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Uncontrolled diabetes increases risk of adverse events. EPs must recognize their scope: they cannot prescribe medications but must defer to medical providers. Referral ensures safety. Once controlled, exercise is highly beneficial for glycemic management.

Syncope may indicate cardiovascular or metabolic emergency. Immediate ABC assessment and EMS activation if unresolved. Continuing or ignoring is unsafe.

In contemplation, clients acknowledge benefits but remain ambivalent. The EP’s role is to explore ambivalence through motivational interviewing—asking open questions, reflecting concerns, and brainstorming solutions. This builds readiness without pressure. Directive commands (A, C) may provoke resistance; fear-based messages (D) often fail. Supporting autonomy, offering empathy, and exploring realistic strategies help clients transition to preparation. Examples: scheduling shorter bouts, pairing activity with daily tasks, or exercising with social support.

ACSM cites ADA standards: fasting glucose 100–125 mg/dL = impaired (prediabetes), ≥126 = diabetes. Recognizing these thresholds informs risk stratification and referral.

ACSM recommends gradual increases of 5–10 minutes/session every 1–2 weeks in the initial phase. This supports adaptation and reduces injury risk. Rapid increases can cause overuse injuries or dropout.