendation 14: Moderate aerobic exercise is recommended for patients with T2DM. Patients with a high level of physical fitness can perform moderate to large intensity or high-intensity aerobic exercise (A) Recommendation 15: It is recommended that patients with T2DM exercise for no less than 10 min per exercise, with a total of 30~60 min per day, and at least 150 min per week.
Recommendation 16: It is recommended to walk no less than 3 days and 6 000 steps/d per week, and the cadence should not be less than 60~90 steps/min according to one's own situation, and it is best to reach 100 steps/min walking exercise prescription (B)
4.2
Resistance movement
Recommendation 17: Regular resistance exercise can reduce HbA1c by about 0.4%, reduce the rate of skeletal muscle loss, and improve the rate of glucose treatment in skeletal muscle (A)
Recommendation 18: It is recommended that patients with T2DM undergo regular resistance exercise 2~3 days a week (A)
Recommendation 19: Inexperienced patients with T2DM can start with resistance exercises for large muscles once a week starting with 20% 1-RM load (B)
4.3
United Movement
Recommendation 20: 3~6 months of aerobic exercise combined with resistance exercise structured exercise prescription can reduce HbA1c by up to 0.89%, and aerobic exercise with a cumulative effect of more than 150 min/week is better (A)
Recommendation 21: Recommend a combination of aerobic exercise and resistance exercise for patients with T2DM (A)
4.4
Flexibility exercises
Recommendation 22: Flexibility exercise alone has no significant effect on blood glucose levels, but it can enhance range of motion, improve flexibility, and prevent falls (A)
Recommendation 23: It is recommended that patients with T2DM undergo at least 2~3 days/week of balance and flexibility exercises (C)
Recommendation 24: Incorporate flexibility exercises into an exercise to better improve physical function and improve blood sugar (C)
4.5
Interruption
Recommendation 25: Interrupting sedentary time may improve glycemic control, reduce CVD risk, and increase longevity (A)
Recommendation 26: All patients with T2DM, especially those with insulin resistance and a high BMI, should interrupt sedentary sitting by engaging in activities of any intensity every 30 minutes to improve glycemic control (A)
4.6
High-intensity intermittent exercise
Recommendation 27: Patients with T2DM who are stable and in good physical condition may consider HIIE as an alternative to continuous intensity aerobic exercise (B)
Recommendation 28: Patients with T2DM with complications should be screened for risk prior to HIIE to avoid potential exercise risks (C)
4.7
National traditional sports
Recommendation 29: Baduanjin or Tai Chi is a moderate-intensity exercise that can reduce HbA1c by no less than 0.4% for 12 weeks for 40 minutes no less than 3 times a week (C)
Recommendation 30: Baduanjin and Tai Chi are suitable forms of exercise, especially for the elderly T2DM(C)
NO5.
Acute complications of diabetes mellitus and exercise
5.1
Hypoglycemia
Recommendation 31: Patients with T2DM who are taking insulin or insulin secretagogues should supplement carbohydrates as needed to prevent hypoglycemia during and after exercise, or adjust the type and dose of glucose-lowering drugs under physician guidance (B)
Recommendation 32: Reducing basal insulin dose, supplementing food at bedtime, and/or continuous glucose monitoring are the main measures to reduce the risk of nocturnal hypoglycemia after exercise (B)
Recommendation 33: Interval or mixed exercise can help reduce the risk of hypoglycemia during exercise and improve blood glucose stability during exercise (C)
5.2
Hyperglycemia
Recommendation 34: Patients with T2DM should monitor blood glucose > 13.9 mmol/L. When ketones are positive, moderate-intensity or above-intensity exercise is not appropriate. In the absence of symptoms related to hyperglycemia, exercise can be started gradually at a low intensity (C)
Recommendation 35: Tidying up after high-intensity exercise can improve post-exercise hyperglycemia (C)
NO6.
