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Managing Diabetes Magazine - diabetes

Get Active!
Improve fitness and better manage your diabetes

Regular physical activity is a powerful tool in controlling diabetes. Activity helps to manage blood glucose and increases your body’s response to insulin. Over time, it can improve insulin action and help maintain weight loss. Physical activity may help reduce or occasionally even remove the need for medication. Exercise requires your body, especially working muscles, to use more oxygen than when you are inactive. Your muscles use more glucose to meet the need for more energy.

Physical activity burns calories, helping you shed pounds and maintain a healthy body weight. This helps keep blood pressure under control. High blood pressure strains blood vessels and makes your heart work harder than normal. Your risk of heart attack, stroke and kidney disease increases. Keeping your weight down may prevent or delay the start of type 2 diabetes and reduces the risk of high blood pressure.

Exercise can increase good cholesterol (HDL) and reduce bad cholesterol (LDL). LDL cholesterol can clog arteries and increase the risk of heart disease and stroke. Exercise improves circulation, especially to the arms and legs. This is a great benefit for anyone with circulation problems.

Physical activity is an effective way to reduce stress. Too much stress can increase blood glucose levels. Regular exercise helps you feel better and have more energy.

The Two Types of Exercise

Aerobic Exercise: This includes activities that involve muscle movements with little resistance, are moderate in intensity and last for ten minutes or more. Muscle energy is produced, using oxygen in combination with glucose and fat. The heart and breathing rates increase to provide more oxygen to exercising muscles. Aerobic activity is weight training for the heart. It makes the heart stronger, lowers blood fats and pressure, and uses up blood glucose. Examples of aerobic activities are brisk walking, jogging, running, cycling, swimming, dancing, rollerblading, cross-country skiing and, of course, aerobic classes.

Anaerobic Exercise: This refers to activities that offer muscle resistance, such as weightlifting, where short bursts of energy are required. Since intensity is high, the activity often lasts for only a couple of minutes or less. This kind of exercise builds muscle but does not strengthen the heart and lungs.

A good, balanced activity program includes both types of exercise. If you have diabetes, plan to accumulate at least 150 minutes of moderate intensity aerobic exercise each week. Space the exercise out over at least three non-consecutive days of the week. You are also encouraged to perform resistance exercise three times per week.

Tips for exercising safely

  • Always check with your diabetes management team before starting or increasing an exercise program. They can help you determine what your blood glucose level should be before and after exercise. Your team can assess you for conditions that might prevent you from performing certain types of exercise, predispose you to injury or be related to a higher chance of cardiovascular disease. You may also need advice on adjusting any medications.
  • Check your blood glucose level before and after your exercise session. This helps you decide whether your level is too high to exercise safely. It also lets you know if you need to take action before you exercise to prevent hypoglycemia (low blood glucose).
  • To avoid hypoglycemia, the best time to exercise is one to two hours after a meal. If you like to exercise in the morning, eat a meal before you begin.
  • If you take insulin, balancing your blood glucose levels may be easier if you exercise at the same time every day.
  • Activities that jar (such as squash) or strain (such as heavy weightlifting) can damage fragile blood vessels in the eye. If you have eye disease (retinopathy), avoid these activities.
  • Have a thorough foot examination before starting your activity program. Invest in the right footwear for your activity and consider using gel or air insoles in your shoes. Keep your feet dry and prevent blisters by wearing cotton or cotton-poly blend socks.
  • If you have a loss of sensation in your feet, choose non-weight bearing activities such as cycling or swimming.
  • Drink plenty of water to stay hydrated. Dehydration can have ill effects on blood glucose levels and heart function. Drink at least two cups (500 mL) of water two hours before exercising. Continue to drink water during and after exercise.
  • Start off slowly with a low-impact activity such as walking, cycling or swimming. Gradually build up the time you spend exercising. Listen to your body. Stop immediately if you feel pain, discomfort, shortness of breath, dizziness, or become light-headed. See your doctor before resuming your exercise program.
  • Have a healthy snack handy in case your blood glucose level drops too low.
  • Wear a medical alert tag stating that you have diabetes. If you experience an injury or a problem during exercise, the tag ensures you’ll get proper treatment.
  • Always warm up before exercising and cool down when you finish.
  • Keep your weight training program moderate by doing more repetitions with light weights. Lifting heavy weights can cause sudden high blood pressure and is best avoided by older people or those with long-standing diabetes.

Starting out

Choose an activity that you enjoy. Consistency is key to gaining the greatest benefit from physical activity. The Clinical Practice Guidelines for the Management of Diabetes in Canada recommend that you should be active for at least 150 minutes per week. This should be spread over at least three nonconsecutive days.

