Ask The Expert
Exercise

Important tips and motivational ideas:

• Exercise is important! The Surgeon General recently recommended moderate amounts of daily physical activity for people of all ages, either as longer sessions of moderate activities (like brisk walking) for 30 minutes, or shorter sessions of more intense exercise, such as jogging or playing basketball for 15-20 minutes. However, the new millennium began with more than 60% of all American adults not being regularly physically active, and 25% not exercising at all in spite of the widely broadcast health benefits of exercise. Don't be one of them!
• Before you start: First consult your diabetes team: If you aren't exercising regularly, or if it has been a long time since you've done so, then first make sure you discuss your plans with your doctor, and have a medical exam before beginning regular exercise. Your healthcare team will be able to evaluate your diabetes control and cardiovascular fitness, recommend what types of exercise are best for you, and make possible adjustments to your meal plan or medication regimen prior to starting any activity.
• It all counts: All exercise you accumulate during the day counts. Until recently, it was thought that regular, intense physical activity (like jogging) was necessary for optimal health and fitness. However, recent studies have shown that almost any physical activity (including golfing, gardening, mowing the lawn, and moderate walking) done 30-45 minutes per day is beneficial to health, even if your fitness is not increased. Every type of exercise expends some calorie-- even walking, gardening, and yard work. In a recent study on adult women, participation in regular, moderate (brisk) walking decreased their risk for developing diabetes similarly to more vigorous activity. Simply being physically active in any manner during leisure time - particularly doing longer or more intense activities - also reduces diabetes risk as well. In other words, as far as your health goes, what really matters is expending those extra calories through physical activity any way that you can!
• Forget the "no pain, no gain" mentality perpetually circulating around fitness clubs and gyms. An uncomfortable sensation of pain in exercising muscles is not necessary to achieve substantial gains in health or fitness!
• Change your inner message: Replace thoughts of "I'm in no shape to exercise!" with more positive ones, such as "Exercising gives me more energy!" Once you start exercising regularly, you will likely discover how bad being inactive and out of shape actually makes you feel.
• Small changes can reap big rewards: For example, if you eat 50 calories a day more than you expend (the equivalent of a small apple or about 5-6 peanut M&M's), the total weight you will gain in one year from that excess intake alone is five pounds of body fat. If instead you expend an extra 50 calories a day by adding in little bits of exercise - easily accomplished with some extra walking - here and there throughout the day-- then the weight gain from these extra calories will be totally avoided. Furthermore, expending an extra 50 calories a day beyond your total caloric intake will result in the loss of five pounds!
• Frequent, regular exercise is the key to good blood glucose control. A heightened sensitivity to insulin in exercised muscle persists for only 1-2 days following the activity. Thus, in order to maximize exercise's positive effects on blood glucose control, you have to exercise regularly. A minimum of 3 to 5 days per week of moderate aerobic exercise (walking, jogging, cycling, swimming, etc.), done for 20 to 60 minutes, is recommended for all individuals. If you have type 2 diabetes, it is recommended that you do this daily or almost every day to optimize weight loss and blood glucose control. If you have type 1 diabetes, performing regular, predictable exercise may make diabetes easier to manage.
• Exercise truly is the best medicine. From a metabolic standpoint, it is better to be fat and fit than lean and sedentary. Recent studies have shown that type 2 diabetes may be preventable with regular physical activity-- even moderate walking. Exercise enhances your body's sensitivity to insulin, which usually results in better blood glucose control; moreover, many other chronic diseases are related to insulin sensitivity, including hypertension and heart disease. Regular exercise also lowers your risk of premature death, heart disease, some cancers (like colon), anxiety and depression, osteoporosis (loss of bone calcium), and severe arthritic symptoms.
• Live longer, too! Even regular walking can keep you living longer, according to a study reported in the June, 2003 issue of the Archives of Internal Medicine. In fact, this study also reported adults of all ages with diabetes who walk at least two hours per week have a 39% lower risk of dying from any cause and a 34% reduction in their risk of dying from heart disease, one of the most common diabetic complications.
• Talk to your healthcare team, and keep a record of your activity, blood glucose levels, and medication doses: To participate in more regular, prolonged exercise training, you should consult with your diabetes healthcare provider about reducing doses of oral medications or insulin (if you take either) to prevent hypoglycemia (low blood glucose). Insulin users have a much greater risk of developing low blood glucose. To prevent this from occurring, check your blood glucose level before, possibly during, and after any physical activity to monitor its effects and compensate for lows by eating some extra carbohydrate.

