Diabetes is one disorder wherein lifestyle modification (physical activity and healthy eating) plays as important a role as medications to control sugar. Regular exercise could bring about a change from “medical management” to “lifestyle management” in patients with Type 2 diabetes.
A Regular exercise regimen in the diabetes-afflicted helps in the better control of blood sugar and reduces the demand for medication by 20%.
Exercise is often advised as the only form of therapy for diabetic patients when the sugar level is between below 200 to 250 mg/dl, provided there are no complications like:
- Damage to the blood vessels of the eye or retinopathy
- Damage to the nerves and circulation to extremities or, neuropathy
- Problems with kidneys or nephropathy
- Heart related problems such as – angina
Diabetes and Benefits of Exercise
Regular exercise reduces the demand for medication by 20% in diabetics and checking the blood glucose levels before and after exercise can be a motivator to continue the exercise regimen. The benefits of exercise for diabetes are many and include:
- Control of blood glucose levels: Glucose is the source of energy in our body. Physical activity utilizes the glucose and helps to reduce the blood glucose levels. Physical activity also decreases the insulin resistance. A few studies have also indicated that activity increases the insulin receptors in the red blood cells. All this together helps to keep the glycosylated hemoglobin (three-month average of blood glucose levels) levels normal.
- Improved cardiovascular function: Individuals with type II diabetes are more prone to cardiovascular diseases (hardening of arteries, heart attack, and stroke). Exercise increases the cardio-respiratory fitness by
- Lowering the blood pressure
- Lowering the bad cholesterol (triglyceride)
- And increasing the good cholesterol (HDL)
- Psychological benefit: Physical activity is associated with an increased sense of well-being, a positive attitude and improved quality of life.
- Weight control: Physical activity helps obese/overweight individuals to lose weight and also helps them to maintain a healthy BMI.
Exercise Program for Diabetes Patients
Diabetics should plan out the intensity, frequency, duration and timing of the exercise. The exercise program should be aimed at achieving and maintaining a healthy weight. Accordingly, one should target an energy expenditure of 700-2000 calories per week through the various exercises that they may choose.
Aerobic exercise, involving large muscle groups, for 30 minutes a day is beneficial, while resistance exercises (weights, elastic resistance bands, or strength training machines) can be an option for people with low cardiac risk.
Before commencing any physical activity, the following parameters need to be given consideration:
- Intensity of exercise: How intense should the physical activity be? This generally depends on the tolerance of an individual.
- Frequency of exercise: How many days in a week should an individual exercise? Generally, 5 days in a week is preferred, unless one needs to lose weight, in which case it should be more. Exercise done for a short duration must be done more often. For example, one can take three brisk 10-minute walks, one shortly after each meal. Since keeping blood glucose within the target range is the aim, the duration between two exercise sessions should be less than 3 days. Diabetics on insulin should be regular with exercise since the blood glucose levels can increase on the days exercise is not performed.
- Duration of exercise: This refers to how long an individual exercise session should last. This is normally related to the intensity of the exercise. High intensity exercises should be of shorter duration and vice versa. It is not advisable for an individual to indulge in long exercise sessions as blood glucose levels may fall below the desired range.
- Timing of exercise: When should exercise be done? The health care team and the patient together usually should decide this aspect and this depends on the individual’s daily routine. However, exercising immediately after major meals (breakfast, lunch, and dinner) should be avoided. Exercising during peak insulin action (for those on insulin) is not recommended. This depends on the type of insulin being used and hence it is best to check with the doctor.
The exercise regimen in diabetics should include warm-up phase, aerobic and cool down phase.
Warm up phase
This phase is the first 5-10 minutes at the start of the exercise and comprises low intensity, easy movements. For example, if one wishes to jog, walking prior to that is the warm up phase. Stretching and bending exercise before a game of badminton or tennis or golf for 5 to 7 minutes is another type of warm up. Stretching helps in making the body flexible and helps in preventing body soreness after exercise.
This phase comprises 20 -30 minutes of intense physical activity in people who are accustomed to a regular exercise plan. People who have just started the exercise program may not be able to maintain the aerobic phase for long, and should increase it gradually. During this phase, the heart beats faster and breathing becomes harder. Aerobic exercises help to increase insulin sensitivity and restore normal glucose metabolism by decreasing the body fat.
Cool down phase
This phase is the last 5-10 minutes towards the end of the exercise program. The cool down phase is to allow the heart beat rate and the breathing to gradually slow down. One must never stop exercising abruptly. Walking after jogging is an example of cooling down phase.