Chronic complications of diabetes mellitus and exercise
6.1
Diabetic nephropathy
Recommendation 36: Diabetic nephropathy is not a contraindication to exercise, patients with different stages of diabetic nephropathy should be active in exercise, and it is recommended to start with low-intensity exercise (E)
Recommendation 37: Dialysis patients should pay attention to maintaining electrolyte balance and correcting electrolyte imbalances in time during exercise (E)
6.2
Diabetic retinopathy
Recommendation 38: Proliferative retinopathy and severe retinopathy (including patients with recent panretinal photocoagulation or other recent ophthalmic surgery) should be avoided at greater intensity and higher intensity and with significantly higher blood pressure (e.g., boxing, high-altitude hiking, diving and other special sports) to reduce the risk of vitreous hemorrhage and retinal detachment, as well as impact sports (e.g., basketball, football, rugby) (E)
Recommendation 39: RPE can be used to monitor exercise intensity in patients with diabetic retinopathy (C)
6.3
Diabetic peripheral neuropathy
Recommendation 40: Patients with diabetic peripheral neuropathy should avoid sports that increase the risk of foot injuries, such as prolonged hiking, jogging, or walking on uneven surfaces (B)
Recommendation 41: Patients with diabetic peripheral neuropathy are more suitable for low-weight exercise and should avoid activities that require high balance (C)
6.4
Diabetic autonomic neuropathy
Recommendation 42: Patients with diabetic autonomic neuropathy should strengthen blood glucose, blood pressure, and heart rate monitoring during exercise, and pay attention to the possibility of hypoglycemia, abnormal blood pressure response, impaired thermoregulation, elevated resting heart rate, and slowing of maximum heart rate (E)
Recommendation 43: Exercise intensity can be adjusted based on heart rate variability, and RPE score is recommended to monitor exercise intensity (C)
Recommendation 44: Patients with T2DM should exercise at a suitable temperature and carry plenty of drinking water to avoid exercise-induced fever (C)
NO7.
Common comorbidities of type 2 diabetes mellitus are associated with exercise
7.1
Hyperphysis
Recommendation 45: Regular exercise improves cardiorespiratory endurance and is associated with a reduced risk of all-cause mortality in T2DM at any weight state (C)
Recommendation 46: Exercise combined with diet for weight loss is better than diet alone, and visceral fat is reduced more. Patients with T2DM who need to lose weight should complete moderate-intensity exercise (about 500 kcal/d) for 5~7 days a week (A)
Recommendation 47: 300 minutes per week of moderate-to-high intensity physical activity is effective in preventing weight regain (A)
Recommendation 48: Recommend preoperative exercise for patients with T2DM who are going to undergo bariatric surgery to reduce the risk of surgery (B)
7.2
Metabolic-related fatty liver disease
Recommendation 49: Recommend lifestyle changes for overweight/obese MAFLD patients, with a goal of losing at least 5% of body weight, preferably ≥ 10% of body weight, and 3% weight loss in normal-weight MAFLD patients can also contribute to the improvement of MAFLD (B)
Recommendation 50: Lifestyle interventions that include diet, exercise, and weight loss are among the main treatments for MAFLD, and personalized exercise prescription may lead to long-term improvement in MAFLD, with benefits independent of weight loss (A)
Recommendation 51: Interrupting sedentary time and reducing sedentary time are beneficial for reducing intrahepatic fat and are independent of physical activity level. Increasing moderate to moderate intensity physical activity or 2 500 steps per day can effectively improve fatty liver disease (E)
7.3
Hypodermatosis
Recommendation 52: Patients with T2DM with sarcopenia should focus on increasing resistance training based on explosive strength training in addition to achieving the physical activity level recommended by the World Health Organization. Explosive resistance training program was used in the elderly to achieve maximum strength, explosive power, muscle volume, and muscle function performance under low-intensity to moderate-intensity (i.e., 40%~60% 1-RM) intervention (B)
Recommendation 53: Traditional ethnic exercises such as Taijiquan and Baduanjin are multi-component exercises, which can effectively improve muscle mass, muscle strength and physical function performance in patients with sarcopenia, and have higher compliance in the elderly (B)
7.4
hypertension
Recommendation 54: Exercise above moderate intensity should be prohibited when blood pressure ≥ 160/100 mmHg (1 mmHg = 0.133 kPa) in diabetic patients. Stable blood pressure control before starting exercise (E)
Recommendation 55: Avoid breath-holding, explosive sports, such as high-intensity resistance training (weightlifting, pull-ups, tug-of-war, etc.), high jump, long jump, etc. (B)
Recommendation 56: Recommend low- to medium-intensity exercises involving large muscle groups, such as walking, cycling, tai chi, etc. (B)
7.5
coronary heart disease
Recommendation 57: The intensity of exercise for cardiac rehabilitation should be lower than the threshold for inducing myocardial ischemia, such as the heart rate during exercise should be lower than the heart rate of 10 beats/min during angina symptoms or ST-segment depression (E)
NO8.
