Physical Activity Practice Exam: Diabetes Chapter 10

Physical activity is a cornerstone of diabetes management, associated with substantially lower morbidity and mortality in people with diabetes. While the benefits of exercise are well-established, prescribing the correct type, intensity, and duration, while managing risks such as hypoglycemia, requires specific clinical knowledge.

This practice exam tests your understanding of the evidence-based recommendations for aerobic and resistance training, strategies to reduce sedentary behaviour, and safety protocols for diverse patient populations.

Key Concepts Covered in This Exam:

Exercise Targets: Mastering the specific recommendations for aerobic exercise (minimum 150 minutes per week) and resistance training (at least 2 sessions per week).
Sedentary Behaviour: Understanding the risks of habitual prolonged sitting and the recommendation to interrupt sitting time every 20 to 30 minutes.
Type 1 Diabetes Management: Identifying strategies to prevent hypoglycemia during and after exercise, such as adjusting insulin doses, carbohydrate intake, and utilizing brief maximal-intensity sprints .
Safety Screening: Recognizing which individuals (e.g., those $\ge$ 40 years of age wishing to undertake vigorous exercise) require medical assessment prior to starting an exercise program.
Exercise Types: Differentiating between aerobic, resistance, and high-intensity interval training (HIIT) and their respective benefits for glycemic control and cardiorespiratory fitness.

1. According to the evidence on thermoregulation, which populations have a restricted capacity to lose heat during exercise?

Only people over age 60

Only those with cardiovascular disease

Only people with type 1 diabetes

Healthy active adults ≥40 years of age and individuals with diabetes

2. Case: A diabetes care team is evaluating supervised vs. unsupervised exercise for a patient with type 2 diabetes. According to the meta-analysis, under what condition did unsupervised exercise improve glycemic control?

Only if there was concomitant dietary intervention

Regardless of any other intervention

When using a pedometer

When performed for >150 min/week

3. Case: A patient with type 2 diabetes asks about resistance bands for exercise. According to the meta-analysis, what effect did resistance band training have on A1C?

No significant effect on A1C but increased strength

Both significant A1C reduction and increased strength

Significant A1C reduction

No effect on either A1C or strength

4. Case: A patient with type 1 diabetes is concerned about hypoglycemia during exercise. Which type of exercise is associated with less hypoglycemia risk compared to aerobic exercise?

Aquatic exercise

Walking

Resistance exercise

Stationary bike use

5. Case: A diabetes educator is counselling a patient about sedentary behaviour. According to systematic reviews, what is the relationship between sedentary time and mortality in people with diabetes?

Inverse association

Association only in people not meeting exercise guidelines

Positive association even after adjusting for moderate-to-vigorous physical activity

No association after adjusting for exercise

6. According to systematic reviews, what effect does tai chi have on A1C in people with diabetes?

Only effective when combined with aerobic exercise

Variable effect depending on diabetes type

Significant reduction in A1C

No effect on A1C

7. Case: A patient with type 1 diabetes on insulin injections asks about reducing hypoglycemia on active days. According to the guidelines, by what percentage can total daily basal insulin be reduced?

10%

20%

40%

30%

8. Case: A patient with type 1 diabetes asks about the order of exercise types to minimize hypoglycemia. According to the guidelines, what order is recommended?

Resistance exercise before aerobic exercise

Order does not matter

Only aerobic exercise, avoiding resistance

Aerobic exercise first, then resistance exercise

9. What is defined as vigorous-intensity aerobic activity in terms of metabolic equivalents (METS)?

>3 METS

>6 METS

>8 METS

>4.5 METS

10. Case: A 55-year-old with type 2 diabetes has peripheral neuropathy but no active foot ulcers. According to the guidelines, can they participate in moderate weight-bearing exercise?

No, all weight-bearing activity should be avoided

Only with physician supervision during each session

Yes, with daily foot inspection and appropriate footwear

Only non-weight-bearing aquatic exercise is permitted

11. Case: A person with type 1 diabetes wants to reduce hypoglycemia risk during moderate-intensity exercise. According to the guidelines, what brief intervention can be performed at the start of exercise?

10-second maximal-intensity sprint

30 seconds of stretching

2 minutes of deep breathing

5-minute warm-up walk

12. According to the guidelines, how often should people with diabetes break up prolonged sitting?

Every 90 minutes

Every 20 to 30 minutes

Every 45 to 60 minutes

Every 10 to 15 minutes

13. According to the evidence from meta-analyses in children and youth with type 1 diabetes, what was the range of A1C reduction with aerobic training?

