Exercise and diabetes: type 2, type 1 and prediabetes

Yes, people with diabetes can and should exercise. Regular activity helps your body use insulin better, lowers HbA1c, and helps some people with type 2 diabetes reach remission [1]. In people at high risk, 150 minutes a week plus modest weight loss cut new cases of type 2 diabetes by 58% in the landmark Diabetes Prevention Program [6]. The catch is doing it safely, especially if you use insulin.

Can diabetics exercise?

Almost everyone with diabetes can be active. For activity no harder than brisk walking, the American Diabetes Association says medical clearance is "generally unnecessary" for people without symptoms [8]; if you have foot, eye or kidney problems, check with your team first [1].

Diabetes UK says regular activity helps your body use insulin better (so insulin users may need less), keeps blood sugar in range and improves HbA1c, helps some people with type 2 into remission, lowers blood pressure and cholesterol, and helps you lose weight and keep it off [1]. Walking "is often a good place to start"; bowls, dancing, walking football, swimming, cycling, chair-based exercise and yoga all count [1].

Can you exercise diabetes away?

It depends which diabetes you mean. Type 1 is an autoimmune condition: exercise improves how you manage it, but it cannot remove the need for insulin. For type 2, Diabetes UK says activity can "help some people with type 2 diabetes put it into remission", usually alongside weight loss and changes to what you eat [1].

Be realistic about exercise on its own. A meta-analysis of 47 trials (8,538 people) found structured exercise lowered HbA1c by an average of 0.67%, while "physical activity advice alone" made no difference [9]: a programme you follow beats being told to move more.

One long-term caution. In Look AHEAD, 5,145 overweight adults with type 2 diabetes followed an intensive weight-loss lifestyle programme for a median of 9.6 years; they lost more weight (6.0% versus 3.5%), but heart attacks, strokes and cardiovascular deaths were not reduced [7]. Exercise is not a substitute for your medicines and reviews.

What's the best exercise for diabetes type 2?

A mix of aerobic and strength work, done most weeks, for a long time. The ADA recommends 150 minutes or more of moderate-to-vigorous activity a week, "spread over at least 3 days/week, with no more than 2 consecutive days without activity", plus resistance exercise 2–3 times a week on non-consecutive days [8].

That matches the UK Chief Medical Officers' guidance for all adults: 150 minutes of moderate activity (or 75 vigorous) a week, strengthening on at least two days, and "any activity is better than none – and more is better still" [5]. The NHS version for type 2 diabetes: at least 2.5 hours across the week of walking or another activity that leaves you out of breath [3].

Dose matters. In the same meta-analysis, aerobic training alone lowered HbA1c by 0.73% and resistance training by 0.57%; programmes of more than 150 minutes a week produced a 0.89% reduction against 0.36% for 150 minutes or less [9]. The exercise you will keep doing is the best one.

Sitting less counts too: the ADA advises breaking up prolonged sitting with light activity every 30 minutes [8].

Exercise and blood sugar: when to check, and avoiding hypos

Gentle activity where you do not get out of breath quickly, such as walking, swimming and cycling, tends to lower blood sugar. Short, fast, powerful efforts such as sprinting, punching and weightlifting tend to push it up [1].

If you use insulin or another medicine that lowers blood sugar, Diabetes UK's rules are clear [2]:

• check your blood sugar before and after activity
• do not exercise at 4 mmol/L or lower (3.5 mmol/L or lower on an insulin pump)
• if you are above target and unsure why, and you have been taught to, test for ketones first
• if you have had a severe hypo in the last 24 hours, do not do any physical activity
• keep checking for up to 24 hours afterwards, because the lowering effect continues
• treat a hypo as usual (glucose tablets or a sugary drink, then some starchy carbohydrate)

Exercise-related hypoglycaemia is common in type 1 diabetes and, to a lesser extent, in type 2 diabetes treated with insulin or sulfonylurea-type tablets [8]. If that is you, ask your team about adjusting insulin or carbohydrate around sessions [2]. On diet or metformin alone, the hypo rules matter far less; ask if you are unsure which group you are in.

Exercise with type 1 diabetes

Everything above applies, with more planning. An international consensus in The Lancet Diabetes & Endocrinology sets out glucose targets for safe exercise and how to adjust food and insulin to avoid swings either way [10]; your team can apply it to your regimen, pump or sensor.

Useful patterns from the ADA statement [8]:

• steady aerobic exercise after a meal, with your usual mealtime insulin, tends to lower glucose
• very intense, brief efforts (10 minutes or less) may hold glucose steady or raise it
• mixed activities such as interval training or team sports give more stable glucose than purely aerobic sessions
• a short sprint, or doing weights before cardio, can reduce the risk of a low

Carry fast-acting carbohydrate and expect some trial and error; a clinical exercise physiologist experienced in type 1 can shorten that learning curve.

Should you exercise after eating?

For blood sugar, yes. Even brief bouts of light activity of 3–15 minutes reduce the post-meal glucose rise in prediabetes, type 1 and type 2, "most prominently after meals" [8]. Diabetes UK suggests exactly this as a realistic first target: a 10-minute walk after a meal [1]. If you use insulin, steady aerobic exercise with mealtime insulin on board makes a fall more likely [8], so discuss timing with your team.

Exercise for prediabetes

This is where the evidence is strongest. The Diabetes Prevention Program randomised 3,234 people with raised blood sugar. Over an average of 2.8 years, a lifestyle programme aiming for at least 150 minutes of activity a week and 7% weight loss cut new cases of type 2 diabetes by 58% compared with placebo; metformin cut them by 31% [6]. The ADA gives that prescription its highest evidence grade [8].

