Prof Martin Schwellnus gives us a rundown of how to form a safe exercise regime when living with diabetes.
Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. Before you start exercising, the first, and most important, step is having a full medical check-up. The main reason for this is to make sure that the prescribed exercise “dose” is safe.
Types of diabetes
Diabetes mellitus is a group of chronic diseases classified into four broad clinical classes:
- Type 1 diabetes is characterised by the destruction of pancreatic β-cells, leading to insulin deficiency.
- Type 2 diabetes is characterised by insulin resistance and a relative insulin deficiency.
- Gestational diabetes is diagnosed during pregnancy.
- Other types of diabetes may be caused by genetic defects, disease of the exocrine pancreas, and drug- or chemical-induced causes.
Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. But it also includes nutrition, psychosocial support, smoking cessation and education. So, don’t forget the other important elements of your strategy for managing diabetes.
Benefits of exercise in diabetes patients
Exercise improves many factors important in the prevention and management of diabetes. These include improved glucose control, muscle and liver insulin sensitivity and muscle glucose uptake; reductions in HbA1c; improved weight management, blood pressure, and overall cardiovascular health.
Before you start exercising, the first, and most important, step is having a full medical check-up. The main reason for this is to make sure that the prescribed exercise “dose” is safe Any treatment plan should be patient-centred, not disease-centred, which means you should be assessed and treated holistically.
Identifying any other health concerns is important. Since these may influence how you manage your overall health, and your ability to exercise safely and effectively. Once you have the full picture, a plan can be created that suits your specific needs.
This lifestyle intervention programme is usually directed by a physician trained in sport and exercise medicine and a physician specialising in diabetes management, together with a multi-disciplinary team. This team includes dietitians, biokineticists, endocrinologists, physiotherapists and others.
Your exercise/activity plan
Structured exercise is an important part of your lifestyle, and the FIT principles below give you an idea of the type of exercise you could include in your regime.
Having said that, your activity/exercise plan needs to take various things into account, including type of diabetes, age, activity done, medication use and the presence of any complications.
As such, your plan needs to be tailored to your specific needs. So, speak to a sport and exercise physician about the strategies you will need to adopt. You may be advised to participate in an out-patient setting, or you may be able to train by yourself. In most instances training is initially conducted in small groups, where sessions (usually three per week) are supervised by members of the lifestyle intervention team.
In addition, try to increase the amount of unstructured activity you do. This is the activity you typically do during your day, such as shopping, errands, household tasks, walking your dog and gardening.
If you feel you are not ready for a structured exercise programme, start by increasing your daily activity, and then start including short bouts of structured exercise. Since any activity will increase energy expenditure and improve glycaemic control, this is a great step in the right direction.
Recently, more attention has been paid to prolonged sitting as this has a negative effect on health, irrespective of how active you are. So, be aware of how long you sit during the day, and try to stand up and do some light activity for a few minutes every 30 minutes.
General exercise guidelines for adults with diabetes and pre-diabetes:
|Type of exercise||Frequency||Intensity||Time||
(cardio – walking, swimming, cycling)
3-7 days per week, with no more than 2 days without exercise.
|Moderate (your breathing and heart rate is increased slightly) to vigorous (only do if already active, your breathing is heavy and heart rate increased).||Build up to at least 150 minutes per week of moderate-intensity. For those already active, 75 minutes per week of vigorous intensity.||
If you are starting an exercise regime, start with bouts of 10 minutes at moderate intensity. Increase intensity, frequency and durations slowly over time to at least 150 minutes per week of moderate intensity.
