This article discusses studies showing that physical activity can lower blood sugar levels after eating.
Post-prandial hyperglycemia (PPH) exists if the blood sugar is above normal (hyper).
Post-prandial glycemia (PPG) is the blood sugar (glucose) level after eating (prandial). Different professional diabetes associations have their definitions of PPG. Any value above the normal PPG is post-prandial hyperglycemia.
- The American Association of Clinical Endocrinologists’ PPG target for a two h post-meal is <140 mg/dL.
- The International Diabetes Federation’s PPG target is <160 mg/dL.
- The American Diabetes Association PPG target 1–2 h post-meal is <180 mg/dL.
PPH increases the risk and can predict atherosclerosis formation better than fasting blood sugar and hemoglobin A1c.
Learn more about it at After meal blood sugar spikes as a cause of vascular failure.
Many people with normal fasting blood sugar tests may be falsely reassured that they are at low risk for developing atherosclerosis since they do not have diabetes, don’t smoke, or take statins.
However, if PPH happens repetitively, it is a setup for a future heart attack or stroke. The good news is that PPH can be avoided.
A simple way will be to rearrange the order of food that we eat.
Veggies Meat Carbohydrate Sequence Prevents After Meal Sugar Spike
Another way to prevent PPH is to do physical activity right after a meal, as discussed in Early control of after-meal glucose spike lowers cardiovascular events.
This brings us to the main topic.
How does physical activity lower blood sugar?
Physical activity lowers blood sugar with the help of skeletal muscles. Skeletal muscles contract and use the stored glycogen for fuel. However, the muscles don’t wait for the glycogen to be depleted. It gets the glucose in the blood that is absorbed after eating with the help of insulin.
Insulin is a hormone that increases after carbohydrate and protein intake and helps to push blood glucose into the liver and the muscles. Physical activity makes the job of insulin easier since the muscles are more receptive to insulin.
In contrast, if the muscles won’t allow insulin in because it is still full of glycogen, a state of insulin resistance will happen. The pancreas will then have to secrete more insulin, and hyperinsulinemia occurs.
Both insulin resistance and hyperinsulinemia can cause disease conditions.
Walking is as effective as mealtime insulin in lowering blood sugar
A Thai study compared the effect of mealtime or prandial insulin on type 2 diabetic patients. Mealtime insulin is injected in some people with diabetes a few minutes before a meal to prevent the excessive rise of blood sugar after eating.
Humalog, Novolog, and Novolin are examples of mealtime insulin.
There were two groups in the study. The exercise group walked 15-20 minutes after one meal daily for six weeks. The other group had insulin before breakfast or the main meal.
The result is that post-meal walking is as effective as prandial insulin in improving blood sugar control as measured by HbA1c. [1]
After-meal walking
Another study involved 29 subjects who participated in a cross-over study. That means the same subjects walked (experiment) and did not walk (control) after eating. This study design removes a lot of variability among different people and makes the study more meaningful.
On the exercise days, the participants walked on a treadmill for 20 minutes after dinner at moderate intensity.
The result showed that after-dinner brisk walking reduced the 2-hour post-prandial glucose spike compared to the control condition. They also found that walking did not increase the risk of hypoglycemia or low blood sugar later in the day.[2]
The image below showed the difference in the blood sugars when the subjects walked (Medium-Intensity Exercise) and when they didn’t (CONtrol). Moderate-intensity walking after a meal resulted in lower blood sugars.
Note the difference in blood sugar levels between the two.
Monitoring heart rates
Exercise intensity is based on heart rates and depends on age. If you want to know the range for a moderate-intensity heart rate for your age, go to this link.
Moderate is 65-70%, and high intensity is 80-95%. I use a Polar H10 heart rate monitor to see my heart rate on my phone continuously.
What is better for lowering after-meal blood sugars? Walking before or after a meal?
A study looked into that. Twelve men and women with type 2 diabetes treated with diet and/or oral medications were involved.
