What are the most important exercises that diabetics should do?

What are the most important exercises that diabetics should do?

People with  diabetes should exercise regularly. A structured exercise program may be advocated for them. Exercise should be regular and continuous. Participation in regular physical activity improves blood sugar levels, prevents or delays the onset of diabetes in adults and those in the pre-diabetic range, and positively influences blood lipids, blood pressure, cardiac events, quality of life, and mortality. All diabetics should be encouraged to avoid a sedentary lifestyle and to engage in physical activity.     

What are the direct effects of exercise.

• During exercise, muscles, especially the large muscles of the body, absorb glucose to generate energy, and the intensity and duration of exercise directly increases the amount of glucose burned.  This tends to lower blood glucose levels.  This decrease continues for hours even after the person has stopped exercising.  Insulin in the body helps muscles absorb glucose and convert it into energy.
• During exercise, the liver increases glucose production and this reduces glucose stores in the liver.
• Peoples blood levels remain low even 24 hours after exercise.
• The combination of aerobic exercise and resistance training is more effective than either alone.

What are the long term effects of exercise

• A chronic exercise regimen increases insulin effectiveness (insulin sensitivity) and decreases insulin resistance.
• Regular exercise tends to increase an individual's muscle mass, and more muscles can, in turn, increase glucose uptake by the muscles.
• The muscles also start to use the fats for energy which leads to a decrease in body fat.
• Regular exercise tends to lower the level of "bad" cholesterol (LDL) in the blood and increase levels of "good" cholesterol (HDL) in the blood.
• A slight decrease in blood pressure is observed in those who exercise regularly.
• It has been observed that death due to cardiovascular disease is lower with regular exercise.
• Regular exercise helps reduce and maintain weight.
• In normal adults with diabetes risk factors such as a strong family history and in individuals with prediabetes, exercise prevents or delays the onset of diabetes.
• Exercising regularly has its psychological benefits, too.  The individual's quality of life improves, symptoms of depression are reduced, and there is psychological well-being.  It improves memory, improves the patient's sleep pattern and is said to make the patient feel happy.

However, if the patient first starts exercising, the elderly person should undergo a pre-exercise evaluation by a physician to rule out any adverse effects that may occur from following the exercise regimen.  The evaluation takes into account the patient's age, duration of diabetes, presence of joint or muscle problems, additional risk factors if any, etc.  The doctor may order a complete cardiac evaluation using an ECG and an echocardiogram if he or she feels so.

What exercises should diabetics do?

The following are the types of exercise recommended for diabetics.  Depending on age and convenience, the patient may practice any exercise regimen that suits him/her.  However, a combination of these exercises is recommended for maximum benefit.

Aerobic exercise. 

“Aerobic” means, “with oxygen.”  This means that breathing controls the amount of oxygen that gets to the muscles.  This type of exercise mainly improves cardiovascular conditioning.  Examples of aerobic exercises are brisk walking, swimming, cycling, rowing, dancing, etc.

The recommendation is that at least 150 minutes of aerobic exercise should be done per week.  This could be 30 minutes a day for at least 5 days a week.  Alternatively, short bouts of aerobic exercise of 10 minutes each can be done 3 to 4 times a day.

The exercises should be of moderate intensity.  Always start slowly and increase your exercise speed over the days.  One should always warm up for five minutes before working out and cool down at the end.

Resistance exercise. 

Here, muscles are made to contract against an external resistance, which leads to an increase in muscle strength, size, and strength.  Muscles are made to work against a force or weight.  Gym workouts and home resistance exercises can be done.  They must be supervised initially by a competent or trained person.  Free weights such as dumbbells, barbells, or kettlebells may be used.  Resistance bands (Therabands) can be used, which provide resistance while stretching.  It is simple and requires no equipment and the patient can carry it anywhere while traveling.  It is available in different colors according to the offered variable resistance.  The person's weight can be used for resistance as in push-ups or squats.

It is recommended to do resistance training at least twice a week on non-consecutive days.  The exercises should involve major muscle groups of the upper and lower body and core muscles of the body.  Usually, 10-15 repetitions are enough to improve muscle strength, tone and strength.

Balance exercises. 

Balance control is necessary for a person to move independently without fear of falling.  This ability decreases with age and in patients with diabetes due to the injury of the nervous system, and its weakness may increase.  Hence exercises to improve balance become especially important to prevent falls.

These are simple exercises.  Standing on one leg, walking side to side, getting up from a chair without an armrest, and squatting are some balance exercises.  Some patients may need to hold on to a chair or a wall at first during training.  Yoga exercises also include balance training in them.  These are simple exercises that can be done at home.  It is useful for diabetics with nerve injury.

Flexibility training.

 Improving joint flexibility is also an important part of exercise.  This prevents injury and falls to the elderly.  Different muscle groups should be stretched.  It is best to perform these exercises under initial supervision.  It can be performed at home.  Yoga and tai chi provide excellent flexibility exercises.

everydayactivities. 

In addition to bodybuilding exercise regimens, a person should be encouraged to be as active as possible during the day.  Using the stairs instead of the elevator, walking to the nearby store, walking the dog, gardening, standing up and turning on the TV or a fan are simple chores where a person is encouraged to be active.  The time taken should be reduced.  The person should be encouraged to get up and walk if they have been sitting for a long time.  Walking for 15 minutes after meals is helpful.

To motivate the individual to move and exercise, there are apps available that they can download on their mobile phones.  These apps measure the number of steps taken per day.  Smart watches are also available which can keep a record of the number of daily steps.

Some practical advice on exercise.

• Choose some exercises that you enjoy and love. 
• Motivate the person to exercise.
• Have a smart goal when you exercise - set the duration, or limit the number of steps you will take per day.
• Set a regular exercise schedule. Some people find it easier to exercise in the morning hours while others may prefer the evening.
• Do not exercise in the hot sun.
• Drink plenty of fluids while exercising.
• Wear appropriate and comfortable shoes. Use cotton clothes and socks.
• Wash your feet after exercising and check your feet frequently for sores or injuries.