Association of Diabetes Care & Education Specialists


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Safe, Simple and Accurate: How Hard Should I Exercise?

Sep 23, 2014

When prescribing exercise or physical activity for a person with diabetes (PWD), diabetes educators should be specific.  Research shows that an  individual is more likely to perform exercise as recommended when those recommendations are specific. We give specifics when educating about medications, meal planning and blood glucose monitoring (i.e., how much and how often).  Why would it be different with exercise?  An individualized exercise or physical activity plan can be made specific by using the FITT Principle where F=frequency, I=intensity, T=type and T=time.  

In this blog, I’ll address exercise intensity for aerobic exercise.  First, to define aerobic (or cardiovascular) exercise, from the Centers for Disease Control and Prevention, it is “activity in which the body's large muscles move in a rhythmic manner for a sustained period of time. Aerobic activity, also called endurance activity, improves cardiorespiratory fitness.”  Some common examples include walking, dancing, cycling, hiking, swimming, and water aerobics.  Fortunately, when prescribing exercise intensity for aerobic exercise, there is a safe, simple and accurate method that can easily be taught to a PWD known as the “talk test.”  Using the talk test, an individual can get an accurate assessment of whether they are exercising at a light, moderate or high intensity. 

This is the way to perform the talk test.  Have the person start their aerobic exercise.  After a few minutes, have them try to talk (originally done by reciting the national anthem) or sing.  Determine their exercise intensity based on the ability to talk or sing. 

• If the person can not only talk, but also sing, the exercise is considered light intensity. This is useful when a person is getting started with exercise or if they have health concerns making moderate exercise unsafe.
• If it is possible to speak without being short of breath, the exercise is considered moderate intensity.  This is a safe and effective level of exercise for most people.
• If the person is not able to talk without needing to take a breath every few words, the exercise is high intensity.  If a person has type 2 diabetes (from the time of diagnosis) or type 1 diabetes if at increased risk of cardiovascular disease, their physician should perform an evaluation prior to exercising at high intensity.

This simple talk test method for determining exercise intensity has been compared to exercise tests where heart rate is monitored and has been determined to be safe and accurate.  In fact, if a person is taking a beta blocker medication, it is generally safer than monitoring of heart rate (which is blunted by the medication).  Obviously, this test doesn’t work in all situations, for example when swimming.  In this case, a person can determine their intensity by doing water exercise and comparing their effort to how they feel when swimming.

So, when prescribing exercise or physical activity for a PWD, let’s be specific with exercise intensity and teach the talk test.

In my next blogs, I will review the specifics of frequency, type and time of exercise so stay tuned! 


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