Type 2 diabetes medication and exercise
Testimonials
Recommendation 58: Patient's treatment regimen should be tailored to improve efficacy and safety based on the elements of exercise prescription and drug characteristics on an individual-centered basis (B)
As the intensity of exercise increases, the distribution of blood flow to the skeletal muscles gradually increases. The blood flow distribution of skeletal muscle accounts for 20% of the total blood volume in the resting state, and the blood flow distribution of skeletal muscle increases to 70%~80% during moderate or large-intensity exercise. The redistribution of blood flow during exercise is one of the main factors affecting the effects and adverse reactions of drugs during exercise. Energy expenditure during exercise, intensity and duration of action of hypoglycemic drugs, and individual islet function all affect the risk of exercise-related hypoglycemia. Post-exercise hypotension is closely related to exercise intensity, exercise duration, exercise mode, and type of antihypertensive drugs. The treatment regimen of patients should be comprehensively adjusted based on the elements of exercise prescription and drug characteristics to improve efficacy and safety.
8.1
Biguanides
Recommendation 59: A single session of high-intensity exercise or prolonged aerobic exercise in diabetic patients taking biguanides generally does not increase the risk of lactic acidosis, but should be wary of comorbid medications or health conditions that increase the risk of lactic acidosis (E)
8.2
Insulin sensitizers
Recommendation 60: The synergistic effect of exercise in improving insulin sensitivity needs to be considered, and the dose of the combination insulin secretagogue or insulin needs to be adjusted in a timely manner (E)
8.3
α-Glycosidase inhibitors
Acarbose, voglibose, and miglitol are representative drugs of this class of drugs. Digestive discomfort such as bloating and abdominal pain are common adverse reactions. There is no evidence that exercise significantly affects the metabolism of these drugs, and hypoglycemia with these drugs requires a diet of simple sugars to correct hypoglycaemia.
