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The Most Effective Forms of Exercise for Diabetes: Strength Training and High-Intensity Exercise

Written by Dr. Joseph Mercola Fact Checked

best exercise for diabetes

Story at-a-glance -

  • Type 2 diabetes arises from faulty leptin and insulin signaling and resistance, both of which are directly related to lack of exercise and a diet high in starchy carbohydrates or sugar
  • When it comes to exercise for diabetic control, though, two types have been found to be the most effective, namely high-intensity exercise and strength training, although any form of physical activity will have some degree of beneficial impact
  • Recent research found a link between muscular strength and Type 2 diabetes incidence. Participants with midlevel muscular strength had a 32 percent lower risk of developing Type 2 diabetes compared to those with lower levels of muscular strength
  • High-intensity interval training has also been shown to effectively reduce your risk for diabetes. In one study, older overweight Type 2 diabetics improved their glucose regulation in just six HIIT sessions done over the course of two weeks
  • Equally, if not more, important is daily nonexercise movement, as sitting shuts down or blocks a number of insulin-mediated systems, including muscular and cellular systems that process blood sugar, triglycerides and cholesterol. Simply standing up activates all of these systems at the molecular level

Type 2 diabetes arises from faulty leptin and insulin signaling and resistance, both of which are directly related to lack of exercise and a diet high in starchy carbohydrates or sugar. Unfortunately, when diagnosed with Type 2 diabetes, many are led to believe their fate has been sealed and all they can do now is "control" it.

This simply isn’t true. A low-carb, high-fat diet as described in “Burn Fat for Fuel,” along with exercise and daily movement are the correct prescriptions to reverse this common condition — not medication. Fasting is yet another proven remedy that can yield rapid results.

Research1 published in Medicine & Science in Sports & Exercise found even a single session of moderate exercise can improve the way your body regulates glucose and reduces postprandial glucose spikes.

When it comes to exercise for diabetic control, though, two types have been found to be the most effective, namely high-intensity exercise and strength training, although any form of physical activity will have some degree of beneficial impact.

The Case for Strength Training if You Have Type 2 Diabetes

Several studies have demonstrated the benefits of strength training for diabetes. Among them is a 2017 study2 published in Medicine & Science in Sports & Exercise, which found strength training lowered women’s risk of Type 2 diabetes by 30 percent, and cardiovascular disease by 17 percent.

According to the authors, "These data support the inclusion of muscle-strengthening exercises in physical activity regimens for reduced risk of Type 2 diabetes and cardiovascular disease, independent of aerobic exercise."

That said, adding aerobic exercise to the women’s fitness regimen did reduce the risks even further. Participants who performed at least 120 minutes of aerobic exercise per week, along with some form of strength training, had a 65 percent lower risk for Type 2 diabetes than those who did neither — a finding that suggests there’s value in all forms of exercise.

Moderate Muscle Strength Linked to Lower Diabetes Risk

More recently, a study3 published in the Mayo Clinic Proceedings this month (March 2019) found a link between muscular strength and Type 2 diabetes incidence. The study enrolled 4,681 individuals between the ages of 20 and 100, none of whom had Type 2 diabetes at baseline. Muscular strength was tested using leg and bench press tests. During a mean follow-up of 8.3 years, 4.9 percent went on to develop diabetes. According to the authors:

“Participants with the middle level of muscular strength had a 32 percent lower risk of development of Type 2 diabetes compared with those with the lower level of muscular strength after adjusting for potential confounders …

However, no significant association between the upper level of muscular strength and incident Type 2 diabetes was observed …

A moderate level of muscular strength is associated with a lower risk of Type 2 diabetes, independent of estimated CRF [cardiorespiratory fitness]. More studies on the dose-response relationship between muscular strength and Type 2 diabetes are needed.”

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Muscle Building Improves Glucose Metabolism and Insulin Sensitivity

A third example of this kind of research was published in BioMed Research International in 2013.4 This review also investigated the mechanisms of how exercise lowers your risk of diabetes.

One way by which strength training improves your glucose metabolism is by increasing glucose transporter type 4 (GLUT4) translocation in skeletal muscle. GLUT4 translocation occurs as a result of muscle contraction,5 and is required for proper regulation of glucose uptake in your muscles.

As mentioned, strength training also increases your insulin sensitivity, as lean muscle is highly sensitive to insulin,6 which helps restore metabolic flexibility. By using insulin more efficiently, your body also ends up using more glucose, leaving less to circulate in your bloodstream — hence the improvements in glucose control.7,8

“Increased energy expenditure and excess postexercise oxygen consumption in response to resistance training may be other beneficial effects,” the review paper9 notes.

The Case for High-Intensity Exercise When You Have Diabetes

High-intensity interval training (HIIT) has also been shown to effectively reduce your risk for diabetes. In one such study,10 older overweight Type 2 diabetics improved their glucose regulation in just six HIIT sessions done over the course of two weeks.

