A Comprehensive Exercise Program for Individuals with Prediabetes and Type 2 Diabetes Mellitus

Created by  by Dr. Wayne A. Reagan, PT, DPT, CEAS, President, Reagan Physical Therapy and WellnessNutrition and hypoglycemia section added by Christina Sonnenberg, RDN, IFNCP, and posted on 07/03/23

Understanding the role of exercise in Prediabetes and Type 2 Diabetes Management

Exercise plays a vital role in the management of Prediabetes Type 2 Diabetes Mellitus (T2DM). Alongside pharmacologic treatment and dietary modifications, regular physical activity can significantly improve blood sugar control, enhance cardiovascular health, and promote overall well-being. In this blog post, we will outline an exercise program based on clinical guidelines and research to help individuals with T2DM achieve their fitness goals and manage their condition effectively. 

Discover the multitude of benefits exercise offers for diabetes management

It is important to note that prior to starting an exercise program, individuals should undergo a thorough screening by a physical therapist to ensure medical safety and identify any potential risks or complications.

Importance of Exercise for Type 2 Diabetes Management

Exercise has numerous benefits for individuals with T2DM, including improved insulin sensitivity, blood sugar control, cardiovascular health, weight management, and overall quality of life. It can also help reduce the risk of long-term complications associated with diabetes.

Optimal exercise parameters for individuals with T2DM based on clinical guidelines

Key factors to consider for effective workouts:

  1. Frequency: Aim for exercise sessions 3 to 5 days per week, ensuring regularity in the exercise routine.
  2. Intensity: Exercise at a low to moderate intensity or 50% to 70% of maximal heart rate. To calculate your target heart rate, first determine your maximum heart rate by subtracting your age from 220 (e.g., a 50-year-old persons max heart rate is 220-50=170 bpm). Then multiply the max heart rate by .50, to calculate the low end of the target heart rate, and max heart rate by .70 to calculate the high end of the target heart rate (e.g., max heart rate = 170, 170 x .50 = 85 bpm, 170 x .70 = 119 bpm; for the 50-year-old person, the max heart rate is 170 bpm and the target range is 85 – 119 bpm).
  3. Duration: Strive for a minimum of 150 minutes of exercise per week. This can be achieved through shorter sessions of 30 minutes on most days of the week.
  4. Type of Exercise:
    1. Endurance Exercises: Engage in activities that elevate your heart rate and improve cardiovascular fitness, such as brisk walking, cycling, swimming, dancing, or using cardio machines.
    2. Resistance Exercises: Incorporate strength training exercises using household items, resistance bands, weights, or bodyweight. Perform 5 to 10 exercises per session, with 3 sets of 10 to 15 repetitions per exercise.
The Importance of comprehensive screening before initiating an exercise program

Before starting an exercise program, it is crucial to undergo a thorough screening by a physical therapist. The screening process helps identify any medical risks or contraindications, assess fall risk, and evaluate physical activity levels, body composition, endurance exercise capacity, and muscle strength. This ensures a safe and tailored exercise program for each individual.

Customizing exercise programs to individual needs and maximizing progress

Every individual is unique, and exercise programs should be personalized to their specific needs, capabilities, and preferences. Gradually progress the intensity, duration, and complexity of exercises over time to prevent plateau and maximize benefits.

Combining exercise with nutrition, stress management, and monitoring for a comprehensive diabetes management plan

In addition to exercise, a holistic approach to diabetes management should include proper nutrition, stress management, regular monitoring of blood sugar levels, and adherence to prescribed medications. Collaborate with healthcare professionals, including physical therapists, dietitians, and physicians, to create a comprehensive plan for diabetes management.

Regular exercise is a cornerstone in the management of Type 2 Diabetes Mellitus. By following the guidelines outlined in this blog post and consulting with healthcare professionals, individuals with T2DM can incorporate a safe and effective exercise program into their daily routine. Remember, the support and guidance of a physical therapist is essential in tailoring an exercise program to your specific needs and ensuring medical safety throughout your fitness journey.

Sample day-by-day exercise program

Here’s a sample day-by-day exercise program for individuals with Prediabetes or Type 2 Diabetes Mellitus, incorporating the guidelines. Remember to consult with a physical therapist or healthcare professional to customize the program to your specific needs and abilities. 

Remember to warm up before each exercise session and cool down afterward. Modify exercises as needed to accommodate your fitness level and any physical limitations. Progress gradually by increasing the number of repetitions, sets, or exercise duration over time. Stay consistent and enjoy the journey towards improved health and well-being.

