Exercise..move a little more, eat a little less
David Kinshuck
Which exercise?
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Walking, swimming, cycling, gardening, and windsurfing are examples of activities that help the body to maintain good health, whether or not you are diabetic.
Exercise lowers blood pressure, and helps to prevent conditions such as heart attacks and stroke, and helps to lower the sugar and keep diabetes under control. Exercise is proven to prevent diabetes. It reduces the dose of insulin needed (BMJ 2011). Doctors tend not to mention the importance of exercise.
Starting off
When starting activities for the first time people with diabetes need to adjust their diet (and insulin if used). If you plan to start to walk or exercise more than usual as a precaution it is best to discuss this with you doctor or nurse.
The UK Department of Health recommends a minimum of 30 minutes a day.
Yoga and tai chi can help people with diabetes, but they need to be combined
with other types of more physical exercise, like walking.
If you are disabled ask your doctor what type of exercise may be appropriate for you. If nothing else it is important to keep your brain active by reading, doing puzzles, or listening to the radio.
How much exercise
Part of the eye clinic cycling team- Adults should take at least 30 minutes of moderate exercise five days a
week.
- For people who need to manage their weight and are at risk of putting on
weight and becoming obese, 45 to 60 minutes a day.
- For people who have been obese, or are still obese and have lost weight,
60-90 minutes a day.
- For older people the above recommendations are appropriate depending on
their ability.
- Children should get at least one hour a day of moderate physical activity,
which should include activities to improve bone health, muscle strength and
flexibility at least twice a week.
- Moderate exercise is classified as brisk walking, playing golf, badminton,
tennis (doubles), cycling, painting, decorating and hoovering.
- Moderate intensity activity will cause an increase in breathing rate, an increase in heart rate to the level where you can feel your pulse and a feeling of increased warmth, possibly sweating on hot or humid days.
- How to lose 3.5 stones in 8 months
Pedometers
Doctors should recommend pedometerss...at least they help increasing weight loss in the short term. They encourage an increase in exercise of about 26%. People with diabetes should buy a pedometer and generally need to try and walk 10,000 steps a day. 10,000 a day to keep the doctor away (about 5000 if you are not overweight).
Expert advice for insulin users
- see adjusting insulin...DAFNE advice
- See 'The Diabetic Athlete', Sheri Colberg gives expert advice, and is worth buying or reading
- an excellent website : If you use insulin, you may need to adjust the dose. This is especially so if you do not exercise the same way each day, see below.
- Joslin outdoor activities.
- Exercise
Insulin dose adjustment with exercise
This is an extract from Dr Sharon Jones, Nov 2006, talk for professionals, here 5mb powerpoint : Exercise in diabetes. aerobic, anaerobic exercise. Improve/maintain health. Exercise helps even if no weight lost. Hypos and avoiding them, pregnancy, neuropathy. The athlete, pre-& post exercise. Fluids, monitor glucose level. Slow and steady, weight loss programs, housebound programs, case examples.
Here are some of the case examples.
- Runner
- uses novarapid before meals and detemir twice daily
- runs after after breakfast
- sips a sugary drink during the run
- reduces breakfast novarapid 25%, with lighter breakfast
- Usual insulin with increase CHO for lunch
- If exercises before breakfast- Less sugary drink during the run - just as needed - normal insulin with breakfast after run
- Football team, both midfield player and goalie have type 1 and are treated
with basal bolus insulin
- Pre match meal-- Midfielder reduces bolus insulin by 50-75% -- Goalie by 25%
- Pretraining meal-- Both midfielder and goalie reduce insulin by 40% -- And basal by 10%
- Rower...training - reduce insulin, more so if cold, hot or windy
- Racing - check glucose pre-race and give extra units if raised anticipating further rise from anaerobic metabolism
- Tennis - greater reduction in dose if playing singles than doubles
- Golf - usual reduction of around 20% with snacks each hour (half banana) but even less insulin or more snacks if caddie fails to turn up
Exercise can prevent diabetes
Exercise has been shown to prevent diabetes, and delay it. The exercise helps even if you don't lose weight. 10000 steps a day is the quoted figure, but this is not enough for children. This seems like an extraordinary amount in Birmingham, but this is the realistic figure needed. See this excellent study.
Exercise if you are disabled
Exercise is even more important if you are disabled.
- 10 minutes 3 times a day is just as good as 30 minutes.
- if you can walk I recommend a short walk every half hour round the house, and a walk outside every 2 hours, and perhaps a longer one if possible
- if you cannot walk, moving legs and arms up and down is very helpful..any exercise you can do...perhaps a little every 10 minutes. An exercise bike, chair exercises all help. Swimming is perfect.
- if you have blocked arteries in your legs, interval exercise can help...3 minutes walk and 1 minutes rest