Physical activity, sedentary behaviors, physical fitness, and their relation to health outcomes in youth with type 1 and type 2 diabetes: A review of the epidemiologic literature

Diabetes is a leading chronic disease of childhood and adolescence. In addition to the well-known auto-immune, insulin-dependent diabetes mellitus (type 1 diabetes (T1D)), the past two decades have witnessed the emergence of type 2 diabetes (T2D) in children and adolescents, which previously was only seen in middle-aged or older adults. One of the key components of diabetes management is physical activity (PA). The beneficial effects of increased PA and decreased sedentary behavior are extremely important in youth with diabetes because of the markedly increased long-term risk of cardiovascular disease in this population compared to persons without diabetes. This review aims to comprehensively summarize the epidemiologic, observational research published and listed in PubMed between 1970 and 2012 on PA and sedentary behaviors, as well as physical fitness in children and adolescents with T1D and T2D. Additionally, we describe briefly the state of knowledge on perceived barriers of PA in persons with diabetes, with a focus on hypoglycemia. Finally, we provide an overview of the epidemiological literature pertaining to health benefits of increased PA in youth with T1D and T2D and briefly discuss the topic of exercise-related hypoglycemia.