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Missing Ingredients: The Line Between Physical Exercise and Diabetes



Missing Ingredients: The Line Between Physical Exercise and Diabetes

Anees Alyafei, MD
Consultant Community Medicine
Primary Health Care Corporation

 

Physical exercise (PE) is critical in preventing and managing type 2 diabetes mellitus (T2DM). With global diabetes rates steadily rising, particularly in regions with high rates of sedentary lifestyles and obesity, structured PE has become a crucial focus in modern diabetes care. While medication and diet are typically the cornerstones of T2DM management, growing evidence underscores that regular, targeted exercise offers unique benefits that improve glycemic control and reduce long-term complications.

Distinguishing physical exercise from physical activity: It is essential to differentiate between physical activity (any body movement requiring energy expenditure) and PE (structured, purposeful, and repetitive activities to improve physical fitness). While general activity benefits overall health, structured exercise programs demonstrate more profound effects on insulin sensitivity, glucose metabolism, and body composition, all of which are central to T2DM prevention and care [1].

Evidence from the Literature: Numerous clinical trials and meta-analyses show that regular exercise significantly reduces HbA1c levels by 0.5-1%—a reduction comparable to the effect of some T2DM medications [2]. Exercise also improves fasting blood glucose (FBG), reduces body mass index, and decreases waist circumference. These changes are particularly valuable in individuals with central obesity, a known risk factor for insulin resistance.

Physiological Mechanisms:  Exercise impacts metabolic, cardiovascular, and neurological systems, all contributing to better T2DM control. On the metabolic level, exercise enhances insulin receptor sensitivity and activates AMPK pathways, facilitating glucose uptake by skeletal muscles independently of insulin [3]. This allows for immediate glucose control during and after exercise, with effects lasting up to 72 hours. Additionally, exercise improves mitochondrial function, reduces visceral fat, and lowers inflammatory markers such as C-reactive protein and IL-6, contributing to insulin resistance [4].

Cardiovascular improvements include enhanced endothelial function, increased vascular elasticity, and reductions in systolic and diastolic blood pressure. These benefits lower the risk of diabetes-related cardiovascular disease [1]. Neurologically, regular PE enhances peripheral circulation, supports nerve regeneration, and improves mental well-being by reducing stress, anxiety, and sleep disturbances—often exacerbated in diabetes patients [5].

Local Data: In Qatar, 17% of the population has T2DM, 64% has uncontrolled glycemia and 71.4% is classified as physically inactive. Local data from PHCC shows that structured exercise programs reduced fasting blood sugar and HbA1c, with 40% of uncontrolled patients regaining glycemic control [6]. Barriers to exercise include cultural norms, hot climate, time constraints, and lack of facilities. Healthcare providers play a critical role, but 82.5% are physically inactive. To improve diabetes outcomes, integrating exercise prescriptions into routine care, alongside culturally tailored awareness campaigns, is essential to increase physical activity and enhance diabetes management outcomes.

Overcoming Barriers: Despite these clear benefits, adherence to regular exercise remains low, especially in hot climates or culturally conservative regions. Barriers include time constraints, lack of access to suitable facilities, cultural expectations, and insufficient physician counseling about exercise benefits [7]. Programs that integrate exercise prescriptions into routine care and tailor plans to cultural and personal preferences are essential to improving adherence and achieving optimal outcomes.

 

References

  1. Colberg, S. R., et al. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079. doi.org/10.2337/dc16-1728.
  2. Umpierre, D., et al. (2011). Physical activity advice or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA, 305(17), 1790-1799. doi.org/10.1001/jama.2011.576.
  3. Bird, S. R., & Hawley, J. A. (2017). Exercise and type 2 diabetes: New prescription for an old problem. Maturitas, 100, 11-16. doi.org/10.1016/j.maturitas.2017.03.010.
  4. Snowling, N. J., & Hopkins, W. G. (2006). Effects of different modes of exercise training on glucose control and risk factors in type 2 diabetes. Diabetes Care, 29(11), 2518-2527. doi.org/10.2337/dc06-1317.
  5. Anderson, J. W., Konz, E. C., Frederich, R. C., & Wood, C. L. (2003). Long-term weight-loss maintenance: A meta-analysis of US studies. The American Journal of Clinical Nutrition, 74(5), 579-584. doi.org/10.1093/ajcn/74.5.579.
  6. Alyafei A, Alkiswani SM, Rbabah HO, Al Abdulla ST, Amdouni S. The Effect of a 12-Week Physical Exercise Program on Glycemic Indices in Adults at Community Wellness Services, Primary Health Care Corporation, Qatar, in 2023. Cureus. 2025 Feb 26;17(2):e79720. DOI: 10.7759/cureus.79720.
  7. Mabry, R., et al. (2016). A systematic review of physical activity and sedentary behaviour in the Arabian Peninsula. BMC Public Health, 16, 1003. doi.org/10.1186/s12889-016-3649-9.