Diabetes, Sport und Bewegung

Aktualisierungshinweis

Die DDG-Praxisempfehlungen werden regelmäßig zur zweiten Jahreshälfte aktualisiert. Bitte stellen Sie sicher, dass Sie jeweils die neueste Version lesen und zitieren.

Bewegung ist für alle Formen des Diabetes mellitus eine der wichtigsten Maßnahmen, die Gesundheit zu erhalten. Durch Sport und Bewegung werden Anpassungs- und Reparaturmechanismen in verschiedenen Organsystemen und Zellen wie der Muskulatur, den Nerven, Gefäßen, im Immunsystem oder Gehirn ausgelöst, die helfen können, Krankheiten abzuwehren [1] [2] [3] [4].

Es muss dabei keine körperliche Höchstleistung erbracht werden. Belastungen nach dem Motto „Laufen ohne Schnaufen“ bringen bereits gute Gesundheitsergebnisse. Neben einer Bewegung von einer halben Stunde pro Tag möglichst zusätzlich zur Alltagstätigkeit wird als effektiver Ansatz auch die Ausweitung der Chancen für Bewegung im Rahmen der Alltagstätigkeiten empfohlen. Nach den Empfehlungen der American Diabetes Association (ADA) aus dem Jahr 2022 sollen sich Erwachsene mit Diabetes 150 Minuten und mehr in moderater Intensität pro Woche bewegen. Jüngere und körperlich fitte Patienten können sich auch intensiver belasten (Mindestempfehlung: 75 Minuten/Woche). Die Bewegung sollte verteilt sein auf mindestens 3 Tage, wobei nicht mehr als 2 bewegungsarme Tage hintereinander liegen sollten. Außerdem wird empfohlen, 2- bis 3-mal pro Woche Krafttraining durchzuführen, aber nicht an aufeinanderfolgenden Tagen. Sitzphasen sollen alle 30 Minuten unterbrochen werden. Für Ältere wird 2- bis 3-mal pro Woche zusätzlich Flexibilitäts- und Gleichgewichtstraining empfohlen. Auch alternative Sportarten wie Yoga und Tai-Chi können geeignet sein. Zur Adipositasbehandlung sind Bewegungsumfänge von 200 bis 300 Minuten pro Woche und ein Energiedefizit von ca. 500 bis 750 kcal/Tag anzustreben [5].

Diese Praxisleitlinie soll die pathophysiologischen Hintergründe und therapeutischen Optionen zur Bedeutung von körperlicher Aktivität in der Therapie des Diabetes mellitus in Grundzügen umreißen und praktische Empfehlungen für die Umsetzung bei Typ-1- und Typ-2-Patienten geben.

^* Geteilte Senior-Autorenschaft.

