Evidence and Implementation of Physical Activity and Exercise

  • Edtna Jáuregui-UlloaEmail author
  • Juan López-Taylor


In this chapter we review the importance and evidence of the benefits of physical activity and exercise in the new perspective of promoting to be active and in due course include exercise as a part of the treatment for diabetes. We emphasize the importance to apply systematic elements such the five As of counseling individuals with diabetes, explore and manage behaviors, focus on SMART goals, and modulate the frequency, intensity, type, and time (FITT) components of the exercise in a real world clinical practice setting. We also recommend a specific management prescribing exercise when the complications of diabetes take place with the recommendations.


Physical activity Exercise prescription Fitness Health Diabetes Indications Precautions Five A´s SMART goals FITT 


  1. 1.
    WHO. Global health risks: mortality and burden of disease attributable to selected major risks. Bull World Health Organ [Internet]. 2009;87:646. Available from: Scholar
  2. 2.
    Ding D, Kolbe-Alexander T, Nguyen B, Katzmarzyk PT, Pratt M, Lawson KD. The economic burden of physical inactivity: a systematic review and critical appraisal. Br J Sports Med [Internet]. 2017;51(19):1392–409. Available from: Scholar
  3. 3.
    Henson J, Yates T, Biddle SJH, Edwardson CL, Khunti K, Wilmot EG, et al. Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia. 2013;56(5):1012–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. Bmj [Internet]. 2016;354:i3857. Available from: Scholar
  5. 5.
    Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801–9. Scholar
  6. 6.
    Janssen I, LeBlanc AG, Janssen I, Twisk J, Tolfrey K, Jones A, et al. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act [Internet]. 2010;7(1):40. Available from: Scholar
  7. 7.
    World Health Organization. Draft WHO global action plan on physical activity 2018–2030. Vol. 2011. 2018. p. 1–36.Google Scholar
  8. 8.
    de Souto Barreto P. Time to challenge public health guidelines on physical activity. Sports Med. 2015;45:769–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Bushman B, American College of Sports Medicine. ACSM’s complete guide to fitness & health, 2E. Champaign: Human Kinetics; 2017.Google Scholar
  10. 10.
    Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health [Internet]. 2011;11(1):119. Available from: Scholar
  11. 11.
    Galaviz KI, Narayan K, Lobelo F, Weber MB. Lifestyle and the prevention of type 2 diabetes: a status report. Am J Lifestyle Med. 2015;12(1):4–20. Scholar
  12. 12.
    Katzmarzyk PT. Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift? Diabetes. 2010;59(11):2717–25.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep [Internet]. 1985;100(2):126–31. Available from: Scholar
  14. 14.
    Blair SN, Khol HW, Powell KE. Physical activity, physical fitness, and health. In: Rogozkin VA, Maughan R, editors. Current research in sports sciences. Boston: Springer; 1996.Google Scholar
  15. 15.
    Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc. 2001;33(6):s364–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, et al. Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association. Circulation. 2013;128(20):2259–79.PubMedCrossRefGoogle Scholar
  17. 17.
    Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N. Physiological and health implications of sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35:725–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act [Internet]. 2017;14(1):75. Available from: Scholar
  19. 19.
    Levine JA, Vander MW, Hill O, Klesges R. Non-exercise activity thermogenesis: the crouching Tiger hidden dragon of societal weigh gain. Arterioscler Thromb Vasc Biol [Internet]. 2006;26:729–36. Available from: Scholar
  20. 20.
    Tremblay MS, Carson V, Chaput J-P. Introduction to the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Appl Physiol Nutr Metab [Internet]. 2016;41(6 (Suppl. 3)):iii–v. Available from: Scholar
  21. 21.
    Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc. 2001;33(6 Suppl):S379–99.PubMedCrossRefGoogle Scholar
  22. 22.
    Gill DL, Hammond CC, Reifsteck EJ, Jehu CM, Williams RA, Adams MM, et al. Physical activity and quality of life. J Prev Med Public Health [Internet]. 2013;46(Suppl 1):S28–34. Available from: Scholar
