Physical Activity in Childhood Diabetes



Physical activity is an important part of childhood. It is important for normal childhood development, to maintain healthy bones and body composition, and is useful in developing and maintaining social contacts. Physical activity is no less important for children and young people with diabetes. It is actively encouraged but presents significant challenges for diabetes management for the child, family, and the diabetes team. Physical activity can lead to fluctuations in blood glucose levels that can be difficult to manage or to avoid. In this chapter, we will provide some background to the developmental aspects of physical activity in children and young people and suggest some strategies for managing type I diabetes during periods of physical activity.


Physical Activity Heart Rate Variability Blood Glucose Level Glycemic Control Vigorous Physical Activity 
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  1. 1.
    Armstrong N, van Mechelen W. Paediatric exercise science and medicine. Oxford: Oxford University Press; 2008.Google Scholar
  2. 2.
    Mulvihill C, Rivers K, Aggleton P. Physical activity ‘at our time’: qualitative research among young people aged 5 to 15 years and parents. Health Education Authority 2000. ISBN 0 7521 1748 3.Google Scholar
  3. 3.
    Williams HG, Pfeiffer KA, O’Neill JR, Dowda M, McIver KL, Brown WH, Patel R. Motor skill performance and physical activity in preschool children. Obesity. 2008;16:1421–6.PubMedCrossRefGoogle Scholar
  4. 4.
    McKenzie TL, Sallis JF, Nader PR, Broyles SL, Nelson JA. Anglo- and Mexican-American preschoolers at home and at recess: activity patterns and environmental influences. J Dev Behav Pediatr. 1992;13:173–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Health Survey for England 2002. Joint Health Surveys Unit: National Centre for Social Research Department of Epidemiology and Public Health at the Royal Free and University College Medical School. In: Sproston K, Primatesta P, editors.
  6. 6.
    Cockburn C, Clarke G. “Everybody’s looking at you!”: girls negotiating the ‘femininity deficit’ they incur in physical education. Women’s Studies Int Forum. 2002;25:651–65.CrossRefGoogle Scholar
  7. 7.
    Bunt JC, Salbe AD, Harper IT, Hanson RL, Tataranni PA. Weight, adiposity, and physical activity as determinants of an insulin sensitivity index in Pima Indian children. Diabetes Care. 2003;26:2524–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes. 2009;4:2–27.PubMedCrossRefGoogle Scholar
  9. 9.
    Reilly JJ, Penpraze IV, Hislop I, Davies G, Grant S, Paton JY. Objective measurement of physical activity and sedentary behaviour: review with new data. Arch Dis Child. 2008;93:614–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Baranowski T, Dworkin R, Cieslik CJ, et al. Reliability and validity of self-report of aerobic activity: Family Health Project. Res Q Exerc Sport. 1984;55:308–17.Google Scholar
  11. 11.
    Sallis JF. Self-report measures of children’s physical activity. J Sch Health. 1991;61:215–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Brage S, Brage N, Franks PW, Ekelund U, Wareham NJ. Reliability and validity of the combined heart rate and movement sensor Actiheart. Eur J Clin Nutr. 2005;59:561–70.PubMedCrossRefGoogle Scholar
  13. 13.
    Brage S, Brage N, Franks P, Ekelund U, Wong M, Andersen L, Froberg K, Wareham N. Branched equation modelling of simultaneous accelerometry and heart rate monitoring improves estimate of directly measured physical activity energy expenditure. J Appl Physiol. 2004;96:343–51.PubMedCrossRefGoogle Scholar
  14. 14.
    WHO. Global recommendations on physical activity for health. WHO Press, Geneva, Switzerland. 2010.Google Scholar
  15. 15.
