Diabetes rarely occurs alone. In addition to elevated blood glucose, patients with diabetes often present with comorbidities such as hypertension and dyslipidemia.
If diabetes and its comorbidities are not controlled over the long term, a variety of other complications may develop, including diabetic peripheral neuropathy, diabetic nephropathy, diabetic peripheral vascular disease, diabetic foot ulcers, diabetic eye disease, and diabetic cardiovascular disease.Exercise is one of the important approaches in diabetes management. When diabetes is complicated by different comorbidities or complications, exercise prescriptions should be tailored accordingly.
Diabetes with Hypertension
For patients with both diabetes and hypertension, daily exercise should focus on relaxing aerobic activities, with the type and intensity chosen based on the hypertension grade.
Grade 1 hypertension (diastolic 90–99 mmHg, systolic 140–159 mmHg):
Rhythmic, moderate‑intensity exercise focusing on the lower extremities is recommended.
Grade 2 hypertension (diastolic 100–109 mmHg, systolic 160–179 mmHg) and Grade 3 hypertension (diastolic ≥110 mmHg, systolic ≥180 mmHg):
Pharmacological treatment should be prioritized. Low‑to‑moderate intensity exercise can be added only after blood pressure is stabilized.Diabetes with Dyslipidemia
For patients with diabetes and dyslipidemia, exercise plans are formulated based on levels of triglycerides, total cholesterol, LDL‑C, and HDL‑C.First, dietary structure should be properly adjusted, followed by active exercise. Exercise is particularly effective for patients with hypertriglyceridemia and low HDL‑C.
Low‑intensity aerobic exercise (50%–60% of maximum heart rate) is recommended, with sessions lasting more than 40 minutes to facilitate triglyceride consumption.
A structured session may include:
5–10 minutes of warm‑up to raise heart rate and regulate breathing;
20–30 minutes of main exercise at about 70% of maximum heart rate;
5–10 minutes of cool‑down.Diabetic Peripheral Neuropathy
The exercise principles for patients with diabetic peripheral neuropathy are moderate training and consistency.
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 a moderate intensity.Diabetic Nephropathy
Exercise plans for diabetic nephropathy are determined by the disease stage:
Stages I–II:Exercise intensity should be slightly lower than for general diabetic patients, around 60% of maximum heart rate.Options include jogging, dancing, cycling, and table tennis.Exercise until mild fatigue is felt.
Stage III:Low‑intensity, gentle exercise such as walking and qigong is advised.Duration and frequency should be limited.Exercise within tolerance, avoiding overexertion.Stop if fatigue or lower‑extremity edema occurs after exercise.
Stages IV–V:Exercise should be avoided.Priority is bed rest.Imagery exercise therapy may be considered.
Dialysis stage:With dialysis support, a similar exercise plan to general diabetic patients can be used.Start with ~30 minutes per session, 2–3 times per week, then gradually increase duration and frequency, adjusting based on tolerance.Muscle soreness or persistent fatigue the next day indicates excessive exercise, requiring adjustment.