Begin with easy, unstructured activities

• TV watching is an extremely sedentary activity during which your energy expenditure (metabolic rate) is even lower than during other sit-down activities, including playing board games or even reading! Possible solutions:
  • Lose the TV remote control so you have to get up to change channels.
  • Stand up and walk in place while watching television.
  • Invest in a rebounder (mini-trampoline) and jump while watching.
  • Ride a stationary bike while you are watching TV.
  • Limit TV and computer use to no more than two hours per day, or at least reduce their use by a minimum of 30 minutes daily.
  • To begin walking more, simply try to emphasize it in an unstructured way - by adding it into your day in every way imaginable.
  • Try taking the stairs instead of the elevator or an escalator whenever possible.
  • If going up steps is too hard, then start by only walking down.
  • Walk up or down the escalator instead of standing still.
  • Walk instead of standing on moving walkways in airports and other places.
  • Park at the farthest end of the lot (stop waiting for the closest parking spot!).
  • Get up and move for 3-5 minutes after every 30 minutes straight of a sedentary activity.

Get Moving

• Walking only 2,000 steps a day equals about a mile, which for adults expends at least 100 extra calories. In fact, a national campaign called "America on the Move" is currently advocating the same increase in steps (2,000 more per day) to be taken by everyone. Here are some ways to get started:
  • If motivation is your biggest problem, make a game out of counting how many steps you currently take in a day.
  • Seeing how active you really are (or are not) during the day may assist you in remembering to add in more steps.
  • Start by adding in 2,000 more steps a day.
  • Then, increase your steps to double your original number.
  • Finally, aim for a minimum of 10,000 steps daily for the greatest benefit.
  • For every excess calorie you eat, add 20 steps to your daily total.
  • Consider going out and investing in a pedometer to use for monitoring and motivation.
• Walk the walk, talk the talk: Don't start out exercising too intensely, or it will feel too hard, and human nature will prevail (i.e., you'll stop doing it). You are also more likely to injure yourself if your exercise intensity is too high to start. Use the "Talk Test" as your guide: If you can't comfortably carry on a conversation with someone else while you are exercising, then you are working harder than you need to. Almost everyone can exercise safely and effectively.
• Remember: Diabetes bestows additional risks, but you can still exercise if you respect your limitations. For example, if you have lost some of the feeling in your feet, you may need to switch to non-weight-bearing activities such as swimming or stationary cycling to minimize injury to your feet common with walking and jogging. If you have high blood glucose levels, you should drink plenty of fluids with exercise to prevent dehydration. If you have diabetic eye problems, then you should avoid jumping, jarring, or breath-holding activities. Also include proper warm-up and cool-down periods (at least 5 minutes of a lesser intensity activity) to ease the stress on your heart and minimize your risk for orthopedic injuries. For all of these recommendations, first check with your healthcare team.
• Keep moving: Once you start moving, you will find almost limitless ways to add more physical activity to every day. Try doing some of these activities:
  • If you have ten free minutes, walk around instead of sitting down.
  • Use a push mower to mow the lawn.
  • Rake the leaves in the yard.
  • Take the dog out for a daily walk (pets need exercise, too!).
  • Go up and down the stairs in your house a few extra times.
  • Bike to work, to run errands, or to visit friends.
  • Clean out the garage or the attic.
  • Walk with a friend over the lunch hour instead of eating out.
  • Volunteer to become a coach or referee.

Stay Flexible

• When you have diabetes, you can lose your flexibility faster than would someone without diabetes, because extra glucose in your bloodstream "sticks" to joint structures.
• Maintain or increase your flexibility by doing the following daily stretches for your lower body:
  • Calf stretch: Lean against a wall with one leg back and alternately bend and straighten your back knee while keeping your foot flat for 5-10 seconds, then switch legs.
  • Knee stretch: Grab one of your ankles by bending at the knee, and bring your ankle up to your buttocks; hold for 10-15 seconds before switching legs.
  • Hamstring stretch: Bending at the hip while either standing or lying on your back, bring one knee up against your chest, holding it there with both hands, then switch legs
• Keep or increase your flexibility by doing the following daily stretches for your upper body for 10-15 seconds each as well:
  • Torso stretch: Lift both arms over your head with your feet more than shoulder width apart and lean as far as you can to one side, then the other.
  • Upper arm stretch: Holding one arm by the elbow, pull your elbow straight up next to your head; next, pull the same elbow across your chest before switching arms.
  • Neck roll: With your shoulders even, lean your head forward and then roll it in a clockwise direction until you have made a complete circle; repeat going in a counter-clockwise manner.