    Lobelo F, Liese AD, Liu J, Mayer-Davis EJ, D’Agostino Jr RB, Pate RR, Hamman RF, Dabelea D. Physical activity and electronic media use in the SEARCH for diabetes in youth case-control study. Pediatrics. 2010;125:e1364–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Benevento D, Bizzarri C, Pitocco D, Crino A, Moretti C, Spera S, Tubili C, Costanza F, Maurizi A, Cipolloni L, Cappa M, Pozzilli P, IMDIAB Group. Computer use, free time activities and metabolic control in patients with type 1 diabetes. Diabetes Res Clin Pract. 2010;88:e32–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Overby NC, Margeirsdottir HD, Brunborg C, Anderssen SA, Andersen LF, Dahl-Jorgensen K, Norwegian Study Group for Childhood Diabetes. Physical activity and overweight in children and adolescents using intensified insulin treatment. Pediatr Diabetes. 2009;10:135–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Massin MM, Lebrethon MC, Rocour D, Gerard P, Bourguignon JP. Patterns of physical activity determined by heart rate monitoring among diabetic children. Arch Dis Child. 2005;90:1223–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Sarnblad S, Ekelund U, Aman J. Physical activity and energy intake in adolescent girls with Type 1 diabetes. Diabet Med. 2005;22:893–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Ekeland E, Heian F, Hagen KB, Abbott J. Nordheim L. Exercise to improve self esteem in children and young people. Cochrane Database Syst Rev. 2004.Google Scholar
  21. 21.
    Hood KK, Huestis S, Maher A, Butler D, Volkening L, Laffel LMB. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics. Diabetes Care. 2006;29:1389–91.PubMedCrossRefGoogle Scholar
  22. 22.
    Edmunds S, Roche D, Stratton G, Wallymahmed K, Glenn SM. Physical activity and psychological well-being in children with Type 1 diabetes. Psychol Health Med. 2007;12:353–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Bowes S, Lowes L, Warner J, Gregory JW. Chronic sorrow in parents of children with Type 1 diabetes. J Adv Nurs. 2009;65:992–1000.PubMedCrossRefGoogle Scholar
  24. 24.
    Mackey ER, Streisand R. Brief report: the relationship of parental support and conflict to physical activity in preadolescents with type 1 diabetes. J Pediatr Psychol. 2008;33:1137–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Fereday J, MacDougall C, Spizzo M, Darbyshire P, Schiller W. “There’s nothing I can’t do–I just put my mind to anything and I can do it”: a qualitative analysis of how children with chronic disease and their parents account for and manage physical activity. BMC Pediatr. 2009;9:1.PubMedCrossRefGoogle Scholar
  26. 26.
    Aman J, Skinner TC, de Beaufort CE, Swift PG, Aanstoot HJ, Cameron F, Hvidoere Study Group on Childhood Diabetes. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes. Pediatr Diabetes. 2009;10:234–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school aged children and youth. Int J Behav Nutr Phys Activity. 2010;7:40.CrossRefGoogle Scholar
  28. 28.
    Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch W, Smith Jr SC, Sowers JR. Diabetes and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation. 1999;100:1134–46.PubMedGoogle Scholar
  29. 29.
    Tsuji H, Venditti Jr FJ, Manders ES, Evans JC, Larson MG, Feldman CL, Levy D. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham heart study. Circulation. 1994;90:878–83.PubMedGoogle Scholar
  30. 30.
    Dekker JM, Crow RS, Folsom AR, Hannan PJ, Liao D, Swenne CA, Schouten EG. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Circulation. 2000;102:1239–44.PubMedGoogle Scholar
  31. 31.
    Chen SR, Lee YJ, Chiu HW, Jeng C. Impact of physical activity on heart rate variability in children with type 1 diabetes. Childs Nervous System. 2008;24:741–7.CrossRefGoogle Scholar
  32. 32.
    Maggio AB, Hofer MF, Martin XE, Marchand LM, Beghetti M, Farpour-Lambert NJ. Reduced physical activity level and cardiorespiratory fitness in children with chronic diseases. Eur J Pediatr. 2010;169:1187–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Heyman E, Delamarche P, Berthon P, Meeusen R, Briard D, Vincent S, DeKerdanet M, Delamarche A. Alteration in sympathoadrenergic activity at rest and during intense exercise despite normal aerobic fitness in late pubertal adolescent girls with type 1 diabetes. Diabetes Metab. 2007;33:422–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Komatsu WR, Gabbay MAL, Castro ML, Saraiva GL, Chacra AR, De Barros Neto TL, Dib SA. Aerobic exercise capacity in normal adolescents and those with type 1 diabetes mellitus. Pediatr Diabetes. 2005;6:145–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Herbst A, Kordonouri O, Schwab KO, Schmidt F, Holl RW. DPV Initiative of the German Working Group for Pediatric Diabetology Germany. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23,251 patients. Diabetes Care. 2007;30:2098–100.PubMedCrossRefGoogle Scholar
  36. 36.
