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