8.4
Insulin secretagogues
Recommendation 61: It is recommended to monitor blood glucose before and after exercise, and when the pre-exercise blood glucose is lower than 5.6 mmol/L, supplement an appropriate amount of carbohydrates according to the intensity and time of planned exercise, avoid exercise at the peak time of drug action, and be vigilant against delayed hypoglycemia after exercise (C)
8.5
SGLT2i
Recommendation 62: Patients with T2DM who are older, have a long course of disease, have poor β cell function, or who are chronically taking SGLT2i may be at higher risk of ketoacidosis (E)
Recommendation 63: Discontinue SGLT2i(C) at least 24 hours before heavy physical activity
8.6
Incretins
Recommendation 64: GLP-1RA should be used with a reasonable diet and exercise to reduce muscle tissue loss (C)
8.7
insulin
Recommendation 65: Patients with T2DM who are already on insulin and have good glycemic control should take carbohydrate supplementation as needed when exercising for more than 30 minutes (A). When increasing the amount of exercise, the insulin dose should be appropriately reduced according to the blood sugar level and the amount of exercise (A). For patients who are new to insulin therapy, insulin with a lower risk of hypoglycemia is preferred (B)
8.8
Lipid-modifying drugs
Recommendation 66: Patients who exercise regularly should start with a low dose of statin therapy. When a person who is already taking statins plans to start regular exercise, they should start with low-intensity, short-duration exercise (B)
8.9
Antihypertensive medications
Recommendation 67: Pay attention to the effects of antihypertensive drugs on blood pressure, heart rate, blood volume and electrolytes, be vigilant against hypotension after exercise, and recommend that patients with polypharmacy judge exercise intensity by RPE (C)
8.1
Antiplatelet drugs
Recommendation 68: Patients on antiplatelet agents should avoid high-intensity exercise or sports with a high impact/impact risk, and be vigilant for prolonged bleeding and internal bleeding in the setting of sports injuries (C)
NO9.
Timing of exercise in type 2 diabetes
Testimonials
Recommendation 69: Regular exercise can improve cardiorespiratory endurance and improve blood sugar control, regardless of exercise timing (A)
Recommendation 70: A single evening exercise is better at improving blood sugar at night; HIIE at 30 min postprandial time could better reduce postprandial blood glucose peaks (B). Exercise 60 minutes after a meal reduces the risk of hypoglycemia (E)
Improvement in cardiorespiratory endurance is not related to timing of exercise. After 5 days of structured exercise, exercise before dinner (6:30 p.m.) improved blood glucose and other metabolic markers better than before breakfast (6:30 a.m.). Structured exercise (30 minutes of aerobic exercise + 4 sets of resistance exercise) supervised by medical staff for 12 weeks and 3 times a week was effective in improving blood glucose in overweight and obese patients with T2DM, with no significant difference between 8 to 10 a.m. and 17 to 19 p.m. exercise. Jogging/walking with 40% HRR 30 or 60 minutes after a single dinner session can effectively improve the blood glucose peak after dinner and the blood glucose fluctuation at 12 h after a meal, without increasing the risk of nocturnal hypoglycemia. Several studies evaluating the effect of exercise before or after breakfast on blood glucose have shown that low- or moderate-intensity aerobic exercise after breakfast in patients with T2DM may have better blood glucose control, but this benefit may not be carried over after lunch.
Compared with 60 or 90 minutes of exercise after breakfast, power-cycling-based HIIE 30 minutes after breakfast could effectively control postprandial blood glucose and maintain 24-hour blood glucose stability in metformin-treated T2DM patients. In addition, preprandial resistance training only improved postprandial blood glucose compared with no resistance training, while postprandial resistance exercise was more effective in reducing CVD risk by reducing postprandial blood glucose and TG levels.
Overall, most of the findings suggest that postprandial exercise leads to better blood sugar control by reducing postprandial blood sugar spikes. In addition, more energy expenditure after a meal lowers blood sugar, regardless of the intensity or type of exercise, and a variety of exercises that last longer periods of time (≥45 minutes) have the same benefit.
NO10.
Digital health and the diabetes movement
Testimonials
Recommendation 71: Recommend T2DM patients to participate in the Internet Health Management Program (C)
Diabetes is a chronic, complex disease that requires good knowledge and self-management skills to optimize glycemic control and improve health outcomes. Physical activity/exercise is a key behavior for diabetes self-management, and IoT/Internet eHealth technology can effectively help patients improve their lifestyle and optimize disease control. Health-related mobile communication apps can help make lifestyle changes and promote healthy behaviors. These applications can provide medical information exchange, text messaging, educational content, web-based video and photo maintenance, and can reduce inter-regional medical disparities and provide more comprehensive information on chronic disease management. For diabetic patients, it can effectively improve blood sugar control, promote the development of good diet and physical activity habits, lose weight, and improve clinical examination and test results. The PRODEMOS study shows that the use of mHealth (mobile health) smartphone software in elderly patients in China can effectively improve their lifestyle and prevent dementia and CVD.
