Interview With Dr. Sheri Colberg from ADA: "Get active and do things you enjoy"

Welcome to our insightful interview with Sheri Colberg, PhD, an expert in exercise and diabetes. She is an author of the 2016 American Diabetes Association Exercise Position Statement. This interview explores the crucial intersection between exercise and diabetes management.

It is a goldmine of practical insights for anyone seeking to learn how physical activity affects blood sugar levels and overall health. Whether it is regular exercise or the ADA’s unique 5 S approach, which was outlined in the ADA’s Standards of Care in Diabetes of 2024, Dr. Colberg’s expertise illuminates how small and meaningful changes can have a significant impact on one’s health.

Explore her valuable tips and advice for living a healthier, more active life with diabetes.

In what ways do the ADA’s exercise recommendations for people with diabetes differ from the CDC’s general guidelines for adults?

The guidelines for adults with and without diabetes are very similar. The main difference is that the Physical Activity Guidelines for Americans allow for adults to be “weekend warriors,” that is, getting all their recommended activities for the week concentrated into very active weekends. For adults with diabetes, it is important to not let more than two days go by without activity in order to keep insulin sensitivity heightened. So, the ADA recommends spreading your activities out over the course of the week.

How do the 5 S’s (Sleep, Step, Sit/Break, Sweat, Strengthen) specifically address the challenges faced by individuals with type 2 diabetes?

We usually recommend that individuals with type 2 diabetes try to manage their blood glucose levels more effectively by being active in various ways and getting adequate sleep (a lack of which can also raise blood glucose).

Taking more daily steps helps keep glucose levels in check, along with taking “activity breaks” during sedentary times—ideally being active doing something (even standing) every 30 minutes during the day for a few minutes at a time. It all adds up.

Sweating is usually the result of raising your heart rate through a moderate to vigorous activity, such as brisk walking, and the strengthening part is doing any type of resistance or weight training to retain and/or gain your muscle mass, which is where most carbohydrate that people eat is stored in the body.

Could you elaborate on the correlation between consistent sleep patterns and diabetes management? How does disrupted sleep affect blood glucose levels?

Broken or disrupted and inadequate sleep increase the body’s physical stress, which in turn leads to higher levels of the hormone cortisol. That hormone increases insulin resistance and potentially leads to higher blood glucose levels. Most physical and mental stressors increase blood glucose for that reason. If your sleep is being interrupted by sleep apnea, it is important to know that and treat it appropriately to help lower blood glucose.

An increase of only 500 steps a day can lower cardiovascular risks. Can you provide more insights into how small increments in physical activity make a significant difference for people with diabetes?

In particular, individuals who are sedentary or minimally active gain the most from adding even small amounts of physical movement to their days. Breaking up sedentary time with short “activity breaks” lowers blood glucose levels, which lowers cardiovascular risk. Focusing on simply taking 500 more steps a day or making sure to get in those frequent activity breaks has far-reaching benefits to your metabolism and overall health.

The recommendation of 150 minutes of moderate-intensity exercise per week is common. What makes this particularly effective for people with diabetes, and are there specific types of exercises that are more beneficial?

Many studies have looked at varying amounts of weekly activity, and larger “volumes” of physical activity have generally been shown to be more beneficial. In fact, the current recommendation is for 150 to 300 minutes.

For anyone with diabetes, this is best spread out throughout the week and can be done as many shorter sessions during each day as well (such as short walks after meals). Any activity is good, so all activities are encouraged. Just pick ones that you can make sure to work into your daily routine and that you’re likely to continue doing over time.

The most common activity done by adults with type 2 diabetes is walking. Varying your types during the week can give you a greater training effect, but none are effective if you don’t end up doing them. (Hint: pick ones you enjoy.)

How does resistance training improve insulin sensitivity and glucose levels, and what beginner-friendly resistance exercises are recommended for people with diabetes?

Any excess glucose from the foods that you eat or released by your liver needs to have somewhere to go into storage to get it out of our bloodstream.

Skeletal muscle (and to a lesser extent the liver) is the main storage depot for excess glucose. It helps you manage your blood glucose to have as much muscle mass as possible, which is where resistance training comes in. Your body is more insulin sensitive when you have a larger glucose “storage tank” and when that tank is always partway empty and ready to store more glucose. Some easy resistance exercises are ones you can do using your own body weight as resistance, such as wall sits, wall push-ups, lunges, and planks.

Are there any potential risks or considerations that people with diabetes should be aware of when engaging in physical activities recommended by the ADA?

It is recommended that you have a checkup by your doctor or healthcare provider at least once a year, and during that visit be assessed for any potential diabetes-related health issues that could be made worse by physical activity.

For instance, if you have lost some feeling in your feet, you’ll need to be more careful about wearing proper footwear for activity and checking your feet daily for signs of redness or trauma to avoid getting ulcers or worse.

Many people may also have some underlying heart disease that they may not be aware of that would be important to diagnose and keep in mind if someone plans on doing more strenuous physical activity.

Given the diversity in individual health conditions, how can people with diabetes personalize the 5 S’s to best suit their needs?

All you need to do is to address any barriers or obstacles that you have related to doing any of the 5 S’s and find ways to overcome them. For instance, if you have sleep apnea, talk to your doctor about possible treatment options.

If your mobility is limited, discover the various ways of doing seated activities (aerobic and resistance). If you have heart disease, most activities are still recommended and appropriate for you, but have a checkup first to establish any limits or precautions that you may need to take. Most of all, find activities that are safe for you that you enjoy and make sure to do them regularly.

For those looking to understand more about exercise and its relationship with diabetes management, what resources or programs does the ADA offer, and how can they access them?

Many physical activity resources are available on the ADA’s website. The ADA also published a position statement on exercise/physical activity in people with diabetes in 2016 that is available online.

Dr. Sheri Colberg has been a professional volunteer for the ADA for decades, and wrote a book about being active for the ADA, Diabetes & Keeping Fit for Dummies.