Scandinavian Journal of Primary Health Care

ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20

Walking for exercise ? immediate effect on blood

glucose levels in type 2 diabetes

Tomas Fritz, Urban Rosenqvist

To cite this article: Tomas Fritz, Urban Rosenqvist (2001) Walking for exercise ? immediate effect
on blood glucose levels in type 2 diabetes, Scandinavian Journal of Primary Health Care, 19:1,
31-33, DOI: 10.1080/pri.19.1.31.33

To link to this article: https://doi.org/10.1080/pri.19.1.31.33

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Walking for exercise – immediate effect on blood
glucose levels in type 2 diabetes
Tomas Fritz1 and Urban Rosenqvist 2
1
Primary Health Care Centre, Krokom, and 1,2
Department of Public Health and Caring Sciences, University of
Uppsala, Uppsala, Sweden.
Scand J Prim Health Care 2001;19:31–33. ISSN 0281-3432
ObjectiØe – To determine the immediate effect of walking on blood
glucose levels in patients with type 2 diabetes.
Design – Participating patients walked for half an hour on one
occasion and on another day they remained physically inactive for half
an hour. Blood glucose was measured before and after walking and
resting.
Setting – Krokom in the north of Sweden.
Patients – Thirty-nine persons with type 2 diabetes, aged 63 (SD 8.5).
Main outcome measures – Difference of blood glucose levels before
and after walking and resting respectively.
Physical exercise is regarded as a corner-stone in the
management of type 2 diabetes. Attempts to make
diabetes patients participate in regular exercise activ-
ities have been disappointing, with high drop-out
rates, and the exclusion of persons with complicating
cardiovascular disease (1,2). A low-intensity training
programme might therefore be more attractive.
The Swedish health survey shows that diabetes
patients exercise less than the population as a whole
(3). Thus, 17.2% of people with diabetes aged 16– 64
years and 36.8% aged 65 or more years abstain from
exercise. Corresponding proportions for the entire
Swedish population are 11.3% and 25.7% in the
same age groups. Various barriers to regular exercise
have been described, such as health problems (e.g.
orthopaedic or cardiovascular), lack of time or en-
ergy, no exercise partner, no support in family, ex-
pense and being unaccustomed to taking exercise
(4,5).
Current recommendations from the United States’
Centers for Disease Control and Prevention recog-
nise the health beneŽ ts of moderate-intensity exercise
for all citizens. An active lifestyle does not require
vigorous exercise programmes. Instead, small
changes that increase daily physical activity are be-
lieved to enable individuals to reduce the risk of
chronic disease and may enhance their quality of life
(6). Walking for half an hour Ž ts well with these
recommendations.
The aim of this pilot study was to determine the
immediate effect of walking on blood glucose levels
in patients with type 2 diabetes.
ORIGINAL PAPER
Results – Post-walk glycaemic levels were reduced by 2.2 mmol/ l
(SD 1.5). No signiŽ cant reduction could be observed after a period of
physical rest.
Conclusion – Walking can be safely employed in groups or individu-
ally as an introduction to low-intensity exercise and as a demonstra-
tion of its blood glucose lowering effect in type 2 diabetes.
Key words: blood glucose, exercise, health education, low intensity
training, patient education.
Tomas Fritz, Fältjägargränd 1A, SE-831 30 OÈ stersund, Sweden.
E-mail: tomas.fritz@jll.se
MATERIAL AND METHODS
The patients participated in one of two health-promot-
ing activities offered by the primary care centre in
Krokom, a community in the north of Sweden. Those
activities comprised group education for persons with
type 2 diabetes. The patients were originally recruited
by mail or personal invitation as they visited the
diabetes nurse or family physician. They were not
therefore randomly selected and could be considered
to be ‘‘motivated patients’’. All 39 participants of those
educational groups consented to incorporate walking
into their activities and to having four blood samples
drawn by capillary Ž nger prick technique for blood
glucose measurement. They were informed that data
from their records would be compiled and they con-
sented to this. Clinical baseline data of the 39 partic-
ipants are given in Table I.
Patients met at the primary health care centre for
half an hour’s walk on one occasion and on another
day for half an hour’s rest in a seated position. The two
test situations were performed in the afternoon. The
participants were asked not to eat 11:2 – 2 h prior to
arriving, but we did not check the exact timing or
composition of their meals. The walking route was 2.6
km along roads with no gradients. A nurse measured
capillary whole-blood glucose levels before and imme-
diately after walking and resting using a Hemo Cue
photometer (7).
RESULTS
The mean pre-walk blood glucose level was 10.5
mmol:l (SD 4.0) and the mean difference after walk-
Scand J Prim Health Care 2001; 19
32 T. Fritz, U. Rosenq×ist

Table I. Participants at the outset of the study, mean (SD).

