Diabetes and Exercise

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Diabetes and Exercise

• Dr Jubbin Jagan Jacob MD
• Department of Endocrinology
• CMC Vellore

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

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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

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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.

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Clinical Implications

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

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THE EXERCISE PRESCRIPTION

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

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Potential adverse effect of exercise

• Cardiovascular
• Microvascular
• Metabolic
• Musculoskeletal and traumatic

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Cardiovascular

• Cardiac Dysfunction and Arrythmias due to silent
  IHD
• Excessive increments in Blood pressure
• Post Exercise Orthostatic hypotension

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Microvascular

• Retinal Haemorrhage
• Increased proteinuria
• Acceleration of other microvascular lesions

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Metabolic

• Worsening of Hyperglycemia and ketosis
• Hypoglycemia

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Musculoskeletal and traumatic

• Foot ulcers
• Accelerated degeneration of joints

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Preparing For Exercise

• proper warm-up consisting of 510 min of aerobic
  activity
• activity session,
• a cool-down should be structured similarly to the
  warm-up and should last about 510 min

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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

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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.

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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.

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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.

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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.

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Aerobic exercise include

• Jogging
• Swimming

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And also

• Walking
• Rowing
• Bicycling

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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.

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Weight-bearing exercise

• Weight lifting
• Walking
• Jogging
• Climbing Stairs

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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.

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What about weight training?

• Weight training, or strength training, builds
  strength and muscles. Calisthenics like push-ups
  are weight-training exercises too

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Thank You