Publication History

Article published online:
18 October 2022

• Literatur

• 1 Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015; 25 (Suppl. 03) 1-72
• 2 Kirchner H, Osler ME, Krook A. et al. Epigenetic flexibility in metabolic regulation: disease cause and prevention?. Trends Cell Biol 2013; 23: 203-209
• 3 Benatti FB, Pedersen BK. Exercise as an anti-inflammatory therapy for rheumatic diseases-myokine regulation. Nat Rev Rheumatol 2015; 11: 86-97
• 4 Fiuza-Luces C, Garatachea N, Berger NA. et al. Exercise is the real polypill. Physiology 2013; 28: 330-358
• 5 American Diabetes Association. Standards in medical care in diabetes 2022. Diabetes Care 2022; 40: 10-38
• 6 Stanford KI, Goodyear LJ. Exercise and type 2 diabetes: molecular mechanisms regulating glucose uptake in skeletal muscle. Adv Physiol Educ 2014; 38: 308-314
• 7 Herbst A, Kordonouri O, Schwab KO. et al. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23251 patients. Diabetes Care 2007; 30: 2098-2100
• 8 Tonoli C, Heyman E, Roelands B. et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med 2012; 42: 1059-1080
• 9 Riddell MC, Gallen IW, Smart CE. et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-390
• 10 Moser O, Riddell MC, Eckstein ML. et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63: 2501-2520
• 11 Roberts AJ, Taplin CE. Exercise in Youth with Type 1 Diabetes. Curr Pediatr Rev 2015; 11: 120-125
• 12 Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes. Pediatr Diabetes 2015; 16: 242-255
• 13 Bally L, Laimer M, Stettler C. Exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus. Curr Opin Clin Nutr Metab Care 2015; 18: 428-433
• 14 Garcia-Garcia F, Kumareswaran K, Hovorka R. et al. Quantifying the acute changes in glucose with exercise in type 1 diabetes: a systematic review and meta-analysis. Sports Med 2015; 45: 587-599
• 15 Riddell MC, Scott SN, Fournier PA. et al. The competitive athlete with type 1 diabetes. Diabetologia 2020; 63: 1475-1490
• 16 Toghi-Eshghi SR, Yardley JE. Morning (fasting) vs afternoon resistance exercise in individuals with type 1 diabetes: a randomized crossover study. J Clin Endocrinol Metab 2019; 104: 5217-5224
• 17 Aronson R, Brown RE, Li A. et al. Optimal insulin correction factor in post-high-intensity exercise hyperglycemia in adults with type 1 diabetes: the FIT study. Diabetes Care 2019; 42: 10-16
• 18 Lean ME, Leslie WS, Barnes AC. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster randomised trial. Lancet 2018; 391: 541-551
• 19 Lean MEJ, Leslie WS, Barnes AC. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2 year results of the DiRECT open-label, cluster randomised trial. Lancet Diabetes Endocrinol 2019; 7: 344-355
• 20 Rohling M, Herder C, Roden M. et al. Effects of Long-Term Exercise Interventions on Glycaemic Control in Type 1 and Type 2 Diabetes: a Systematic Review. Exp Clin Endocrinol Diabetes 2016; 124: 487-494
• 21 Umpierre D, Ribeiro PA, Kramer CK. et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011; 305: 1790-1799
• 22 Wing RR, Bolin P, Brancati FL. et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
• 23 Knowler WC, Fowler SE, Hamman RF. et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374: 1677-1686
• 24 Look AHEAD research group et al. Effect of a long-term behavioural weight loss intervention on nephropathy in overweight or obese adults with type 2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2014; 2: 801-809
• 25 Colberg SR, Laan R, Dassau E. et al. Physical activity and type 1 diabetes: time for a rewire?. J Diabetes Sci Technol 2015; 9: 609-618
• 26 Jayawardene DC, McAuley SA, Horsburgh JC. et al. Closed-loop insulin delivery for adults with type 1 diabetes undertaking high-intensity interval exercise versus moderate-intensity exercise: a randomized, crossover study. Diabetes Technol Ther 2017; 19: 340-348
• 27 Breton MD, Chernavvsky DR, Forlenza GP. et al. Closed-loop control during intense prolonged outdoor exercise in adolescents with type 1 diabetes: the artificial pancreas ski study. Diabetes Care 2017; 40: 1644-1650
• 28 Dovc K, Macedoni M, Bratina N. et al. Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomised controlled crossover trial. Diabetologia 2017; 60: 2157-2167
• 29 Ding S, Schumacher M. Sensor monitoring of physical activity to improve glucose management in diabetic patients: a review. Sensors 2016; 16: 589
• 30 Lunde P, Blakstad Nilsson B, Bergland A. et al. The effectiveness of smartphone apps for lifestyle improvement in noncommunicable diseases: systematic review and meta-analyses. J Med Internet Res 2018; 20: 1-12
• 31 Wu X, Guo X, Zhang Z. The efficacy of mobile phone apps for lifestyle modification in diabetes: systematic review and meta-analysis. JMIR mHealth uHealth 2019; 7: e12297
• 32 Yom-Tov E, Feraru G, Kozdoba M. et al. Encouraging physical activity in patients with diabetes: intervention using a reinforcement learning system. J Med Internet Res 2017; 19: e338
• 33 Jimenez G, Lum E, Car J. Examining diabetes management apps recommended from a Google search: content analysis. JMIR mHealth uHealth 2019; 7: e11848
• 34 Pais S, Parry D, Petrova K. et al. Acceptance of using an ecosystem of mobile apps for use in diabetes clinic for self-management of gestational diabetes mellitus. Stud Health Technol Inform 2017; 245: 188-192
• 35 Kordonouri O, Riddell MC. Use of apps for physical activity in type 1 diabetes: current status and requirements for future development. Ther Adv Endocrinol Metab 2019; 10: 1-7
• 36 Thomas JG, Bond DS, Raynor HA. et al. Comparison of smartphone-based behavioral obesity treatment with gold standard group treatment and control: a randomized trial. Obesity (Silver Spring) 2019; 27: 572-580
• 37 Schütte L. Digitale Selbsthilfe. Digitalisierungs- und Technologiereport Diabetes 2019. https://www.dut-report.de/wp-content/uploads/2019/01/Selbsthilfe_Schuette.pdf . Zugriff 26.05.2019
• 38 Staiano AE, Beyl RA, Guan W. et al. Home-based exergaming among children with overweight/obesity: a randomized clinical trial. Pediatr Obes 2018; 13: 724-733
• 39 Cooper AR, Tibbitts B, England C. et al. Potential of electric bicycles to improve the health of people with type 2 diabetes: a feasibility study. Diabet Med 2018; 35: 1279-1282
• 40 van der Berg JD, Stehouwer CD, Bosma H. et al. Associations of total amount and patterns of sedentary behaviour with type 2 diabetes and the metabolic syndrome: The Maastricht Study. Diabetologia 2016; 59: 709-718
• 41 Dunstan DW, Dogra S, Carter SE. et al. Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol 2021; 18: 637-648
• 42 Duvivier BM, Schaper NC, Hesselink MK. et al. Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes. Diabetologia 2017; 60: 490-498
• 43 Han HO, Lim J, Viskochil R. et al. Pilot study of impact of a pedal desk on postprandial responses in sedentary workers. Med Sci Sports Exerc 2018; 50: 2156-2163
• 44 Karstoft K, Winding K, Knudsen SH. et al. The effects of free-living interval- walking training on glycemic control, body composition, and physical fitness in type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 2013; 36: 228-236
• 45 Yang Z, Scott AC, Mao C. et al. Resistance exercise versus aerobic exercise for type 2 diabetes: a systematic review and meta-analysis. Sports Med 2014; 44: 487-499
• 46 van Buuren F, Horstkotte D, Mellwig KP. et al. Electrical myostimulation (EMS) improves glucose metabolism and oxygen uptake in type 2 diabetes mellitus patients – results from the EMS study. Diabetes Technol Ther 2015; 17: 413-419
• 47 Robinson CC, Barreto RP, Sbruzzi G. et al. The effects of whole body vibration in patients with type 2 diabetes: a systematic review and metaanalysis of randomized controlled trials. Braz J Phys Ther 2016; 20: 4-14
• 48 Kempf K, Martin S. Autonomous exercise game use improves metabolic control and quality of life in type 2 diabetes patients – a randomized controlled trial. BMC Endocr Disord 2013; 13: 57
• 49 Kemmler W, Weissenfels A, Willert S. et al Recommended contraindications for the use of non-medical WB-electromyostimulation. Dtsch Z Sportmed 2019; 11: 278-281
• 50 Baskerville R, Ricci-Cabello I, Roberts N. et al Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2017; 5: 612-620