Rules for Safe Exercises
- Avoid exercising when blood glucose is more than 250mg/dl and ketones are positive in urine
- Carry food or glucose tablets when undertaking exercise in case there are episodes of hypoglycemia
- Do not skip meals especially prior to exercise
- Take a quick-acting carbohydrate (sweetened tea or milk, regular soft drink) when blood glucose is less than100mg/dl or if one experiences symptoms of hypoglycemia – headaches, increased sweating, feeling of hunger, trembling or shakiness, rapid heart rate or palpitations, drowsiness and mental confusion
- Avoid exercise when blood glucose is more than 300mg/dl
- Avoid exercise outdoors on very hot or humid days. One can get heat exhaustion or heat stroke. Wear a hat or sunscreen – if necessary in such conditions
- In warm weather, dress in light-colored and loose-fitting cotton clothing
- To prevent dehydration, drink a cup of cold water before and after you exercise
- If exercising for longer than 30 minutes or if the workout leads to a lot of sweating drink water during the workout
- Always carry a diabetes identification card, duly filled, while exercising
- Drink plenty of fluids to avoid dehydration
- Avoid exercise at the peak action time of insulin
- Avoid injecting insulin in the muscle that is to be used for exercise
- Check with your health care team about the best time to exercise before commencing any physical activity
- Always use correct type of shoes to avoid injury and check them regularly for wear and tear
- After exercise, check the feet for any blisters or sores
- Be aware of the warning signs of heart problems such as chest, left arm or jaw pain, dizziness, fainting and shortness of breath during exercise
- Learn how to measure pulse rate so that a self-check can be done to look for any irregular pulse, especially if there is heart condition that has been diagnosed
No exercise program can be described as the ideal program. Each has its own advantages.
This is the safest, commonest and the cheapest form of physical activity. All one needs to invest in is a pair of good walking shoes and sports socks. It can be done by people of any age and anywhere. It is ideal for people not used to physical activity. It is the warming up or cooling down activity of choice.
Some prefer to jog since it is more fun. It is more intense and requires lesser time than walking for the same amount of exercise. Comfortable pair of shoes, preferably with extra cushion should be used. Jogging on hard surface should be avoided. The footwear should be replaced much before it wears off. For one to get into a jogging habit, it is better to walk first (warm up) and jog for a few minutes and then walk again, repeat the process, and finally walk at the end as mentioned in cool down phase.
This uses large muscles that burn more calories. This can include using small weights in the gym or health club. One should begin with light weights and then increase the weights gradually. As one becomes stronger, more weights can be lifted. It helps to reduce osteoporosis and builds muscles especially in the elderly. It also decreases the risk of heart attacks. This type of exercise increases glucose uptake by the muscles and enhances their ability to store glucose.
A number of individuals may not adhere to the exercise program due to various reasons:
- Ignorance about the benefits of exercise
- Fear of accidents from exercise
- Inability to adapt to some of the lifestyle changes that exercise requires
- No moral support from family or friends
- Chronic illness
- Old age
In such cases, an alternate exercise program, such as walking 10 minutes every hour or every other hour in the house, cleaning the house, gardening and doing extra chores around the house can help.
Do & Don’ts about Exercise Programme in Diabetes
The exercise program should be initiated only after approval from the physician. Screening and evaluation before starting the physical activity can significantly reduce the risks involved in exercise.
Appropriate activity pattern is prescribed according to age, presence or absence of diabetic complications and physical disability. One must exercise at one’s own pace rather than trying to compete with others. Diabetics with certain complications should avoid physical activities:
- If there are eye problems (retinopathy) – exercise should not be allowed till retinopathy is corrected
- If there is nerve damage (neuropathy) in the foot – Avoid running, jogging, or cycling. Advised only to wear prescribed footwear
- If there is damage to the nerves that regulate internal body function (autonomic neuropathy) – physical activity should be avoided as there may be risk of developing dehydration or low blood pressure
- If the high blood pressure (hypertension) is high – avoid resistance exercises
Some undesirable effects that may be related to physical activity include;
- Increase in the amount of protein in the urine
- Increase or decrease in blood pressure during exercise
- Fluctuation of blood glucose levels
- Increase in ketones in uncontrolled diabetics
Exercise reduces the severity of the disease and the long term complications of diabetes.
In effect, a well-planned and-regular exercise regimen can be very beneficial if made a part and parcel of everyday life, more so if one has diabetes. Exercise has the advantages of controlling the blood sugar levels without taking additional medications.
Overall, regular exercise cannot only help in better control of blood sugar but also helps with control of weight and blood pressure as it lowers the bad cholesterol and raises the level of good cholesterol in the blood. Exercise can reduce the risk of heart disease and nerve damage, the risks of which are higher with diabetes.
Sedentary people have shriveled hearts and most of us who do not exercise have an atrophied body. – Bruce B. Dan, 1984
If you have been diagnosed of diabetes and you desire a natural way to reverse it, read about the Diabetes Remedy Kit – HOLISTIC HERBAL AND GUARANTEED NATURAL TREATMENT TO REVERSE DIABETES.
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1. Maimonides. The regimen of health. In Mishneh Torah, ch. 1. 1472 [As cited in Corson SA, O’Leary CE. Purkyne and System-Oriented Physiology. In Purs J (ed). Jan Evangelista Purkyne in Science and Culture. Praha: CSAV; 1988.
3. Dan, Bruce B. In Lyons RD. Scientists find even mild exercise prolongs life. New York Times. 27 Jul 1984, p. B7.