Diabetes and Physical Therapy: How PT Can Help in Prevention

With the prevalence of diabetes diagnosis on the rise, and associated illnesses and complications costing millions of healthcare dollars every year, diabetes and physical therapy are coming into contact more often. Those at risk for diabetes are encouraged to participate in screenings to identify symptoms of prediabetes. These screenings often diagnose prediabetes, a condition that indicates that blood sugar levels are elevated, but not high enough yet to qualify as a diabetes diagnosis that requires medication and treatment.

Instead, those with prediabetes can benefit from a regimen of cardiovascular intervention that could reverse the trend. Early intervention can establish healthy habits, increase longevity, and reverse dangerous glucose levels. These types of programs help patients to control factors that they can manage and give them the skills to improve their own health outcomes. With the support of professionals, like physical therapists, nutritionists, and other healthcare providers, early intervention can prevent disease progression and save money on treatment.

What Is Cardiovascular Intervention?

Cardiovascular intervention is a subset of physical therapy (PT) that focuses on improving heart and lung health. The goal is to increase strength, endurance, and cardiac function in order to affect the overall health of the patient and prevent diseases such as diabetes. It is often prescribed for those recovering from heart attacks, heart surgery, or lung disease. Customized cardiovascular inventions can also help patients manage asthma, high blood pressure, and heart disease. New research shows that it’s also helpful for preventing chronic conditions such as diabetes.

While cardiovascular physical therapy is highly personalized, most treatment plans include the same basic components.

1. Exercise programs: Usually a combination of cardio (walking, swimming, cycling), strength, and mobility is prescribed.
2. Supervision: Therapists teach patients the exercises, correct form, and modifications to make the exercises easier or harder, depending on the patient’s ability. Regular monitoring for progress and suggestions for improvement and progression is included.
3. Education: Besides guidance on exercises, education on nutrition, stress management, and lifestyle modifications are essential.
4. Pain management: Particularly helpful for patients who are recovering from a procedure or have not exercised recently, learning to manage pain and discomfort helps them maintain their progress toward goals.
5. Mental health support: Anxiety and depression are common in cardiac patients, with research indicating that 31% experience depression, 33% experience anxiety, and 58% report stress. A successful rehab program will address these mental health issues as well.

How Does Physical Therapy Reduce the Risk for Diabetes?

While physical therapy interventions like cardiovascular programs have been used for years to recover from events like heart disease and diagnoses such as diabetes, new research indicates that similar interventions can be used to reduce the risk for developing these conditions and even reverse a prediabetes diagnosis. A recent study was done with participants who were diagnosed with prediabetes—they had elevated glycemia levels but were not yet within range of being diagnosed as diabetic and requiring additional medical intervention. Like other cardiovascular intervention programs, the recommended regimen consisted of:

• A structured program for patients
• More than 150 minutes of exercise per week
• Quarterly check-ins with a multidisciplinary team
• Participants with an average age of 69.5
• Support for improved diet and tobacco and alcohol use reduction
• Regular evaluation of lab results

Results were positive, and showed that this PT-forward approach to overall cardiovascular health is a meaningful intervention that can reverse the course of diabetes. Results found:

• An increase in the odds of diabetes reversal by 3.36 times
• Reversion to normal glycemic levels occurred in 21.5% of participants
• An overall positive correlation between glycemic levels and exercise, combined with a support program

Exercise as a form of prevention and reversal for diabetes is being used more often, and more studies continue to support this trend. The American Diabetes Association included in their 2025 Standards of Medical Care in Diabetes recommendations that adults with diabetes engage in both aerobic activity and resistance training. They further break down the goals for the program into 150 minutes of moderate to vigorous physical activity spread across at least three days per week and two to three sessions of strength or resistance training. Implementing these practices has shown the following results:

• Preventing weight gain
• Lower blood pressure
• Improved insulin sensitivity
• More optimized glucose control
• An improved lipoprotein profile
• 40% decrease in cardiovascular mortality
• Decrease in mortality from other causes

How Can My Physical Therapy Clinic Play a Role in Prevention?

These studies show that physical therapy plays a crucial role in prevention, management, and reversal of diabetes. Physical therapists should play a much more active role in disease management than they currently do, and are important multidisciplinary team members for patients with risk factors for developing chronic conditions.

