Post-Dinner Walking versus Active Stretching on Post-Meal Glucose in Type 2 Diabetes: A Randomized Trial

Abstract

Post-dinner hyperglycemia contributes substantially to daily glycemic burden in type 2 diabetes mellitus (T2DM), yet many patients cannot walk after the evening meal. This randomized controlled trial compared post-prandial walking with post-prandial active stretching, a low-load indoor alternative, on post-dinner glucose excursions and glycemic variability. Sixty adults with T2DM (HbA1c 7.0–8.0%) were randomized, stratified by HbA1c, to walking (RPE 11–13) or active stretching (RPE 9–11) begun 15–30 min after dinner, five days per week for 12 weeks. Masked continuous glucose monitoring (CGM) was worn for 14 days at baseline and in weeks 11–12, each period including three standardized dinners. The primary outcome, the 0–3 h post-dinner incremental area under the glucose curve (iAUC), was analysed by intention-to-treat ANCOVA with multiple imputation. Fifty-four participants (90%) completed the trial. Post-dinner iAUC fell by 23.4% with walking and 12.1% with stretching; the adjusted between-group difference was -20.7 mg/dL·h (95% CI -35.9 to -5.6; p = 0.007; d = -0.72) and was robust across sensitivity analyses. Walking also lowered peak post-dinner glucose more (-16.7 mg/dL; Bonferroni-adjusted p = 0.027), whereas MAGE, CV, time in range and time above range did not differ, and the MAGE difference lay within the pre-specified 15 mg/dL margin. Adherence was 78% and 83%, respectively; no severe hypoglycemia occurred. Post-dinner walking blunts the evening glucose excursion more than active stretching, but stretching provides a meaningful partial benefit with comparable glycemic variability and is a practical indoor alternative when walking is not feasible.