Research proves that staying active may help lead to remission. Here's what you need to know to start sweating in the most effective way to stabilize your blood sugar.
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Credit: Getty Images / LeoPatrizi

Thought to be the result of the standard American diet (SAD) that's rich in refined carbs and shy in activity—about 23% of us rack up our recommended physical activity minutes—a whopping one in three American adults has prediabetes, according to the U.S. Department of Health and Human Services. This precursor to type 2 diabetes involves blood sugar that is elevated, but not to the level to be officially diagnosed as type 2.

Most prediabetes and type 2 diabetes interventions focus mostly on food, but mounting scientific evidence suggests that it's much more effective to give this condition a one-two punch with both diet and exercise. Read on for more about the latest research, plus what trainers suggest as the best exercises for those who have prediabetes.

Blood Sugar 101

Let's rewind a bit: Blood sugar, a.k.a. blood glucose, is the usable form of energy our body makes out of the food we eat. Foods higher in quick-burning carbs or added sugar, such as sugary candy and white pasta, triggers a larger spike in blood sugar than, say, blueberries or beans, which have fiber and nutrients to slow down their digestion. In a healthy body, the pancreas pumps out the amount of insulin needed to help to usher the blood sugar to cells so that they can use it as energy.

In those with type 1 diabetes, the body is genetically unable to produce insulin. And in those with type 2, the body's cells become unable to respond to that insulin, so the sugar accumulates in the blood. (Hence, why pre diabetics are often referred to as "insulin resistant." See more about the differences between type 1 and type 2 here.)

Over time, above-normal blood sugar can cause chronic inflammation, feelings of extreme thirst or hunger, frequent urination, blurred vision fatigue and more. Among those with prediabetes, however, there are often no symptoms at all.

So what is "normal" blood sugar? After giving a patient a fasting blood glucose test (usually taken at the start of the day when nothing has been eaten in at least 8 hours), doctors use the following criteria to make a diagnosis:

  • Normal: under 100 mg/dL
  • Prediabetes: 100 to 125 mg/dL
  • Diabetes: above 126 mg/dL

Why Exercise is Beneficial for Those With Prediabetes

With all this discussion of blood sugar spikes and how it's precipitated by what we eat, it makes sense that type 2 diabetes and prediabetes treatment programs often focus on nutrition. (Our prediabetes diet plan for beginners is a great place to start.)

"Hands down the most important thing is nutrition. Of what you can control, the food going into your body is more responsible for your blood sugar than your activity," explains Austin Johnson, a San Antonio, Texas-based NCSF certified personal trainer and the national personal training manager for Gold's Gym.

But just as with the prevention of other common diseases, such as heart disease, dementia and cancer, researchers are learning that a multifaceted approach is often best to reverse prediabetes.

That's because exercise does more than improve fitness, says a July 2017 meta-analysis of previous research in the Cleveland Clinic Journal of Medicine. Whether it's aerobic exercise or strength training, regular physical activity benefits the liver, pancreas, skeletal muscle, cholesterol levels, blood sugar levels, aids in weight loss, and beyond. Plus, the body is more sensitive to insulin (which is a positive thing for stable blood sugar levels) for up to 96 hours, or 4 days, after exercise.

Over the course of 5 years, a lifestyle intervention strategy that included goal setting, personalized diets with calorie recommendations, 180 minutes of physical activity per week, meal replacement and quarterly check-ups could even reverse prediabetes, according to a June 2020 study published in the journal BMJ Open Diabetes Research and Care.

Translation: Exercise is the helpful prediabetes prescription when used in conjunction with a diabetes-friendly eating pattern and healthy lifestyle.

"Exercising requires higher utilization of sugar in the bloodstream by cells in the body for energy, and since type 2 diabetes is a problem of elevated blood sugar, regular exercise addresses this issue directly. Exercise also seems to improve the insulin stimulated take up of sugar by the body's cells," Johnson says. "So, exercise has somewhat of a double whammy effect on helping diabetics control their blood sugar."

In addition, exercise can (although doesn't always) lead to weight loss, which can help reduce risk as being overweight is one common factor linked to type 2 diabetes.

