Table 5 List of the actions performed by the exercise specialist during the theoretical and practical counseling sessions

1

Establishes clinical condition and physical fitness and identifies the adequate exercise protocol (using a homemade exercise algorithm) on the basis of previous evaluations.

2

Measures BP, HR, and glucose level before and after each exercise session and provides feedback to the subject on the effect of the specific exercise adopted.

3

Instructs the patient to perform these measurements, indicates the range of glycemic values allowing or contraindicating exercise, and suggests to start with resistance exercise when glycemia is on the low side of the range, especially for those treated with insulin or secretagogues.

4

Reviews with the patient the structure of the exercise session (warm-up, exercise, and cool-down phases), instructs on how to perform a safe warm-up and cool down, providing practical examples for the different exercise types, and stressing the importance of the gradualism of the increase and decrease of the intensity for the warm up and cool down, respectively.

5

Explains the difference between aerobic and resistance exercise, proving practical examples of the different exercise forms (endurance exercise machines, resistance exercise devices, free body exercises).

6

For aerobic exercise training, illustrates the correct exercise progression and control and, throughout the counseling sessions, encourages the patients to progressively increase the exercise intensity, instructing on how to identify and control light, moderate and vigorous intensity on the basis of breathing frequency (talk test), rate of perceived exercise, and HR. As an example, exercise intensity is explained on the basis of the ability to perform a conversation as follows: o light intensity: “allows to respond to conversation without problems.” o moderate intensity: “allows to carry on a conversation but with some difficulties.” o vigorous intensity: “ the speech is limited to short phrases.”

7

Especially for unsupervised PA/exercise and for patients with complications, advises the patients to work at low-to-moderate intensity, as it is the one allowing to reduce the risk of adverse events while providing substantial benefits.

8

With regard to the volume of aerobic exercise, gives examples on how to comply with the exercise recommendations on the minimum amount of PA/exercise providing health benefits, and stressing that adding more PA/exercise will results in additional benefits.

9

Describes the correct way of increasing training volume, augmenting first duration and then intensity, especially in patients with complications.

10

Explains the difference between weight bearing and non-weight-bearing exercise and the relevance for the subjects with complications, providing practical examples.

11

For resistance exercise training, provides examples on the exercise taxing the major muscle groups (eight to 10 exercises), explaining (and checking the learning of) the correct exercise technique, and illustrates a typical sequence of resistance exercises, alternating opposing muscle groups and/or upper and lower body exercises.

12

Explains the concept that a higher repetitions number corresponds to a light weight to be lifted (therefore lighter intensity) and vice versa, and teaches the correct breathing pattern during the different resistance exercises adopted, reminding that breath holding (Valsalva maneuver) should be avoided.

13

Instructs to perform multiples sets (for example, two to three sets) with adequate recovery between them (for example, 2 min), depending on the intensity adopted (less repetitions per set usually equal longer recovery time).

14

Identifies indicated and contraindicated resistance exercises on the basis of the specific patient’s complications.

15

Provides examples on how to substitute the typical exercises executed in the gym setting with other forms of PA/exercise to be performed outside the gym, reminding patients that new forms of unsupervised PA/exercise should be adopted after consulting the exercise specialist.

16

Helps the patient to organize a typical working day and weekend in order to find time and space for performing any type of PA (home, commuting, occupational, and LT), reduce the SED-time, and remove potential obstacles.

17

Assists the patient in setting behavior and outcome goals as well as in the choice of the indoor and outdoor PAs that are the most appealing and feasible.