Physical Exercise: The Perfect Ally for Managing Diabetes in Older Adults

The increasing life expectancy driven by medical advancements and an aging population has resulted in a significant rise in chronic conditions like diabetes among older adults. According to the World Health Organization, diabetes is one of the leading causes of healthy life years lost worldwide. Type 2 diabetes (T2D) is particularly prevalent among middle-aged and older adults, significantly impacting their quality of life. This scenario poses substantial challenges for global healthcare systems due to the growing burden of this condition.

Physical exercise has emerged as an effective non-pharmacological strategy for managing T2D, offering benefits such as improved insulin sensitivity, reduced blood glucose levels, and enhanced cardiovascular health. While both aerobic exercise (AE) and resistance exercise (RE) have proven beneficial, most studies have focused on younger adults, leaving a gap in understanding the best practices for older adults.

A recent study addressed this gap by analyzing randomized controlled trials (RCTs) to determine how different intensities and types of exercise influence fasting glucose levels and glycated hemoglobin (HbA1c) in older adults with T2D. The analysis included supervised and unsupervised exercise programs lasting at least 12 weeks, providing critical insights into designing tailored exercise guidelines for this population.

The meta-analysis highlighted that moderate- and high-intensity exercise significantly reduces HbA1c and fasting glucose levels in older patients. Moderate-intensity exercise decreased HbA1c by -0.34%, while high-intensity exercise achieved a reduction of -0.54%. These results emphasize the importance of exercise intensity as a key factor in glycemic control.

No significant differences were found between the effects of aerobic and resistance exercise on HbA1c or fasting glucose levels. This suggests that both methods are equally valid as long as the appropriate intensity is maintained. This finding is particularly relevant for older adults who may face physical limitations but can still benefit from adapted alternatives.

Another notable finding was that patients who engaged in at least 2.5 hours of moderate exercise per week experienced significantly greater improvements in HbA1c levels compared to those with less activity. This underscores the importance of not only intensity but also frequency and duration of exercise for achieving meaningful outcomes.

The study offers several practical recommendations for implementing exercise programs for older adults with T2D:

• Personalized Program Design: Healthcare professionals should create individualized exercise routines that consider each patient’s physical capabilities, prioritizing moderate- to high-intensity activities with a minimum of 2.5 hours of weekly exercise.
• Combining Exercise Types: While aerobic and resistance exercises are equally effective for glycemic control, combining them can provide additional benefits such as improved muscle strength and reduced fall risk.
• Initial Supervision: Given the presence of comorbidities or physical limitations in older patients, supervised exercise is recommended at least during the initial stages to ensure safety and proper intensity adjustments.
• Continuous Monitoring: Regular assessments are essential to measure the impact of the exercise program on glucose and HbA1c levels, allowing for adjustments to maintain progress.
• Promoting Adherence: Motivating patients to consistently engage in exercise is crucial. Emphasize the long-term benefits for diabetes management and prevention of associated complications.

TRAK’s technology addresses all five recommendations derived from the study. It facilitates personalized prescription, combines different exercise types, enables monitoring, and enhances adherence—an essential factor in managing chronic conditions like diabetes. Additionally, the moderate-intensity exercises available in TRAK’s library are particularly effective for older adults, the demographic most affected by diabetes.

Moderate- to high-intensity exercise performed for at least 2.5 hours per week is an effective intervention for improving glycemic control in older adults with type 2 diabetes. While the specific type of exercise does not appear to be a determining factor, intensity and regularity are key elements that should be prioritized in exercise programs. These findings underline the need to tailor intervention strategies to the individual capacities and needs of each older patient.

Yan X, Lu Y, Zhang H, Zhu C, Tian L, Chen J, He E, Li Y. Optimal strategies for exercise intervention in older people diabetic patients: The impacts of intensity, form, and frequency on glycemic control: An exercise prescription for older people with diabetes. Arch Gerontol Geriatr. 2024 Sep 14;128:105621. doi: 10.1016/j.archger.2024.105621.