Diabetes and Exercise

Dr Jubbin Jagan Jacob MD

Department of Endocrinology

CMC Vellore

Exercise is the best insulin sensitizer on the market; better than any medication we currently have available" Bartol

Clinical Implications

Even short-term (2-week), regular aerobic exercise in type 2 diabetic patients results in significant improvement in both aerobic capacity and whole-body insulin sensitivity.

Clinical Implications

Long-term endurance training in diabetic patients markedly improves whole-body insulin sensitivity and the expression of key muscle enzymes regulated by insulin. However, the maintenance of this effect seems to require dedication to a regular and uninterrupted exercise regimen

Clinical Implications

Intramyocellular lipid accumulation, which is associated with insulin resistance in muscle, can be acutely decreased by even a single bout of sustained endurance exercise, in a manner that depends on both duration of exercise and workload.

Clinical Implications

Exercise is beneficial for both glucose uptake mechanisms and the antilipolytic effects of insulin.

THE EXERCISE PRESCRIPTION

1. Before beginning an exercise program, the individual with diabetes mellitus should undergo a detailed medical evaluation

2. A careful medical history and physical examination should focus on the symptoms and signs of disease affecting the heart and blood vessels, eyes, kidneys, and nervous system.

`Potential adverse effect of exercise

Cardiovascular Microvascular Metabolic Musculoskeletal and traumatic

Cardiovascular

Cardiac Dysfunction and Arrythmias due to silent IHD

Excessive increments in Blood pressure

Post Exercise Orthostatic hypotension

Microvascular

Retinal Haemorrhage Increased proteinuria Acceleration of other

microvascular lesions

Metabolic

Worsening of Hyperglycemia and ketosis Hypoglycemia

Musculoskeletal and traumatic Foot ulcers Accelerated

degeneration of joints

Preparing For Exercise

proper warm-up consisting of 5–10 min of aerobic activity

activity session, a cool-down should be structured similarly to

the warm-up and should last about 5–10 min

Avoiding Complications

Proper Footwear Avoid Exercise in extreme Heat or Cold Inspect Feet daily before and after Exercise Avoid Exercise when metabolic control is

poor Maintain good water intake Prevent hypoglycemia

Practical considerationsHow much exercise? A good goal for many people is to work up to

exercising 4 to 6 times a week for 30 to 60 minutes at a time. Remember, though, that exercise has so many benefits that any amount is better than no exercise.

How to get the patient started? Begin with a 10-minute period of light

exercise or a brisk walk every day and gradually increase the duration of exercise.

Tips that will help the patient start and stick with an exercise program: Choose something the patient likes to do. Get a partner. Vary the routine. Choose a comfortable time of day. Forget "no pain, no gain." Make exercise fun.

Aerobic exercise

Aerobic exercise is the type that moves large muscle groups and causes you to breathe more deeply and your heart to work harder to pump blood. It's also called cardiovascular exercise. It improves the health of your heart and lungs.

Aerobic exercise include

Jogging

Swimming

And also

Walking Rowing Bicycling

Weight-bearing exercise

The term weight-bearing is used to describe exercises that work against the force of gravity. Weight-bearing exercise is important for building strong bones.

Weight-bearing exercise

Weight lifting Walking Jogging Climbing Stairs

What is the best exercise?

The best exercise is the one that your patient will stick to

Walking is considered one of the best choices because it's easy, safe and cheap. Brisk walking can burn as many calories as running, but is less likely than running or jogging to cause injuries.

What about weight training? Weight training, or strength training, builds

strength and muscles. Calisthenics like push-ups are weight-training exercises too

Thank You