Diabetes & Exercise
Whole Body Fitness trainers are certified in Diabetes and Exercise through DSW Fitness. We understand the types of diabetes and the role of blood glucose monitoring, how to respond to glycemic responses, nutrition and exercise prevention and management strategies. We understand the needs of the diabetic population, including pregnant woman, teens, athletes and older adults. We have acquired the tools and strategies to improve physical fitness and help with weight loss.
According to the American Diabetes Association Data from the 2011 National Diabetes Fact Sheet 25.8 million children and adults have diabetes and 79 million people are pre-diabetic.
Exercise is important in everyone’s life. However it is particularly important if you have diabetes. Exercise can help control blood sugar levels, maintain desirable weight, increase circulation, reduce the risk of cardiovascular disease. As a fitness professional it is important to understand the benefits and risks associated with exercise.
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Diabetes is the sixth leading cause of preventable death in the U.S. and is a disease that increases the risk of death from leading causes of preventable death: heart disease, stroke and cancer. Type 2 diabetes is more prevalent than Type 1 and is preventable and reversible. The costs associated with diabetes are large and increasing. Direct medical costs related to diabetes are $116 billion per year. Average medical expenditures among people with diabetes are 2.3 times higher than those people without the disease. The indirect cost of diabetes due to disability, work loss, or premature mortality, are $58 billion per year (NIDDK 2009). These costs are disturbing and frustrating considering diabetes is preventable. Diabetes is a chronic, costly condition and is increasing at an alarming rate.
Diabetes is classified as a metabolic disorder characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Type 1 Diabetes relates to the absence of insulin due to immune destruction of beta cells. Type 2 Diabetes involves the inability of the body to appropriately regulate blood glucose levels due to impaired action of insulin and/or secretion. Insulin is an essential hormone that regulates glucose, fat, and protein metabolism and effects the way the body uses food for fuel. When insulin does not work properly or when there is insufficient production, blood glucose levels remain high.
- Hyperglycemia (High blood glucose levels) is quite damaging and leads to long term complications of diabetes, which include:
- Neuropathy – kidney disease and failure
- Retinopathy – increased risk of blindness
- Nephropathy – hyperglycemia results in the progressive loss of protective insulation around nerves. Tingling and burning in feet are first signs of damage to sensory nerves
- Arthrosclerosis – hyperglycemia negatively affects the artery walls. Heart attack and peripheral vascular disease are common disorders. Hypertension is present in 75% of diabetics.
Symptoms and Complications of Disease
Increased thirst, constant/extreme hunger, excessive fatigue, blurred vision, increased infections of gums, urinary tract, eyes and skin, dry itchy skin, slow-healing infections, tingling or loss of feeling in hands or feet.
Exercise and Diabetes
Guidelines for Exercise for Diabetics
Ensure client checks blood glucose level prior to exercise. Do not initiate exercise if blood glucose levels are less than 100 mg/dl or greater than 250mg/dl. In addition the physician should establish the clients acceptable blood glucose upper limit allowable for exercise.
Begin client with entry exercise levels. Gradual progression allows for less blood sugar fluctuation and for changes in medication and meal planning.
Consistency is paramount. It is recommended to exercise at the same time of day and at similar intensities, durations and frequencies. Consistency results in less fluctuation of blood sugar.
Blood sugar monitoring should be performed more often than normal when first starting an exercise program or when changes are made to the program.
Avoid isometric exercises or any exercises that results in a sustained increase in systolic blood pressure. This is of particular concern for those with microvascular disease. Sustained increase in systolic BP can result in retinal hemorrhage or excess protein in urine.
All clients should keep their physician informed of their current exercise program.
To achieve better health and quality of life, people with diabetes should be encouraged to participate in physical activity regularly.
Benefits of Exercise
- Lower blood sugar levels
- Help reverse the insulin resistance that is associated with excess body fat T2DM
- Delay and prevent the development of artherosclerosis
- Modify body composition and reduce weight when combined with a reduction in caloric intake.
- Increase circulation to all parts of the body
- Reduce depression and stress
Risks of Exercise
Hypoglycemia can occur during or after exercise. Exercise induces glucose utilization, and, therefore, generally a reduction in blood glucose levels, which means that during exercise your client’s blood glucose levels may drop too much. If blood glucose level prior to exercise is less than 100 mg/dl, 15 grams of Cho need to be consumed and client needs to wait 15 minutes.
Injection or infusion site for the insulin is important. Insulin is absorbed more rapidly when administered to an area close to working muscles.
Dehydration is a concern when working with diabetics. People with diabetes have a greater risk of dehydration due to increase fluid requirement of kidneys and urine output needed to flush excess glucose from body. Make sure client drinks 20oz of water 2 hours before exercise.
People who use insulin should not exercise alone. Avoid exercise at the time of peak insulin.
It is crucial for fitness professional to recognize the symptoms of hypoglycemia and know how to treat it: 4oz fruit juice, 8 oz sport drink, 1/2 banana, 1 fig newton.
- Abnormal gait
- Clicking feet when running (kicking feet together, stumbling)
- Lack of balance
- Fatigue, “puniness”
- Seeing stars
- Buzzing in ears
- Increased heart rate
- Reduction in power (cannot perform at usual level)
- Heart palpitations
Exercise Program Development
The American Diabetes Association and the American Heart Association support the Physical Activity Guidelines for Americans (US Dept Health & Human Services 2009) for individuals with diabetes who do not have medical contradictions. In addition, in 2010 the American College of Sports Medicine (ACSM) and the ADA issued guidelines for T2DM which call for both aerobic and resistance training exercise.
Aerobic exercise guidelines – at least 3 times a week, preferably 5 times a week 40%-60% of Vo2max, greater health benefits can be achieved at >60% of Vo2max. Aerobic activity alone cannot provide the full benefit of exercise to diabetics. Recent studies has shown that resistance training is perhaps more important than aerobic training in managing diabetes. Much of the effect appears to be due to the metabolic adaption’s of skeletal muscle.
Resistance training guidelines – at least 2 times per week on nonconsecutive days and progress to 3 times per week, machines and free weights can be used; both have shown equivalent benefits in blood glucose control. 5-10 resistance training exercise of major muscle groups is appropriate. Strength training improves muscular strength and endurance, functional ability, bone health and balance
Due to potentially complex physical limitations of diabetic client, the ACSM and ADA recommend that clients always be supervised by a qualified exercise trainer when engaged in resistance training. This will help ensure optimal blood glucose management and other health benefits while minimizing the risk of injury.
Health screening is a crucial first step in maintaining safety and effectiveness of any exercise program. Health screening has several purposes:
1) Identifying health conditions and risk factors that put your client at risk when participating in an exercise program or may necessitate referral to a healthcare professional
2) Assisting in the design of appropriate exercise program
3) Identifying possible contradicted activities
4) Fulfilling legal and insurance requirement
5) Encouraging and maintaining communication with client’s health care provider.
6) Obtaining medical clearance
7) Review prescription medications that client is taking
We at Whole Body Fitness can design a personalized progressive fitness program, monitor your progress and provide supervision and support throughout. We can work with your healthcare provider in getting you started on an exercise program that would be best for you.