A physically active lifestyle enhances cardiovascular system function and physical sensation, improves insulin sensitivity, blood pressure and blood lipids. Regular exercise improves glycemic control and reduces the use of glucose-lowering medications. Therefore, exercise therapy should be an essential component of the diabetes management program for all patients with diabetes. All patients should be medically examined prior to developing an exercise program. 1. Principles of exercise therapy The principles of exercise therapy are moderation, regularity and individualization. The development of an exercise program should be carried out under the guidance of medical personnel. The physical activity for the purpose of maintaining health is at least 30 minutes of moderate intensity activity daily, such as jogging, brisk walking, cycling, swimming, etc. However, the exercise program should be adapted to the patient’s age, health status, social, economic, and cultural background, i.e., the exercise program and the amount of exercise should be individualized. Physical activity should be integrated into daily life, such as using cars for walking and elevators as little as possible. The intensity of exercise can be estimated based on the relationship between the heart rate after one hour of exercise and the expected maximum heart rate (not applicable to those with autonomic neuropathy). 2, the safety of exercise therapy Exercise therapy should not only emphasize the benefits of exercise but also pay attention to and avoid the risks that exercise may cause, such as the risk of angina pectoris, myocardial infarction or arrhythmia in patients with coronary artery disease; the possibility of vitreous hemorrhage in patients with proliferative retinopathy; the risk of trauma to the lower extremities (especially the feet) in patients with neuropathy. All diabetic patients should be examined accordingly before exercising. (1) Exercise and blood glucose changes: All diabetic patients treated with insulin and insulin-producing agents should be informed of the acute effects of exercise on blood glucose. Except in the case of very high blood glucose levels (e.g., >15 mmol/L), low to moderate intensity exercise can lower blood glucose levels during and after exercise, increasing the risk of hypoglycemia. Therefore, care should be taken to adjust the dose of insulin and insulinotropic agents according to the changes in blood glucose before and after exercise, and to increase the intake of carbohydrates before and during exercise. On the contrary, high-intensity exercise can increase blood glucose level during and after exercise and may cause persistent hyperglycemia. In patients with type 1 diabetes or those whose blood glucose has been significantly increased before exercise, high-intensity exercise can also induce ketosis or ketoacidosis, therefore, exercise should be performed after blood glucose is well controlled. Before exercise, insulin injection into the limb to be used during exercise should be avoided. Patients using proinsulin secretagogues and insulin injections should avoid exercising on an empty stomach, and exercise should be started one hour after a meal. Alcohol can increase the risk of hypoglycemia after exercise. (2) Exercise and complications of diabetes mellitus 1. Vascular disease: In those with the following manifestations, moderate to high intensity exercise has the risk of aggravating underlying cardiovascular disease. Patients should be evaluated for cardiovascular disease prior to exercise. Age > 35 years Type 2 diabetes duration > 10 years Type 1 diabetes duration > 15 years Other risk factors for cardiovascular disease With microvascular disease: proliferative retinopathy, nephropathy (including microalbuminuria) Peripheral vascular disease Autonomic neuropathy 2. Peripheral vascular disease: Depending on the condition, light to moderate intensity exercise may be engaged. 3, retinopathy: patients with proliferative retinopathy are not suitable for negative oxygen exercise, resistance exercise, jumping exercise and exercise that includes breath-holding movements. 4, kidney disease: can engage in low to moderate intensity exercise. 5, neuropathy: patients with protective sensory loss should avoid weight-bearing exercises and sports that require repetitive foot movements, such as treadmills, long-distance walking, jogging, and stair-stepping exercises; swimming, bicycling, rowing, chair-based exercises, upper-body exercises, and other non-weight-bearing exercises can be performed. Attention should be paid to the comfort of the shoes worn during exercise, and routine foot examination before and after exercise.