The role of exercise in diabetes

Dr Th Premchand Singh, MD, FCCP
India is regarded as the diabetes capital of the world due to its staggering number of people living with diabetes. The country has upward 100 million diagnosed and undiagnosed cases alongside an incredibly high rate of pre-diabetes. Exercise along with diabetic diet   are the cornerstones of the management of diabetes melli- tus, which form the most non-pharmacological means to significantly improve  high blood sugar. Participation in regular physical exercise  improves blood glucose  control and can even  prevent or delay onset of type 2 diabetes in prediabetic persons. There is  strong evidence for the blood glucose lowering value of combined aerobic and resistance exercises in adults with diabetes. The American College of Sports Medicine and the American Diabetes Association joint position statement states “The inclusion of an exercise program or other means of increasing overall physical activity is critical for optimal health in individuals with diabetes”.


Regular physical activity improves insulin sensitivity and  is associated with reduced blood sugar levels during and after exercise as muscles use glucose for energy. Exercise has other health-promoting benefits like improvements in lipid profile by increasing the good chlesterol HDL, lowering triglycerides decrea- sing the bad cholesterol LDL. and blood pressure. Physical training appears to improve muscle ability to up-take and oxidize free fatty acid. Exercise also promotes beneficial effects on psychological well-being, cardiovascular fitness, muscle capacity and reducing obesity in diabetes.
A 2025 comprehensive systematic review and meta-analysis provided robust evidence to guide step-based physical activity recommendations not only for diabetes but also for patients with chronic diseases. The research demon- strates that 7000 steps per day represents an evidence-based, achievable target associated with significant risk reductions across multiple health outcomes : 47% lower all-cause mortality, 25% lower heart disease incidence, 37% lower cancer mortality, 14% lower type 2 diabetes risk, 38% lower dementia risk, and 22% lower depressive symptoms compared to 2000 steps daily.
Importantly for clinical practice, the study reinforces that "every step counts" – even modest increases from very low baseline levels (e.g., from 2,000 to 4,000 steps) yield substantial health benefits (36% mortality reduction). While 10000 steps remains beneficial for more active patients, 7000 steps provides a more realistic and achievable initial target that still delivers clinically meaningful outcomes.
Exercise for Diabetes
People  with diabetes should decrease sedentary behaviour time, interrupting prolonged sitting with short bouts of light activity about every 30 minutes for blood sugar and general health benefits. The  exercise program should include aerobic, resistance, flexibility and balance regime. Current guidelines recommend a frequency of at least 5 days/week of aerobic exercise with resistance training 2-3 days/week,  because the effect of exercise-induced improvements in insulin action is short-lived. These workouts  helpto improve and maintain fitness, strength, and flexibility. Below are 10 ideas to get started.
1. Walking
Walking is a low-impact activity that does not need any equipment but a pair of walking shoes. Walking  improves blood pressure, blood sugar, and cholesterol levels. Recommends  a minimum of 30 minutes of brisk walking, about 100 steps a minute, 5 days a week. The Intensity of the walk may be boostedby adding activities like  climbing stair or steep slopes.
2. Running
Running is a highly effective exercise to burn calories. With proper training  brisk walking may gradually proceed to running. This faster-paced activity has been linked to a reduced risk of high blood pressure, high blood sugar, and high cholesterol.
3. Cycling
Cycling is an excellent low impact aerobic exercise for managing and preventing diabetes. Regular bicy- cling can improve everything from heart and lung health to body balance and posture. Using any old  bike and hitting  the outdoors is an excellent exercise. Otherwise a stationary bike at home or  local gym is a good choice.
4. Dancing
Dancing is a highly enjoyable way to manage diabetes. It can make the workouts more fun. Dancing is a heart-healthy activi- ty that  improves fitness and blood sugar levels. One study found that people with diabetes who participated in a dance program were more motivated to stick to a routine than those who did a different fitness program.
5. Water exercise
Aquatic workouts like swimming or other water exercises are easy on the joints and  reduce blood sugar levels. They also boost overall fitness, strength, and heart health in people with diabetes.
6. Resistance Training
Resistance training forms a part and parcel for diabetes management. The aim is 2 to 3 full body strength sessions per week. In weight training, weights like dumbbell,barbell, kettlebell or resistant bands are used  to build muscle mass and strength either at a gym or at home. Whereas in  body weight exercise one uses own weight as a resistance without using  equipment. Examples include push-ups, squats, planks and lunges. Building muscle mass improves insulin sensitivity allowing to process blood sugar more effectively and controlling blood sugar.
7. Pilates
Pilates is a low – impact mind-body exercise focused on core strength, flexibility and muscular balance. Studies have suggested  prac- ticing pilates regularly  can help people with diabetes to maintain normal blood sugar level.
8. Flexibility Exercises
Flexibility exercises improves flexibility, enhances circulation, reduces muscle tension and helps manage blood sugar levels by improving overall mobility. It should be done 2-3 sessions per week.
9. Yoga
Yoga involves low-impact movement, meditation, and breathing. It can improve balance, flexibility, and strength. This is especially helpful for older people with diabetes who might be at greater risk of falling. The practice also helps to manage blood sugar and cholesterol levels.
10. Tai chi
Tai chi  combines low-impact moves, meditation, and breathing techniques. This ancient practice promotes better balance, range of motion, and overall well-being. It helps to  lower blood sugarlevel.
In summary, exercises in the form of aerobic, resistance and flexibility should be included in the management of diabetes for every- body with diabetes whether on diabetic medicine or diet alone. Exercise is an efficient way not only to control  blood sugar but also to improve  heart  health and mental wellbeing.

The writer is Commonwealth Medical Fellow, Chief Consultant Physician, Aadarsh Hospital and Research Institute, Imphal