"Physical activity can help a person go into remission for prediabetes. Research has shown that after 6 months of returning blood sugar levels to normal status, they are finally remitted from blood sugar levels being dangerously high," adds Ben Walker, certified personal trainer with Anywhere Fitness in Dublin, Ireland. Research has shown that when insulin levels are elevated, we might gain weight more easily. Not only is weight gain a risk factor for developing diabetes, but also it can make it more difficult for our internal organs to do their job. "When we exercise regularly, we can counteract this complication from taking place, while reducing the level of glucose in the bloodstream at the same time," shares Walker.

The Best Exercises to Do If You Have preDiabetes

The best exercise Rx for prediabetes includes both aerobic and strength training, Walker says.

Ahead, we'll focus on the "what," or the exercises to try. But what about the "how much"? The physical activity guidelines for a person with diabetes or prediabetes is the exact same as any American adult. The World Health Organization (WHO) recommends that we accumulate:

  • 150 minutes of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, plus
  • 2 or more days of moderate-intensity resistance training

Walking

If you're starting from the couch (read: you don't exercise regularly ATM), start by walking. Aim for 30 minutes per day at a moderate to brisk pace, or about a 15- to 20-minute mile, Johnson suggests. Try this strategy to work your way up:

  • Week 1: Two 30-minute walks per week
  • Week 2: Three 30-minute walks per week
  • Week 3: Four 30-minute walks per week
  • Week 4: Five 30-minute walks per week

At month two, try incorporating walking at an incline, either on hills outside or using a treadmill walking workout, and add on the next exercise for prediabetes below.

"It may be too early to consider jogging, but this will help raise the heart rate and burn more calories, plus offer a lower body resistance workout. The core, quadriceps, hamstrings and hips become activated when walking on steeper ground. As a result, more glucose is burned during activity and at rest, as muscle fibers use this energy to recover," Walker says.

Strength Training

Once you've mastered your walking workout throughout month one, during month two, start peppering in 2 days of total-body strength training. The goal is to work up to 3 over time, Walker says. Space out these muscle-building workouts throughout the week—say, on Tuesday, Thursday and Saturday—so your body has time to rebuild and recover.

"The more muscle groups we target, the more glucose we use as a fuel source. By targeting all muscle groups in the body every 2 to 3 days, we can utilize blood sugar around the entire body and recover for the next workout," Walker says. "Start with simple resistance training exercises to target your upper and lower body."

For a well-balanced strength training program for beginners, Walker recommends:

  • Chest Press
  • Lat Pull-Down (using a machine or resistance band; buy it$10.99 for three, Target)
  • Back Row
  • Seated Shoulder Press
  • Tricep Kickback
  • Biceps Curl
  • Squat
  • Lunge
  • Deadlift

Choose a weight that allows you to complete 3 sets of 15 to 20 reps with the last few reps in each set being relatively challenging, Johnson advises, then rest for 30 to 45 seconds between each set.

"Once this 8-week phase is over you will have built a pretty good baseline fitness level and you can move on to higher intensity workouts if desired," Johnson says. Plus you can start increasing your weights once the ones you're using begin to feel easy.

Step Aerobics, Rowing Machine, Cycling, or Jogging

Higher-intensity aerobic exercises burn more calories than lower-intensity ones, such as walking. So when you're ready to step things up, consider picking up the pace with your choice of one of the activities above. Try it to replace one day of your walking workout, then add one or two more days of high-intensity aerobic activity so you have a mix of walking, strength training, and high-intensity exercise.

Walker prefers step aerobics over jogging as a first step up from walking since it elevates the heart rate, is safe for the lower back and is low-impact. Similarly, rowing and cycling are an efficient cardio workout that can be scaled to your desired intensity and is performed while sitting (which can be more comfortable for some individuals).

And jogging, or even jogging intervals, are excellent options when you're seeking a do-anywhere option. (ICYMI, here's how to jog off 10 pounds.)

Be sure to stretch after all of the above best exercises for prediabetes to help your muscles cool down and to maintain flexibility.

The Bottom Line

"Proper diet and exercise can together help to reverse prediabetes," Johnson says, but you have to stick with it. "It's very important to note though that these habits need to be a lifestyle change not a short-term change. If you start eating great and exercising and reverse your prediabetes symptoms, then return to your previous way of eating and inactivity, you could develop prediabetes again."

If you could use some coaching about how to build a prediabetes remission program that is personalized for you—and one that you can stick with long-term—consult with your primary care doctor, a dietitian and a trainer.