Physical activity and structured exercise in patients with type 2 diabetes mellitus and heart failure

Patients with type 2 diabetes mellitus (T2DM) or heart failure (HF) are encouraged to adopt a physically active lifestyle and participation in structured exercise is endorsed as a safe and effective adjunct to medical therapy in both conditions. This article aims to provide health care professionals with the information required to tailor guidance relating to physical activity and exercise for individuals with T2DM and HF by: (1) presenting an overview of current guidelines, and (2) providing practical suggestions for their implementation. ‘Traditional’ forms of exercise training include moderate to vigorous-intensity aerobic exercise and dynamic resistance exercise. Benefits of exercise training include improved cardiorespiratory fitness and physical function, more favourable body composition, lower metabolic risk and enhanced quality of life. Before engaging in structured exercise, medical clearance may be required for certain types of activities, and precautions should be taken to minimise the risk of hypoglycaemia and left-ventricular overload in patients with T2DM and HF. Importantly, patients with HF should be educated to distinguish severe adverse symptoms during exercise from expected feelings of breathlessness and fatigue. The latter should not be a reason to discourage patients from engaging in as much physical activity and structured exercise as possible. In order to optimise adherence, exercise prescription should be driven by patient preferences, motivations and individual circumstances. Consideration should also be given to more novel approaches, such as reducing sedentary behaviour and high-intensity interval training. Copyright © 2018 John Wiley & Sons.