Wearable devices such as sports bands or smartwatches can effectively increase the daily step count of diabetic patients by about 1,800 steps. Somatosensory games can effectively improve the physical activity of diabetic patients, and studies have shown that 12 weeks of somatosensory games can improve the physical fitness of T2DM patients.
NO11.
Blood glucose monitoring during exercise
Testimonials
Recommendation 72: Blood glucose monitoring is the best means of managing blood glucose levels during and after exercise. Continuous glucose monitoring (CGM) can provide data, including alarms, to inform patients if they need to increase caloric supplementation, particularly carbohydrate intake, to maintain optimal glucose levels. For patients who do not use CGM, capillary blood glucose testing should be performed as needed, and finger capillary blood glucose testing is recommended every 30 minutes during the first exercise or increase in exercise intensity, and based on this, adjustment decisions should be made before, during, and after exercise prescriptions (E)
Blood glucose monitoring is an important part of exercise management in diabetic patients, and the results of blood glucose monitoring can reflect the degree of glucose metabolism disorder in diabetic patients, which can be used to formulate a reasonable hypoglycemic program, evaluate the effect of hypoglycemic treatment, and guide the adjustment of treatment plan. Self-glucose monitoring (SMBG) is the basic form of blood glucose monitoring, which can help people with diabetes better understand their blood sugar control status before, during, and after exercise, and provide them with a means to actively participate in diabetes management, adjust behaviors as needed, and intervene with medications.
CGM provides continuous, comprehensive information about blood glucose throughout the day, understanding trends and characteristics of blood glucose fluctuations. Therefore, CGM can be an effective supplement to traditional blood glucose monitoring methods, and can monitor the changes in blood glucose in diabetic patients in real time during exercise. It should be noted that SMBG still plays an important role during the use of CGM. In addition to correction for some CGM systems, capillary glucose testing should be performed to guide clinical decision-making when CGM indicates hypoglycemia, or when hypoglycemia is suspected, or when the patient's own symptoms do not match CGM blood glucose values.
Blood glucose monitoring is the best way to manage blood sugar levels during and after exercise. CGM can provide data, including alarms, to inform patients if they need to increase caloric supplementation, especially carbohydrate intake, to maintain optimal glucose levels. For those who do not use CGM, capillary glucose should be measured frequently as needed, and finger capillary glucose measurement is recommended every 30 minutes during the first exercise or when the intensity of exercise increases, and based on this, adjustment decisions should be made before, during, and after exercise.
NO12.
Nutritional supplementation during sports and sports injuries
Testimonials
Recommendation 73: Supplementation of nutrition during exercise should not only ensure that energy intake meets the needs of exercise, but also stabilize blood sugar as much as possible, and emphasize individualized adjustment of daily carbohydrate and protein intake on the basis of following general principles (E). Moderate carbohydrate intake before exercise to prevent hypoglycemia after exercise (E)
Recommendation 74: Patients with T2DM should drink appropriate amounts of water before, during, and after exercise (E)
Recommendation 75: Patients with T2DM should follow the RICE principle for first aid treatment and seek medical attention in time when they have mild sports injuries (E)
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Carbohydrates are the main source of energy for moderate-intensity or higher-intensity aerobic exercise. Moderate carbohydrate supplementation before and during exercise can better maintain blood sugar stability and improve exercise performance. Consuming foods with a high glycemic index, such as biscuits or bananas, shortly after exercise can help with muscle glycogen supplementation. Diabetic patients can consume a small amount of protein (0.2~0.4 g/kg per hour) and less carbohydrate (0.8 g/kg per hour) at the same time after exercise, which can better maintain blood sugar stability while replenishing muscle glycogen. Patients who are fasting or using basal insulin only need to supplement 10~15 g of carbohydrates to prevent hypoglycemia if the insulin level in the blood circulation is relatively low, and only need to supplement 10~15 g of carbohydrate for 30~60 min of low-intensity exercise. If the level of insulin in the blood circulation is high due to taking insulin secretagogues or exercising after insulin injection, 30~60 g of carbohydrates should be supplemented every 1 h to prevent hypoglycemia. A physician or dietitian can strategically select proteins or fats with the right mix of nutrients to prevent late-onset hypoglycemia. Increasing protein intake is important for muscle recovery and muscle mass gain after exercise, especially after resistance exercise.
