Physical Activity


Physical activity is an important aspect of a healthy lifestyle. In addition to improving your general health and well being, increasing your daily level of activity may help you in the management of your diabetes.

The integration of exercise into the management of Type 1 diabetes is considered in "Managing Type 1 Diabetes - Exercise" and the specific role of exercise in the management of Type 2 diabetes is considered in "Managing Type 2 Diabetes - Diet and Exercise".

Here, we look at the ways in which physical activity forms part of a healthy lifestyle.




What's covered on this page


Reap the benefits
Start Slowly
Safety First
Is your mobility limited?
Motivation
You're full of excuses!
Healthy Living - Exercise in your daily activities
Exercising and Hypoglycaemia
Trial and Error - Keep Testing



Reap the benefits

Your diabetes care team may well suggest that you could benefit from a little more physical activity. Why?

Here are some of the benefits of exercise:

  • It can reduce insulin resistance - this means that your body can use insulin more efficiently and this is especially important for people with Type 2 (non insulin dependent) diabetes.
  • It can help you achieve and maintain a healthy weight.
  • It can improve your heart and circulation, and reduce blood pressure.
  • It can increase your energy levels, but also help you to sleep and relax.
  • It can have positive psychological effects, making you 'feel good' and can help you combat stress and anxiety.
  • It can also improve the health of your bones and help prevent osteoporosis.

Research has shown that physical activity, on a regular basis, will improve our general health and well-being. The Health Education Authority (HEA) recommend moderate activity which makes you feel warm and increases your breathing rate. You don't have to break into a sweat to improve your health - there can be gain without pain! Exercises which use groups of muscles such as brisk walking, dancing, cycling or swimming are recommended. Try alternating activities so that you don't get bored.

Improves circulation and reduces the risk of heart disease

The UK has one of the highest rates of coronary heart disease in the world. Men with diabetes are two to three times more likely to develop heart problems than those without diabetes. This risk rises to four to five times for pre-menopausal women.

Partly, this is because high levels of glucose and insulin lead to damage of the lining of the blood vessels. Also, people with diabetes often have abnormal levels of blood fats (cholesterol and triglycerides). These factors combine, increasing the risk of narrowing of the blood vessels (affecting circulation) at an earlier age than people without diabetes.

Increasing levels of physical activity should improve these abnormal levels of blood fats and help reduce the rate at which this damage to blood vessels occurs. Regular physical activity also improves the way we use oxygen.

Reduces the risk of kidney problems and strokes.

People with diabetes are more at risk of developing kidney problems and of having strokes than the general population. This is partly because blood pressure rises throughout middle age - particularly in those with diabetes. It is thought that regular physical activity may help prevent a rise in blood pressure, or at least slow the increase down, thereby reducing the risk of a stroke or kidney problem.

Improves cholesterol levels

As already mentioned, people with diabetes often have higher cholesterol levels than people without the condition; regular physical activity can help. People with diabetes should have their cholesterol levels checked at regular intervals. Regular physical activity can improve amounts of good cholesterol in proportion to bad, even if the total amount of cholesterol does not alter significantly.

Increases the sense of well being and slows the ageing process

Many people with diabetes also have some feelings of depression and anxiety. Physical activity has been shown to make you feel better about yourself. It is thought that some of the changes in the body during physical activity affect your mood and also reduce muscle tension.

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Start Slowly

You should start slowly and aim to build up to about half an hour of moderate activity a day. Remember that every little bit counts. Any activity you can do will help you on the road to a healthier lifestyle. You might start by taking the lift to the floor below and walk one flight of stairs; then increase it to two, and so on, until you're walking up the whole way without thinking.

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Safety First

Follow these guidelines to help ensure that you exercise safely:

  • Before you start a new activity or exercise check with your diabetes care team, especially if you're currently not very active. You may need some general checks - blood pressure, for example. You should also seek advice on any changes to your medication or blood testing routine that might be necessary.
  • Test your blood glucose level before and after exercising. Activity can dramatically lower your blood glucose and this effect can last for several hours afterwards - it's a good idea to keep your eye on what's happening to prevent hypoglycaemia.
  • Ensure that you have a source of fast acting carbohydrates, such as glucose tablets, to hand.
  • Make sure you 'warm up' your muscles gradually before you get stuck in. Warming up will help to prevent injury and reduce any aching you might suffer from the next day.
  • Cool down slowly after exercising to avoid feeling sick or dizzy.
  • If you are too puffed to talk, or sweating profusely you should slow down a bit.
  • Stop exercising immediately if you feel pain or tingling, or if you suddenly become breathless.
  • Wear a safety helmet and reflective clothing when cycling and remember to take some carbohydrates with you and your diabetic identification.
  • Make sure you understand water safety procedures if you're swimming. If you are alone and not wearing a diabetic identification bracelet, you may decide you want to 'warn' the duty lifeguard that you have diabetes.

