Exercise prescription in patients with type 2 diabetes and coronary heart disease: could less be more?

Physical activity is a powerful nonpharmacological intervention that improves glucose metabolism and other cardiovascular risk factors in patients with type 2 diabetes; advice about physical activity should therefore be included in basic therapeutic recommendations wherever possible [1]. It is, of course, well appreciated that our patients do not always adhere to the lifestyle advice. Sometimes they challenge us about our recommendations. For example, in earlier years, one of us (S.J.) was often puzzled when people with diabetes reported that they experienced higher blood glucose levels after their strenuous 30-min exercise bout. This challenged the advice to engage in regular exercise as the patients felt they had experienced the opposite of the proposed benefit: exercise acutely exacerbated rather than alleviated their hyperglycemia. Such discrepancies between theory and practice may be difficult to satisfactorily explain in the context of a brief clinical consultation and can potentially undermine the physician–patient relationship.