Replace 500 mL of fluid 1 hour before exercise to ensure that the body is in a good hydration state when you start exercising. If the preexercise blood glucose < 5.6 mmol/L, fluids containing carbohydrates (such as sports drinks) may be supplemented to prevent exercise-related hypoglycaemia. 150 mL of fluid can be supplemented every 15 minutes during exercise, which can be increased or decreased according to the exercise intensity, exercise volume and ambient temperature. If exercising in a hot or humid environment, hydrate more frequently and monitor for signs of dehydration. After exercising, you can estimate the amount of water you lose by monitoring your weight and use it as a reference for rehydration. If you exercise for more than 1 hour or in a hot environment, you should supplement with electrolyte-containing beverages to help restore water and electrolyte balance and enhance blood glucose monitoring. In addition, alcohol intake, both before and after exercise, may increase the risk of hypoglycemia.
Principles of treatment of sports injuries: muscle strains and joint sprains after sports can generally be treated with cryopressurization bandaging; Once a fracture is confirmed, it should be fixed before being sent to the hospital. After the head collision, the bleeding is stopped, compressed and bandaged, and then sent to the hospital. For mild sports injuries, follow the RICE principle for first aid treatment. Specifically, it includes: (1) rest (rest): the injured part immediately stops exercising and rests sufficiently. (2) Ice pack: Wrap the ice pack in a towel and place it on the injured part to constrict the blood vessels, reduce swelling, pain and spasm, and shorten the recovery time. Remove the ice pack when applying ice for 20~30 min each time or when the skin feels cold, painful, burning, and finally becomes numb. Ice can be applied every 0.5 or 1 hour until the pain is relieved or the doctor is referred to the doctor. (3) Compression: Wrap an elastic bandage on the injured area to reduce internal bleeding. Pay attention to the appropriate pressure bandaging and observe the color of the exposed toes or fingers. If symptoms such as pain, skin discoloration, numbness, and tingling appear, it indicates that the bandage is too tight, and the elastic bandage should be unwrapped and sent to the hospital according to the doctor's instructions. (4) Elevation: Continue to elevate the injury (higher than the heart) within 24 hours after the injury to reduce the swelling of the injury. Quite serious injuries and trauma should be rushed to the hospital for treatment.
Prevention of sports injuries: Warm-up exercises before exercise can reduce the occurrence of muscle strains and joint sprains. Patients with joint lesions should wear joint protection belts (knee pads, wrist pads, and belt pads) when exercising, wear comfortable sports shoes for exercise, and it is forbidden to wear leather shoes and high heels for exercise. Older people should avoid activities that are too heavy and strenuous to exercise. If peripheral neuropathy or degenerative arthritis is present, non-weight-bearing exercises, such as stationary biking, swimming, etc., should be used, or weight-bearing and non-weight-bearing exercises should be alternated.
NO13.
