Proven benefits of physical activity in diabetes are:
- Improvement in glycemic control
- Reduction of CV risk factors and CV mortality
- Contribution to weight lose
- Inprovement of well-being
In spite of that, less than 50% of patients meet the recommended goals Current ADA recommendations as to exercise and diabetes are:
For children and teenagers with type 1 or type 2 diabetes:
- >=60 min/d of moderate or vigorous exercise
and
- >= 3 days/week of muscle-strengthening or bone-strenthening activities
For adults with type 1 or type 2 diabetes:
- One of them:
- >=150 min of moderate to vigorous-intensity aerobic activity, at least 3 days a week, with no more than 2 days without exercise, that is, mon-wed-fri, tue-thu-sat, etc.
or
- >=75 min/week of vigorous-intensity or training intervals for younger and more physically fit adults, defined as those able to run at least 10 Km/h (6 miles/h) or 6 min/Km.
and
- 2-3 sessions/week of non-consecutive days of resistance exercise (free weights or weight machines), because clinical trials have proven benefit of it in A1c.
and
- Decrease the amount of time spent in sedentary activities, interrupting prolonged sitting every 30 minutes
For older individuals:
- Flexibility and balance training 2-3 times/week, including yoga and tai-chi based in patient preferences.
PRE-EXERCISE EVALUATION
- Coronary artery disease screening for asymptomatic individuals is not recommended, but caution should be exercised in patient with risk factors
- Non-physically fit and high risk individuals should begin with low-intensity and short-duration sessions
- Conditions that contraindicate certain exercises are:
- Uncontrolled hypertension. In diabetic kidney disease, however, although vigorous exercise raises albumin excretion, there is no acceleration of kidney failure and exercise is not contraindicated.
- Untreated proliferative retinopathy: vigorous-intensity aerobic and resistance exercise is contraindicated because of risk of retinal detechment or vitreous hemorrhage
- Autonomic neuropathy. They can develop exercise hypotension, poor visual night adaptation, thermoregulatory failure, and cardiac arrest. Therefore they should undergo previous cardiac evaluation.
- Peripheral neuropathy: they must wear propper shoes and protections to avoid skin wounds, ulcers and charcot foot. Brisk walking is not contraindicated in this case
- Previous foot ulcers or charcot foot
EXERCISE HYPOGLYCEMIA
- Patients on insulin or secretagogues must be trained to recognize exercise and post-exercise hypoglycemia, and check their glycemia before, during and after the exercise. Hypoglycemia may occur depending on some of those factors:
- Duration and intensity of exercise
- Insulin or secretagogue dose
- Pre-exercise glycemia
- Previous ingested carbs
- Patients not on insulin or secretagogues are at low risk of hypoglycemia.
