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Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences
  1. John P Buckley1,2,
  2. Michael Riddell3,4,
  3. Duane Mellor5,6,
  4. Richard M Bracken6,
  5. Marie-Kristelle Ross7,
  6. Andre LaGerche8,9,
  7. Paul Poirier10
  1. 1 Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
  2. 2 Institute of Sport Exercise and Health, University College London, London, UK
  3. 3 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
  4. 4 LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
  5. 5 Aston Medical School, Aston University, Birmingham, West Midlands, UK
  6. 6 Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
  7. 7 Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
  8. 8 Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  9. 9 St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
  10. 10 Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
  1. Correspondence to Professor John P Buckley, Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine Dentistry and Life Sciences, Chester CH1 4BJ, UK; j.buckley{at}


Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant’s improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.

  • cardiovascular
  • diabetes
  • exercise rehabilitation
  • heart disease
  • nutrition

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  • Correction notice This article has been corrected since it published Online First. Table 1 has been corrected.

  • Contributors We declare in keeping with the ICMJE, that: JPB provided the original conception and design of the work and all authors contributed to the drafting, acquisition of evidence and data, the critical analysis and interpretation and the critical and written structural revisions of all parts of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.