CDE Exercise Prescription 4 — Questions and Answers
Question 1: A patient with well-controlled type 2 diabetes and no complications asks about exercise during illness. What is the best advice?
- Continue exercise at full intensity
- Avoid all exercise when ill, regardless of glucose levels
- Reduce intensity and monitor glucose closely; stop if glucose is very high or low or symptoms worsen (Correct answer)
- Only perform resistance training, never aerobic, when ill
Correct answer: Reduce intensity and monitor glucose closely; stop if glucose is very high or low or symptoms worsen
Illness raises glucose through stress hormones; light to moderate activity may be continued cautiously with close glucose monitoring, but high or very low glucose or worsening symptoms are reasons to stop.
Question 2: Which measure most directly assesses cardiorespiratory fitness and is used to guide aerobic exercise intensity in diabetes management?
- Body mass index (BMI)
- VO2 max (maximal oxygen uptake) (Correct answer)
- Fasting insulin level
- Hemoglobin A1c
Correct answer: VO2 max (maximal oxygen uptake)
VO2 max is the gold standard measure of cardiorespiratory fitness and is used to set aerobic exercise intensity as a percentage of maximal capacity.
Question 3: What insulin adjustment strategy is generally recommended for a patient with type 1 diabetes planning a 60-minute afternoon aerobic workout?
- Increase rapid-acting insulin at the meal before exercise
- Reduce rapid-acting insulin at the meal before exercise by 25-75% depending on individual response (Correct answer)
- Discontinue all insulin on exercise days
- Take an extra dose of long-acting insulin before exercise
Correct answer: Reduce rapid-acting insulin at the meal before exercise by 25-75% depending on individual response
Reducing the premeal rapid-acting insulin dose by 25-75% before planned aerobic exercise helps prevent exercise-induced hypoglycemia in type 1 diabetes.
Question 4: A sedentary 65-year-old with type 2 diabetes and mild osteoarthritis should be encouraged to begin physical activity with which approach?
- Immediately start running 5 days per week
- Begin with low-intensity, short-duration activity and gradually progress (Correct answer)
- Avoid all exercise until arthritis is fully resolved
- Only do vigorous exercise to maximize benefits
Correct answer: Begin with low-intensity, short-duration activity and gradually progress
A gradual, progressive approach starting with low-intensity, shorter sessions minimizes injury risk and improves adherence in older sedentary adults with comorbidities.
Question 5: What is the mechanism by which regular aerobic exercise improves glycemic control in type 2 diabetes independent of weight loss?
- It increases glucagon secretion
- It improves insulin sensitivity in skeletal muscle by increasing mitochondrial density and GLUT-4 expression (Correct answer)
- It decreases insulin secretion from the pancreas
- It raises fasting glucose to provide more energy
Correct answer: It improves insulin sensitivity in skeletal muscle by increasing mitochondrial density and GLUT-4 expression
Regular aerobic exercise enhances insulin sensitivity by increasing mitochondrial biogenesis and upregulating GLUT-4 expression in skeletal muscle.
Question 6: Which of the following is a contraindication to unsupervised exercise that requires medical clearance first?
- HbA1c of 7.5% with no complications
- Resting blood pressure of 115/75 mmHg
- Unstable angina or recent cardiac event (Correct answer)
- BMI of 27 kg/m²
Correct answer: Unstable angina or recent cardiac event
Unstable angina or a recent cardiac event requires medical evaluation and clearance before initiating or resuming an exercise program.
Question 7: When counseling a patient about exercise and nephropathy, which statement is most accurate?
- Exercise is absolutely contraindicated with any degree of nephropathy
- Moderate exercise does not worsen diabetic nephropathy and may be beneficial for cardiovascular risk (Correct answer)
- Only vigorous high-intensity exercise is recommended with nephropathy
- Exercise always causes acute kidney injury in diabetic patients
Correct answer: Moderate exercise does not worsen diabetic nephropathy and may be beneficial for cardiovascular risk
Moderate-intensity exercise does not worsen diabetic nephropathy and provides cardiovascular and metabolic benefits; extreme high-intensity exercise may transiently increase proteinuria.
CDE Exercise Prescription 4
A patient with well-controlled type 2 diabetes and no complications asks about exercise during illness.
What is the best advice?