Vary Your Routine

• Another practice to enhance your overall fitness and insulin sensitivity is to incorporate workouts of varying intensities into your weekly routine.
  • Alternate easy/hard workouts: For example, it is good for a number of physiological reasons to alternate easier and harder workout days. By alternating workout intensities, your body gets both the enhanced fitness benefits attributable to working out at a higher level, combined with the healing effects of greater recuperative time before undergoing another such workout.
  • Avoid overdoing it: This practice helps to prevent "overuse syndrome," which includes more frequent colds, chronic tiredness, and orthopedic injuries, such as bone stress fractures and tendonitis (inflammation of tendons, the muscular attachments to bone), to which people with diabetes are especially prone.

Add Resistance

• Resistance, or weight training, is an essential part of an overall exercise program, because it is the best way to increase your muscle mass-a tissue vital for keeping glucose levels low and decreasing insulin resistance. Having more muscle raises your basic metabolic rate and burns more calories - all day and night. In addition, resistance training helps combat the loss of muscle fibers and bone calcium that occurs as you age. How to train:
  • Include exercises for each of the major muscle groups in your body.
  • Use a weight or resistance that you can lift 8-15 times in one set.
  • Do a minimum of one set (but preferably 2-3 sets) on each activity.
  • Train 2 to 3 days per week alternating rest days in between.
• Easy resistance training that can be done with 1 to 5 pound dumbbells:
  • Dumbbell Chest Press: This exercise works the pectorals (the muscles at the top of the chest), triceps (the muscles under the upper arm), and anterior deltoid (the front of the shoulder).
    • Lying flat with your knees bent, hold the weights directly above your chest. Your arms are extended and palms are facing towards your feet. Keep your torso and stomach muscles firm.
    • Keeping your elbows pointed directly out from your sides, slowly bend them and lower the weights to your chest. Keep them under control, inhaling through your mouth as they are lowered.
    • Press the weights back up to the starting position while exhaling and repeat.
    • Avoid locking your elbows to prevent joint damage if using heavier weights.
• Lateral (Side) Raises: This exercise works your deltoid muscles (surrounding your shoulders) and your lats (muscles extending from under your arm part way down your sides).
  • Stand upright with your knees slightly bent and your legs shoulder width apart, holding the weights in arms extended down the side of your thighs.
  • With slightly bent elbows, extend your arms at right angles to your torso, with your palms facing the floor up to shoulder height.
  • Slowly lower the weights back down and repeat.
  • If you catch yourself arching your back, dipping your knees, or bringing your shoulders back, use a lighter weight or bend your knees more.
• Half squats: This exercise helps work your quads (muscles on the front of your thighs), hamstrings (on the back of your thigh), gluts (your buttocks), lower back, and calves.
  • Hold the weights in your hands at your sides, and stand upright with your feet shoulder width apart.
  • Bend your knees only until your thighs are almost parallel to the ground, at a 90° angle, or as far as you can bend without feeling pain in your knees.
  • Keep your back flat (not rounded) and your head up.
  • Return to an upright position and repeat.
  • Do squats with your back against a wall if needed to maintain balance.
• Upright Row: This exercise works the trapezius muscle (located in your upper back and neck).
  • Stand upright, feet shoulder width apart, knees slightly bent, and extend your arms down along the thighs. Hold the weights in your hands, palms facing the front of your thighs.
  • Keeping the weights close to your body, raise them up as close as possible to your chin. Your elbows should be pointing directly out to the right and left.
  • Hold for a count of two and slowly lower to the start position and repeat.
• Concentration curls: This exercise works the biceps (muscles in front portion of your upper arm).
  • Sit on the very edge of an armless chair (or weight bench) with your feet flat on the floor, about two feet apart.
  • Holding a weight in your right hand, place your right elbow on the inside of your right thigh just above your knee.
  • Support your back by placing your left hand on your left knee. Your right palm should be facing toward your left ankle.
  • Use only your biceps to bend your elbow and curl the weight up. Do not swing back as you lift the weight.
  • Slowly lower the weight and repeat before switching arms.
• Kickbacks: This exercise works the triceps (muscles in back portion of upper arm).
  • Stand upright next to a chair or bench. Bend your left leg and rest your shin on the chair (first putting a towel or mat underneath your shin).
  • Bend from your waist and support yourself by placing your left hand on the chair. Your upper body should be almost parallel to the ground.
  • Hold the weight in your right hand and raise your elbow so your upper arm is parallel to the ground, with your elbow bent at a right angle (like you would hold a pool cue to make a shot).
  • Extend your arm from the elbow until your entire arm is parallel to the ground.
  • Return the weight to the starting position and repeat before switching arms.
• Keeping it simple: The addition of resistance (weight) training can be done without joining a gym or even buying expensive equipment for your home. Here are some easy-to-do resistance exercises that you can do without ever having to leave your house:
  • Flour chest press: Chest press done using a 5-lb bag of flour (or a lighter bag of corn meal to start).
  • Bottled water side raises: Lateral raises done with bottles of varying weights (12 oz, 20 oz, 1 liter, or 2 liter sizes).
  • Spaghetti half squats: Half squats done holding a jar of spaghetti sauce in each hand (try larger jars as this exercise becomes easier).
  • Broom upright row: Upright rowing done holding a broom or mop; for more weight, tie empty milk jugs on each end and fill with varying amounts of water.
  • Soup can concentration curls and kickbacks: Concentration curls and kickbacks done holding a soup can in your hand (try larger cans or jars for more weight).

