Preparation for exercise in patients with Diabetes

Exercise is an important therapeutic tool in people with or at risk of diabetes. However, like any other the effects of exercise in patients with diabetes must be thoroughly understood by the patient. It has been shown that regular exercise (as simple as brisk walking), improves the control of blood sugar and reduces the demand of medication by approximately 20% over period of time. In this blog, let’s take a look at the most important phase of exercising in patients with diabetes – “the preparation phase”.

Young patients (below 35 years of age) in good blood glucose control can safely participate in most activities. The middle-aged (age 35 years to 50 years) individual with diabetes should be encouraged to be physically as active as possible. However, among patients aged more than 50 years, the aging process leads to degenerative changes in muscles and joints, disuse of muscles, commonly seen in patients with diabetes may exacerbate the problem. Therefore, before beginning any exercise program, among elderly the individual with diabetes should be screened thoroughly for any underlying complications.

It is highly recommended for diabetic individuals, that exercise should include a proper warm-up and cool-down period. A warm-up should consist of 5–10 min of low-impact aerobic activity (walking, cycling, etc.) and stretches. The warm-up session is to prepare the skeletal muscles, heart, and lungs for a progressive increase in exercise intensity. Primarily, the muscles used during the active exercise session should be stretched, but warming up all muscle groups is optimal.

After the core exercise session, a cool-down should be structured similarly to the warm-up. The cool-down should last about 5–10 min and gradually bring the heart rate down to its pre-exercise level.

There are several considerations that are particularly important and specific for the individual with diabetes, these include,
• Taking precautionary measures for exercise involving the feet is essential for many patients with diabetes and keep the feet dry is important for minimizing trauma to the feet.
• Proper footwear is essential and must be emphasized.
• Individuals must be taught to monitor closely for blisters and other potential damage to their feet, both before and after exercise.
• Proper hydration is also essential, as dehydration can affect blood glucose levels and heart function adversely.
• High-resistance exercise using weights may be acceptable for young individuals with diabetes, but not for older individuals or those with long-standing diabetes.
• Moderate weight training programs that utilize light weights and high repetitions can be used for maintaining or enhancing upper body strength in nearly all patients with diabetes.

Based on:
Exercise and NIDDM (Technical Review). Diabetes Care 13:785–789, 1990.
Exercise in individuals with IDDM (Technical Review). Diabetes Care 17:924–937, 1994.