All subjects underwent three trials on separate days. The first consisted of a rest day, and they ate a standardized dinner. The other two are exercise days when they undertook 20 minutes of self-paced treadmill walking immediately before or 15 to 20 minutes after eating.
They found that twenty minutes of self-paced walking shortly after meal consumption resulted in lower blood glucose levels than when subjects had walked pre-dinner.[3]
A meta-analysis using eight randomized controlled trials in 116 participants (47 diagnosed with type 2 diabetes, 69 without type 2 diabetes).[5]
The conclusion was that walking is much better in lowering after-meal sugar spikes when done as soon as possible after a meal rather than waiting for 30 minutes or before eating.[5]
Comparison of standing, walking, and bodyweight exercise
Solomon et al. compared the effects of different physical activities right before, immediately after, or 30 min after breakfast.
The subjects did three different physical activities:
- Standing still (for 30 min)
- Walking (for 30 min)
- Bodyweight exercises (3 sets of 10 squats, ten push-ups, ten lunges, ten sit-ups).
The results showed that low- to moderate-intensity walking and bodyweight exercises immediately after the meal improved after meal blood sugars.
Standing only immediately after the meal almost improved the after-meal glucose.
Overall, the study shows that the timing is more important than the type of activity.[4]
What is more effective, before or after-meal aerobic exercises?
The research was made by Sacchetti et al. to compare whether aerobic exercises before and after meals are better than only after a meal.[6]
Nine healthy volunteers ate a standardized mixed lunch and rested for the following three h (Control) or performed 40 min of cycling after lunch, or two 20-minute sessions, one before and the other after lunch, at the same intensity.
Forty minutes of post-prandial exercise or 20 min before and 20 minutes after meal activities effectively lower the blood sugar and insulin after a mixed lunch. [6]
Exercises for office workers
A study from Japan aimed to identify the types and timings of exercises that office workers can do during a 60-minute lunch break that can lower the after-meal rises in blood glucose levels.[7]
Healthy working people aged 20 years and older were subjected to aerobic (AER) or resistance (RES) exercise before and after lunch. The study assumes a 60-minute lunch break. Each participant performed four different patterns of activity.[7]
All participants did all the exercise variations after a 1-2 weeks reset period. The image below shows the rest, lunch, and exercise patterns that the subjects did.
The image focus is not that great. I list what the study participants did below. The lunch, rest, and exercises lasted for 20 minutes each.
- Aerobic exercise ⇒ lunch⇒ Rest
- Lunch ⇒Rest ⇒ Aerobic Exercise
- Resistance exercise ⇒ Lunch⇒ Rest
- Lunch⇒ Rest ⇒ Resistance Exercise
People in the control period ate only lunches with no exercise. The reset period was a period of regular lunch and activity.
The diet was 100 g of rice (40 g of carbohydrate) as the main meal during lunch.
Exercises
The program consisted of a 20‐minute moderate‐intensity exercise. For the aerobic exercise condition, participants walked at 6 km/h (3.7 mi/hr) for 18 minutes and 4 km/h (2.5 mi/hr) for 1 minute each before and after lunch.
The participants did resistance exercises, push-ups, squats, and front bridges (plank) that required no equipment. They were done in the corner of the workplace, using a mat.
Participants repeated these exercises for 18 minutes at their own pace with 10‐ to 20‐second breaks. Stretches were performed for 1 minute for warm‐up and cool‐down before and after resistance exercises.
Front bridges are also known as plank, shown below.
Results:
Walking done after meals had the most blood sugar-lowering effect, followed by walking before meals.[7]
Based on Yoko et al.’s study, office workers might benefit from a 20-minute aerobic exercise period after 20-minute lunch and then a 20-minute rest period.
An alternative is to do 20-minute aerobic exercises before lunch to decrease after-meal glucose spikes.
