July 9, 2018
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Regular physical activity is a key element for blood glucose management and overall health in diabetic patients. Comorbid conditions like hypertension, depression and heart disease also stand to benefit from regular exercise. Its importance was further emphasized when the American College of Sports Medicine and the American Diabetes Association released a joint statement in 2010 recommending regular exercise for patients with diabetes. However, the challenges to suitable diabetes management vary with diabetes type, exercise type and other related complications. Physical activity should therefore be customized to suit the specific needs of each individual.
What is physical activity?
Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure, viz. walking, cycling, or participating in sports requiring moderate intensity.2
Current recommendations suggest a broader approach to physical activity which would serve everyone, including sedentary lifestyle. Evidence says that all individuals should reduce the sedentary time by limiting the sitting time to not more than 90 minutes.3
Thus, the best you can do is add more physical activity and reduce the sedentary time in your day-to-day work to help manage diabetes and improve your health.
Why should I be physically active if I have diabetes?
Benefits of physical activity:
Patients with impaired glucose tolerance and diabetes have a higher risk for cardiovascular events. Lifestyle modifications like physical activity and weight loss have been instrumental in delaying or preventing onset of diabetes and reducing cardiovascular events, thus reducing or slowing complications of diabetes.4,5
Multiple benefits of physical activity include:6
- Lower blood glucose levels with reduced insulin requirements
- Lower blood pressure
- Improved blood flow and increased cardiovascular fitness
- Improved lipid profile
- Decreased weight gain
- Improved vigor and well-being
- Can prevent falls and improve memory in elder patients
- May help in better sleep
- Brisk walking or similar moderate physical activity is enough; physician’s advice must be taken before starting any strenuous exercise.
- Contact your doctor in case you experience chest pain, shortness of breath or unexplained symptoms of extreme fatigue.
- Diabetic patients are prone to nerve problems, circulation problems, leading to infections and can cause serious foot problems. Care must be taken to prevent any such injury to foot and appropriate footwear should be used.
- Monitor the blood glucose level before, during and after activity, especially in patients taking insulin or medications that increase insulin levels.
- Vigorous exercise; viz. jumping, should be avoided in patients with unstable proliferative retinopathy (eye disease).
- Exercise can be undertaken without any risks in patients with kidney disease.7
- Consult a doctor to set a target range for your blood glucose level.
- Set an ideal activity routine based on the target range, a proper meal plan and diabetes medications.
- Additional sugars and/or insulin reductions are required to maintain an adequate glycemic control during and after physical activity.3
Prevent low blood glucose
- Exercise-related low blood glucose (hypoglycemia) is more common in type 1 diabetes, but is also seen in type 2 diabetes patients.
- This can be treated using an appropriate insulin/other diabetes medicine regimen and carbohydrate (sugar) intake.
- Other strategies include running short sprints, or performing resistance exercise before aerobic exercise in the same session.
- There should be continuous monitoring of the blood glucose levels.7
Stay safe when blood glucose is high
- Exercise-induced high blood glucose level (hyperglycemia) is more common in type 1 diabetes, requiring insulin dose modulation.
- Physical activity is not recommended for patients with hyperglycemia or high ketone blood levels.7
What kind of activity is best?
- Involves larger muscles: walking, cycling, jogging and swimming
- In type 1 diabetes: increases cardiorespiratory fitness, decreases insulin resistance, improves lipid levels
- In type 2 diabetes: reduces HbA1C levels, triglycerides, blood pressure.7
- Involves exercises with free weights, weight machines, body weight, or elastic resistance bands
- Although effective control in type 1 diabetes is unclear, resistance before aerobic exercise in a single session minimizes exercise-induced hypoglycemia.
- Benefits type 2 diabetes by improving glycemic control, insulin resistance, strength, and lean body mass.7
How much is enough?
- Ideally adults with diabetes are recommended ≥ 150 min of moderate to vigorous activity on at least 3 days/week with 2-3 sessions/week of resistance training on non-consecutive days.
- Younger, fitter individuals with type 2 or type 1 diabetes can undergo shorter duration (75 min/ week) of vigorous intensity exercise.
- For children and adolescents with type 2 or type 1 diabetes, 60 min/week of vigorous intensity exercise should be advised.7
- Colberg S.R., Sigal R.J., Fernhall B., Regensteiner J.G., Blissmer B.J., Rubin R.R., et al. (2010). Exercise and Type 2 Diabetes: American College of Sports Medicine and the American Diabetes Association: Joint Position Statement. Diabetes Care. 33(12). pp. 2692-2696.
- World Health Organization. Health topics: Physical activity. (2017). Available from: http://www.who.int/topics/physical_activity/en/. Last accessed: 07.12.2017.
- Standards of Medical Care in Diabetes – 2015. (2015). Physical activity. Diabetes Care. 38(Supplement 1). pp. S24-S25.
- Sigal R.J., Armstrong M.J., Colby P., Kenny G.P., Plotnikoff R.C., Reichert S.M. and Riddell M.C. (2013). Clinical Practice Guidelines: Physical Activity and Diabetes – Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Journal of Diabetes. 37. pp. S40-S44.
- Balk E.M., Earley A., Raman G., Avendano E.A., Pittas A.G. and Remington P.L. (2015). Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increase Risk: A Systematic Review for the Community Preventive Services Task Force. Annals of Internal Medicine. 163(6). pp. 437-451.
- Lisa M.L. Endocrineweb. Type 2 Diabetes and Exercise. (2017). Available from: https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-/exercise. Last accessed: 07.12.2017.
- Colberg S.R., Sigal R.J., Yardley J.E., Riddell M.C., Dunstan D.W., Dempsey P.C., Horton E.S. et al. (2016). Physical Activity/Exercise and Diabets: A Position Statement of the American Diabetes Association. Diabetes Care. 39. pp. 2065-2079.