Catherine Roberts explores the issues surrounding the advice, support and information on exercise given by health professionals in primary care to people with diabetes

A diagnosis of diabetes should be accompanied by advice from a health professional that a healthy diet, regular exercise and stopping smoking are fundamental to management of the condition. Early textbooks referred to exercise as one of the three cornerstones of diabetic therapy (Joslin et al 1959). There is now evidence to suggest that such lifestyle changes can prevent many people ever developing the condition (Tuomilehto et al 2001, Helmrich et al 1991). There is, however, concern about the exercise component of advice at diagnosis and later through the management of this chronic condition. The focus here is on primary care and individuals with type 2 diabetes; the metabolic effects of physical exertion differ fundamentally between type 2 and type 1 diabetes (Alberti et al 1992).