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Is your mobility limited?

If you have limited mobility, or are wheelchair bound you can still benefit from exercise. Specific exercises for muscle toning and flexing of the joints can be recommended by a physiotherapist; your diabetes care team should be able to refer you to one.

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Motivation

Joining a group can make exercising more fun and having other people with you can make it easier. You might also benefit from the added bonus of meeting new people. Contact your local leisure centre and find out which classes are available. Then take a friend along with you.

Many local authorities are participating in a campaign called "Active for Life" which was launched by the HEA back in 1996. It resulted from a study in England which reported that 60% of men, and 70% of women, were not active enough to benefit their health. The idea is to encourage everyone to become more physically active.

The "Active for Life" web site at http://www.active.org.uk/ has good advice on how to increase your daily level of activity

Other useful resources include:

SPARC (Sport and Recreation New Zealand) - Physical activity tips and information

www.sparc.org.nz
pushplay.sparc.org.nz

Bike Wise

www.bikewise.co.nz

Department of Conservation - Parks and recreation

www.doc.govt.nz

Parks and council-run sports facilities

Local councils can provide lists of parks and recreation areas, bush walks, and council run sports facilities. See the Local Councils website.

Active Transport - Walking and cycling

www.travelwise.org.nz
www.journeyplanner.org.nz

New Zealand YMCA

www.nzymca.com

New Zealand Recreation Association

www.nzrecreation.org.nz



IMPORTANT!

Exercising and Hypoglycaemia

Exercise can cause low blood glucose levels, a condition known as hypoglycaemia. You are most at risk of having a 'hypo' if you use insulin or sulphonylurea tablets.

 


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You're full of excuses!

So what's stopping you then? Everyone says they want to exercise, but all too often they will allow obstacles to get in their way. We provide the answers to some of your favourite excuses (perhaps some of these will sound familiar.)

"I'm too busy." Of course you're busy. You lead a harried, stressful life. That's why you need to exercise - to build the stamina, strength, confidence, and self-esteem you need to cope with all the demands that you face.

"I hate exercise!" Don't do anything you dislike. Ask yourself what kinds of physical activities you do like - then simply do them more often. You don't have to run, do sit-ups or use a stair-climbing machine. Bicycling, gardening, folk dancing, bowling, roller-skating, and ping-pong can be great exercise. If you can't think of physical activities you enjoy, try to recall the ones you liked years ago. The chances are, you will still enjoy them.

"I've never been active. I'm too old to start now." You're never too old to start exercising. Recently, researchers at the University of Dundee in Scotland, divided 49 residents of a nearby old-age home into two groups. One group engaged in reminiscence sessions twice a week. The other group spent the time doing low-intensity exercise. After seven months, the exercisers stood up faster, moved more easily, had greater grip strength. They also suffered less depression. Maria Fiatarone, M.D., an instructor of medicine at Harvard Medical School, came to the same conclusion while working with frail elderly residents of the Hebrew Rehabilitation Center for the Aged in Boston. She recruited 10 men and women, aged 85 to 96, into a weight-lifting program! After eight weeks, their strength, muscle mass, and walking ability all showed significant improvement. "The physical deterioration we have traditionally associated with growing old has nothing to do with chronological age," Dr. Fiatarone says, "and everything to do with lack of exercise." No matter how long you've been out of shape, you can still take steps towards getting back into shape.

"I don't have big blocks of time to exercise." "You don't need them," Dr. Rippe says, "Sporadic exercise adds up. If you take just three 10-minute walks a day during breaks, you're exercising 30 minutes." What kind of physical activities do you already engage in? Shopping, housework, cooking, childcare? Just walk a little more briskly while shopping. Stretch, bend, and lift a little more during housework and cooking. And play more physically with your pet and/or children.

"I feel self-conscious. I hate looking ridiculous." You don't look ridiculous. You look like a person who's taking positive steps toward better health. You look good. Soon, you'll look even better.

