“As a specialist in diabetes, one of the most important messages I convey to my patients is that moving is not only advisable, but necessary. And I am not talking about a heroic effort — I am talking about physical activity adapted to each individual, progressive and improving over time. Christian Leyva Prado. Diabetes Specialist at Hospital Quirón Huelva.”

 

Why does exercise benefit people with diabetes?

To understand the impact of exercise on diabetes, we must first analyse what happens in the body of a person with this condition.

In type 2 diabetes, the most prevalent form, there is insulin resistance: the body’s cells do not respond adequately to this hormone, which prevents glucose from entering the tissues properly and causes it to accumulate in the blood. In type 1 diabetes, insulin production is nil or almost nil, meaning the patient depends on the external administration of this hormone.

In both cases, exercise acts beneficially:

1. Improved insulin sensitivity: when we exercise, the muscles absorb glucose independently of insulin, thanks to the activation of specific transporters (GLUT-4). This effect can last between 24 and 72 hours after a moderate exercise session, resulting in more stable blood glucose levels.

2. Reduction of glycated haemoglobin (HbA1c): HbA1c is the indicator specialists use to assess long-term glycaemic control. Numerous studies have shown that a regular exercise programme can reduce this parameter by between 0.5% and 1% — a figure that, for many patients, makes the difference between needing to adjust medication or not.

3. Weight control and reduction of visceral fat: fat accumulated in the abdomen is one of the main factors that worsens insulin resistance. Physical exercise, combined with an appropriate diet, helps to reduce this metabolically active fat, thereby improving the patient’s glycaemic and lipid profile.

4. Cardiovascular protection: people with diabetes have a significantly elevated cardiovascular risk. Regular aerobic exercise reduces blood pressure, improves the blood lipid profile, decreases chronic inflammation, and strengthens the heart muscle, acting as a shield against heart attacks and strokes.

5. Benefits for mental health and quality of life: living with a chronic illness has an emotional impact. Anxiety and depression tend to be more common in people with diabetes. Physical exercise stimulates the release of endorphins and serotonin, improves mood, reduces stress, and reinforces a sense of control over one’s own health.

What type of exercise is most recommended for a person with diabetes?

There is no single type of exercise for all patients with diabetes. The key lies in individualisation. Nevertheless, clinical guidelines consistently recommend a combination of different modalities.

Aerobic exercise

Brisk walking, swimming, cycling, dancing, or using a cross-trainer are examples of moderate-intensity aerobic exercise. A minimum of 150 minutes per week is recommended, spread across at least three days, without leaving more than two consecutive days without activity. This type of exercise is the most effective for reducing blood glucose levels in the short term.

Strength or resistance exercise

Training with weights, resistance bands, or your own body weight (squats, press-ups, etc.) helps to increase muscle mass, which is the body’s primary glucose-consuming organ. As with aerobic exercise, it is recommended two or three times per week, on non-consecutive days.

Flexibility and balance exercise

Yoga, tai chi, and stretching are particularly beneficial for older patients or those with complications such as peripheral neuropathy, as they improve balance and reduce the risk of falls.

Precautions before starting exercise

Starting an exercise programme as a person with diabetes requires certain prior considerations that should not be overlooked:

• Consult your doctor: before beginning any moderate or high-intensity physical activity, a medical assessment is essential to rule out contraindications, such as uncontrolled cardiac problems, severe retinopathy, or foot ulcers.
• Glycaemic monitoring before exercise: it is recommended to measure blood glucose before starting. If glucose is below 100 mg/dl, a small snack may be necessary. If it exceeds 250 mg/dl with ketosis, exercise should be postponed.
• Continuous monitoring: patients treated with insulin or sulphonylureas are at risk of hypoglycaemia during or after exercise. Always carrying fast-acting glucose (glucose tablets, fruit juice) is essential.
• Adequate hydration: dehydration raises blood glucose. Drinking water before, during, and after exercise is essential.
• Foot care: people with neuropathy must pay particular attention to their feet, wear appropriate footwear, and check for any rubbing or blisters after each session.

The specialist’s perspective

Dr Christian Leyva, diabetes specialist at Hospital Quirón Huelva, puts it clearly in his consultations:

“Physical exercise is, without doubt, the best medicine we have for managing diabetes and an indispensable ally. In my clinical experience, patients who incorporate regular physical activity into their daily routine not only achieve better glycaemic control, but also reduce their medication doses, improve their cardiovascular profile and, above all, recover a sense of wellbeing and autonomy that the illness so often takes from them. My recommendation is always to start slowly, with realistic goals, monitoring and improving progressively.”

This view reflects what we see daily in clinical practice: exercise does not only improve laboratory numbers — it improves people.

How to start if you have not been active for a while

One of the greatest obstacles for many patients is precisely the starting point. Years of sedentary living, joint pain, fatigue, or fear of hypoglycaemia can make exercise seem unattainable. But the good news is that any movement counts, and small, sustained changes produce significant results.

Some practical recommendations for getting started:

• Begin with 10 minutes of walking per day and gradually increase.
• Use the stairs instead of the lift whenever possible.
• Integrate movement into your routine — get off the bus one stop early, park further away, do stretches whilst watching television.
• Find an activity you enjoy. Adherence to exercise is far greater when we enjoy what we are doing.
• Consider working with a specialist personal trainer.

Physical exercise in diabetes is not a lifestyle option — it is part of the treatment. Combining exercise with a balanced diet, appropriate medication, and regular medical follow-up can radically transform the progression of the disease and the person’s quality of life.

As a diabetes specialist, we aim to convey a clear and hopeful message: it is never too late to start moving, and the benefits begin from day one. The human body has an extraordinary capacity for response and adaptation, and people with diabetes are no exception.

If you have diabetes and have not yet incorporated exercise into your life, today is a good day to take the first step. Your blood glucose, your heart, and your wellbeing will thank you for it.

Article prepared for informational purposes. Always consult your doctor or healthcare team before starting an exercise programme.