Diabetes and exercise in the elderly.

Abstract

Type 2 diabetes mellitus is highly prevalent among the elderly. Age-associated changes in body composition, obesity and sedentary behavior are some of the main factors responsible for the increased prevalence of diabetes in this population. Elderly patients experience important and specific issues, including the association of comorbidities and geriatric syndromes, use of many medications, the presence of dependencies and frailty. Physical activity has been shown to be as effective for the treatment of diabetes in the elderly as in younger patients, so that its practice must be strongly encouraged. Resistive activities are preferable for the frail and vulnerable diabetic elderly. Aerobic activities should be prescribed whenever possible, and the association of both modalities is the best choice. Moderate- to high-intensity exercises are more effective for glycemic control and, unlike previously thought, are generally safe for the elderly population. The frequency of exercising should be at least 3 days/week for aerobic and 2 days/week for resistance activities. Balance exercises may be beneficial in special situations. In the elderly patient, special care must be taken for: the presence of contraindications for the practice of each exercise modality; the interactions and limitations imposed by medications, chronic comorbidities and geriatric syndromes; the higher possibility of developing hypoglycemia, especially if insulin is used for treatment, and the prevention of orthostatic hypotension that may be worsened by dehydration. The prescription of exercises tailored for each patient's preferences and limitations is highly effective not only for glycemic control, but also for improving independence, self-esteem and quality of life.