Think about the following.

  • Do you like to be indoors or outdoors?
  • Do you prefer exercising alone or with other people?
  • How convenient is the activity you like?
  • Can you easily schedule the activity into your routine?
  • Do you need to join a facility? How much does it cost? How far will you have to travel to get there?
  • Does the activity require equipment? Do you have the equipment? If not, is it expensive to buy? Do you have a place where you can store and use it?

The best activity is one that you enjoy, fits into your schedule, doesn’t require a lot of equipment and isn’t expensive. Walking is ideal for most people. It is low-impact and can be done indoors or out. The only equipment needed is a good pair of shoes.

A walking program for aerobics

If you walk alone outside, choose a safe route. Let someone know where you are going and how long you expect to be gone. Carry a cell phone in case you need help.

Begin with a five to 10 minute warm-up. Walk at a gentle pace for three to five minutes. Stop and stretch your calf muscles, thighs and hips. Hold each stretch for 30 seconds. Start walking again at a gentle pace for two to three minutes. When you feel warmed up, increase your pace to a level that you are comfortable with. Find a pace that increases your breathing rate and heart rate but does not make you tired.

Walk for 10 to 15 minutes. After a few weeks you will become more fit, so plan to walk a little longer and faster. When you walk at proper intensity for your fitness level, you can talk to someone without feeling out of breath. Set your goal to slowly increase your walking until you reach at least 150 minutes per week. This might be 30 minutes a day over five days or it could be 50 minutes a day spread over three days. Listen to your body – don’t overdo it! At the end of your walk, slow down and walk slowly for three to five minutes. Allow your heart rate to drop and your breathing to return to a resting level.

Daily activity counts, too

Using a pedometer is a fun way to find out how many steps you take each day. Pedometers are not expensive and are available at your Safeway Pharmacy. The goal is to walk 10,000 steps each day. Your pedometer will tell you how you measure up.

Plan to slowly increase your number of daily steps. Walk more stairs, or get off the bus a stop earlier and walk the extra distance home. When you go shopping, walk around the store a few times before making your purchases, or walk around the mall. Park your car at the far end of the parking lot so you have to walk a little farther to your destination. In no time you’ll find yourself reaching the 10,000 step goal.

At home, put on your favorite CD and dance, take the dog for a walk, or play catch with your children. Pop in an exercise video to safely add variety to your exercise program. Refer to Canada’s Physical Activity Guide for more ideas.

A guide to stretching your muscles

While you stretch, keep breathing. Stretching is supposed to relax muscles, but holding your breath increases muscle tension. Stretch muscles only until a light tension is felt. If there is a severe pulling feeling, or the muscle is shaking, it is over-stretched. Instead of making you more flexible, over-stretching makes muscles more tense and tight. Hold the stretch for 30 seconds or until you no longer feel any tension in the muscle.

CALF STRETCH: Stand about two feet from a wall, with your feet pointing at the wall. Lean towards the wall and step forward with one foot. Keep your feet parallel to each other and pointing at the wall. Keep your back heel on the floor, pressing down slightly. Hold until muscles feel relaxed. Repeat with the other leg. To stretch the lower muscle towards your ankle, bend your rear knee slightly during the stretch.

THIGH STRETCH: Place your left hand against the wall for balance. Grasp your right ankle with your right hand. Pull your heel gently towards your buttocks until your leg feels gently stretched. Do not arch your back! Repeat with the other leg. An alternate position involves lying on one side, bending your bottom leg. Bend your top leg, and bring your heel towards your buttocks. Grasp your ankle, shoe or sock, and pull your heel gently towards your buttocks. Do not arch your back! Repeat with the other leg.

THIGH STRETCH: Lie on your back with both knees bent. Grasp your right thigh with both hands, and slowly pull your right leg towards your chest. Straighten your leg, keeping your foot relaxed, until you feel a gentle stretch in the back of your thigh. Do not extend your leg to the point where you feel a pull in the back of your knee. Hold until your leg feels relaxed. Repeat with the left leg.

HIP ROTATOR STRETCH: Lie on your back. Bring one leg up, turn the knee to the outside and rest the ankle on the top of the other knee. Slowly lift your foot off floor, bringing the knee and crossed leg closer to your chest. Hold the stretch until your leg feels relaxed. Repeat on other side.

LUMBAR STRETCH (for lower back): Lying on your back, clasp one hand under each knee. Gently pull both knees towards your chest, keeping the lower back on the floor. Hold until your back feels stretched and loose. Alternately, clasp both hands behind one knee and gently pull your leg towards your chest. Keep the other knee bent with the foot flat on the floor. Repeat with the other leg.