Exercise may lower the dose of diabetes medications
Some drugs for diabetes specifically target reducing post-prandial glucose. They include:
- Alpha-glucosidase inhibitors – miglitol (Glyset), Acarbose (Precose)
- DPP-4 inhibitors – sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza), alogliptin (Nesina)
- Glinides – repaglinide (Prandin), nateglinide (Starlix)
- GLP-1 agonists – semaglutide (Ozempic), semaglutide oral (Rybelsus)
- Short-acting sulfonylureas – tolbutamide (Orinase)
- Prandial insulin regimens
Take away message
A brisk 15-20 minute walk lowers after-meal blood sugars and helps lower your risk of a heart attack. I put a book stand on our treadmill to read from a laptop while walking.
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Talk to your doctors before you start an exercise program.
You can check your after-meal blood sugar levels with an over-the-counter glucometer like the Care Touch Blood Glucose Monitor Kit – with 1 Glucometer, 100 Blood Sugar Test Strips, 1 Lancing Device, 100 Lancets, Travel Case for Blood Glucose Meter and Diabetic Supplies. It has more than 31 thousand reviews with 4.5 stars on Amazon.
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References:
- Suntornlohanakul O, Areevut C, Saetung S, Ingsathit A, Rattarasarn C. Glycemic effect of post-meal walking compared to one prandial insulin injection in type 2 diabetic patients treated with basal insulin: A randomized controlled cross-over study. PLoS One. 2020 Apr 1;15(4):e0230554. doi: 10.1371/journal.pone.0230554. PMID: 32236116; PMCID: PMC7112182.
- Li Z, Hu Y, Yan R, Li H, Zhang D, Li F, Su X, Ma J. Twenty Minute Moderate-Intensity Post-Dinner Exercise Reduces the Postprandial Glucose Response in Chinese Patients with Type 2 Diabetes. Med Sci Monit. 2018 Oct 8;24:7170-7177. doi: 10.12659/MSM.910827. PMID: 30295296; PMCID: PMC6190726.
- Colberg SR, Zarrabi L, Bennington L, Nakave A, Thomas Somma C, Swain DP, Sechrist SR. Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. J Am Med Dir Assoc. 2009 Jul;10(6):394-7. doi: 10.1016/j.jamda.2009.03.015. Epub 2009 May 21. PMID: 19560716.
- Solomon TPJ, Tarry E, Hudson CO, Fitt AI, Laye MJ. Immediate post-breakfast physical activity improves interstitial postprandial glycemia: a comparison of different activity-meal timings. Pflugers Arch. 2020 Feb;472(2):271-280. doi: 10.1007/s00424-019-02300-4. Epub 2019 Aug 8. PMID: 31396757; PMCID: PMC7035221.
- Engeroff T, Groneberg DA, Wilke J. After Dinner Rest a While, After Supper Walk a Mile? A Systematic Review with Meta-analysis on the Acute Postprandial Glycemic Response to Exercise Before and After Meal Ingestion in Healthy Subjects and Patients with Impaired Glucose Tolerance. Sports Med. 2023 Apr;53(4):849-869. doi: 10.1007/s40279-022-01808-7. Epub 2023 Jan 30. PMID: 36715875; PMCID: PMC10036272.
- Sacchetti M, Haxhi J, Sgrò P, Scotto di Palumbo A, Nicolò A, Bellini A, Bazzucchi I, di Luigi L. Effects of exercise before and/or after a mixed lunch on postprandial metabolic responses in healthy male individuals. Eur J Nutr. 2021 Sep;60(6):3437-3447. doi: 10.1007/s00394-021-02512-4. Epub 2021 Feb 26. PMID: 33635408.
- Yoko N, Hiroshi Y, Ying J. Type and timing of exercise during lunch breaks for suppressing postprandial increases in blood glucose levels in workers. J Occup Health. 2021 Jan;63(1):e12199. doi: 10.1002/1348-9585.12199. PMID: 33605494; PMCID: PMC7893808.
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