Diabetes seldom occurs alone. Besides elevated blood glucose, patients with diabetes often have comorbidities such as hypertension and dyslipidemia. If diabetes and its comorbidities are poorly controlled in the long term, various complications may develop, including diabetic peripheral neuropathy, diabetic kidney disease, diabetic peripheral vascular disease, diabetic foot ulcers, diabetic eye disease, and diabetic cardiovascular disease. Exercise is an important component of diabetes management. When diabetes is complicated by different comorbidities or complications, exercise prescriptions should be individualized accordingly.
Diabetes with Hypertension
For patients with diabetes and hypertension, exercise should focus on relaxing aerobic activities, with type and intensity adjusted according to hypertension stage:
Stage 1 hypertension (DBP 90–99 mmHg, SBP 140–159 mmHg): rhythmic, moderate-intensity exercise, mainly involving the lower limbs.
Stage 2 hypertension (DBP 100–109 mmHg, SBP 160–179 mmHg) and Stage 3 hypertension (DBP ≥ 110 mmHg, SBP ≥ 180 mmHg): prioritize pharmacological treatment. Low-to-moderate intensity exercise may be added only after blood pressure is stabilized.Diabetes with Dyslipidemia
For patients with diabetes and dyslipidemia:
First, optimize dietary structure based on levels of triglyceride, total cholesterol, LDL-C and HDL-C.
Then implement structured exercise, which is especially effective for hypertriglyceridemia and low HDL-C.Prescription:
Low-intensity aerobic exercise (50–60% of maximum heart rate).
Duration: ≥40 minutes per session to promote triglyceride breakdown.
Structure:
Warm-up: 5–10 minutes to increase heart rate and adjust breathing.
Main phase: 20–30 minutes at ~70% maximum heart rate.
Cool-down: 5–10 minutes.Diabetic Peripheral Neuropathy
Principle: moderate, consistent exercise.
If motor dysfunction is mild: daily or every-other-day aerobic exercise such as brisk walking, jogging, cycling or swimming.
Walking: 30–60 minutes, once daily.
Jogging: 20 minutes, once daily, at moderate intensity.Diabetic Kidney Disease (DKD)
Exercise should be prescribed based on DKD stage:
Stage I–II DKDSlightly lower intensity than general diabetic patients (~60% maximum heart rate).Options: jogging, dancing, cycling, table tennis.Stop when feeling mildly fatigued.
Stage III DKDLow-intensity, gentle exercise: walking, qigong.Short duration and low frequency.Stop if fatigue or lower-extremity edema occurs after exercise.
Stage IV–V DKDAvoid physical exercise; focus on bed rest.Imagery exercise therapy may be considered.
Dialysis stageExercise prescription similar to general diabetic patients.Start with ~30 minutes per session, 2–3 times weekly, then gradually increase duration and frequency.If muscle soreness or fatigue persists into the next day, reduce intensity.