To Lower Blood Sugar, Concrete Plan Is Better Than Advice

People with type 2 diabetes are more successful at controlling their blood sugar when their doctors give them a structured exercise plan instead of simply telling them to get more physical activity.

That's the conclusion of a recent study. The researchers also looked at the results of 47 clinical trials and found that exercising at moderate intensity levels for longer periods of time was better at bringing blood sugar levels down than exercising more intensively for shorter periods.

Why is exercise so beneficial? It increases insulin sensitivity and helps people with diabetes lower their blood sugar. Doctors typically recommend that their patients get a minimum of 150 minutes of moderate-intensity aerobic exercise and strength training every week. The catch is, they don't tell their patients how to do it.

"We always tell patients, even those without diabetes, that it's important to exercise, but we don't tell them how," says Joel Zonszein, M.D., at Montefiore Medical Center in New York City. "We don't provide a good structure on what to do."

Different approaches

In the study, more than 8,500 participants were divided into two groups - those who received structured exercise instruction and coaching, and those who were only told to exercise. The second group was given advice on what to do but didn't receive planned, individual instruction. Researchers then recorded their hemoglobin A1C (HbA1C) levels. (HbA1C is an average measurement of a person's blood sugar level over a two- to three-month period and is a standard measurement of control in people with diabetes.)

Those who participated in the structured exercise programs were able to lower their A1C levels 0.67 percent more than those in a control group. Those in the physical activity advice-only programs, on the other hand, had an average HbA1C reduction of 0.43 percent over the control group. When combined with dietary advice, physical activity advice lowered HbA1C levels by 0.58 percent over the controls.

Long-term impact

The results have prompted some to suggest that health insurance companies consider paying for the costs of structured exercise programs or fitness center memberships in order to help control the long-term costs of treating diabetes.

"Given the health benefits of physical exercise on diabetes prevention, managing type 2 diabetes in patients, and on improving the health of the general adult and older population," says Marco Pahor, M.D., at the University of Florida, Gainesville, "it may be time to consider insurance reimbursements for structured physical exercise programs."

Always talk with your health care provider to find out more information.