Michelle Jonck informs us that positive planning and state of mind are two key factors to initiate and achieve sustainable behaviour changes, such as increasing physical activity.
Despite physical activity (PA) being a cornerstone of diabetes management, it is by far the most underused1. The multiple benefits of physical activity for all ages in almost every population, including people with diabetes have been well-established.
These benefits include improvements in glycaemic control, insulin action, cardiovascular fitness, systemic inflammation, diabetes-related health complications and mental health1. In a study2, the level of HbA1c among diabetic patients was decreased by 0,73% and 1,33% after 16-weeks post-intervention and one-year follow-up, respectively.
Considering the positive health impact of PA, it’s imperative for diabetic and pre-diabetic patients to become and remain physically active. Positive planning and state of mind are two key factors to initiate and achieve sustainable behaviour changes.
Breakdown perceived barriers
Too often PA is neglected, particularly in those with other comorbidities due to perceived barriers. Multiple studies have confirmed lower levels of PA in diabetic patients compared to non-diabetic patients.
In most cases, however, the factors regarded as barriers do not hold true. In a study3, 62% of the study population listed lack of time, workload and other engagements as a barrier to increase PA.
While most people have hectically busy schedules and might find it hard to include an exercise routine into their daily lives, small changes in daily tasks can significantly increase levels of PA. For instance, taking the stairs at work instead of the elevator (which you must wait for in any case), walking to a colleague’s desk to ask them a question instead of sending an email, getting up in your lunch break for a walk instead of staying in to check social media.
Many of us have that one series we just must watch. Why not get on the treadmill while watching or stand up and march during the ad-breaks? If you have time for social media and online streaming, you sure have time to be physically active. Therefore perceiving lack of time as a barrier does not hold true. It’s rather how you choose to spend your time.
As little as 10 minutes of PA each day can improve fitness levels. Although longer exercise durations result in greater improvements, the saying, “Anything is better than nothing” holds true when it comes to physical activity.
Tips for becoming more physically active daily
- Take more steps throughout the day.
- Take the stairs instead of an elevator whenever possible. If climbing upstairs is too difficult, start by taking the stairs only going down.
- Walk on moving walkways instead of standing still.
- Park at the furthest end of a parking lot instead of searching for the closest parking.
- After every 30 minutes spent sedentary (sitting down) get up and move for three to five minutes.
- Take short walks during work breaks instead of remaining seated.
- For every excess calorie you eat, add 20 steps to your daily total.
- Minimise screen time (maximum two hours/day) and stand up to change the channel or perform some physical activity while watching TV, such as walking on a treadmill or cycling on a stationary bicycle.
Weakness and illness
Two other factors perceived as barriers toward PA include weakness and illness including joint pain and pregnancy3. It’s important to remember PA doesn’t necessarily mean running, skipping, jumping and heavy weight lifting, but rather increasing incidental activity and engaging in even low-intensity exercise or unstructured forms of PA.
Activities, such as golfing, gardening, dancing and mild walking, done for 30-45 min is beneficial for health, even if it doesn’t improve fitness levels.
In a recent study on adult women, regular, moderate (brisk) walking decreased their risk for developing diabetes similarly to engaging in more vigorous activity, demonstrating that intensity may not be as important as participation in any PA1.
While people with diabetes are more likely to experience comorbidities, such as high blood pressure, heart disease, obesity and other diabetes-related complications, that may limit their ability to participate in more intense activities, they should exercise as intensely as possible but not so excessively hard that they lose the motivation to continue, develop an athletic injury or put their health acutely at risk.
Begin with easy unstructured exercise including taking more daily steps and simply standing up more often. The talk test is another tool to help guide your exercise intensity. If you aren’t able to talk while going for your daily walk, you can slow down the pace a bit enabling you to have a slightly breathless conversation with your workout partner.
- Always include a proper warm up and cool down (five minutes at lower intensity).
- Check your blood glucose before and after exercise.
- Be aware of the signs and symptoms of hypoglycaemia and hyperglycaemia.
- Always carry a fast-acting sugar drink or sweet.
- To reduce the risk of hypoglycaemia, make sure to eat one to three hours prior to exercising.
- Individuals with peripheral neuropathy should consider non-weight bearing activities, such as swimming or stationary cycling, to minimise trauma and potential injury to their feet and lower extremities.