Adherence to exercise
Testimonials
Recommendation 76: To improve the adherence of exercise prescription in patients with T2DM, it is necessary to pay attention to the individualization of exercise prescription, establish incentive mechanisms, combine community resources, make good use of online or intelligent management methods, and strengthen education and training for patients and medical staff on exercise to promote health (E)
Due to various factors such as individual differences and lifestyle habits of patients, the compliance of exercise prescription is generally low. Therefore, a series of strategies are needed to ensure the effective implementation of exercise prescription guidelines, including: (1) highly personalized exercise prescription, fully considering patients' exercise habits, and selecting appropriate exercise methods and intensities based on their interests and abilities. (2) Use community resources to provide more exercise opportunities and support for patients, cooperate with sports groups in the community, organize diabetic patients to participate in group exercise activities, and enhance their exercise motivation and social support. (3) Online supervision and follow-up to understand the patient's exercise status and compliance. At the same time, healthcare providers can also communicate with patients through online chat, video calls, etc., to provide personalized guidance and support. (4) Through holding lectures, training courses and other activities, patients are taught correct sports knowledge and skills, and their sports awareness and self-management ability are enhanced. (5) In order to stimulate the enthusiasm of patients to participate in sports, medical service providers can set up an incentive mechanism and give certain rewards or honorary certificates after completing the sports goals set for them.
NO14.
Summary and outlook
This guideline provides detailed guidance for the implementation of exercise intervention in patients with T2DM, and also provides support for the extensive development of physical and medical integration and health promotion in diabetic patients. However, at the level of research fields, there are still many questions to be explored. For example, there is insufficient evidence on the long-term effectiveness of exercise in preventing and controlling T2DM complications, and an effective T2DM exercise intervention model that meets the characteristics of Chinese people and regions has not been established. In addition, at the level of clinical practice, there are many challenges in how to systematically carry out T2DM exercise intervention. On the one hand, the development of T2DM exercise intervention puts forward higher ability requirements for clinicians. In addition to mastering the knowledge of T2DM diagnosis and treatment, clinicians should also be familiar with sports medicine. At this stage, there is still a relative shortage of compound talents in the integration of sports and medicine in the mainland. On the other hand, there are still some problems in the development of T2DM exercise intervention, such as difficulty in promotion and persistence. The reasons may be related to the lack of appropriate technology for exercise intervention, the unclear implementation path of exercise intervention, the weak active health awareness of diabetic people, and the lack of subjective initiative. On the other hand, there is still a lack of exercise prescription clinics and effective sports clinic referral mechanisms in mainland China, as well as a lack of standardized construction plans for sports health promotion centers and exercise intervention centers for chronic diseases, which also restricts the effective development of T2DM exercise intervention to a certain extent. Therefore, improving the understanding of the importance of exercise in the treatment of diabetes, strengthening the cultivation of interdisciplinary talents integrating sports and medicine, promoting interdisciplinary cooperation between sports and medicine, developing appropriate technologies for exercise intervention, improving the implementation path and management process of exercise intervention, and exploring new diabetes management models for exercise intervention will help improve the management level of T2DM, improve the clinical outcomes of diabetic patients, and help achieve the ambitious goal of Healthy China 2030.
