Special Considerations for Physical Activity and Type2 Diabetes

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Exercise testing is recommended for many persons with type-2 diabetes before beginning an exercise conditioning program because of the high prevalence of occult cardiovascular disease, symptoms of which may only be manifested during exercise [30, 31]. Specifically, many patients with diabetes may have ischemia or infarction without angina. Most experts recommend that persons with type-2 diabetes be tested if the individual has previously been inactive, has had diabetes for more than 10 years, or is over the age of 35 [30, 31]. However, because of the potential of false-positive exercise tests, further more invasive testing may be required to substantiate a positive stress test.

Exercise testing can also be used to provide an exercise prescription. Although measurement of oxygen consumption is the most reliable way to assess exercise capacity and create an exercise prescription, it is often not practical to measure it in the clinical setting. Therefore, maximal heart rate measured during the treadmill test can be used as a crude but reasonable substitute. One exception is that patients with autonomic neuropathy as a complication of diabetes may not be able to achieve an age-predicted maximal heart rate which may reduce the sensitivity of the test. In these patients, if an accurate exercise prescription is of importance, maximal oxygen consumption should be measured.

The presence of type-2 diabetes alone does not require a supervised exercise conditioning program. However, there are several specific groups of patients with type-2 diabetes for whom a more formal exercise conditioning program is desirable including patients with some types of heart disease.

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