They also increased their mitochondrial capacity, which means their bodies became more efficient at producing energy. Overall, the average 24-hour blood glucose concentration was reduced from 7.6 mmol/L (± 1.0) to 6.6 mmol/L (± 0.7) following the exercise.

The total time investment was 60 minutes per week. The key in HIIT is intensity. In this study, participants performed 10 bouts of 60-second cycling at 90 percent of their maximum heart rate, interspersed with 60 seconds of rest. According to the authors, “Our findings indicate that low-volume HIIT can rapidly improve glucose control and induce adaptations in skeletal muscle that are linked to improved metabolic health in patients with Type 2 diabetes.”

Another study11 used the same kind of HIIT program on sedentary but otherwise healthy middle-aged individuals. The only difference was that, here, they exercised at 60 percent of their max heart rate rather than going all-out.

Despite the reduction in intensity, they too were able to improve their insulin sensitivity and blood sugar regulation after just three sessions per week for two weeks. According to the authors, “Glucose transporter protein content increased about 260 percent, and insulin sensitivity, on the basis of the insulin sensitivity index homeostasis model assessment, improved by about 35 percent after training.”

In a follow-up study,12 people with full-blown Type 2 diabetes saw improvement in blood sugar regulation for the next 24 hours following a single HIIT session at 90 percent of their max heart rate.

Just how minimal a time investment can you get away with, provided the intensity is high enough? Remarkable as it may seem, a fourth study found that just three minutes of HIIT per week for four weeks improved participants' insulin sensitivity an average of 24 percent!

Daily Movement Is Crucial, Even if You Exercise Regularly

As important as strength training and HIIT are for controlling diabetes, it may not be enough in and of itself. Equally, if not more, important is daily nonexercise movement. The reason for this is because inactivity, the mere act of sitting, shuts down or blocks a number of insulin-mediated systems, including muscular and cellular systems that process blood sugar, triglycerides and cholesterol.

Simply standing up, bearing your own body weight on your legs, activates all of these systems at the molecular level. Indeed, research has shown that prolonged sitting is an independent risk factor for chronic disease and premature death — even if you exercise regularly and stay fit.

Several studies have highlighted this point, and confirmed that chronic sitting is particularly hazardous for those with diabetes. For example:

A 2016 study13 conducted by researchers in New Zealand found that taking a 10-minute walk after each meal provided greater blood sugar control in diabetics than 30 minutes of exercise done once a day, lowering post-meal blood sugar levels by 22 percent. This confirms that increasing the frequency of movement is an important component of effective blood sugar control.

A 2016 review14 of 28 studies found an inverse relationship between exercise and overall diabetes risk. In other words, the more you exercise, the lower your risk of Type 2 diabetes. They also concluded that one of the primary mechanisms is that exercise allows your muscles to use sugar more effectively. Essentially, the review showed that increasing exercise from 150 minutes to 300 minutes per week reduced the risk of Type 2 diabetes by 36 percent.

A 2017 study,15 done by Australian researchers, found Type 2 diabetics who sit all day (rising only for bathroom breaks) have much riskier blood fat profiles than those who get up and move for three minutes every 30 minutes. Lead author Megan Grace, Ph.D., and senior research officer at Baker Heart and Diabetes Institute in Melbourne, told Reuters:16

“Our current findings reinforce the message that avoiding prolonged periods of sitting, and finding ways to increase activity across the day, is beneficial for health.

In line with the … American Diabetes Association Position Statement, we recommend interrupting sitting every 30 minutes with a few minutes of light intensity activity, in addition to regularly taking part in a structured exercise program … Stand up, sit less and move more — particularly after meals.”

To Reverse Diabetes, Diet and Exercise Changes Are Essential

There’s no doubt exercise is vital if you have diabetes, but even though physical activity alone is likely to improve your condition, I would advise against relying on it as your sole treatment strategy. You also need to address the root of your problem, which is insulin and leptin resistance, which is directly attributable to not only lack of exercise but also the food you eat.

One of the most effective ways to prevent and reverse insulin resistance (and hence Type 2 diabetes) is cyclical nutritional ketosis. It can also have a dramatic impact on your weight, finally allowing you to shed unwanted pounds, as your body begins to burn fat as its primary fuel.

In short, by optimizing your metabolic and mitochondrial function, nutritional ketosis helps set you squarely on the path to better health. In fact, emerging evidence suggests a high-fat, low net-carb, low- to adequate-protein diet (in other words, a diet that keeps you in cyclical nutritional ketosis) is ideal for most people.

Even endurance athletes are turning away from conventional high-carb strategies and adopting this way of eating because it boosts physical stamina and endurance.

Just remember that continuous nutritional ketosis could potentially backfire, which is why I stress cycling in and out of ketosis once your body starts to efficiently burn fat for fuel. You do this by increasing your carb and protein intake a few times a week, ideally on days you’re doing strength training and after a day of partial fasting.

