Words: Drs Mahesh B BORHADE & Shikha SINGH
Diabetes mellitus leads to macrovascular and microvascular complications, resulting in life-threatening conditions. Exercise is considered an important therapeutic regimen for diabetes mellitus. Exercise in patients with diabetes mellitus promotes cardiovascular benefits by reducing cardiovascular risk and mortality; it also assists with weight management and improves glycaemic control. The increased tissue sensitivity to insulin produces a beneficial effect on glycaemic control.
Indications
Recommendations about exercise regimen come from the American Heart Association, the American Diabetes Association, and the American College of Sports Medicine standards of medical care in diabetes [2013].
Type-1 and type-2 patients with diabetes are encouraged to do 30-60 minutes of moderate-intensity aerobic activity. Patients suffering from diabetes should also be encouraged to perform resistance training at least twice per week. Patients with moderate to severe proliferative retinopathy have contraindications for resistance training. Otherwise, for physically fit patients, a shorter duration of more vigorous aerobic exercise is recommended.
Moderate-intensity aerobic activity. Perform 30-60 minutes of moderate-intensity aerobic activity on most days of the week. Begin with 10 minutes of stretching and warm-up, follow that with 15-20 minutes of aerobic exercise of person’s choice, such as walking, running, swimming, dancing, cycling, or rowing, to name few. Maintain regularity in exercise regimen at least three to five times per week. Continue to perform exercise at the same time in relation of meals and insulin injections. Gradual increment in duration and intensity as tolerated by the patient should be planned. The goal is to perform 150 minutes of moderate-intensity aerobic exercise per week.
Resistance training. Exercise with free weights, or weight machines. In the absence of contraindications listed above, patients should perform resistance training at least twice per week. Patients should involve the larger group of muscles for exercise training, such as core, upper and lower body. Proliferative retinopathy may cause retinal bleeding due to Valsalva manoeuvres with a possibility of marked increase in blood pressure precipitating intraocular bleeding in such patients.
Vigorous aerobic exercise. Patients with diabetes who are generally fit, exercising regularly and have higher aerobic capacity may perform 75 minutes per week of more vigorous aerobic exercise. The preferable regimen is jogging 9.6km per hour. An alternative regimen can be low-volume, high-intensity training, during which patients exercise more vigorously for a shorter amount of time, such as cycling at 85-90 per cent of individual maximal heart rate for 60 seconds, followed by 60 seconds of rest, with a total of 10 repetitions. The long-term health effects of low-volume, high-intensity training is unknown. Again, as with moderate excise regimen, a gradual increment in duration and intensity as tolerated by the patient should be planned.
Contraindications
Relative contraindications for exercise regimen include proliferative retinopathy that may cause retinal bleeding due to Valsalva manoeuvres with a possibility of a marked increase in blood pressure precipitating intraocular bleeding in such patients. Patients with diabetic neuropathy should avoid traumatic weight-bearing, as it leads to pressure ulcers.