"I never seem to improve." The chances are, you just don't notice. Keep track of your progress. Make a chart showing how much insulin or oral medication you need, or how many flights of stairs you can climb before you feel winded, or how long it takes you to walk around the block - anything that's measurable. Plot your progress weekly and soon you'll be looking back at how far you've come.

"I can't afford to join a gym or turn my home into one." You don't have to. Housework is good exercise (see "Exercise in Your Daily Activities"). Just do it a little more vigorously. Or take a walk. Walking is great exercise outdoors or around the local shopping mall, alone or with friends.

"I never stick with it." You're not alone. Half of those who start an exercise program quit within six months. To keep from being a quitter:

  • Be realistic. For every year you've been out of shape, it takes about a month to get back in shape. It takes about eight weeks to start feeling the physical and emotional benefits of exercise, longer to lose weight.
  • Start slowly, and don't overdo it. You should be able to carry on a conversation while exercising. If you become breathless you're overdoing it.
  • Stick to things that you enjoy. If it's no fun, try something else.
  • Find a buddy and exercise together. Support each other.
  • Vary your activities so that you don't get bored.
  • If you increase your workout at all during your first six months, do it slowly. Don't add more than an extra five minutes a month.

"I understand that before I start exercising, I should check with my Doctor or Diabetes Specialist. That's a hassle." Remember, it's more of a hassle to develop cardiovascular disease, retinopathy, neuropathy, nephropathy, or other diabetes complications. You should be seeing your healthcare team regularly anyway. Make a note to discuss exercise with them next time.

Are you still making excuses? Get on with it!

Try following our suggestions for ways of increasing your level of activity with minimal effort in: "Exercise in Your Daily Activities" below.

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Healthy Living - Exercise in Your Daily Activities

People of all ages can benefit from increasing their level of activity. You don't have to go to the gym to 'work out' every day; little changes to your daily habits can make all the difference.

For example, you might:

  • Choose to take the stairs, rather than the lift.
  • Park your car five minutes walk away from your destination, rather than as close as possible.
  • Get off the bus a stop earlier.
  • Spend an extra five or ten minutes pottering in the garden.

If you'd rather not "exercise," don't. Just put a little more oomph behind the things you do anyway every day. You don't have to do all of the following to get more exercise. Just pick a few that fit easily into your life:

Take a walk. Walking is wonderful exercise. It also helps prevent bone-thinning osteoporosis, which often plagues older women, and men, sometimes, too.

If you're out of shape, start by walking down stairs. When you feel ready, walk up part way, and work up to climbing all the way. When climbing stairs no longer leaves you winded, climb a little faster.

Park a few blocks farther away. Walk the extra distance to work, the mall, the moves, church, or friends' homes. As you gain stamina, park even farther away and/or walk more briskly.

Take a walk before lunch. In addition to getting exercise, you may find you eat less for lunch and suffer less from mid-afternoon blahs. Watch out for hypos though, as often blood glucose levels are starting to drop before meals.

Stash a pair of walking shoes at work. Slip them on for walks at lunch and on breaks.

Buy a backpack. Instead of driving to all your errands, walk as much as possible, and use your backpack for purchases.

Cancel "food dates." Instead of meeting friends for lunch, coffee, or dessert, make dates to take walks, go dancing, or go for bike rides. Or make a date to visit a health club. Most clubs allow free one-time visits to check out the facility. Try several.

Walk your dog. If you don't have one, consider getting one. Dogs are great exercise companions.

Make breaks count. During breaks at work or television commercials, get up and stretch or walk around. Organize your co-workers and house mates to join you.

Don't automatically use the phone or intercom at work. Walk to neighbours' homes or co-workers' desks.

Make the most of phone time. Don't sit while talking on the phone, pace. Invest in a longer handset cord so you can walk farther, or get a cordless phone. If you must stand in one spot, march in place, raising your knees up high. Or rise to tip-toes. Do this five times, then do five deep-knee bends. When you feel ready, do 10. Or keep a small three-pound weight or a canned food item, and do some weight-training curls and presses. Curls: With your arm straight, hold your weight down by your hip. Then bend your elbow and bring the weight up to your shoulder. Presses: With your arm in the curled position, straighten it over your head. Do five of each. When you feel ready, do 10.