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Swipe up and down to see the list of experts
Writers:
Zhang Xianbo, Department of Endocrinology, Beijing Hospital, National Geriatrics Center, Institute of Geriatrics, Chinese Academy of Medical Sciences
Cai Xiaoling, Department of Endocrinology, Peking University People's Hospital
Qiu Shanhu, Department of General Medicine, Zhongda Hospital, Southeast University
Preparation of the list of members of the Expert Committee (in alphabetical order of surname):
Bao Yuqian, Department of Endocrinology and Metabolism, Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine
Chen Hong, Department of Endocrinology, Zhujiang Hospital, Southern Medical University
Chen Li, Department of Endocrinology, Qilu Hospital, Shandong University
Chen Liming, Zhu Xianyi Memorial Hospital, Tianjin Medical University
Shiyi Chen, Institute of Sports Medicine, Fudan University
Duan Binhong, Department of Endocrinology, Heilongjiang Provincial Hospital
Gao Ling, Department of Endocrinology, People's Hospital of Wuhan University
Gu Weiqiong, Department of Endocrinology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Guo Jianjun Capital Institute of Physical Education and Sports and Medicine Integration Innovation Center
Guo Lixin, Department of Endocrinology, Beijing Hospital, National Geriatrics Center, Institute of Geriatrics, Chinese Academy of Medical Sciences
Xiaohui Guo, Department of Endocrinology, Peking University First Hospital
Tianpei Hong, Department of Endocrinology, Peking University Third Hospital
Hu Ji, Department of Endocrinology, The Second Affiliated Hospital of Soochow University
Ji Qiuhe, Department of Endocrinology, Xi'an International Medical Center Hospital
Ji Linong, Department of Endocrinology, Peking University People's Hospital
Jiang Weixin, Department of Physical Education, Southeast University
Hongyu Kuang, Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University
Jun Li, Department of Endocrinology, First Affiliated Hospital, Shihezi University School of Medicine
Li Quanquan, Department of Endocrinology, Rocket Army Characteristic Medical Center
Li Xiaoying, Department of Endocrinology, Zhongshan Hospital, Fudan University
Li Yiming, Department of Endocrinology, Huashan Hospital, Fudan University
Liang Yuzhen, Department of Endocrinology, Second Affiliated Hospital of Guangxi Medical University
Liu Ming, Department of Endocrinology, General Hospital of Tianjin Medical University
Guochun Liu, School of Sports Medicine, Chongqing Medical University
Lu Dajiang, School of Physical Education and Training, Shanghai Sport University
Luo Xijuan, Sports and Health Center, Sun Yat-sen University
Ma Jianhua, Department of Endocrinology, Nanjing First Hospital, Nanjing Hospital, Nanjing Medical University
Mu Yiming, Department of Endocrinology, First Medical Center, PLA General Hospital
Pan Qi, Department of Endocrinology, Beijing Hospital, National Geriatrics Center, Institute of Geriatrics, Chinese Academy of Medical Sciences
Qin Guijun, Department of Endocrinology, First Affiliated Hospital of Zhengzhou University
Kwon Jinxing, Department of Endocrinology, Gansu Provincial People's Hospital
Ran Xingwu, Department of Endocrinology, West China Hospital, Sichuan University
Su Qing, Department of Endocrinology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
Sun Yadong, Department of Endocrinology, Jilin Provincial People's Hospital
Sun Zilin, Department of Endocrinology, Zhongda Hospital, Southeast University
Zhengzhen Wang, School of Sports Medicine and Rehabilitation, Beijing Sport University
Wei Hongwen, School of Physical Training, Beijing Sport University
Wu Hao, School of General Medicine, Capital Medical University
Xi Yue, Diabetes Center, Jinzhou Medical University
Department of Endocrinology, General Hospital of the Central Theater of the People's Liberation Army
Xiao Xinhua, Department of Endocrinology, Peking Union Medical College Hospital
Xie Xiaomin, Department of Endocrinology, Yinchuan First People's Hospital
Jing Xu, Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University
Xu Yong, Affiliated Hospital of Southwest Medical University
Brother Xu Ji, Department of Endocrinology, First Affiliated Hospital of Nanchang University
Xu Xiangjin, Department of Endocrinology, 900th Hospital, Joint Logistics Support Force of the People's Liberation Army
Xu Yushan, Department of Endocrinology, First Affiliated Hospital of Kunming Medical University
Yaoming Xue, Department of Endocrinology, Nanfang Hospital, Southern Medical University
Yang Tao, Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University
Peng Yuan, School of Athletics, Shanghai Sport University
Yuan Huijuan, Department of Endocrinology, Henan Provincial People's Hospital
Zhang Huili, Department of Endocrinology, Affiliated Hospital of Qinghai University
Zhang Qiu, Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University
Zhiguang Zhou, Institute of Metabolic Endocrinology, Second Xiangya Hospital, Central South University
Zhu Dalong, Department of Endocrinology, Drum Tower Hospital, Nanjing University School of Medicine
Zhu Li, Chinese Sports Science Society
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