Diabetes Standards of Care and Resources for Clinicians and Educators

• Assess individuals for medical conditions that might affect the type, frequency, duration, and intensity of the physical activity (PA) in which they engage at initial visit and as needed, but at least annually thereafter. The Physical Activity Readiness Questionnaire (PAR-Q+) Exit Disclaimer: You Are Leaving www.ihs.gov  is one resource that can be useful in completing an initial assessment.²
• Evaluate the need for provider consultation or medical clearance. Specific guidance on pre-exercise evaluation is available in the ACSM Consensus Statement on Exercise/Physical Activity in Type 2 Diabetes.³ Exit Disclaimer: You Are Leaving www.ihs.gov 
  • Medical clearance is not needed for most individuals planning to participate in a low-to-moderate intensity PA like brisk walking. However, evaluation by a provider is needed for individuals diagnosed with cardiovascular disease (CVD), retinopathy, chronic kidney disease, and/or peripheral neuropathy.3 Special precautions may be necessary for these individuals.
  • Further evaluation and medical clearance are recommended for exercise participation for:
    • Individuals who report signs and symptoms suggestive of CVD (e.g. chest discomfort, lightheadedness, shortness of breath);
    • Middle-aged and older individuals with diabetes who are not regularly exercising and want to begin a supervised high-intensity exercise program.

• Address physical activity (PA) at every diabetes visit.
• Assess level of motivational readiness and encourage people to set activity goals.
• Advise to begin slowly and increase gradually. Specific recommendations for increasing PA will vary by age, activity, and presence of diabetes-related complications.
• Develop person-centered recommendations based on consensus guidelines, see below.

American Diabetes Association (ADA) and American College of Sports Medicine (ACSM) Physical Activity/Exercise Recommendations^3,4

Note: When appropriate and available, referral to a certified fitness or exercise specialist for supervision and coaching is highly recommended. For high-intensity training, participation in supervised exercise training is recommended over non-supervised programs.

• Provide general guidance on safety considerations for physical activity (PA) and address important safety issues more specific to people with diabetes. Important safety tips for people with diabetes include:
  • Exercise at a safe intensity level.
  • Take steps to avoid low blood glucose.
  • Avoid high blood glucose and ketoacidosis.
  • Stay hydrated.
  • Use caution when exercising in hot and humid environments.
  • Use caution when exercising in cold environments.
  • Take care of feet.
  • Be alert to personal safety.

See Additional Information: Safety Guidance for Counseling Individuals with Diabetes

• Share strategies for implementing and sustaining lifestyle changes that promote and increase physical activity (PA) such as:
  • Look for ways to incorporate PA into your day.
  • Find physical activities you enjoy.
  • Make PA social (asking a friend or family member to accompany you).
  • Walk your dog for regular PA.
  • Interrupt prolonged sitting with activity breaks, such as walking or simple resistance activities, for 3-5 minutes every 30-60 minutes. View Move More Sit Less.
• Encourage goal setting and plans for overcoming barriers to PA.
• Leverage technology to promote, measure, or facilitate PA. Resources include cell phones, smart watches, fitness trackers, pedometers, step counters, and internet-based exercise programs.