By periodically pulsing higher carb intakes, consuming, say, 100 or 150 grams of carbs opposed to 20 to 50 grams per day, your ketone levels will dramatically increase and your blood sugar will drop. I go into the details of this in my book, “Fat for Fuel,” for which there is also an accompanying online course that guides you through the entire program, which is designed to optimize your mitochondrial function.

How Your Diet Affects Your Diabetes Risk

To fully grasp why your diet is so important if you want to prevent or reverse diabetes, you need to understand some of the basic mechanics of insulin and leptin resistance.

Leptin is a protein hormone produced in your fat cells. One of leptin's primary roles is regulating your appetite and body weight. It tells your brain when to eat, how much to eat, when to stop eating and what to do with the energy available. Leptin is largely responsible for the accuracy of insulin signaling and whether or not you become insulin resistant.

Insulin is released in response to rising glucose in your blood. Sugars and grains raise your blood sugar the most, while healthy fats have little effect on your glucose level. As your blood glucose rises, insulin is released to direct the extra energy into storage. A small amount is stored as a starch-like substance called glycogen, but the majority is stored as your main backup energy supply, namely your fat cells.

This is an important distinction: Insulin's major role is not to lower your blood sugar, but rather to store the extra energy for future times of need. Insulin's effect of lowering your blood sugar is merely a "side effect" of this energy storage process.

As you can see, leptin and insulin work in tandem, creating either a health-damaging or health-promoting cycle, depending on what you eat. If you consume loads of sugars and grains, your blood sugar spikes will lead to increased insulin, which leads to increased fat storage. The extra fat then produces more leptin.

The problem arises when your leptin levels become chronically elevated. At this point, you become leptin resistant, meaning your body can no longer "hear" the hormonal signals telling your brain you're full and should stop eating. As your fat stores increase, your weight goes up and insulin resistance sets in.

Now your body has become "deaf" to the signals from both hormones (leptin and insulin), and disease follows, one of which is diabetes. While exercise helps lower postprandial glucose spikes and improve insulin sensitivity, your daily diet can easily sabotage your efforts by working in the opposite direction. You simply cannot out-exercise your mouth, which is why addressing your diet is such a critical component of diabetes control.

Are You Ready to Send Your Diabetes Packing?

Adhering to the following guidelines can help you accomplish at least three things that are essential for successfully treating Type 2 diabetes: 1) recover your insulin/leptin sensitivity; 2) normalize your weight; and 3) normalize your blood pressure:

Severely restrict (or eliminate) all forms of sugar and grains in your diet — Following my Nutrition Plan will help guide you through the necessary dietary changes. Also avoid excessive protein, as your body converts that to sugar in your liver, which can also sabotage your ability to control insulin resistance. Excess protein may even be more damaging to your health than excess carbs.

Make sure you’re eating the right kinds of fats — Marine-based omega-3 fats are particularly important for optimal health. To learn more about the ins and outs of dietary fats — which are beneficial and which need to be avoided to protect your health — be sure to pick up a copy of my book, “Superfuel,” co-written with James DiNicolantonio, Pharm.D.

The following list from Dr. Cate Shanahan, author of "Deep Nutrition: Why Your Genes Need Traditional Food," also details some of the best and worst fats found in our modern diet.

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Try fasting — Fasting is yet another powerful treatment strategy for diabetes. To learn more, see my interview with Dr. Jason Fung, author of “The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally.”

Exercise and stay active — If you're unsure of how to get started, I recommend reviewing my Peak Fitness program for tips and guidelines. Remember to include HIIT and strength training in your program, and to stay as active as possible throughout each day.

Optimize your vitamin D level — Research has demonstrated a clear relationship between your vitamin D status and insulin resistance, showing vitamin D is necessary for normal insulin secretion, and improves insulin sensitivity.

Optimize your gut microbiome — Multiple studies have shown obese individuals have different gut bacteria than lean people, and that certain microbes tend to promote obesity. Fortunately, optimizing your gut flora is relatively easy. You can reseed your body with beneficial bacteria by eating traditionally fermented foods and/or taking a high-quality probiotic supplement.

Address any underlying emotional issues and/or stress — Noninvasive tools like the Emotional Freedom Techniques (EFT) can be helpful and effective.

Get eight hours of sleep every night — Research shows lack of sleep increases your risk of both weight gain and diabetes. One 2015 study17 linked daytime sleepiness and napping (which tends to be a sign of insufficient sleep) with a 58 percent increased risk for Type 2 diabetes, so sleep is by no means an insignificant factor.

Monitor your fasting insulin level — This is every bit as important as your fasting blood sugar. You'll want your fasting insulin level to be between 2 and 4. The higher your level, the worse your insulin sensitivity is.