Make the most of microwave minutes. Don't just stand there watching the clock tick away the seconds. Pace, stretch, or do some weight lifting.

Put more energy into housework. Washing floors, taking out the trash, vigorous sweeping and vacuuming, and other chores provide more exercise than most people think. If you step up the pace a bit, you'll get finished faster and you'll get more exercise as well.

Make the most of unpacking groceries. Curl and press cans a few times. When you feel ready, try it with six-packs.

Don't automatically reach for the food processor. When time permits, cut, chop, and dice vegetables by hand.

Wash and iron your own clothes. Take the money you save on laundering, and spend it on something active, like bowling or a dance class.

Clean out your attic, basement, or garage. They probably need it, and all that lifting and carrying is good exercise.

Mow the lawn. Pushing a power mower provides surprisingly good exercise. (see below) Or for a somewhat more strenuous workout, retire your power mower and invest in a push model.

Tend a garden. Digging, weeding, raking, cutting, and hauling build strength, flexibility, and stamina.

Sweep some snow. Unless you're in reasonably good shape, stick to small accumulations of dry, powdery snow, the kind that can be swept with a broom. Snow shovelling can be very strenuous, and every winter people suffer heart attacks from overexertion. People with diabetes probably shouldn't shovel heavy wet snow or major accumulations.

For parents and grandparents:

Walk the baby. Infants love motion. Put the little one in a backpack or stroller and take a walk.

Weight train with the baby. Press the youngster over your head once or twice. When you feel ready, increase the number.

Push the child. Kids love swings and merry-go-rounds. Pushing them provides great arm exercise.

Join in children's games. Play tag. Go roller skating. Jump rope. Climb a play structure. Take a swim, or bike ride, or a rowboat outing on a lake. You'll have so much fun, you won't notice you're exercising!

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Exercising and Hypoglycaemia

Exercise can cause low blood glucose levels, a condition known as hypoglycaemia. You are most at risk of having a 'hypo' if you use insulin or take sulphonylurea or repaglinide tablets.

Recognising hypoglycaemia

You should be aware of the warning signs, which may include some of the following:

  • Sweating
  • Shaking
  • Weakness
  • Dizziness
  • Hunger
  • Blurred vision
  • Confusion
  • Increased heart rate

Intense exercise can mask some of these symptoms - sweating and increased heart rate, for example. For this reason you might miss your usual early warning signs and it may not be until you stumble or find that you are very confused that you realise something is amiss.

Always carry diabetic ID and glucose with you at all times. Make sure that someone with you knows that you have diabetes and educate them about hypoglycaemia, what the signs are, and how it should be treated.

Treating hypoglycaemia

Glucose tablets or a glucose drink is the best treatment for hypoglycaemia. You may also need to eat a small snack, such as a sandwich or biscuits to keep you going until your next mealtime.

Preventing hypoglycaemia

You can avoid a hypo by eating extra carbohydrate before exercising. How you do this will depend on what form of exercise you are doing and when (in relation to your usual meal or snack times). You might have an extra portion of potatoes with your meal, or take a sandwich or snack bar with you.

If you are trying to lose weight, you may prefer to reduce your medication - insulin or tablets - before taking part in planned activity. If so, you must discuss this with your diabetes team beforehand.

If your diabetes is treated with insulin, then you need to choose your injection site carefully before exercising. If you inject in your thigh, then go cycling, the insulin will be absorbed into the bloodstream faster than usual. This is because when exercising a limb you increase blood flow to that part of the body. If the insulin is absorbed too quickly it can cause your blood glucose levels to drop suddenly, resulting in a hypo. You might need to try a number of different sites before you decide which one works best for you.

Avoid mixing exercise and alcohol. Each can cause the blood glucose level to drop and together they can cause severe hypoglycaemia, which may be dangerous. This advice extends to exercising the morning after a 'night on the town'.  If exercise is unavoidable, then keep a close eye on your blood glucose level and be aware that you may need additional extra carbohydrate.

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Trial and Error - Keep Testing

It's a good idea to try and work out how different activities affect your blood glucose level by testing before, during and after physical activity. Then you can see what sort of effect the exercise is having on your body and determine what changes you need to make to your normal routine, and when. As with many things, it's often a question of learning as you go, there are no hard and fast rules governing what is right for you.

Remember that the effects of strenuous exercise can last for up to 24 hours, so monitor yourself carefully during this period to help you decide what adjustments, if any, you might need to make.

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