- Individuals with proliferative retinopathy should avoid any jumping, jarring or breath holding activities including heavy weight lifting.
- A biokineticist will be able to further assist with any safety concerns you might have with regards to physical activity, exercise and your health condition.
A positive mind-set is needed
It might be easy to list constraints and limitations when it comes to PA but this is where a positive mind-set is important. Instead of placing your focus on what you can’t do rather focus on what you can do and the benefits derived from PA.
Factors that enable and encourage individuals to perform some form of PA are called enablers. These include: health related benefits, such as blood pressure control, diabetes control, reduced joint pain and weight management as well as feeling good, social support and professional advice.
Knowing the risks associated with a sedentary lifestyle and changes that can be brought about by PA can encourage a lifestyle change. One study1 suggested that PA participation is higher when individuals are made aware of what constitutes an unhealthy lifestyle and when they perceive themselves as being more susceptible to diseases that can result from inactivity.
Serotonin and endorphins, better known as the happy hormones, are also released during PA. These makes one feel good, which in turn further encourages engagement in PA.
Social support is another vital factor when it comes to sustainability. Participating in activities, such as walking, as a family not only creates support but also a feeling of accountability, connection and a common goal.
Obtain professional advice
Lastly, obtaining professional advice and encouragement for lifestyle change can often be the determining factor towards behaviour change.
As a biokineticist, I’ve dealt with many patients who started a supervised physical activity routine due to doctor’s orders. In this regard, a study4 found positive changes in physical fitness levels were greater for individuals given an actual exercise prescription with a detailed regimen. Conducting a fitness assessment prior to starting such a programme and supervised participation therein also had a positive effect.
Biokineticists are health professionals concerned with health promotion, the maintenance of physical abilities and final phase rehabilitation by means of individualised scientifically-based physical activity programme prescriptions. Therefore, they can assist by prescribing the appropriate duration, intensity and type of exercise. Plus, educate you about certain safety precautions at stake for a variety of medical conditions. To find a biokineticist, visit www.biokineticssa.org.za. If you live in a remote area or when on holiday, you can always consider an online consultation.
Remaining physically active
Becoming and remaining physically active is crucial to living well with diabetes. Frequent regular exercise of any type is the key to effective blood glucose control because the heightened insulin action in exercised muscle persists only for one to two days1.
Although most clinical trials follow improvements after an exercise intervention over a six to 16-week period, improvements are likely to result from exercise with a duration of one or more years. One can conclude that incorporating PA as an integral lifestyle behaviour over a lifetime will have the greatest benefits. Luckily all PA accumulated during the day counts. Change your mind-set, plan for exercise, set realistic goals and focus on what you can do.
Improve sustainability of a physically active lifestyle
- Set realistic short-term and long-term goals.
- Keep an activity diary.
- Set up non-caloric rewards for achieving short- and long-term goals.
- Schedule physical activity into your daily routine and keep these appointments.
- Exercise with someone to increase motivation and safety.
- Include variety in your daily activities: alternate higher intensity activities with lower intensity and more fun activities.
- Set up a good support system by making it a family or team effort.
- Increase incidental activities (those that form part of your daily life) to accumulate a greater total exercise time.
- Ensure slow and steady progression in the duration and intensity of structured physical activity to prevent overuse injuries and demotivation.
- Include both aerobic and resistance training.
- Undergo periodic fitness assessments and revision of physical activity programmes and self-management goals for PA to provide reinforcement and continued motivation for participation.
- Colberg, S.R. Encouringing patients to be physically active: What busy practitioners need to know. Clinical diabetes, 26(3):123-127.
- Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N.M., Niafar, M., Gharamaleki, J.H. & Sadra, V. Effect of regular exercise training on changes in HbA1c, BMI and VO2max among patients with type 2 diabetes mellitus: an 8-year trial. BMJ Open Diabetes Research & Care, 5(e000414):1-7.
- Pati, S., Lobo, E., Desaraju, S. & Mahapatra, P. Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India. Primary Health Care Research & Development, 20(e44):1-6.
- Nielsen, P.J., Hafdahl, A.R., Conn, V.S., Lemaster, J.W. & Brown, S.A. 2006. Meat-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes. Diabetes Research and Clinical Practice, 74:111-120.
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