    Trigona B, Aggoun Y, Maggio A, Martin XE, Marchand LM, Beghetti M, Farpour-Lambert NJ. Preclinical noninvasive markers of atherosclerosis in children and adolescents with type 1 diabetes are influenced by physical activity. J Pediatr. 2010;157:533–9.PubMedCrossRefGoogle Scholar
  37. 37.
    McMahon SK, Ferreira LD, Ratnam N, Davey RJ, Youngs LM, Davis EA, Fournier PA, Jones TW. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metabol. 2007;92:963–8.CrossRefGoogle Scholar
  38. 38.
    Temple MY, Bar-Or O, Riddell MC. The reliability and repeatability of the blood glucose response to prolonged exercise in adolescent boys with IDDM. Diabetes Care. 1995; 18:326–32.PubMedCrossRefGoogle Scholar
  39. 39.
    Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, Wysocki T, Weinzimer SA, Buckingham BA, Kollman C, Xing D, Ruedy KJ, Diabetes Research in Children Network Direcnet Study Group. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatrics. 2005;147:528–34.CrossRefGoogle Scholar
  40. 40.
    American Diabetes Association. Diabetes mellitus and exercise. Diabetes Care. 2000;23:s50–4.Google Scholar
  41. 41.
    Herbst A, Bachran R, Kapellen T, Holl RW. Effects of regular physical activity on control of glycemia in pediatric patients with type 1 diabetes mellitus. Arch Pediatr Adolesc Med. 2006;160:573–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Nansel TR, Iannotti RJ, Simons-Morton BG, Plotnick LP, Clark LM, Zeitzoff L. Long-term maintenance of treatment outcomes: diabetes personal trainer intervention for youth with type 1 diabetes. Diabetes Care. 2009;32:807–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Roberts L, Jones TW, Fournier PA. Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus. J Pediatr Endocrinol. 2002;15:621–7.CrossRefGoogle Scholar
  44. 44.
    Brazeau A, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008;31:2108–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Robertson K, Adolfsson P, Scheiner G, Hanas R, Riddell MC. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2009;10:154–68.PubMedCrossRefGoogle Scholar
  46. 46.
    Berman N, Bailey R, Barstow TJ, Cooper DM. Spectral and bout detection analysis of physical activity patterns in healthy, prepubertal boys and girls. Am J Hum Biol. 1998;10:289–97.CrossRefGoogle Scholar
  47. 47.
    Tsalikian E, Kollman C, Tamborlane WB, Beck RW, Fiallo-Scharer R, Fox L, Janz KF, Ruedy KJ, Wilson D, Xing D, Weinzimer SA, Diabetes Research in Children Network (DirecNet) Study Group. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care. 2006;29:2200–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Admon G, Weinstein Y, Falk B, Weintrob N, Benzaquen H, Ofan R, Fayman G, Zigel L, Constantini N, Phillip M. Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics. 2005;116:e348–55.PubMedCrossRefGoogle Scholar
  49. 49.
    Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatrics. 2010;157:784–8.CrossRefGoogle Scholar
  50. 50.
    Riddell MC, Iscoe KE. Physical activity, sport, and pediatric diabetes. Pediatr Diabetes. 2006;7:60–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Smart C, Aslander-van Vliet E, Waldron S. Nutritional management in children and adolescents with diabetes. Pediatric Diabetes. 2009;10 Suppl 12:100–17.PubMedCrossRefGoogle Scholar
  52. 52.
    Rovner AJ, Nansel TR. Are children with type 1 diabetes consuming a healthful diet?: a review of the current evidence and strategies for dietary change. Diabetes Educ. 2009;35:97–107.PubMedCrossRefGoogle Scholar
  53. 53.
    Mehta SN, Haynie DL, Higgins LA, Bucey NN, Rovner AJ, Volkening LK, et al. Emphasis on carbohydrates may negatively influence dietary patterns in youth with type 1 diabetes. Diabetes Care. 2009;32:2174–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Steen SN. Timely statement of The American Dietetic Association: nutrition guidance for adolescent. J Am Diet Assoc. 1996;96:611.PubMedCrossRefGoogle Scholar
  55. 55.
    Steen SN. Timely statement of The American Dietetic Association: nutrition guidance for child athletes. J Am Diet Assoc. 1996;96:610.PubMedCrossRefGoogle Scholar
  56. 56.