Day 1: Monday – Endurance and Resistance Training
  • Brisk Walking, Jogging, Hiking, or Cycling: 30 minutes at a moderate intensity. 
  • Cool Down for 5 minutes with a slow walk or gentle stretching.
Day 2: Tuesday – Active Rest Day 
  • Engage in light physical activity such as gentle stretching, yoga, or a leisurely walk/hike to promote active recovery.
Day 3: Wednesday – Endurance Training 
  • Brisk Walking, Jogging, Hiking, or Cycling: 30 minutes at a moderate intensity
  • Cool Down for 5 minutes with a slow walk or gentle stretching.
Day 4: Thursday – Resistance Training 
  • Cool Down for 5 minutes with a slow walk or gentle stretching.
Day 5: Friday – Endurance and Resistance Training 
  • Cool Down for 5 minutes with a slow walk or gentle stretching.
Day 6: Saturday – Active Rest Day 
  • Engage in light physical activity, such as stretching, gentle yoga, or a leisurely walk/hike.
Day 7: Sunday – Rest Day 
  • Take a day off from structured exercise to allow your body to recover and prepare for the upcoming week. 

The significance of regular exercise and the role of physical therapists in guiding individuals with T2DM: This exercise program is a general guideline and may need to be adjusted based on your individual needs and capabilities. Always consult with a physical therapist before starting or modifying any exercise routine, especially if you have underlying health conditions.

Important considerations and the need for professional medical advice: This blog post is for informational purposes only and should not replace professional medical advice. It is important to consult with your healthcare provider or a certified physical therapist before starting any exercise program or making changes to your diabetes management plan.

Supporting research and resources for further exploration:

  • Physical Therapy, Volume 93, Issue 5, 1 May 2013, Pages 597–610
  • American Diabetes Association. Standards of Medical Care in Diabetes

How to address hypoglycemia during exercise

Hypoglycemia occurs when your glucose levels fall below 70 mg/dL. This could happen if you exercise so intensely that your heart rate remains elevated for a long time. If you use insulin to manage type 2 diabetes, always check your glucose before and after you exercise to prevent hypoglycemia. 

Your risk of hypoglycaemia during exercise is increased if:

  • You have type 1 diabetes
  • You inject insulin or take a sulphonylurea
  • You have had recurring episodes of hypoglycemia
  • You are unable to detect the early warning signs and symptoms of hypoglycaemia
  • You have an episode of hypoglycaemia before exercise (as both exercise and hypoglycaemia reduce your ability to detect further hypoglycaemia)
  • You have drunk alcohol before exercise (alcohol reduces your ability to detect hypoglycemia).

Source: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-and-exercise#diabetes-exercise-and-blood-glucose-levels

Be prepared in case your blood glucose starts to drop quickly, or is getting too low and wait to resume exercising until your blood sugars stabilize.

If you feel the symptoms of hypoglycemia, check your blood sugar and eat 15-20 grams of carbohydrates if needed. 

15-20 grams of fast-acting carbs to quickly raise your blood sugars can be:

  • 4 glucose tablets (4 grams per tablet)
  • 1 glucose gel tube (15 grams per gel tube)
  • 4 ounces (1/2 cup or 118 ml) of juice or regular soda (not diet soda)
  • 1 tablespoon (15 ml) of sugar or honey
  • 5 lifesaver candies

To read about more options, check out this 15 Gram Carbohydrate Food List.

Check your glucose levels again after 15 minutes. If it’s still too low, have another 15 grams of carbs and wait. Repeat this every 15 minutes

There is some evidence that men are at a greater risk than women for hypoglycemia during or after weightlifting or resistance exercise, but by checking your glucose before, during, and after exercising, you can prevent hypoglycemia.

The time of day you exercise may also affect your insulin needs

For example, in the morning, glucose levels tend to decrease less with exercise because hormones produced in the morning help raise glucose levels. On the other hand, in the afternoon, levels of the same hormone fall, so you may need to temporarily reduce your insulin dose to prevent hypoglycemia.

It’s important to always consult with your healthcare provider before you make any adjustments to your medications to find what works best for you and your level of physical activity.


  1. Talk with your doctor or healthcare provider before you make any major changes to your exercise or activity routine.
  2. Always check your glucose levels before and after exercising 
  3. Start small, with a short exercise session and add just one more minute each time. Making small, healthy changes in your daily activity will lead to bigger improvements in your overall health and dramatically increase the likelihood that your new habits will stick with you for the rest of your life.
  4. Be prepared for hypoglycemia. Always have some juice or glucose tablets and a healthy snack with you when you exercise. Stop exercising if you feel lightheaded or have symptoms of hypoglycemia. 

The information provided in this blog post is for educational and informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or medical care team regarding any medical condition or concerns you may have. They are the best resource for personalized guidance and can provide you with the most appropriate recommendations based on your individual circumstances. Do not disregard or delay seeking medical advice based on the information presented in this blog post. Reliance on any information provided in this blog post is solely at your own risk.

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