Optimal exercise combinations for patients with diabetes.

OBJECTIVES: Exercise is a key way to control the blood glucose, which can improve blood lipids and blood pressure, reduce glycated hemoglobin levels, and increase insulin sensitivity. It is of great significance for maintaining blood glucose homeostasis. This study aims to explore the optimal exercise combinations suitable for diabetic patients, and to provide scientific and effective personalized exercise guidance for diabetic patients.

METHODS: The physical examination data and questionnaire results of were collected from the Third Xiangya Hospital of Central South University. The study was involved in 3 867 diabetes from January, 2020 to December, 2021. The basic information and living habits were obtained through questionnaires. The fasting blood samples were collected to measure the levels of total cholesterol (TCh), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose. Physical measurements included height, weight, waistline, hipline, and blood pressure. Categorical variables were tested using chi-square tests, and continuous variables were tested using non-parametric Kruskal-Wallis test. Multiple linear regression model was used to analyze the relationship between exercise behaviors (frequency, duration, and intensity), years of exercise, diet habits, medicine, and fasting blood glucose. The relationship between different exercise behaviors and various indexes (BMI, blood pressure, blood lipids, blood glucose) was analyzed by multiple rising sun rose plots. The polar thermal diagram showed the relationship of exercise behaviors with the best expected effect.

RESULTS: Non-parametric Kruskal-Wallis test showed that there were significant differences in other indexes except LDL-C ( P =0.681) among groups with different exercise behaviors (all P <0.01). The multiple rising sun rose plots showed that diabetic patients who did moderate to high intensity exercise more than 5 times a week for more than 30 min each time had a healthier BMI, blood lipid levels, blood glucose levels, and blood pressure. Polar thermal diagram showed that low-intensity exercise once or twice a week requires 30 to 60 min or more of exercise to achieve the desired results. Multiple linear regression analysis showed that frequency ( β =-0.208, 95% CI -0.356 to -0.059, P =0.006), duration ( β =-0.227, 95% CI -0.387 to -0.066, P =0.006), intensity of exercise ( β =-0.110, 95% CI -0.218 to -0.002, P =0.046), diet habits ( β =0.462, 95% CI 0.295 to 0.556, P <0.001) and medicine ( β =-0.520, 95% CI -0.720 to -0.312, P <0.001) were correlated with fasting blood glucose.

CONCLUSIONS: Moderate to high intensity exercise for more than 30 min and 5 times a week is the most beneficial combination for diabetes. Low exercise intensity should be combined with higher exercise frequency and longer exercise time to achieve the desired effect. With the increase of exercise intensity, the relationship between low exercise frequency and long exercise time is weakened.