Exercise Prescription for Diabetics

The Exercise Prescription for individuals with diabetes is pretty similar to that for individuals without the disease. The big difference is that diabetic exercisers must be cautious of hypoglycemia, or low blood sugar, which I will discuss in greater depth in a future blog.

To begin, I want to highlight for you all the great benefits of exercising for individuals with diabetes and prediabetes. Regularly exercising can help improve glucose tolerance, increase insulin sensitivity, and decrease HbA1C (aka glycosylated hemoglobin, which is a reflection of the average blood glucose control over a period of 2-3 months, with a typical goal being <7%) in those of you with Type 2 diabetes and prediabetes. Individuals using insulin (Type 1 diabetics and some Type 2 diabetics) can experience a reduction in insulin needs with regular activity. For those of you with any of the three conditions, exercise can help improve a number of CVD risk factors (i.e. lipid profiles, blood pressure, weight) and overall well-being. In addition, if you have prediabetes and are at high risk to develop DM, exercise can help delay, and sometimes even prevent, the transition to Type 2 diabetes. Lastly, regular exercise can be used as a means of weight loss or weight maintenance, which is especially important if you have Type 2 DM or prediabetes, but it can also be helpful if you have Type 1 DM.

In exercise science, we use FITT - Frequency, Intensity, Time, and Type - to build exercise programs; we also throw in a very important rule: Progression. Exercise programs should consist of aerobic training (aka cardiorespiratory fitness, such as walking, running, cycling, etc.), resistance training (aka strength training, such as weight lifting, using resistance bands or physio-balls, etc.), and flexibility (stretching for pre-exercise warm-up and post-exercise cool down). For individuals with DM, the FITT guidelines are as follows:

1. Frequency - 3-7 days/week
2. Intensity - RPE 11-13 on a scale of 6-20; better glucose control could be achieved at higher intensities, so if you have been participating in regular exercise, you may consider increasing the intensity to RPE 14+
3. Time - 150+ min/week of moderate intensity exercise, performed in bouts of 10 minutes or more and spread out throughout the week; exercising 300+ min/week at moderate-to-vigorous intensities can have even greater health benefits
4. Type - the best exercises are those that use large muscle groups (shoulders, chest, back, abs, arms, thighs, calves); the particular type of exercise can and should be tailored to your individual goals and interests
5. Progression - it is of utmost importance to gradually progress frequency, intensity, and time of exercise to maximize calories burned and to increase health benefits, as well as prevent boredom from an unchanging program and injury from progressing too quickly

• As long as you do not have any contraindications to exercise (please see the second and third blog posts for these!), retinopathy, or recent laser surgery, resistance training should be incorporated into your program
• 2-3 days/week; light-to-moderate intensity; work all the major muscle groups listed in #4 (type) above; 8-20 repetitions, 2-4 sets, 30 sec-2 min rest between sets (all vary depending on the goal of the program); at least 48 hr rest between resistance training workouts; gradual progression
• Exact resistance training programs will vary from person to person because they should be designed for the individual
• Another important aspect of the exercise program is flexibility exercise
• You should warm up and cool down before and after every bout of exercise; warm up should be dynamic stretching that incorporates movement into the stretching (i.e. high knees, butt kicks, walking lunges, etc.), while cool down can be static (standing or seated, such as toe touches, butterflies, etc.) stretching
• 2-3+ days/week (can be done every day - the more you stretch the better you will be); stretch to the point of slight discomfort; hold each stretch for 20-30 sec (hold longer if older); perform enough reps (2-3) that you perform each exercise for 60 sec

Combining both aerobic and resistance training may have a greater effect on glucose control than simply partaking in one or the other, although there is still some research to be done in this field. You should take no more than 2 days off each week. To increase cardiorespiratory fitness (CRF), you should eventually focus on vigorous intensity exercise. If the goal is weight loss (as is the case for many individuals with Type 2 DM), then you should look at performing longer bouts of moderate intensity exercise incorporated with, if it is right for you, calorie restriction.

For the most part, children with diabetes can play as much as their peers who do not have DM, but be sure to look out for hypoglycemia both during and after exercise. For more information on exercise and children with DM, check out the ADA website or talk to your child's physician.

The big takeaway from this is that, even though each of you has diabetes or prediabetes, there is an exercise program out there that is tailored specifically and individually for you. In the next few posts, I am going to discuss some considerations for diabetics while exercising, as well as present a sample exercise program for you to see the FITT principles in action!


Have a great day!
-Emalee


Information for this blog came from the ACSM's Guidelines for Exercise Testing and Prescription, 9th edition (2014) and the website for the American Diabetes Association.