Physical activity has important physiological and psychological benefits for all people. An exercise programme has a key role in the management of diabetes. It helps in utilisation of sugar by the body without additional requirement of insulin. Thus, it reduces the dose of insulin to be taken. Many patients report greater ease in maintaining glucose control when their lifestyle includes consistent and planned exercise. However, inappropriate exercises can be very hazardous. Attention must be paid to minimising potential exercise complications.
Precautions before Starting an Excercise Programme
a) Blood sugar should be in control: Uncontrolled diabetes, may give rise to more complications during exercise which will further impair the general health of the patient.
b) Functioning of the heart is normal: A diabetic with a family history of heart disease of high cholesterol level, should consult his doctor before starting an exercise schedule.
Such patients should always avoid strenuous exercises. If the doctor is doubtful about the response of the heart to exercise, he may prescribe a stress test. A stress test is the easiest way to detect any anomaly. A calculated formula for the same is 220 – age in years maximum heart rate (permissible).
c) Non-existence of retinopathy: Retinopathy is one of the common complications of long-term diabetes. At times, it is asymptomatic and remains undetected. Diabetics should undergo an eye examination before they start on an exercise. Sudden, jerky exercise in such patients may result in bleeding of blood vessels on the retina, leading to further complications.
d) Do not have any foot problem: A diabetic foot is particularly, at a greater risk of complication. Meticulous care should, therefore, be taken. Any cut or injury, however minor or painless, should never be neglected. Exercise programmes should be postponed till the wound is completely healed.
e) Absence of neuropathy: A diabetic suffering from nerve complications should not undergo any exercise until the problem is controlled. In such patients, blood circulation of the affected part is disturbed. A physician should be consulted before starting an exercise.
f) Observe timings for exercise to prevent hypoglycemia: Exercise should be properly timed in relation to meal, insulin and oral drugs, to avoid any sudden fluctuation of blood sugar level. Insulin-dependent diabetics are advised to avoid exercise before a meal or when insulin action is at maximum (6/7 hours after slow acting insulin and 2/3 hours after fast acting insulin). Patients undertaking vigorous exercises for a long duration should always keep 10-20gms of simple carbohydrate like toffee, sugar cubes and candy, etc. handy.
g) Site of insulin injection: Exercising increases absorption of the insulin that is injected. If one is exercising his arm a lot, for instance, while playing tennis, the site of injection should be changed to some other part. Negligence regarding the site of injection may lead to the condition of low blood sugar and its associated complications.
Diabetics who are more than thirty years of age and have not been physically active for years, should not undertake indiscriminate exercises. They should always consult their physician regarding the exercise schedule.
Choosing the Exercise Activity
Once the patient is found fit for exercises, the doctor prescribes the nature of exercise, depending on the individual problem.
For a diabetic, aerobic exercises are of great benefit. Aerobic is a system of exercising by means of such rhythmic activities as walking, swimming and cycling that aims to improve physical fitness through increased oxygen intake.
In recent years, yogic exercises and calisthenics are gaining vast popularity. They offer the best of all flexibility exercises and contribute significantly to the mobility, strength, balance and general relaxation of the body.
The patient’s nature of work, the availability of facilities, his interest, the expenses incurred, all these must be taken into account in designing the fitness schedule.
Exercise Routine
Exercise should be increased gradually. Regular daily exercise is much more valuable than spurts of activity at weekends.
Exercise should never be started abruptly. Slow warm-ups are essential, to enable the body to adjust to increased energy requirements.
Exercise should end gradually by mild jogging or the like. Gradual cooling down is advisable. The patient could experience dizziness, chest pain or even nausea if exercise is stopped suddenly.
Make exercise a routine. Some of the tips which would help in achieving this are as follows:
a) Use stairs instead of a lift.
b) Park your car at a distance and walk the rest.
c) Participate in household activities.
d) Indulge in outdoor games than watching television.
A regular exercise programme is found to decrease the blood sugar level and hence the diet and insulin/drug requirement should be revalued.
Regular exercise is a boon for an obese diabetic, since energy expenditure during exercises help in weight reduction.
An appropriate exercise programme should be an adjunct to diet and/or drug therapy to improve glycemic control, reduce certain cardiovascular risk factors and increase psychological well-being in individuals with NIDDM. Patients, who are more likely to respond favourably to exercises, are those with mildly to moderately impaired glucose tolerance and hyper-insulinemia. This recommendation is based on the principle that, benefits of exercises outweighs the risks.
Guidelines for Exercises in IDDM
1) Monitor glycemia before, during and after exercise.
2) Avoid hypoglycemia during exercise by:
a) Starting exercises 1-2 hours after a meal.
b) Taking 20-40 gm extra carbohydrate before and during exercise.
c) Avoiding heavy exercise during peak insulin action.
d) Using non-exercising sites for insulin injection.
e) Reducing pre-exercise insulin dosage by 30-50 per cent if necessary.
f) After prolonged exercise, monitor glycemia and take carbohydrates to avoid delayed hypoglycemia.
General Guidelines
All people with diabetes should be advised to comply with the following guidelines:
a) Use proper footwear and (if appropriate) other protective equipment.
b) Avoid exercise in extreme heat or cold.
c) Inspect your feet daily and after exercise.
d) Avoid exercise during periods of poor metabolic control.
Your Exercise Programme
Every person’s exercise programme is different. Your programme will depend on what shape you are in and what you like to do. Most exercise programmes include four steps.
1. Stretching
Loosen up by walking for a few minutes. Then, take about five minutes to stretch all the muscles in your body. Otherwise, you’ll get sore or hurl during exercise. Don’t bounce while you stretch.
2. Warming up
Begin any exercise slowly. This lets your heart rate go up gradually. Walking or jogging slowly for five minutes is a good way to warm up.
3. Aerobic exercise
Aerobic exercise gets your heart beating fast and your lungs working hard. Brisk walking, jogging, cycling, and swimming are all aerobic exercises. Gradually work up to 20-30 minutes a day.
4. Cooling down
Your heartbeat needs to come down slowly. Walk or jog slowly for 5-10 minutes, just as you did when you warmed up. Stretch your muscles again, too.