Exercise for people with type 2 diabetes (Part 3)

Exercise for people with type 2 diabetes (Part 3)

Food intake. Since exercise burns fuel, people with diabetes need to monitor food intake carefully in relationship to increased activity. ADA advises individuals with diabetes to exercise from 1–3 hours after eating a meal. One hour of exercise generally requires 15 additional grams of carbohydrates, which clients should consume before or after exercise, depending on their individual condition and needs. If exercise is vigorous or longer than one hour, an additional 15–30 grams are recommended for each additional hour. [Ed. a single slice of bread contains 15 grams of carbohydrates, as does a half-cup of fruit juice. Single doses of Glutose gels from Paddock Laboratories also contain 15 grams of carbohydrates.]


People with diabetes should keep a source of rapidly acting carbohydrate easily available during exercise and tell others where this source is located. Health and wellness professionals should also keep hard candy or other sources of simple sugar available for emergency purposes.


Dehydration. High blood sugar levels can increase urination, contributing to dehydration. In addition, diabetic complications such as autonomic neuropathy, which affects the nerves serving internal organs and regulating blood pressure, blood glucose and perspiration, may impair an individual’s sweating response, increasing the risk of heat-related illness. (“Hyperthermia: a hot weather hazard for older people” on page 15 tells how to recognize and prevent heat-related illness).


Professionals should encourage participants with diabetes to drink fluids before, during and after exercise, especially in warmer environments. ADA recommends that people with the disease drink at least a half liter of fluid two hours before exercise. During exercise, plain water is usually sufficient for sessions of one hour or less, according to ACSM. For workouts lasting longer than one hour, water and extra carbohydrates are needed. People with diabetes will absorb beverages with a 6–8% carbohydrate solution, such as Gatorade, more easily than soft drinks or fruit juices, which are typically 13–14% carbohydrate solutions.


Foot or lower leg injuries. Clients with diabetes, especially those with more severe conditions, may have nerve damage or circulatory disorders, such as peripheral vascular disease. As these individuals may have impaired blood flow to the extremities, they require extra protection of the feet to prevent bruising or injury.


Health and wellness professionals should advise clients to wear appropriate athletic footwear, and to wash and dry their feet thoroughly after class and check for sores. Petroleum jelly may help to decrease friction on specific areas. If a client has an open sore that is not healing, he or she should consult a healthcare provider immediately. When not treated promptly, an infection can spread to the bone, resulting in amputation.


Fitness equipment that may impair circulation should be avoided, i.e. bands or buoyancy equipment on legs or feet in water exercise. Aquatic instructors should cue participants to keep their legs moving during class by jogging or kicking to avoid blood pooling in the legs. Inadequate blood supply may cause participants to be more prone to pain, aching or cramping during exercise. Instructors should encourage exercisers to rest for about two minutes if cramping occurs during a workout.


Exercise program recommendations. Health and wellness professionals should ensure that clients have a thorough medical evaluation and obtain clearance to exercise before beginning any program or increasing intensity levels. They should then review this form for specific guidelines. ACSM also recommends that people with diabetes ages 35 and above have a stress test “to assess cardiovascular and respiratory systems.” As diabetes is a major risk factor for cardiovascular disease, certain individuals may have advanced cardiovascular complications, which will require exercise modifications.


Physical activity for people with autonomic neuropathy should also be approached with caution, according to ACSM, which stresses the need for medical clearance for these individuals. For people with this condition, "[p]hysical activity should focus on low-level daily activities, where mild changes in heart rate and blood pressure should be accommodated."


Generally speaking, however, people with diabetes benefit most from aerobic exercise and resistance training.


Include cardiovascular training. ACSM strongly recommends that individuals with type 2 diabetes expend a minimum cumulative total of 1,000 kcals per week in aerobic activity. This includes at least three nonconsecutive days and up to five sessions per week. Ideally, exercise sessions should last a minimum of 30 minutes.


This article is provided courtesy of the International Council on Active Aging www.icaa.cc