When looking to build a team and collaborate effectively in preventative care for chronic conditions like diabetes, important team members include:

• Internist
• Physical therapist
• Nutritionist
• Psychologist
• Patient
• The patient’s support network, including friends, family, and medical professionals

With the combined expertise of this team, a balanced approach can be developed that places as much emphasis on behavior modification and exercise as there is on medical intervention. At one time, all team members can discuss progress, review medications, and make changes in real time. This creates the best possible outcomes for the patients.

The APTA’s recent campaign, “PT for Future Me,” supports the concept that PT is not just for recovery, but rather, it is an integral part of a healthy lifestyle and prepares the body for aging while maintaining activity levels and strong health markers.

Your PT clinic can participate in the goal to bring more physical activity to all adults, but most particularly to those who are at risk of developing diabetes.

Developing Diabetes Prevention Programs at Your Physical Therapy Clinic

Your physical therapy practice can provide an essential service to the community by developing a comprehensive diabetes prevention program for those at risk for developing the disease. Studies indicate that about 14% of the world’s population has diabetes, and that number is likely higher, considering that it is estimated that 2.7% of people are not diagnosed. This total number also continues to rise. In 1990, only about 7% of the world’s population had diabetes.

Your practice can play an important role in reducing the prevalence of diabetes in your local community by offering preventative programming that is easy to access and provides the support patients need to make lifestyle changes.

Consider incorporating some or all of the following suggestions into your practice.

• Personalized and safe aerobic and strength-building exercise programs: Activities like walking, cycling, and swimming may be more accessible for older adults and can be just as effective as high-impact cardio. Strength programs can include weights, resistance bands, bodyweight exercises, and other equipment that helps to build muscle and, in turn, reduce blood sugar levels.
• Flexibility, mobility, and balance training: Those with diabetes are at an increased risk for falls, and increasing balance and mobility can improve range of motion and agility.
• Weight management should also be part of a prediabetes program: Excessive body fat can contribute to the development of diabetes. Physical therapy programs that include exercise and nutrition help participants maintain a healthy weight and can also help prevent further disease progression.
• Foot care: checking for wounds and ulcers, and ensuring footwear fits correctly and provides necessary support are critical in treating diabetes.
• Neuropathy management by a physical therapist: this provides relief by manual manipulation and gentle stretching to relieve symptoms. Diabetes can cause neuropathy, including pain, numbness, tingling, or burning sensations in the hands and feet.
• Physical therapists are a great source of education: for patients and the community, teaching patients how to manage their symptoms, change harmful behaviors, and improve nutritional practices will improve rates of disease in the population.
• Collaborating with other professionals: public health officials, community groups, and physical therapists can contribute to the overall health of the community and provide a needed service for those at risk of developing diabetes.

New Business Opportunities for Physical Therapy Clinics

Your clinic likely gets referrals for patients who have had surgery or an injury with a secondary diagnosis of diabetes. You can offer more services to these patients, in addition to their standard post-surgical or -injury treatment, as well as others in the community who are struggling with an increased risk of developing diabetes. This improves public health and increases business opportunities for your practice.

Consider offering additional services that will support the health efforts of existing patients and attract new patients who need support to reduce their risk for diabetes.

• Develop and advertise exercise and weight management programs specifically for those with an increased risk of developing diabetes. Focus on a balance of cardio, strength training, and lifestyle changes that are easy to follow. Following the research-backed program we discussed early on will produce better results for participants.
• Offer educational programming and classes that teach patients to monitor their symptoms, set goals, and achieve better glucose control through proven methods.
• Include specialized foot care services, like orthotic fitting and wound care, through your office to prevent ulcers or chronic wounds.
• Make screenings available to the public so they are aware of their risk factors, can measure glucose levels frequently, and understand the services available to them through your practice.
• Build collaborative relationships with other professionals like nutritionists, wound care professionals, primary care physicians, and public health professionals. They can refer patients to your practice, and you can create a multidisciplinary team for the best outcomes.

Diabetes and Physical Therapy Practices Can Be Partners in Prevention

Any community can benefit from additional support for those at risk of developing diabetes, but certain communities have a higher prevalence. If your physical therapy clinic is in the “diabetes belt,” found in the southern US, you have a large population that can benefit from your services. This region covers 15 states and more than 600 counties, where a sedentary lifestyle, obesity, and poverty contribute to more than 11% of the population developing diabetes.

Establishing community education and specialized cardiovascular interventions that are available to anyone in the community will support the health and well-being of the entire region. While your clinic can play a pivotal role in any area, if your community is at a higher risk for diabetes diagnoses, you have an opportunity to engage with more patients, create programs that impact the health of the community, and bring in more consistent income for your practice.