(body weight exercises, free weights, resistance machines or bands)
At least 2 (preferably 3) non-consecutive days per week.
|Moderate (using weights that allow you to do up to 15 repetitions) to vigorous (using heavier weights allowing you to do up to 6-8 repetitions).||At least 8-10 different exercises, doing 1-3 sets of 10-15 reps, to near fatigue.||
Start with weights that allow you to do 10-15 reps per set. Increase weight only once you can do 15 reps consistently. When you increase the weight, reduce the reps to 8-10, then increase reps again over time.
|Flexibility & balance
(stretching, yoga, tai chi, balance exercises)
2-3 days per week.
|Stretch to point of slight discomfort, not pain. Balance exercises of easy to moderate difficulty.||Hold static stretch, or do dynamic stretch for 10-30 seconds, 2-4 reps per stretch.||
Increase duration and/or frequency slowly over time
Exercise guidelines during pregnancy with gestational diabetes:
|During pregnancy with gestational diabetes: check with your doctor||Up to 30min of moderate-intensity (if sedentary before pregnancy, start at a lower intensity). No more than 2 consecutive days without exercising.
|5-10 different exercises, 1-2 sets of 8 -15 reps, up to 60 minutes. At least 2 but ideally 3 times a week, at moderate-intensity.|
Monitoring and follow-up
All patients participating in a lifestyle intervention should be assessed regularly during exercise training sessions by a member of the healthcare team. Before each exercise session symptoms of diabetes mellitus (polyuria, polydipsia), other symptoms (cardiac, infectious disease), resting heart rate, resting blood pressure and blood glucose concentrations should be taken.
During the training session, rating of perceived exertion, peak heart rate, and peak blood pressure should be monitored.
After exercise, a blood glucose measure may also be taken.
All the measurements that were recorded during the initial assessment, before starting the lifestyle programme, should be repeated two to three months later. These results should be discussed and a revised strategy created for the subsequent few months. All patients with diabetes should be re-assessed at least once a year.
Cautions to keep in mind when exercising
- Blood glucose responses are influenced not only by the type, timing, intensity, and duration of exercise, but also by many other factors. This variation in the way blood glucose responds to exercise makes it difficult to give generalised recommendations for the management of food (carbohydrate) intake and insulin dosing during and after exercise. Speak to your sport and exercise physician, doctor and/or dietitian about the strategies you will need to adopt.
- Adults with diabetes are frequently treated with multiple medications for other conditions. Some medications may have a negative interaction with exercise and therefore dosage may need to be adjusted.
- Older adults or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary disease should avoid exercising outside on very hot and/or humid days to prevent heat-related illnesses.
- Patients with autonomic neuropathy should undergo cardiac screening before starting exercise, and be monitored for hypoglycaemia and abnormal thermoregulatory responses during training.
- High-intensity endurance and resistance training, jumping, jarring, head-down activities and breath-holding are not recommended for patients with proliferative diabetic retinopathy or severe non-proliferative diabetic retinopathy, due to the increased risk of triggering vitreous haemorrhage or retinal detachment.
- Patients with peripheral neuropathy should practise proper foot care during activity. Non-weight bearing exercise is recommended, to decrease the risk of skin breakdown, infections and joint destruction.
- During pregnancy, avoid sports with a risk of forceful contact or falling (basketball, rugby, horseback riding, gymnastics), exercising in a supine position after the first trimester, scuba diving, and prolonged intensity workouts that increase body temperature and perspiration. Stop exercising immediately if your experience vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain or swelling and dyspnea without exertion.
What does the Sport, Exercise Medicine and Lifestyle Institute (SEMLI) offer?
SEMLI at the University of Pretoria has a team of specialist sport and exercise physicians, qualified to assess your current health status and advise you on an activity programme that will suit you.
The multi-disciplinary approach of SEMLI means you have access to a variety of healthcare professionals, including biokineticists, physiotherapists, dietitians and psychologists, as well as sport scientists who can assist you along your journey to good health.
For more information contact us at: firstname.lastname@example.org 012 484 1749. www.up.ac.za/sport-exercise-medicine-and-lifestyle-institute/
- Schwellnus MP, Patel DN, Nossel C et al. Healthy lifestyle interventions in general practice
- Part 4: Lifestyle and diabetes mellitus. SA Fam Pract 2009; 51(1): 19-25
- Colberg SR, Sigal RJ, Yardley JE et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39: 2065–2079
- Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6(8): 1033-1044
MEET OUR EXPERT
Prof Martin Schwellnus is the director of SEMLI. He is a specialist sport and exercise medicine physician who regularly consults with athletes of all levels. He is passionate about promoting safe physical activity for all, as part of a healthy lifestyle.