Revisiting the role of physical activity and exercise in the treatment of type 2 diabetes.

There is tremendous potential for improving glycemic control, insulin sensitivity, and cardiovascular risk factors through increased physical activity in individuals with Type 2 diabetes. The demonstrated effects of structured endurance exercise on select outcomes compare favorably with those of typical pharmacological treatment modalities. Adherence to these types of program is problematic, however. We know less about the expected effects of lifestyle-based physical activity. Preliminary results require further investigation, given the apparent acceptability of these programs in this population, however. The effects of resistance training on cardiovascular risk factors to date likely limit its application as an adjunctive therapy for individuals with Type 2 diabetes. The question is no longer "can exercise/physical activity benefit the individual with Type 2 diabetes?" The answer is yes. Future research needs to refine questions regarding type, dose, and magnitude of effects of physical activity (and its subcategory exercise) on glycemic control, insulin sensitivity, and on risk factors for cardiovascular disease within the context of program acceptability and feasibility.