0.1% to 0.3%

0.3% to 0.5%

0.9% to 1.2%

0.5% to 0.85%

14. Case: A person with type 1 diabetes plans to exercise 2 hours after a meal. According to the guidelines, what prandial insulin reduction is effective in limiting hypoglycemia?

80% to 90%

10% to 20%

25% to 75%

. Complete omission

15. For how long can prolonged aerobic exercise increase insulin sensitivity in recovery?

Up to 24 hours

Up to 48 hours

Up to 12 hours

Up to 72 hours

16. According to the guidelines, what strategies should be collaboratively performed between the person with diabetes and health-care provider to increase physical activity?

Only setting exercise goals

Providing gym memberships recommendations

Only medication adjustments

Goal setting, problem solving, providing information on where/when to exercise, and self-monitoring

17. According to the guidelines, what is the recommended minimum duration of moderate- to vigorous-intensity aerobic exercise per week for people with diabetes?

150 minutes

120 minutes

175 minutes

90 minutes

18. According to the guidelines, what heart rate range defines moderate-intensity aerobic exercise?

50%–63% of maximum heart rate

77%–85% of maximum heart rate

64%–76% of maximum heart rate

>85% of maximum heart rate

19. Case: A diabetes educator is counselling a patient with type 2 diabetes about exercise benefits. According to the meta-analysis, what additional A1C reduction was achieved with higher-intensity vs. lower-intensity aerobic exercise?

-0.12%

-0.42%

-0.22%

-0.32%

20. Case: A diabetes educator is explaining interval training to a patient. What is the recommended duration for alternating intervals of higher and lower intensity exercise?

30 seconds to 3 minutes each

15-20 minutes each

5-10 minutes each

5-10 seconds each

21. What is the definition of sedentary behaviour according to the guidelines?

Any activity with energy expenditure <3 METS

Activity involving little or no movement with energy expenditure 1-1.5 METS

Any non-exercise activity

Sitting for more than 30 minutes continuously

22. Case: A 65-year-old with type 2 diabetes plans to start high-intensity interval training. According to the guidelines, what assessment should be performed?

Assessment with history, physical examination, fundoscopic exam, foot exam, neuropathy screening, resting ECG, and possibly exercise ECG stress testing

No assessment needed if asymptomatic

Only resting ECG

Only foot examination

23. How is aerobic exercise defined in terms of minimum duration for continuous activity?

At least 10 minutes at a time

At least 30 minutes at a time

At least 60 minutes at a time

At least 5 minutes at a time

24. What is the recommended frequency of resistance exercise for people with diabetes?

Daily

At least twice per week

Once per week

Every other day

25. Case: A patient with type 2 diabetes has a capillary blood glucose of 18.0 mmol/L before planned exercise. According to the guidelines, what should be done?

Take extra insulin and wait 2 hours before exercising

Exercise should be cancelled

Ensure proper hydration and monitor for dehydration symptoms; exercise can proceed if feeling well

Postpone exercise until glucose is <10 mmol/L

26. What blood ketone level indicates that vigorous exercise should be postponed in a person with type 1 diabetes?

≥0.5 mmol/L

≥1.0 mmol/L

1.5 mmol/L

≥2.0 mmol/L

27. Case: A patient with type 1 diabetes on CSII plans evening exercise. According to the guidelines, by how much should the overnight basal insulin infusion rate be reduced to prevent nocturnal hypoglycemia?

Approximately 10%

Approximately 30%

Approximately 20%

Approximately 50%

28. According to the evidence, what is the optimal resistance training program for greatest A1C impact in type 2 diabetes?

1 set of 15-20 reps, twice weekly

3 sets of approximately 8 reps at moderate-high intensity, 3 times per week

2 sets of 10-15 reps, twice weekly

4 sets of 6 reps at high intensity, daily

29. Case: A patient with type 1 diabetes experiences exercise-induced hyperglycemia after resistance training. According to the guidelines, how can this be addressed?

Avoid all resistance exercise

Give a small bolus of rapid-acting insulin in exercise recovery

Suspend basal insulin completely

Increase carbohydrate intake before exercise

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Key Concepts Covered in This Exam:

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