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I think clinicians actually play a huge role in helping patients set goals for their physical activity, but they need to be S.M.A.R.T. goals.

Oftentimes physical activity does get overlooked when it comes to giving your patients advice on what to do. Exercise is important, not only for helping the body manage and use blood glucose, but also just generally in health. The main thing that happens is that the muscles are able to take up glucose out of your bloodstream directly when you’re exercising, just due to contraction induced mechanism, which is completely separate from the effects of insulin at rest. So, it gives you another way to actually reduce blood glucose.

I think the main thing that clinicians need to know, in order to prescribe exercise, is that there usually isn’t any bad exercise for someone to be doing. And certainly there are a number of recommended ones. For example, there are four main categories: Aerobic activities, such as walking. If you can just simply get people to walk more; Resistance training, which doesn’t mean that people have to join a gym, but that they can use their own body weight as resistance and do simple activities; Balance training for anybody over 40 with diabetes is really critical; and also Stretching is also important, it’s a part of what allows us to keep our balance, to be more flexible. And then simply there’s a fifth category, which is lifestyle activity—and I think that’s one we don’t actually talk about enough with our patients, and standing more. Taking more daily steps; doing anything to add activity into the day. There’s a lot of research now looking at just simply breaking up sedentary time and how effective that can be on improving how well metabolism works.

What you can do is just quickly ask them a few questions like, “What types of activities do you like to do, or did you used to do, or would you like to do again?” And try to focus their prescription around what’s going to be enjoyable to them because that’s the only way they’re going to continue to do it over time.

Don’t just tell your patients, “You need to exercise more.” Not only do they already know that, and they aren’t doing it for some reason, but it doesn’t really give them a good measure to tell if they are actually meeting that goal or not. What do you mean by “more active?” So help them say like maybe, “I’m going to take three 15-minute walks on Monday, Wednesday and Friday; and on Tuesday and Thursday I’m going to do some body weight resistance training for 20 minutes.” And then have them try to meet those specific goals. Then you say, “Great! What do you want to do next week?” and have them set similarly attainable goals that are going to work for them. The physical activity becomes an integral part that really needs to be discussed there because it allows people to manage their lifestyle more effectively, so that any medications they do take will work more effectively. And the physical activity, not just planned exercise—but being more active all day long—helps complement the changes they make in their diet and their lifestyle, and all these things are going to help improve their diabetes management.