What are the benefits of physical activity for people with diabetes?

Physical activity can help people with diabetes achieve a variety of goals including: Increased cardio-respiratory fitness Increased vigour Improved glycemic control Decreased insulin resistance Improved lipid profile Maintenance of weight loss.11 Moderate to high levels of physical activity and cardio-respiratory fitness are also associated with substantial reductions in morbidity and mortality in both men and women and in both type 1 and type 2 diabetes.11 How much physical activity is recommended? The Canadian Diabetes Association recommends that all people with diabetes should meet the following expectations: Accumulate a minimum of 150 minutes a week of moderate to vigorous aerobic exercise spread out over at least three days of the week, with no more than two consecutive days without exercise. This could mean 50 minutes three days a week or 30 minutes five days a week or 15 minutes twice a day, five days a week Perform resistance exercise at least three times a week.11 What is the difference between aerobic exercise and resistance exercise? Aerobic exercise11 Definition
Any physical activity that increases the heart rate. It strengthens the heart and lungs, increases metabolism, tones muscles, reduces blood pressure and can help with weight loss.12

Intensity
Moderate(generally 5070% of persons maximum heart rate) Vigorous (generally greater than 70% of persons maximum heart rate)

Examples
Biking Brisk walking Continuous swimming Dancing Raking leaves Water aerobics Brisk walking up an incline Jogging Aerobics Hockey Basketball Fast swimming Fast dancing

*Maximum heart rate is best determined through clinical measurement (i.e. stress test)

Resistance Exercise11 Definition Activities that use muscular strength to move a weight or work against a resistant load* Intensity Examples

Start with 1 set of 1015 repetitions at Exercise with weight moderate weight machines Progress to 2 sets of 1015 repetitions Weight lifting Progress to 3 sets of 8 repetitions at heavier weight

*Initial instruction and periodic supervision are recommended

What precautions should people with diabetes take when increasing physical activity? People with diabetes should be informed that while regular exercise is a key part of their treatment plan, there are several things for them to consider before beginning a program of physical activity. Patients should be advised to: Talk to their healthcare provider before starting any exercise program that is more strenuous than brisk walking, especially if they have been inactive for some time. This is important so that they can be evaluated for conditions that might be contraindications to certain types of exercise, predispose them to injury or be associated with increased likelihood of cardiovascular disease. Start out slowly and gradually work up to the recommended levels. Make sure to wear comfortable, proper-fitting shoes. Wear a MedicAlert bracelet or necklace. Listen to their bodies and speak to their healthcare provider if they become short of breath or have chest pain. Find out if they are at risk for hypoglycemia and learn how to recognize and treat it properly. Monitor blood glucose before, during and many hours after activity to see how it affects blood glucose levels.13

Additional Precautions11: An exercise electrocardiogram (ECG) stress test may be advisable for previously-sedentary patients with diabetes at high risk for cardiovascular disease who wish to undertake exercise more vigorous than brisk walking. These people may have to gradually build up their amount of exercise, starting with as little as 5 - 10 minutes per day. During and especially after brief, very intense exercise (e.g., competitive track and field, hockey, basketball, intense resistance training), blood glucose will rise as a result of increases in glucose production that exceed increases in glucose disposal. Exercise late in the day can be associated with increased risk of overnight hypoglycemia in people with type 1 diabetes.

Key point:
Checking blood glucose before, during and after physical activity is a safety precaution that makes it possible to recognize and treat hypoglycemia promptly.

How can physical activity become part of everyday living? Despite strong evidence supporting the health benefits of lifestyle modification in people with type 2 diabetes, its application remains a challenge. Healthcare professionals can heighten awareness of the importance of physical activity by promoting regular exercise as a key component of therapy and identifying resources in the community. It has been shown that structured physical activity counselling by a physician or other skilled healthcare personnel has been very effective in increasing physical activity, improving glycemic control, reducing the need for oral antihyperglycemic agents and insulin and producing modest but sustained weight loss.11 Sometimes people say they do not have time for activity. Some simple suggestions to make it easier to stick with it include: Do something you like! It is hard to stick to an activity that is not fun. It may take you a few tries before you find the activity that is right for you. Have a support network. Ask your family, friends and co-workers to help you stay motivated by joining you for a walk or a workout at the gym. Set small, attainable goals and celebrate when you reach them. Reward yourself in healthy ways. Maintain a healthy weight. Seek professional help from a personal trainer, or someone knowledgeable who can help you find a fitness regimen that will work for you.13