Optimizing the therapeutic benefits of exercise in Type 2 diabetes.

AB - Background Besides diet and medication, exercise is considered one of the 3 cornerstones of good diabetes treatment. Nevertheless current clinical guidelines on type 2 diabetes provide no detailed information on the modalities of effective exercise intervention in the treatment of type 2 diabetes. Method Based on a review of currently available literature, exercise modalities are being identified to maximize the benefits of exercise intervention in the treatment of different type 2 diabetes subpopulations. Results Both endurance and resistance type of exercise have equal therapeutic strength to improve metabolic control in patients with type 2 diabetes. When applying endurance type exercise, energy expenditure should be equivalent to ~1.7-2.1 MJ per exercise bout on 3, but preferably 5 days per week. In sarcopenic or severely deconditioned patients with type 2 diabetes, focus should lie on the implementation of resistance type exercise to attenuate and/or reverse the decline in skeletal muscle mass and strength. Before choosing the most appropriate exercise modalities, the patient's disease stage should be well characterized and an ECG-stress test should be considered. Based on baseline aerobic fitness, level of co-morbidities, body composition and muscle strength, patients should be provided with an individually tailored exercise intervention program to optimize therapeutic value. Conclusion A multi-disciplinary individualized approach and continued exercise training under personal supervision is essential to enhance compliance and allow long-term health benefits of an exercise intervention program. Key words: type 2 diabetes, exercise, energy expenditure, sarcopenia, neuropathy.