Other Important Tips

• To find structured exercise programs, check around to find out which ones are located nearby in your community or workplace. Here are a few places to look:
  • Fitness gyms, health clubs and spas, and local universities and colleges
  • Local YMCAs, Jewish community centers, and other affiliated organizations
  • Martial arts instructional centers (for t'ai chi, kickboxing, karate, and others)
  • Low-impact aerobics or other exercise classes offered at your workplace
  • Organized groups of individuals that walk together during lunch breaks or after hours at your workplace or in your neighborhood
• Water Exercise: If you are overweight, then water-based activities may be better for you. Body fat is buoyant in water; thus, your extra fat actually makes you float better. Conversely, on land, it may decrease your speed, agility, and stamina. Extra fat stored under the skin also acts to insulate and keep you warmer in the pool (body heat losses in water are about 20 times greater than in air). Also, the water serves to hide your figure, which may decrease any inhibition you normally feel about exercising in plain view of others. Try water aerobics, walking in the water (with or without a buoyancy belt), and swimming.

Some Final Motivational Ideas

• If you have already started an exercise program and are having trouble staying motivated, then try these tips:
  • Set realistic exercise goals or milestones to keep track of your hard work.
  • Use a sticker chart to keep a visible account of all of your physical activities.
  • Set up a reward for yourself when you meet your goals (like going out to a movie or buying yourself a new book).
  • Find an exercise buddy to increase your likelihood of showing up for scheduled activities.
  • Setting up a good social network to support you will help your adherence, so involve your spouse, other family members, friends, and co-workers.
  • Vary the activities that you do, and occasionally substitute in a more fun physical activity, like social dance or golf (no golf carts!) to stay interested.
  • Let your interests lead you somewhere: be more active in ways you already love-visit a museum, the zoo, a charity event, a concert, or kids' sporting events in the park.
• Focus on less structure: In reality, you are more likely to accumulate the recommended amounts of physical activity during the day by increasing your "unstructured" activities than through a formal exercise program with the same cumulative exercise time. A higher level of motivation is needed to continue participating in structured exercise, and 50% of adults drop out of such programs in the first six months. So, becoming more active without having a defined exercise program (like at a gym or health club) may be the best solution for staying active.
• The power of positive thinking: If you think you can do it, you will. Be positive: where your mind goes, your body follows.
• Don't forget a reward! Reward yourself when you reach a goal, by treating yourself to non-food items, such as new walking shoes, a new t-shirt, exercise video, or manicure.

Have fun, stay active, and stay healthy!