    Meyer F, O’Connor H, Shirreffs SM. Nutrition for the young athlete. J Sports Sci. 2007;25:73–82.CrossRefGoogle Scholar
  57. 57.
    Jeukendrup A, Cronin L. Nutrition and elite young athletes. Med Sports Sci. 2011;56:47–58.Google Scholar
  58. 58.
    Neumark-Sztainer D, Story M. Factors influencing food choices of adolescents: findings from focus-group discussions. J Am Diet Assoc. 1999;99:929.PubMedCrossRefGoogle Scholar
  59. 59.
    Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39 Suppl 1:5–41.PubMedGoogle Scholar
  60. 60.
    Rodríguez G, Moreno LA, Sarría A, Fleta J, Bueno M. Resting energy expenditure in children and adolescents: agreement between calorimetry and prediction equations. Clin Nutr. 2002;21:255–60.PubMedCrossRefGoogle Scholar
  61. 61.
    National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand. 2006.Google Scholar
  62. 62.
    Department of Health. Report on health and social subjects 41: dietary reference values for food energy and nutrients for the United Kingdom. London: HMSO; 1991.Google Scholar
  63. 63.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504.PubMedCrossRefGoogle Scholar
  64. 64.
    Ridley K, Ainsworth BE, Olds TS. Development of a compendium of energy expenditures for youth. Int J Behav Nutr Phys Act. 2008;5:1–8.CrossRefGoogle Scholar
  65. 65.
    Ridley K, Olds TS. Assigning energy costs to activities in children: a review and synthesis. Med Sci Sports Exerc. 2008;40:1439–46.PubMedCrossRefGoogle Scholar
  66. 66.
    Position of the American Dietetic Association. Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. J Am Diet Assoc. 2009;109:509–27.CrossRefGoogle Scholar
  67. 67.
    Riddell MC. The endocrine response and substrate utilization during exercise in children and adolescents. J Appl Physiol. 2008;105:725–33.PubMedCrossRefGoogle Scholar
  68. 68.
    Timmons BW, Bar-Or O, Riddell MC. Energy substrate utilization during prolonged exercise with and without carbohydrate intake in preadolescent and adolescent girls. J Appl Physiol. 2007;103:995–1000.PubMedCrossRefGoogle Scholar
  69. 69.
    Timmons BW, Bar-Or O, Riddell MC. Influence of age and pubertal status on substrate utilization during exercise with and without carbohydrate intake in healthy boys. Appl Physiol Nutr Metab. 2007;32:416–25.PubMedCrossRefGoogle Scholar
  70. 70.
    Timmons BW, Bar-Or O, Riddell MC. Oxidation rate of exogenous carbohydrate during exercise is higher in boys than in men. J Appl Physiol. 2003;94:278–84.PubMedGoogle Scholar
  71. 71.
    Phillips SM, Moore DR, Tang JE. A critical examination of dietary protein requirements, benefits, and excesses in athletes. Int J Sport Nutr Exerc Metab. 2007;17:S58–76.PubMedGoogle Scholar
  72. 72.
    Tipton KD, Witard OC. Protein requirements and recommendations for athletes: relevance of ivory tower arguments for practical recommendations. Clin Sports Med. 2007;26:17–36.PubMedCrossRefGoogle Scholar
  73. 73.
    Petrie HJ, Stover EA, Horswill CA. Nutritional concerns for the child and adolescent competitor. Nutrition. 2004;20:620–31.PubMedCrossRefGoogle Scholar
  74. 74.
    Barr SI, Rideout CA. Nutritional considerations for vegetarian athletes. Nutrition. 2004;20:696–703.PubMedCrossRefGoogle Scholar
  75. 75.
    Rowland T. Fluid replacement requirements for child athletes. Sports Med. 2011;41:279–88.PubMedCrossRefGoogle Scholar
  76. 76.
    American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Climatic heat stress and the exercising child and adolescent. Pediatrics. 2000;106:158–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Division of Metabolic and Vascular Health, Warwick Medical School, Clinical Sciences Research LaboratoriesUniversity HospitalCoventryUK
  2. 2.Department of Nutrition and DieteticsAlder Hey Children’s NHS Foundation TrustWest Derby, LiverpoolUK

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