220 Diabetes Spectrum Volume 22, Number 4, 2009 In Brief Ulf G. Bronas, PhD, ATC, ATR, Diane Treat-Jacobson, PhD, RN, FAHA, and Patricia Painter, PhD, FACSM Alternative Forms of Exercise Training as Complementary Therapy in the Prevention and Management of Type 2 Diabetes This review explores the available evidence for the benefts of performing con- ventional (cardiovascular, resistance, and combined) or alternative forms of exercise training (yoga, tai chi, and qigong) on glycemic control for individuals with impaired glucose tolerance and type 2 diabetes. Based on the available evidence, it appears that a combined cardiovascular and resistance exercise training program should be part of a comprehensive treatment program for the prevention and management of type 2 diabetes, as recommended by American Diabetes Association guidelines. The prevalence of type 2 diabetes has been increasing during the past decade and is projected to reach ~ 300 million individuals worldwide by 2025. 1,2 In the United States, there are > 24 mil- lion individuals living with diabetes, with an estimated additional 25% currently undiagnosed. 3 The projected prevalence of diabetes is expected to increase 165% by 2050 in the United States, primarily because of an increase in type 2 diabetes. 4 Of particular concern are the comorbidities associated with the development of type 2 diabetes, including chronic kidney disease and macro- and microvascular disease such as cardiovascular disease (CVD), peripheral artery disease, retinopathy, and neuropathy. 5 These complications contribute to a disproportionate use of health care resources and cost to the Medicare system, approaching 10% of total Medicare expenditures. 5 There has been a dramatic increase in the risk factors for type 2 diabetes, including obesity and physical inac- tivity, contributing to the increasing prevalence of impaired fasting glucose levels and pre-diabetes. 6 Pre-diabetes, or hyperglycemia that does not meet criteria for a diabetes diagnosis, is defined as a fasting blood glucose level of 100–125 mg/dl or an oral glu- cose tolerance test resulting in a blood glucose level of 140–199 mg/dl. 2 This population is considered to be at the highest risk for developing type 2 dia- betes. 5 A complete discussion of the complex etiology and pathophysiology of type 2 diabetes is beyond the scope of this review and has been discussed extensively elsewhere. 7 Regular moderate-intensity (50–75% of heart rate reserve) car- diovascular exercise training of at least 150 minutes per week, alone or in conjunction with resistance exer- cise training three times per week, has been shown to improve glucose control and glucose disposal, improve insulin sensitivity, contribute to weight loss, and improve the CVD risk factor pro- fle in patients with impaired glucose tolerance and type 2 diabetes. 2 The interest in alternative forms of exercise has been increasing steadily during the past few decades; however, the evidence base related to the use of these popular alternative forms of exercise in the prevention and man- agement of chronic disease has not been widely disseminated. This review focuses on the use of alternative forms of exercise as complementary therapy in the prevention and treatment of type 2 diabetes and CVD risk factor reduction in individuals with impaired glucose tolerance and type 2 diabetes. Although regular exercise training is considered a cornerstone of com- plementary therapy, it is frequently underutilized as a treatment strategy for the prevention and treatment of diabetes. Regular Exercise Training in the Prevention and Management of Type 2 Diabetes Several epidemiological prospective studies have shown a strong asso- ciation between physical inactivity,