The Optimal Exercise Routine for Individuals with Type 2 Diabetes

Exercising at certain times of the day and implementing certain types of activity can help people with type 2 diabetes get the most out of a workout, a new study finds.

About 10% of adults in the United States have type 2 diabetes, and about one-third have prediabetes. Unlike type 1 diabetes, type 2 diabetes can sometimes be reversed with healthy lifestyle interventions.

Exercise is usually prescribed as a treatment alongside diet and medication, but on its own, exercise can induce short-term glycemic (blood sugar) control.

“Exercise is nature’s insulin sensitizer, meaning it makes your body more sensitive to the effects of insulin,” Joanne Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center who was not involved with the new research, told Health.

Muscle and fat cells act like sponges, absorbing glucose from the bloodstream and transporting it into cells, which lowers blood sugar levels. Exercise helps this process along, especially in people with type 2 diabetes, where muscles may be unable to absorb glucose like they normally should.

“Regular exercise is better than pretty much any medication for improving insulin resistance,” Dushay told Health. 

To understand how exercise helps regulate type 2 diabetes, people must first understand what goes wrong in the body to cause the disease in the first place, Steven Malin, PhD, an associate professor of kinesiology and health at Rutgers University, told Health.

First, over time, the body becomes less responsive to the hormone insulin. As the body becomes less responsive to insulin, muscles don’t take up glucose as they normally would. The body tries to compensate by producing more insulin.

This overexertion causes the pancreas—the organ that secretes insulin—to become exhausted. As a result, it no longer makes enough insulin. 

Malin, who led the study, emphasized the benefits of using exercise to counteract insulin resistance.

Not only does physical activity help regulate blood sugar and insulin, but it can also ward off some common complications of diabetes, including heart disease and nerve damage.

To determine how people with type 2 diabetes can best optimize exercise, Malin and his team analyzed existing studies that looked at how different types of exercises—such as high-intensity interval training (HIIT) and strength training—impact glycemic control in people with type 2 diabetes, as well as whether or not it matters when the exercise is being done. 

“Either type of exercise, aerobic or strength, and exercise at any time of day is thought to be beneficial for helping the body become more insulin sensitive,” Malin told Health. So the first focus should be on getting any type of exercise whenever you can, he added. 

The next step up can be optimizing those workouts to get the most benefits—but being physically active in any way remains the most important thing, Malin said. 

Several studies have found that exercising after eating a meal is the best way to optimize the benefits of a workout when it comes to glycemic control.

After eating, a person’s blood sugar spikes. But a post-meal workout can help quell these spikes by prompting the muscles to take up more glucose from the blood. Since dinner is typically the largest meal of the day in the U.S., exercising in the afternoon or evening is slightly better for managing glucose than exercising in the morning.

If you exercise in the evening, those benefits last until the next morning, Malin said. 

“If you’re in a spot where you have to make a decision and you have barriers in your way, pick whichever option, before or after a meal, that is easier and get it done,” he said. “But if you have more flexibility, the evidence is pointing towards exercising after the meal.”

According to Dushay, a combination of cardio, strength, and flexibility exercises is best, especially as people get older. 

“Each has unique and important benefits,” she said. “Cardio helps with cardiovascular health; strength helps maintain muscle mass as we age; flexibility helps with balance and to prevent falls.”

If you can only pick two, stick with cardio and strength training. “If you’re able to do both strength and aerobic exercise you’re going to get the best benefits for glucose control,” Malin said.

Mixing it up can also keep exercise interesting and allow you to do most workouts at the time of day you prefer, even if it isn’t post-meal or in the evening. 

“Don’t get caught up in doing the same thing every day, you can mix it up,' he said. 'If you prefer morning you can do it once or twice a week in the evening but primarily in the morning.' 

Studies have also shown that one of the big barriers to exercise is time, Malin said. The key to eliminating that barrier may be to break down exercise into smaller increments. 

“People will say 'I don’t have 45 minutes to get out and do the exercise,' but you can break that apart and do 15 minutes after each meal,” said Malin. “Studies have shown that breaking up the exercise over the course of the day is just as good if not even a little better than one burst of 45 minutes.”

A 2021 study found that even opting to take the stairs decreased a person’s risk of developing metabolic syndrome, which includes type 2 diabetes.

Dushay said marching in place, climbing stairs, or strength training for just 5 or 10 minutes several times a day can significantly improve blood sugar among people with type 2 diabetes. 

“I can't emphasize this enough, exercise is hands down the best medicine for diabetes,” she said, adding that it should still be used in tandem with a healthy diet and, if needed, medication.