Background: Regular exercise has important health and social benefits for children and adolescents with type 1 diabetes mellitus (T1DM). Different exercise types, intensity and duration have significantly different effects on blood glucose (BG) control, and on the endocrine response to exercise. There have been significant recent Improvements in the knowledge of what underlies these changes and in the appropriate management to support the maintenance of euglycemia. This effects frequently presents additional barriers to exercise – fear of hypoglycemia and loss of glycemic control – increasing sedentary lifestyle in this population. Thus, exercise presents several important challenges to diabetes management, and requires special management by patients and clinicians, based on the knowledge of the impact of exercise on BG homeostasis.

Objective: To systematize the principles of exercise prescription in pediatric population with DMT1, including practical advices in the management of the metabolic control.

Methods: Systematic literature searching in PubMed database. Two types of literature were reviewed: guidance and published studies.

Conclusion: The most recent studies show the positive effects of exercise on cardiovascular risk management, helping to achieve target lipid profile, body composition and fitness and glycaemic goals. This population should be encouraged to practice a wide variety of exercise, with a careful management to ensure a good metabolic control. In general, aerobic exercise tends to lower BG concentrations, while anaerobic exercise tends to increase them. Both exercise types can be performed by children and adolescent with T1DM, and exercise prescription must be individualized, based on a sound understanding of the underlying physiology and adapted to the patient`s characteristics. The collaboration between the child/adolescent, healthcare provider, parents, school and the physical education instructor is crutial to a good adherence, promoting an optimal glycemic control during and after exercise.