A simple strength training program

People who have diabetes are encouraged to do resistance activities three times each week. Strength training doesn’t have to involve a gym membership and complicated, expensive machines. It’s easy to do a simple program at home without any equipment. All you need is a chair, the floor and a wall. Make sure that you do the following.

Warm-up and cool down

  • Breathe! Concentrate on breathing out when you are making the effort and breathing in when the effort is less.
  • Take your time! Move muscles slowly to get the best results and reduce the chance of injury.
  • Start with enough repetitions to make the muscle feel tired. The last few repetitions should feel hard to do.
  • Stretch the muscles after to maintain their flexibility.
  • Don’t overdo it. Listen to your body.

KNEE EXTENSIONS (for quadriceps - front of the thigh): Sit on the edge of a bench or chair. Keep your stomach muscles tight and shoulders back. Lift one leg slowly off the floor and fully extend your lower leg. Do not lock the knee joint! Repeat with the other leg. Use ankle weights to add more resistance.

LEG LIFT (for gluteals - buttocks): Support your weight on your elbows and knees. Pull your stomach muscles in and extend one leg straight back, pointing your toes towards the floor. Slowly lift your leg, keeping your knee straight, until your leg is even with your torso. You should be able to see your toes as you look through your arms. Do not arch your back! Repeat with the other leg. Use ankle weights to add more resistance.

KNEE FLEXION (for hamstrings - back of the thigh): Support your weight on elbows and knees. Pull your stomach muscles in and extend one leg straight back, pointing your toes towards the floor. Slowly bend your knee, bringing your heel towards your buttocks. Then slowly straighten your knee to the starting position. Do not arch your back! Repeat with the other leg. Use ankle weights to add more resistance.

CURL UPS (for abdominals): Lie on the floor with your knees bent and your feet flat on the floor. Tighten stomach muscles by pulling your belly button towards your spine. Place your hands on your thighs. Slowly lift your head and shoulders off the floor, sliding your hands up your thighs. You do not need to come up to a sitting position. Once you feel your stomach muscles contract, slowly curl back down. Repeat.

PUSH UPS (for arms and chest): 1) Wall push ups: Stand arm’s length from the wall, facing it. Place your hands on the wall with fingertips pointing up. Slowly bend elbows until you can almost touch the wall with your nose. Slowly straighten your elbows to the starting position. Do not lock your elbows when you straighten them! Increase the difficulty by standing further away from the wall.
2) Modified push ups: Support your weight on your hands and knees. Your hands should be about shoulder-width apart and even with your chest. Tighten your stomach muscles and slowly lower your upper body to the floor, bending your elbows until you can almost touch the floor with your nose. Slowly straighten your elbows to push yourself back up to the starting position. Do not lock your elbows. As you become stronger, keep your back straight while you do your push ups.

A simple upper-body strength program can be done using soup cans or bleach bottles with handles. You can make them heavier as you get fitter by adding water to them. If you prefer, inexpensive dumbbells are available at most department stores.

BENCH FLY (for pectorals – chest): Lie on a bench or the floor. Hold the weights straight above you, over your chest. Slowly lower your arms in a semi-circular arch until they are level with your chest. Then slowly raise the weights back up to the start position, following the semi-circular arch pattern. Bending your elbows while you lower and raise your arms makes this exercise easier.

LATERAL RAISE (for deltoids – shoulders): Stand with your feet shoulder-width apart and your knees slightly bent for good stability. Hold weights at your sides. Slowly lift weights out to the sides to shoulder level, keeping elbows slightly bent. Slowly lower the weights to the starting position.

UPRIGHT ROW (for trapezius – upper back, shoulders and arms): Stand as in the lateral raise exercise for good stability. Hold weights side by side at thigh level, with your palms facing your thighs. Slowly lift weights up to your collarbone by bending your elbows and keeping weights close to your body. Slowly lower weights to the starting position.

BICEP CURLS (for front of the upper arm): Sit leaning forward with your legs apart. Keep your elbow on your thigh, with your arm extended. Lift the weight up and in toward your chest. Slowly lower the weight to the starting position.

SINGLE ARM FLY (for triceps – back of the upper arm): Support one knee and hand on a chair or bench and lean forward. Hold the weight at the side of your chest with your arm bent and your elbow behind you. Slowly extend the weight behind you without moving the position of your elbow. Slowly return to the starting position.

Remember always to check with your diabetes management team before starting any new activity programs. Plan your new, active lifestyle by doing an aerobic activity for at least 150 minutes per week and simple resistance training three times a week. Each day, think about new ways you can improve your fitness, stay healthy, and better manage your diabetes.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specifid medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1  [DI_MDc04]
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