In England this is a free NHS service. The Healthier You NHS Diabetes Prevention Programme is a nine-month lifestyle programme, face to face or digital, that "cuts the risk of developing type 2 diabetes by more than a third" for people who complete it; ask your GP practice or use the Know Your Risk tool [4].

Who should you see?

Clinical Exercise Physiologists (CEPs) are the most specialised exercise professionals for diabetes. They hold a one-year master's degree and, if the course is AHCS-accredited, join the Academy for Healthcare Science's voluntary register, which is PSA-accredited [11]. NHS Health Careers lists "metabolic" care, including obesity and diabetes (gestational diabetes too), among the services they work in [11], and their training covers exercise testing and assessment as well as designing and evaluating programmes for chronic and complex conditions [12]. They are the right call for type 1, insulin users, complications such as neuropathy or retinopathy, or heart or kidney disease alongside diabetes.

Level 4 Obesity, Diabetes and Metabolic Syndrome instructors sit underneath CEPs. They hold an Ofqual-regulated Level 4 qualification (or a CIMSPA-endorsed equivalent) built on Level 3 exercise referral; NICE guidance reserves specialist populations for "a specialist instructor (trained to level 4)". They deliver supervised exercise to clinically referred, stable clients, often in leisure centres and NHS-commissioned schemes, at lower cost. They do not diagnose and are not regulated clinicians.

Physiotherapists (HCPC-regulated) are the right professional for injury, pain and hands-on treatment; their skills overlap with CEPs and the two complement each other.

	Clinical Exercise Physiologist	Level 4 Obesity, Diabetes & Metabolic Syndrome instructor	Physiotherapist
Training	AHCS-accredited MSc	Level 4 certificate on top of Level 3 exercise referral	HCPC-registered degree
Register	AHCS voluntary register (PSA-accredited)	Qualification, not a healthcare register	HCPC statutory, protected title
Best for	Type 1, insulin users, complications, several conditions at once	Stable, assessed type 2 or prediabetes wanting supervised sessions	Injury, pain, diagnosis
Exercise testing	Yes, part of core scope	Ask about their assessment approach	Varies by specialism

Request a match with a verified clinical exercise physiologist through The Health Nav, or read about how the tiers differ and what a clinical exercise physiologist is.

When to be cautious / talk to your doctor first

Speak to your diabetes team before starting or stepping up exercise if any of these apply:

• Feet or nerve damage. With peripheral neuropathy you can lose feeling in your feet, and untreated problems "can lead to foot ulcers, infections and, at worst, amputations" [1]. The ADA says activity with neuropathy "necessitates proper foot care": check your feet, keep them dry, and wear cushioned footwear with polyester or blend socks rather than pure cotton [8]. Report any new cut or blister to your GP or foot protection team straight away [1].
• Eye disease. With severe non-proliferative or unstable proliferative retinopathy, avoid vigorous exercise, jumping, jarring, head-down positions and breath-holding [8].
• Kidney disease. Discuss with your team first [1].
• A severe hypo in the last 24 hours, or high sugars with ketones. Do not exercise until it is sorted [2].
• Chest pain, unusual breathlessness or dizziness during activity. Stop and get medical advice.
• Pregnancy. Gestational diabetes has its own guidance; talk to your midwife or diabetes team [11].

Getting matched with a specialist

Ask The Health Nav for a clinical exercise physiologist and we match you to one. Level 4 diabetes instructors are usually reached through your GP, an exercise referral scheme or your local leisure centre. Related guides: cardiac rehab, pulmonary rehab and exercise referral schemes.

Request a match with a verified clinical exercise physiologist through The Health Nav.

This article is general information and does not replace advice from your own healthcare team.

References

1. Diabetes UK. Exercise for diabetes | Type 1 and type 2. https://www.diabetes.org.uk/living-with-diabetes/exercise (accessed 15 Sep 2026).
2. Diabetes UK. Does exercise lower blood sugar levels? https://www.diabetes.org.uk/living-with-diabetes/exercise/blood-sugar-levels (accessed 15 Sep 2026).
3. NHS. Treatment for type 2 diabetes. https://www.nhs.uk/conditions/type-2-diabetes/treatment/ (accessed 15 Sep 2026).
4. NHS England. NHS Diabetes Prevention Programme (NHS DPP). https://www.england.nhs.uk/diabetes/diabetes-prevention/ (accessed 15 Sep 2026).
5. UK Chief Medical Officers. Physical activity guidelines: UK Chief Medical Officers' report. Department of Health and Social Care, 2019 (updated 2026). https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report (accessed 15 Sep 2026).
6. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. https://doi.org/10.1056/NEJMoa012512
7. Look AHEAD Research Group; Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. https://doi.org/10.1056/NEJMoa1212914
8. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. https://doi.org/10.2337/dc16-1728
9. Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. 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(17):1790-1799. https://doi.org/10.1001/jama.2011.576
10. Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5(5):377-390. https://doi.org/10.1016/S2213-8587(17)30014-1
11. NHS Health Careers. Clinical exercise physiologist. https://www.healthcareers.nhs.uk/explore-roles/healthcare-science/roles-healthcare-science/physiological-sciences/clinical-exercise-physiologist (accessed 15 Sep 2026).
12. Clinical Exercise Physiology UK. What is a CEP? https://www.clinicalexercisephysiology.org.uk/what-is-a-cep (accessed 15 Sep 2026).