People with type 2 diabetes may be able to upgrade their health in about half the time it takes to watch one episode of Desperate Housewives.

Increasing physical activity by 38 minutes a day helped people with type 2 diabetes improve their blood pressure, cholesterol, and blood sugar levels, even without losing weight. Those who walked a little longer (about an hour a day) made even more progress and shed some extra pounds, too.

Those results come from an Italian study in June's issue of Diabetes Care. The findings prompted a journal editorial urging doctors to help their diabetes patients start walking. Here's a look at what it takes.

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Step 1: Get Cleared for Take-off

Research has shown that people with diabetes benefit more when they eat healthfully and add exercise to their routine. That finding -- based on women with type 2 diabetes -- was reported in The Journal of Clinical Endocrinology & Metabolism in March.

Easier said than done? Making big lifestyle changes on top of a demanding health condition can seem hard, confusing, or tough to get right.

So delete the guesswork. It's best to check in with a doctor first. That way, you can get approval to exercise, find out about safe and effective methods, and gain encouragement from a medical expert.

Step 2: Choose an Activity


The people in the study weren't superathletes. They were about 62 years old, on average, and they were all in roughly the same condition at the study's start.

They also didn't exercise in a fancy gym or plunk down a lot of money for trainers. Instead, they were free to do as much exercise of any kind as they wished. Most chose brisk walking, say the researchers, who included Chara di Loretto, MD, of the internal medicine department at Italy's University of Perugia.

People who can't walk may want to consider other types of exercise that don't strain the body as much, like swimming or riding a stationary bike, says the study. Those who want to do more intense exercise (like jogging) may need a shorter amount of time, say the researchers.

Step 3: Learn How

Participants got a counseling program designed to help them become more active. Moderate- intensity exercise was recommended.

Doctors should help their patients "start slow, increase gradually, [and] celebrate the success of ... achieving each goal," says the University of Colorado's James Hill, PhD, in the editorial.

A step-counter (pedometer) might also help, says Hill. The devices are inexpensive ($10-$20). Worn on the waist, they count the number of steps you take.

Hill's advice: Wear a pedometer for a couple of days, tell your doctor how many steps you take on a normal day, and then make a plan with your doctor to nudge that number up. The ultimate goal would be 6,400 extra steps per day, says Hill. However, he doesn't recommend doing that all at once.

Click here to read Web MD's "Better Late Than Never for Exercise."


Step 4: Get Going

All the knowledge in the world won't help if it just gathers dust in the brain. At some point, action has to be taken.

No one made the study's subjects use what they learned in the counseling program. Instead, di Loretto and colleagues sat back and watched what happened for the next two years. (Yes, two years. Think fundamental change, not short-term exercise binge.)

Participants filled out activity surveys every three months. They were also asked to record their activities every day. Those who were overweight or obese got 300 calories trimmed from their daily diets.

Some people didn't budge much, sticking to their usual activity level. Others walked a bit more than before, and some radically ramped up their activity level.

Step 5: Reap the Rewards

Their efforts paid off. The least amount of additional activity that helped blood pressure, cholesterol, and blood sugar was 38 minutes per day (about 2.2 miles). That was over and above whatever participants were already doing.

Bump that up to an hour (walking about 3 miles), and people had greater improvements plus some weight loss (which didn't happen at lower levels of exercise). Those who were even more active improved most, says the study.

Ideally, the researchers say they recommend walking 3 miles in an hour every day (or getting an equivalent amount of exercise). That's a "reasonable target," they say, noting that greater activity levels yielded even better results.

Exercise may be particularly effective in slashing belly fat, says the study. Fat waistlines have been shown to be less healthy than fat in other parts of the body (such as the hips).

Step 6: Enjoy a Fatter Wallet

Besides boosting health, activity also cut the amount of money participants spent on medical costs. The more active they were, the less they forked out for health care expenses.

"Over two years, prescription costs, which were usually medication for diabetes, [high blood pressure], and dyslipidemia [cholesterol and other lipid problems], were reduced by $259 and other healthcare costs by $259 per capita per year in the entire group, even after allowing for the costs of counseling, which took a physician 75 minutes over the first year and 60 minutes over the second," says the study.

Those figures may not translate directly to the U.S., where medical costs are generally higher than in Italy, say the researchers.

Click here to read Web MD's "Diabetes: Frequently Asked Questions."

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: di Loretto, C. Diabetes Care, June 2005; vol 28: pp 1295-1302. Hill, J. Diabetes Care, June 2005; vol 28: pp 1524-1525. WebMD Medical News: "Type 2 Diabetes: The More Exercise, the Better." WebMD Medical News: "Exercise a Must for Losing Deep Belly Fat."