Evidence summary (Updated 2022)
Few studies, and no RCTS, have examined the effect of exercise alone on microvascular complication risk, however given that exercise improves HBA1c and blood pressure, which are two important risk factors for microvascular complication in type 2 diabetes, regular exercise is likely to reduce risk. Cohort studies have shown that greater levels of physical activity and higher cardiorespiratory fitness levels in people with type 2 diabetes are associated with reduced development and progression of retinopathy and nephropathy [1-5]
A recent review of the available evidence has strengthened the evidence.: A systematic review indicated that moderate intensity aerobic exercise, with or without resistance or balance exercise, may improve nerve function or neuropathy-related symptoms in people with T2DM and pre-diabetes. (6) Physical activity also plays a role in improving postural imbalance which thereby minimises falls risk and associated injuries. (7) Resistance and combined training has shown to improve vascular function and reduce prevalence of diabetic retinopathy. (8)
Quality of Evidence
Grade B – Moderate Quality
Strength of recommendation
Grade 1 – Strong recommendation
Regular moderate intensity exercise may improve nerve function and vascular function thereby minimizing prevalence of diabetic complications, such as microvascular injury, retinopathy, nephropathy and neuropathy. It is noted that high intensity aerobic or resistance exercise are not advised with uncontrolled proliferative retinopathy/ neuropathy.
 Estacio RO, Jeffers BW, Gifford N, Schrier RW. Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care. 2000 Apr;23 Suppl 2:B54- 64.
 Holt RIG, Cockram C, Flyvbjerg A, Goldstein BJ, Chen MZ, Andrews RC. Textbook of Diabetes, 5th Edition, Wiley-Blackwell, Chapter 26; 351-371 (2017). ISBN: 978-1-118-91202-7
 John L, Rao PS, Kanagasabapathy AS. Rate of progression of albuminuria in type II diabetes. Five-year prospective study from south India. Diabetes Care. 1994 Aug;17(8):888-90.
 Lazarevic G, Antic S, Vlahovic P, Djordjevic V, Zvezdanovic L, Stefanovic V. Effects of aerobic exercise on microalbuminuria and enzymuria in type 2 diabetic patients. Ren Fail. 2007;29(2):199-205.
 Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR. UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia. 2001 Feb;44(2):156-63.
 Gu, Y., Dennis, S., Kiernan, M. and Harmer, A. (2018) Aerobic exercise training may improve nerve function in type 2 diabetes and pre‐diabetes: A systematic review. Diabetes/Metabolism Re- search and Reviews, p.e3099.
 Kiani, N., Marryam, M., Malik, A.N. and Amjad, I., 2018. The effect of aerobic exercises on balance in diabetic neuropathy patients. Journal Of Medical Sciences, 26(2), pp.141-145.
 Dos Santos Araujo JE, Nunes Macedo F, Sales Barreto A, Viana Dos Santos MR, Antoniolli AR, Quintans-Junior LJ. Effects of Resistance and Combined training on Vascular Function in Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials. Rev Diabet Stud. 2019;15:16-25. doi: 10.1900/RDS.2019.15.16. Epub 2019 Apr 19. PMID: 31132077; PMCID: PMC6760892.