Treatment Diet Oral Insulin All

Sex (F:M) 7:7 12:7 4:2 23:16

Age (years) 60 (10.3) 64 (6.5) 64 (8.9) 63 (8.5)
BMI kg:m2 32 (3.4) 29 (4.1) 26 (5.3) 30 (4.4)
HbA1c (%) 6.5 (0.9) 7.3 (1.4) 7.7 (1.5) 7.1 (1.3)
Diabetes duration (years) 3.4 (2.9) 7.6 (5.3) 7.5 (3.3) 6.1 (4.6)

Table II. Blood glucose (mmol:l) reactions to 30 minutes’ walk and 30 minutes’ rest as a function of initial blood glucose levels,
age, sex, treatment, BMI, and HbA1c, mean (SD).

Difference after rest n Difference after walk n

Initial B -glucose concentration

B8 0.01 (0.7) 14 ¼1.4 (1.0) 15
]8511 ¼0.4 (1.1) 12 ¼2.9 (1.2) 10
\11 ¼1.0 (2.4) 13 ¼2.6 (1.9) 14
Sex
Female ¼0.5 (1.7) 23 ¼2.6 (1.4) 23
Male ¼0.3 (1.3) 16 ¼1.7 (1.6) 16
Age (years)
B60 ¼0.7 (2.0) 16 ¼2.3 (1.8) 16
]60570 ¼0.1 (1.2) 16 ¼2.2 (1.4) 16
\70 ¼0.5 (1.3) 7 ¼2.1 (1.4) 7
Treatment
Diet ¼0.3 (1.3) 14 ¼1.8 (1.1) 14
Oral ¼0.4 (1.8) 19 ¼2.5 (1.8) 19
Insulin ¼1.1 (1.3) 6 ¼2.4 (1.4) 6
BMI (kg :m 2)
B27 ¼0.7 (1.6) 10 ¼2.6 (2.1) 10
]27530 ¼0.3 (1.0) 14 ¼2.3 (1.6) 14
\30 ¼0.4 (2.1) 14 ¼1.9 (1.0) 14
HbA1c (%)
B6.5 ¼0.4 (1.1) 15 ¼2.3 (1.5) 15
]6.557.5 ¼0.3 (1.4) 10 ¼1.7 (0.6) 10
\7.5 ¼0.6 (2.1) 14 ¼2.5 (1.9) 14

ing was ¼ 2.2 mmol:l (SD 1.5). The corresponding
Ž gures in the resting state were 10.9 mmol:l (SD 4.4)
and ¼ 0.4 mmol:l (SD 1.6). The difference between
post-rest and post-walk decline was statistically sig-
niŽ cant when tested by paired t-test (p B 0.001).
The magnitude of post-walk:post-rest blood glu-
cose decline had no relation to initial blood glucose
levels, patients’ sex, age, diabetes treatment, BMI or
HbA1c. However, there was a tendency towards
greater decline with higher pre-walk blood glucose
levels (Table II).
DISCUSSION
Regular intensive exercise in diabetes care is known
to induce an immediate lowering of blood glucose
levels, increased insulin sensitivity, and a decline of
glycated haemoglobin (HbA1c) (8). The results from
this study show that low-intensity exercise was sufŽ -
cient to produce a signiŽ cant acute reduction of
blood glucose levels in elderly type 2 diabetes pa-
tients. No adverse effects were observed.
Our results suggest that walking in small groups
can constitute a safe strategy for introducing low-in-
tensity exercise training in the treatment of type 2
diabetes. This allows for a more common use of this
preventive measure in this group of patients.
The study also demonstrates that it is advanta-
.
geous to start at an intensity level that most persons
of all ages can manage. Many exercise projects in-
volving diabetes patients have failed in making par-
ticipants continue with regular strenuous training.
The reason might be that high-intensity exercise regi-
mens are not feasible or attractive to most type 2
diabetes patients, 50 years or older, who may also
suffer from cardiovascular or orthopaedic ailments.
Our study has demonstrated the feasibility of low-
intensity exercise training in patients with type 2

Scand J Prim Health Care 2001; 19


diabetes, but further studies will be needed to docu-
ment any long-term beneŽ cial effects. Demonstrat-
ing the immediate effects on blood glucose in
connection with a bout of low-intensity exercise can
be useful in patient education and may help dia-
betes patients acquire a more physically active way
of life. This might contribute in preventing or re-
ducing long-term complications of type 2 diabetes.
In the short run, the 30 min walk can be used to
demonstrate that diabetes patients can induce low-
ered glucose levels and get one more handle on
their disease.
ACKNOWLEDGEMENTS
We thank nurses Ulla-Greta Olofsson, Rut Malm-
rot, Marianne Torberntsson, Ann-Katrin Kvarnlöv
and Inger Klüfth for their assistance. The study
was supported by a grant from the Swedish Council
for Social Research 97-0077: 1BC, Mid-Sweden
University, and the County Council of Jämtland.
Walking for exercise 33
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