Ask an expert: A strength-training prescription for diabetes

Q: "It's common knowledge that walking and other kinds of exercise can help people control diabetes and pre-diabetes, but I recently read that weight training is important, too. How does it help? What type of training is recommended?"

Answered by Elizabeth Stephens, M.D., endocrinology, Providence Medical Group-Northeast, and medical director, Providence Diabetes Education

Thank you for this great reminder to everyone who has Type 2 diabetes, and to everyone who is at risk for it: Don't forget your strength training!

It's well established that aerobic activities such as brisk walking, swimming and bicycling help improve blood sugar control and manage diabetes risks. What is less commonly known, but also firmly supported by research, is that muscle-strengthening activities such as weight lifting and resistance training are just as important. Simply put, strength training helps your muscles take up more glucose and use it more effectively, so less of it is floating around in your bloodstream.

Research shows that strength training improves blood sugar control, reduces insulin resistance and helps shed body fat, which further improves blood sugar levels. That's why both the American Diabetes Association (ADA) and the American College of Sports Medicine (ACSM) recommend including strength training as part of a regular exercise plan to control and prevent diabetes.

Want more details? A joint position statement on Exercise and Type 2 Diabetes issued by the ADA and ACSM in 2011 states that:

  • Resistance exercise and lower-intensity muscular conditioning exercises are independently associated with a reduced risk for diabetes.
  • A combination of aerobic exercise and resistance training may improve blood sugar control more effectively than either one alone.
  • A 16-week study of resistance exercise in older men with newly diagnosed Type 2 diabetes resulted in a 46.3 percent increase in insulin action, a 7.1 percent reduction in fasting blood glucose and a significant loss of visceral fat.
  • Another study found that men who did either aerobic or resistance exercises three times a week for 10 weeks all improved their blood glucose control, but A1C values dropped significantly lower in those who did resistance exercise.

I've seen the results in my own patients, male and female, diabetic and pre-diabetic – incorporating strength training has a big effect on blood sugar.

So what type of training is recommended? Anything that helps you strengthen your muscles. That could be lifting free weights or working out with weight machines at a gym, doing exercises with resistance bands, or using your own body weight to do push-ups, planks, squats, lunges and pull-ups. Even yoga and tai chi can help you build muscle.

The ADA and ACSM offer these recommendations for people who have Type 2 diabetes; the same advice will benefit anyone working to prevent diabetes, as well:

  • Engage in moderate to vigorous strengthening exercises at least two days a week, and ideally three days a week, with at least one day off between each session.
  • Include five to 10 exercises that work the major muscle groups in your upper body (arms and shoulders), lower body (legs and hips) and core (belly and low back).
  • Start with one set of 10 to 15 repetitions of each exercise or weight per session for the first few weeks.
  • Once you can do more than 15 reps of each exercise, gradually increase the weight or resistance and cut back to eight to 10 reps of each exercise.
  • Do at least one set to near fatigue, and up to three or four sets for optimal strength gains.
  • Take it slowly! Don't add weight or sets too quickly. In most progressive training programs, you begin by increasing weight or resistance first, then you increase the number of sets, and finally you increase the number of sessions per week.
  • For best blood sugar results, do your strength training in addition to the recommended 30 minutes a day, five days a week of moderate aerobic activity.

To this expert advice, I add a little of my own:

  • Don't expect to work out like you did when you were 18. Your body changes over time – be realistic and kind to yourself. Set small goals, and increase them in small, sensible and gradual increments.
  • Don't think that you have to join a gym or spend a lot of money on equipment. Using your own body weight to do squats and planks is absolutely free.
  • Don't worry that this has to take a lot of time. Start with 5 minutes per session – something you could do easily while watching TV or taking a break from your desk – and work your way up to 15 or 20 minutes per session.
  • Do track your progress in a notebook or phone app, and acknowledge your successes.

Finally, the ADA, ACSM and I strongly recommend that you invest in professional training to learn the types of exercises that suit your body best, and how to do them safely. Studies have shown that the effects on blood sugar control are best when people receive coaching from qualified trainers.

Good luck, and good health to you!