CDCES Exercise and Physical Activity Management 2 — Questions and Answers
Question 1: A patient with type 1 diabetes reports that blood glucose rises significantly during early-morning high-intensity exercise. What physiological phenomenon most likely explains this?
- The Somogyi effect
- A surge in counter-regulatory hormones (epinephrine, cortisol) that increase hepatic glucose output (Correct answer)
- Decreased peripheral glucose uptake due to cold morning temperatures
- Rebound hyperglycemia from nocturnal hypoglycemia
Correct answer: A surge in counter-regulatory hormones (epinephrine, cortisol) that increase hepatic glucose output
High-intensity exercise triggers a large release of counter-regulatory hormones, particularly epinephrine, which stimulates hepatic glucose output and can cause transient hyperglycemia.
Question 2: To reduce the risk of nocturnal hypoglycemia after an afternoon exercise session in a patient with type 1 diabetes, which strategy is most commonly recommended?
- Increasing the morning basal insulin dose
- Consuming a bedtime snack containing carbohydrate and protein (Correct answer)
- Avoiding all exercise after noon
- Increasing the dinner bolus insulin by 20%
Correct answer: Consuming a bedtime snack containing carbohydrate and protein
A bedtime snack containing both carbohydrate and protein can help stabilize blood glucose overnight by providing a sustained glucose source during the period of enhanced muscle glycogen resynthesis.
Question 3: A patient with diabetic peripheral neuropathy wants to increase physical activity. Which exercise type presents the lowest risk for foot injury and should be prioritized?
- Long-distance running
- Swimming or water aerobics (Correct answer)
- High-impact aerobics
- Jump rope
Correct answer: Swimming or water aerobics
Swimming and water aerobics are non-weight-bearing, eliminating pressure on insensate feet, which significantly reduces the risk of undetected injury in patients with peripheral neuropathy.
Question 4: Which of the following exercise activities is generally contraindicated for a patient with proliferative diabetic retinopathy?
- Walking at moderate pace
- Swimming laps
- Heavy weightlifting with Valsalva maneuver (Correct answer)
- Chair yoga
Correct answer: Heavy weightlifting with Valsalva maneuver
Heavy weightlifting involving the Valsalva maneuver sharply increases intraocular and blood pressure, raising the risk of vitreous hemorrhage or retinal detachment in proliferative retinopathy.
Question 5: Before a previously sedentary patient with type 2 diabetes and known cardiovascular risk factors begins a vigorous exercise program, the CDCES should recommend which pre-participation step?
- A 24-hour dietary recall
- A stress test or physician cardiovascular clearance (Correct answer)
- A hemoglobin A1C below 7% first
- A fasting lipid panel
Correct answer: A stress test or physician cardiovascular clearance
Patients with diabetes and cardiovascular risk factors should receive medical cardiovascular clearance, often including a stress test, before beginning a vigorous exercise program to identify silent ischemia.
Question 6: A patient with type 1 diabetes uses an insulin pump. What is the recommended pump basal rate adjustment during prolonged moderate aerobic exercise?
- Increase the basal rate by 20–30% during exercise
- Suspend or reduce the basal rate by 50–80% starting 60–90 minutes before exercise (Correct answer)
- Disconnect the pump at the start of exercise only
- No adjustment is needed if pre-meal bolus is reduced
Correct answer: Suspend or reduce the basal rate by 50–80% starting 60–90 minutes before exercise
Reducing or suspending the basal rate 60–90 minutes before exercise allows insulin levels to fall in anticipation of the glucose-lowering effect of exercise, reducing hypoglycemia risk.
Question 7: Which of the following statements best describes the effect of high-intensity interval training (HIIT) on blood glucose in type 1 diabetes compared to continuous moderate exercise?
- HIIT consistently causes greater hypoglycemia than moderate exercise
- HIIT may cause acute hyperglycemia during exercise but carries less hypoglycemia risk than continuous moderate exercise (Correct answer)
- HIIT has no measurable effect on blood glucose levels
- HIIT and moderate exercise produce identical glycemic responses
Correct answer: HIIT may cause acute hyperglycemia during exercise but carries less hypoglycemia risk than continuous moderate exercise
HIIT stimulates a strong counter-regulatory hormone surge, which can raise blood glucose acutely during exercise, and research shows it is associated with less hypoglycemia than prolonged moderate aerobic exercise.
CDCES Exercise and Physical Activity Management 2
A patient with type 1 diabetes reports that blood glucose rises significantly during early-morning high-intensity exercise.
What physiological phenomenon most likely explains this?