Physical Activity and Diabetes Mellitius
By Mustafa Coja, BA (Health Studies), BPHE
State of Mind Health & Wellness

The importance of physical activity for those with diabetes

Physical activity (PA) is one of the most effective methods to prevent and manage diabetes. With as little as 30 min a day, PA can help diabetics improve their health in the following areas:

  • Improved cardiorespiratory fitness
  • Improved glycemic control
  • Improved lipid profile
  • Weight loss management
  • Strengthens the heart, lungs and muscles
  • Helps to control blood pressure and blood sugar
  • Helps to improve states of anxiety and depression
  • And much more …

Furthermore, moderate to high levels of PA is associated with a significant decrease in morbidity/mortality in both men and women, and in both type I and type II diabetes.


Getting Active!

Every little bit counts! You do not have to perform vigorous or strenuous PA/exercise in order to benefit from the many health attributes they have to offer!

Incorporating PA into your life-style that includes aerobic, strength, and flexibility training will give you the most benefit.


Aerobic Activity

Each individual should strive to perform moderate-intensity aerobic activity 3-7 days a week, totalling 150 minutes per week. For elderly individuals or for those who are presently sedentary, smaller bouts of activity can be used when beginning to incorporate PA into their life. For example, an over-weight individual who has trouble walking for 30 consecutive minutes can split up the walking into 3 ten-minute walking sessions spread throughout the day!


Examples of aerobic activity include, but are not limited to:

  • Walking or other moderate-intensity exercises, Swimming, Bicycling, Playing sports (Ex. Soccer, football, hockey, etc.), Canoeing/kayaking, cross-country skiing, hiking

Resistance Activity

Diabetics should aim to perform resistive exercises 2 to 3 times a week. These exercises should emphasize the use of large muscle groups such as arms and legs for example. Resistance activities are important as they compliment the benefits gained from aerobic training. Each resistance exercise should range from 10-15 repetitions with moderate resistance. It is important to speak with an exercise professional before beginning such activities. Exercising using weights or resistance bands are examples of resistance activities.


Flexibility

Although this aspect of PA is very important to one’s health, it is often neglected. The use of stretching exercises can help to increase mobility and range of motion which in turn will make activities of daily living easier to perform.


Warm-Up & Cool-Down

Diabetics and non-diabetics alike should begin with a 5-10 min light warm-up consisting of aerobic activity (ex. Jogging, stationary bike, etc.) in order to prepare the body for PA. Next, the body should be stretched for 5-10 minutes based on the muscle groups to be used.

After the main PA has ended, it is important to cool-down the body using similar activities as the aforementioned warm-up and stretching. This will help to gradually lower the heart rate back to a normal resting level.

Before you start

It is important to note that before starting a PA program that is more vigorous than walking, diabetics should see their physician for an assessment of conditions that may be contraindications to certain types of physical activities, predispose them to certain injuries or increase the risks of cardiovascular diseases.

Previously sedentary individuals may have to gradually increase their level of PA. This can be accomplished by increments of as little as 5 to 10 minutes of PA per day.

Did you know! … that multiple shorter PA sessions of approximately 10 minutes spread out over the course of a day can be just as beneficial as a single longer bout of PA?

People with diabetes need to be a little more careful about PA than other individuals. Paying extra attention to low blood sugar, feet and eyes while being physically active is very important.

Here are some tips for diabetics to use for safe PA:
  • Start slowly – if you are new to exercise or have not exercised for a long time, begin slowly with low-impact activities such as walking, swimming, bicycling
  • Time it right – The best time to exercise is approximately one hour after a meal, as that is when your blood sugar levels are likely to be higher
  • Know your limits – Monitoring your blood sugar levels before and after PA is important to see how your body is responding to exercise
  • Care for your feet – wearing proper footwear that is not too snug will help reduce the formation of blisters, which can lead to skin ulcers. If you have a loss of sensation in your feet, try to avoid high-impact activities that could lead to pressure ulcers and/or stress fractures
  • Protect your eyes – If you have developed retinal complications such as retinopathy for example, avoid lifting heavy weights and other activities that would increase blood pressure.
  • Think ahead – in the event your blood sugar becomes too low due to exercise, keep water and high-carbohydrate snacks close to help boost your sugar levels
  • Advertise – Wear a medical alert bracelet/necklace indicating you have diabetes just in case you need medical assistance


Special considerations

For those who are Type I Diabetic or who are required to take daily insulin doses, special consideration must be taken before beginning an exercise program:

  • Post-exercise glucose levels may be high due to increased levels of epinephrine (adrenalin). However, because PA helps increase insulin sensitivity, it may result in a reduction (improvement) of blood glucose levels for up to 24 hours post-exercise
  • As a result, PA combined with regular insulin doses can potentially lead to hypoglycaemia (low blood sugar)
  • This is why exercising each day is so important - one must ensure that physical activity is incorporated into their daily lives in order to ensure that it coincides with their regular insulin treatment
  • It is therefore important to discuss these considerations with your doctor before beginning an exercise program or any form of PA that is higher than moderate intensity

Tips to become and stay physically active
  • Set a schedule
  • Encourage yourself through positive self-talk
  • Tell your family and friends of your goals – they can be a great support network!
  • Take advantage of the little opportunities – for example, take the stairs instead of the elevator or park further away from the door at your grocery or other shopping centres
  • Choose realistic goals: Start slowly, and progress from there
  • If you fall off the wagon, it’s ok. Get back up and try again!
  • Most of all, have fun - choosing activities you enjoy will increase the likelihood of maintaining them and will also continue to encourage/motivate you to stay on track.

For more great physical activity ideas, visit the Canadian Physical Activity Guide at: http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pag-gap/index-eng.php

Resources

  • Alireza, E., Mohammad, H., Farzin, H., & Michael, B. (2008). Exercise prescription in patients with diabetes type 2. Iranian Journal of Diabetes and Lipid Disorders,8, 1-15.
  • Canadian Journal of Diabetes. (2008). Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.
  • Lee, T., H. (2009, November). Exercise prescription for diabetes. Harvard Heart Letter.
  • Nagi, D. (2005). Exercise and Sport in Diabetes. John Wiley & Sons, Ltd.
  • Warburton, D. E. R., Katzmarzyk, P. T., Rhodes, R. E, & Shephard, R. J. (2007). Evidence-informed physical activity guidelines for Canadian adults. Applied Physiology, Nutrition & Metabolism, 32, s16-s68.