Exercise for people with type 2 diabetes (Part 4)

Exercise for people with type 2 diabetes (Part 4)

Use Ratings of Perceived Exertion (RPE) to monitor intensity.

Low- to moderate-intensity aerobic training is recommended to enhance exercise adherence and to reduce the risk of injury, especially foot trauma. However, conditions such as autonomic neuropathy affect an individual’s heart rate response to exercise, so the best method to determine intensity is the Borg RPE scale. [Ed. the June 2003 issue of Functional U TM includes the Borg Scale and instructions for its use.


Progress gradually. People with type 2 diabetes often find endurance exercise uncomfortable. Interestingly, individuals with this disease category have an increased number of type II or fast twitch muscle fibers, a low percentage of type I or slow twitch muscle fibers and low capillary density. These muscle fiber differences may affect both tolerance for aerobic activity and make the intensity of exercise at the anaerobic threshold lower.


When designing a class structure, health and wellness professionals should plan a longer warm-up, increase exercise intensity gradually and provide a longer cooldown for participants. Keeping exercise intensity at a low enough level to be comfortable is particularly important for beginning exercisers. ACSM recommends exercise at RPE 10–12 during the initial stages of training. Progressing to higher levels should be undertaken gradually as tolerance improves.


“Given that older age and obesity are common elements of type 2 diabetes,” states ACSM, “a longer period of time may be necessary for the older adult and/or obese person to adapt to a recommended physical activity program.”


Incorporate resistance training. Resistance training at least two days a week to improve muscular strength and endurance and to improve body composition is also recommended by ACSM. In addition to improving muscular fitness, resistance training can enhance the muscle’s ability to absorb and store glucose. However, the intensity of a strength training program will need to vary depending on individual conditions.


Health and wellness professionals must ensure their clients have been medically cleared specifically for resistance training before they begin any program, as this type of activity may not be recommended for some individuals. For example, ACSM advises caution with people who have advanced cardiovascular or retinal complications. And while those with nephropathy (kidney disease) or diabetic retinopathy (in which blood vessels in the eye are damaged) may benefit from low-intensity exercise, they should avoid any activity that results in a rise in systolic blood pressure to 180–200 mmHg, including high-intensity strength training.


In general, lower intensity resistance training, such as 12–15 repetitions to fatigue, is recommended for participants with diabetes. Circuit training that includes short cardiovascular bouts mixed with strength training exercises may be particularly beneficial and fun.


Did you know?

“People with peripheral vascular disease (which causes poor circulation to the legs and feet), to which people with diabetes are predisposed, should avoid cross-legged positions when stretching.” – Elizabeth Best-Martini and Kim A. Botenhagen DiGenova, authors, Exercise for Frail Elders. 2003. Champaign IL: Human Kinetics


Modify as necessary for coexisting conditions.

For people with more severe diabetes or more advanced diabetic complications, ACSM suggests considering modifications in resistance training such as “lowering the intensity of lifting, preventing exercise to the point of exhaustion and eliminating the amount of sustained gripping or isometric contractions.”


The valsalva maneuver should be avoided, as should the use of handheld equipment for long periods of time. (In the book Essentials of Strength Training and Conditioning, Thomas R. Baechle and Roger W. Earle describe the valsalva maneuver as “airway straining during forced exhalation against a closed glottis.”) Health and wellness professionals should cue frequently to remind participants to breathe and maintain a relaxed grip when using equipment. Other activities to avoid include those that cause any large or sudden increases in blood pressure, such as repetitive overhead arm movements, suddenly lowering the head or excessive jarring movements, i.e. repetitious jumps or hops.


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