INDOOR EXERCISE FOR PEOPLE WITH DIABETES
S.Bamila,
Seena Rajsekar
M.V. Centre for Diabetic Foot Care,
Podiatry, Research & Management.
The incidence of
diabetes mellitus, a metabolic disease, is a growing problem worldwide. The World Health Organization, projects an alarming 79,441,000 cases in 2030 from that of 367,000 in 2000 in India!
Type 1 diabetes mostly occurs in younger individuals and comprises approximately 10% of all diabetic cases. 90% of the cases are Type II, which is more common among older individuals.
A healthy diet and regular physical activity can prevent or delay the onset of
Type 2 diabetes.
Exercise and blood glucose levels:
Under normal conditions, insulin is released from the pancreas when the amount of glucose in the blood increases. Insulin stimulates the liver and muscles to absorb excess glucose and thus lowers its level in the blood. When exercising, the body needs extra energy in the form of glucose. For short, strong surges of exercise, such as a quick run to catch the bus, the muscles and the liver can release stores of glucose for fuel. However,
with continuous moderate exercising, the muscles take in glucose at
almost twenty times the normal rate, and lower the level of glucose in the blood.
Exercise and diabetes:A healthy lifestyle is necessary for people with
diabetes and physical activity or exercise plays an important role in achieving this. Regular exercise helps people with
diabetes in many ways.
* It lowers blood glucose levels.
* It lowers blood pressure.
* Exercise helps lower the level of triglycerides and raises the level of HDL or "good cholesterol"
* It reduces the risk of heart disease.
* It relieves stress.
* It relieves symptoms of depression.
* It helps to lose weight.
* It keeps joints and muscles flexible and reduces the risk of osteoporosis, back pain and osteoarthritis.
* It improves muscle strength, power and stamina.
* It strengthens the bones.
People with
diabetes should seek medical advice before exercising if they have any of the following contraindications:
* Complications involving retinopathy (any non-inflammatory disease of the retina)
* Hyperglycemia (> 250 mg/dl)
* Times of peak medication activity
* Drop in blood pressure with exertion
* Hypoglycemia (< 80 mg/dl).
A healthy exercise program is a three-part routine.
Warm-up before you begin.
Do some stretching, flexing, and rotating exercises to get your body ready for a workout by slowly increasing your heart rate and loosening up your muscles and ligaments. This also helps prevent dizziness and injury.
Workout or the actual physical activity you choose to do.
The goal of a workout is to increase the heart rate and loosen muscles and ligaments. Increase the pace gradually. Whatever activity you choose, breathe deeply and try to exercise your whole body - when walking, swing your upper body and arms.
Relaxation at the end of the exercise.
Bring your heart rate back to normal by slowing down your activity gradually. Begin this process before you become too tired. Do continuous slow walking or the stretching, flexing, rotating exercises you used during the warm-up.
Aerobic exercises for people with diabetes (Types1 and 2)
For Type I :
Frequency: daily, regular pattern of exercise corresponding to pattern of diet and medication.
Intensity: 40-85% of maximum heart rate.
Time: Begin with 20-30 minute programs.
For Type II:
Frequency: at least 3 – 5 times a week.
Intensity: 40-60% of maximum heart rate.
Time: 30-60 minutes.
A thirty-minute indoor exercise regimen for people with diabetes
Indian summers are hot and sultry. But your exercise routine must continue. Walk early in the mornings before it gets hot. If that is not possible, do the following exercises to maintain your level of physical activity.
Warming up – 10 minutes.
Deep breathing exercises –
Lie down on your back. Raise your knees. Take a deep breath and let it out through pursed lips. Use the 1:2 ratio for time taken to inhale and exhale. That is, if you inhale for 1 second, then exhale for 2 seconds. Repeat ten times.
Normal speed walking: for ten minutes. Walk around the house or on your terrace if you cannot, go out. Periodic swinging of your arms helps to improve circulation.
Exercise - 20 minutes.
Pelvic bridging- Repeat ten times
Lie on a flat surface. Bend your knees. Place feet on the floor 6-8 inches apart. Keep palms flat on the floor at the side of your body. Relax the upper body and back. Draw in abdominals and squeeze pelvic floor muscles (as if you were stopping the flow of urine). Exhale as you press your hands and forearms into floor. Slowly push pelvis up. It should be in a straight line from your knee to your shoulder. Count three and hold. Inhale as you slowly lower your body back to start position. Rest for 30-60 seconds and repeat.
Pelvic rolling - Repeat ten times.
Roll your knees over to one side. Keep your feet flat on the floor and look to the opposite side. You should feel a gentle stretch on your back. This exercise stretches and massages your lower back and hips.
Alternate straight leg raising – Repeat ten times each. Lie on your stomach with your hands by your side. Raise each leg as shown. Lie flat on your back with hands at your side. Raise each leg as shown in the picture.
Spinal extension / Flexion - Repeat ten times. Lie flat on your stomach. Raise your upper body pressing on your arms. Hold for a few seconds. Lower your body to the flat position and rest for few seconds.
Swimming on the floor – Repeat fifteen times.
Lie on your stomach on the floor and make swimming movements
Alternate heel / toe standing – Repeat ten times.
This exercises the calf muscle which helps you to take steps forward by pushing off the ground. Toe raises are an excellent way to strengthen this group of muscles. Stand with both feet flat on the floor. Point the toes on both feet causing your heels to lift off the ground.
Hold this position for 5 seconds. Lower your heels back onto the ground slowly.
Quadriceps / Hamstrings curls – Repeat ten times
Biceps / triceps curls – Repeat ten times
Pectoralis / lattissmus Dorsi exercises – Repeat ten times.
Arm Cycling - Repeat ten times.
Leg cycling in lying position – For five minutes.
Push-ups – Repeat ten times
Marching / Jogging – For five minutes
Squats / Stepping- Repeat ten times
Cooling Down – Ten minutes
* Deep breathing exercises. (As explained in the warming up phase)
* Static stretching for biceps / triceps – 30 second- hold. Repeat three times.
* Static stretching for Quadriceps/Hamstrings/Calf – 30 second- hold. Repeat three times
Normal speed walk for 5 minutes
Precautions for People with diabetes during exercise:
1. If you have
Type 2 diabetes, you must monitor your glucose before and after exercise to understand how you respond to certain type of activities.
2. Be sure to wear your Diabetic ID card. Whenever possible, exercise with your partners or friends. You will enjoy your activity and be more regular.
3. Check with your doctor before beginning a physical activity program and visit regularly to assess the diabetic complications.
4. If you exercise regularly you may need to reduce your insulin dose before and/or after exercise. Consult with your doctor, or diabetic educator for further advice on altering insulin.
5. Always drink plenty of fluids after exercise.
6. People with
diabetes need to take particular care of their feet. Always wear suitable footwear. Take off your shoes and socks and inspect your feet carefully after exercise.
7. Look for blisters, splinters, or rubbed places. People with
diabetes can get skin infections easily; so take care of any irritation immediately.
8. During exercise the blood glucose is used for energy, so the amount of glucose in the blood falls. If the level of glucose falls too low Hypoglycemia or "Hypo" occurs
Steps to Avoid Hypoglycemia
1. Beginners should check blood glucose level, before, during & after exercise.
2. Before planned exercises - Reduce pre-exercise insulin.
3. Before unplanned exercises – Consume 20-30 g of carbohydrates.
4. During exercises- Carry fast-acting sugar & consume as needed if hypoglycemia occurs.
5. After exercises – Consume 20-30g of carbohydrate, if blood glucose level less than 80 mg/dl.