  23. 23.
    Levine JA. Health-chair reform: your chair: comfortable but deadly. Diabetes. 2010;59(11):2715–6.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Katzmarzyk PT, Barreira TV, Broyles ST, Champagne CM, Chaput JP, Fogelholm M, et al. Physical activity, sedentary time, and obesity in an international sample of children. Med Sci Sports Exerc. 2015;47(10):2062–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Tudor-Locke C, Swift DL, Schuna JM, Dragg AT, Davis AB, Martin CK, et al. WalkMore: a randomized controlled trial of pedometer-based interventions differing on intensity messages. BMC Public Health [Internet]. 2014;14(1):168. Available from: Scholar
  26. 26.
    Surani S, Bopparaju S. Sleep and diabetes. Int J Endocrinol. 2010;2010:759509.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Praet SF, Rozenberg R, Van Loon L. Type 2 diabetes. In: Exercise and chronic disease: an evidence-based approach. Routledge: Taylor & Francis Group; 2011. p. 265–96.Google Scholar
  28. 28.
    Jauregui-Ulloa E, Lopez-Taylor JR, Navarro I. Prescription of exercise to patients with diabetes mellitus. Evidence, benefits and management. Diabetes Hoy. 2013;19(2):3144–55.Google Scholar
  29. 29.
    Mendes R, Sousa N, Almeida A, Subtil P, Guedes-Marques F, Reis VM, et al. Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review. Br J Sports Med [Internet]. 2016;50(22):1379–81. Available from: Scholar
  30. 30.
    Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Goedecke JH, Ojuka EO, editors. Diabetes and physical activity. Med Sport Sci. 2014;60:130–40.
  32. 32.
    Rana JS, Li TY, Manson JE, Hu FB. Adiposity compared with physical inactivity and risk of type 2 diabetes in women. Diabetes Care. 2007;30(1):53–8.PubMedCrossRefGoogle Scholar
  33. 33.
    McCarthy M, Edwardson CL, Davies MJ, Henson J, Gray L, Khunti K, et al. Change in sedentary time, physical activity, bodyweight, and HbA1c in high-risk adults. Med Sci Sports Exerc. 2017;49(6):1120–5.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. In: Ells LJ, editor. Cochrane Database Syst Rev [Internet]. Chichester: Wiley; 2017 [cited 2017 Aug 15]. Available from:
  35. 35.
    Karstoft K, Pedersen BK. Exercise and type 2 diabetes: focus on metabolism and inflammation. Immunol Cell Biol [Internet]. 2016;94(2):146–50. Available from: Scholar
  36. 36.
    Teixeira-Lemos E, Nunes S, Teixeira F, Reis F. Regular physical exercise training assists in preventing type 2 diabetes development: focus on its antioxidant and anti-inflammatory properties. Cardiovasc Diabetol [Internet]. 2011;10:12. Available from: http;// Scholar
  37. 37.
    Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med [Internet]. 2017;2(1):e000143. Available from: Scholar
  38. 38.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.Google Scholar
  39. 39.
    Takaishi T, Hayashi T. Stair ascending–descending exercise accelerates the decrease in postprandial hyperglycemia more efficiently than bicycle exercise. BMJ Open Diabetes Res Care [Internet]. 2017;5(1):e000428. Available from: Scholar
  40. 40.
    Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care. 2016;39(6):964–72.PubMedCrossRefGoogle Scholar
  41. 41.
    Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56:2655–67.PubMedCrossRefGoogle Scholar
  42. 42.
    Heden TD, Winn NC, Mari A, Booth FW, Rector RS, Thyfault JP, et al. Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. J Appl Physiol [Internet]. 2015;118(5):624–34. Available from: Scholar
  43. 43.
    Batacan RB Jr, Duncan MJ, Dalbo VJ, Tucker PS, Fenning AS. Effects of light intensity activity on CVD risk factors : a systematic review of intervention studies. Biomed Res Int. 2015;2015:1–10.CrossRefGoogle Scholar
  44. 44.
    Dutton GR, Lewis CE. The look AHEAD trial: implications for lifestyle intervention in type 2 diabetes mellitus. Prog Cardiovasc Dis. 2015;58(1):69–75.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Angermayr L, Melchart D, Linde K. Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus—a systematic review of randomized controlled trials. Ann Behav Med [Internet]. 2010;40(1):49–64. Available from: Scholar
  46. 46.
    Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, Look AHEAD Research Group. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489–96. Scholar
  47. 47.
    Zizi F, Jean-Louis G, Brown CD, Ogedegbe G, Boutin-Foster C, McFarlane SI. Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights. Curr Diab Rep. 2010;10(1):43–7.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Glasgow RE, Emont S, Miller DC. Assessing delivery of the five “As” for patient-centered counseling. Health Promot Int. 2006;21(3):245–55.PubMedCrossRefGoogle Scholar
  49. 49.
    Galaviz KI, Jauregui-Ulloa E, Fabrigar LR, Latimer-Cheung A, Lopez Y, Taylor J, Lévesque L. Physical activity prescription among Mexican physicians: a structural equation analysis of the theory of planned behaviour. Int J Clin Pract. 2015;69:375.PubMedCrossRefGoogle Scholar
  50. 50.
    Moore G, Durstine JL, Painter P, American College of Sports Medicine. ACSM’s exercise management for persons with chronic diseases and disabilities, 4E. Champaign: Human Kinetics; 2016.Google Scholar
  51. 51.
    Galaviz KI, Jauregui-Ulloa E, Fabrigar LR, Latimer-Cheung A, Lopez Y, Taylor J, Lévesque L. Physical activity prescription among Mexican physicians: a structural equation analysis of the theory of planned behaviour. Int J Clin Pract. 2015;69(3):375–83.PubMedCrossRefGoogle Scholar
  52. 52.
    Jauregui-Ulloa E, Lopez-Taylor JR, Navarro I. The physical activity professional role as a provider of exercise prescription in chronic diseases. In: Reynaga-Estrada P, Muñoz-Hernandez T, editors. La actividad física y la salud en la formación básica del profesional de la cultura física y del deporte. Guadalajara, Jalisco. Mexico: Universidad de Guadalajara; 2013. p. 97–105.Google Scholar
  53. 53.
    Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M, et al. Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47(11):2473–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Galaviz KI, Hutber A. Exercise is medicine. A flexible global model for linking sports medicine to primary and community care. Aspetar Sports. 2017;6:104–8.Google Scholar
  55. 55.
    Deci EL, Ryan RM. The “what” and “why” of goal pursuits: of behavior human needs and the self-determination. Psychol Inq. 2000;11(4):227–68.CrossRefGoogle Scholar
  56. 56.
    Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. Hoboken: John Wiley & Sons; 2008.Google Scholar
  57. 57.
    Pelmezi D, Jennigs E, Marcus B. Self-efficacy and physical activity. Health Fit J. 2009;13(2):16–21.Google Scholar
  58. 58.
    Rikli RE, Jones CJ. Senior fitness test manual. Leeds: Human Kinetics; 2013.Google Scholar
  59. 59.
    Pescatello LS, Riebe D, Thompson PD, editors. ACSM’s guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins; 2013.Google Scholar
  60. 60.
    Heyward VH, Gibson AL. Advanced fitness assessment and exercise prescription. New Mexico: Human Kinetics; 2014. p. 138–72.Google Scholar
  61. 61.
    Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065–79.PubMedCrossRefGoogle Scholar
  62. 62.
    American College of Sports Medicine. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Med Sci Sports Exerc. 2010;42(12):2282–303.CrossRefGoogle Scholar
  63. 63.
    Barisic A, Scoot BA, Leatherdale MA, Kreiger N. Importance of frequency, intensity, time and type (FITT) in physical activity assessment for epidemiological research. Can J Public Health. 2011;102(3):174–5.PubMedCrossRefGoogle Scholar
  64. 64.
    Meriwether RA, Lee JA, Lafleur AS, Wiseman P. Physical activity counseling. Am Fam Physician. 2008;77(8):1129–36.PubMedGoogle Scholar
  65. 65.
    Hoffman TC, Maher CG, Briffa T, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ. 2016;188(7):510–8.CrossRefGoogle Scholar
  66. 66.
    Tracy MF, Chlan L. Interdisciplinary research teams. Clin Nurse Spec [Internet]. 2014;28(1):12–4. Available from: Scholar
  67. 67.
    Zabaleta AM, Forbes A. Structured group-based education for type 2 diabetes in primary care. Br J Community Nurs [Internet]. 2007;12(4):158–62. Available from: Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Institute of Applied Sciences for Physical Activity and Sport, Department of Human Movement Sciences, Education, Sport, Recreation and DanceUniversity Health Sciences Center, University of GuadalajaraGuadalajaraMexico

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