Exercise with heart and metabolic conditions
By Matheus de Paiva, Exercise coach, BSc Physical Therapy, MSc Rehabilitation Science. Updated 2026-10-03.
Regular aerobic exercise and strength training are core treatments for type 2 diabetes, high blood pressure and heart health. Aim to build toward 150 minutes of moderate activity a week plus strength training two to three times a week. When losing weight, especially on GLP-1 medications, strength training and enough protein help protect muscle.
Who this guide is for
- Type 2 diabetes and prediabetes
- High blood pressure
- High cholesterol
- Obesity and weight loss on GLP-1 medications
- Stable heart disease after cardiac rehab
- Fatty liver disease
What the evidence says
Diabetes Canada and the American Diabetes Association recommend combining aerobic and resistance exercise, with no more than two days in a row without activity. Both lower blood sugar and improve insulin sensitivity.
Regular aerobic exercise lowers blood pressure by an amount similar to some medications. Strength training adds further benefit.
During significant weight loss, part of what is lost is muscle. Resistance training is the most effective way to limit that loss and keep strength.
How to start
- Start at a level that feels easy to moderate, about 3 to 5 out of 10 effort, and build slowly over weeks. How you feel the next day matters as much as how you feel during the session.
- Short walks after meals help lower blood sugar spikes.
- Breathe steadily during strength work rather than holding your breath, especially with high blood pressure.
- If you take insulin or medications that can cause low blood sugar, check your levels around exercise and keep fast-acting carbohydrates nearby.
- On GLP-1 medications, plan sessions around side effects and appetite, and prioritize strength training.
When to check with a health professional
- Chest pain, pressure or unusual shortness of breath during activity
- Dizziness, fainting or an irregular heartbeat
- Frequent low blood sugar episodes, or foot wounds that are slow to heal
- If you have a heart condition and have not been cleared for exercise
Common questions
What is the best exercise for type 2 diabetes?
A combination of aerobic activity, like brisk walking or cycling, and strength training works better than either alone. Spread activity across the week.
Can strength training raise blood pressure?
Blood pressure rises briefly during lifting and returns to normal after. Over time, regular strength training tends to lower resting blood pressure. Avoid breath holding and very heavy maximal efforts if your blood pressure is not controlled.
How do I keep muscle while on Ozempic or Wegovy?
Strength train two to three times a week with progressive load, eat enough protein spread across meals, and stay active daily. Track strength, not just weight.
Sources
- Diabetes Canada Clinical Practice Guidelines: physical activity and diabetes
- Rabi et al. 2020, Hypertension Canada comprehensive guidelines
- Dibben et al. 2021, exercise-based cardiac rehabilitation for coronary heart disease (Cochrane)
- WHO guidelines on physical activity and sedentary behaviour (2020)
These guides are general education and do not replace advice from your doctor or health team. True Pace does not diagnose or treat medical conditions.