Diabetes complications can affect your choice of physical activities, making some safer for you than others. For example, if you have retinopathy (diabetic eye disease) you may want to avoid activities that dramatically elevate blood pressure (such as power weight lifting), involve pounding or jarring (such as jogging or boxing), bring the head level with or lower than the heart, or are very strenuous, because of their potential to cause retinal detachment or a vitreous hemorrhage (in which blood leaks from vessels in the retina, blocking vision). Those with neuropathy (diabetic nerve disease) may have lost the protective sensation in their feet. They should limit weight-bearing exercise such as step aerobics or prolonged walking or jogging because repetitive exercise on insensitive feet can lead to ulcers and fractures. However, most exercises can be enjoyed by most individuals with diabetes. Low-impact activities such as swimming, chair exercises, or stationary cycling are good alternatives for those with complications.
When you consider an exercise program, don’t feel as though you’ll be required to run a marathon to improve your health and diabetes control. The Surgeon General’s Report on Physical Activity and Health (1996) states that significant health benefits can be obtained by including a moderate amount of physical activity (such as 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball) on most if not all days of the week. A moderate amount of physical activity is equivalent to physical activity that uses approximately 150 calories of energy per day, or 1,000 calories per week. Greater health benefits can be achieved by increasing the amount (duration, frequency, or intensity) of physical activity.
If you’re not able to set aside at least 30 minutes at a time for physical activity, you’ll be happy to know that research has shown that cardiorespiratory fitness gains are similar when physical activity occurs in several short sessions (10 minutes at a time, for example) as when the same total amount and intensity of activity occurs in one longer session (30 minutes all at once). Think in terms of accumulating physical activity over the course of the day. Walking, gardening, and washing windows are as important to your fitness efforts as a formal exercise class. (For more about walking, see “Step It Up!”)
If you do choose to start a structured exercise program, plan to include proper warm-up and cool-down periods. A warm-up should consist of 5–10 minutes of aerobic activity, such as walking or cycling, at a low intensity, which gets your body ready for the more intense activity to follow. Gently stretch your muscles for another 5–10 minutes, then begin your chosen activity. Afterward, do a cool-down session that lasts 5–10 minutes and is similar in structure to your warm-up. Your goal is to return your heart rate to preexercise levels.
The benefits of physical activity are immense, but you also should give consideration to staying safe while exercising with diabetes. Obtaining medical clearance if needed, and developing an appropriate exercise plan are important steps to safe fitness. In addition, consider the following issues:
Foot care. Properly fitted shoes are essential if you are participating in aerobic physical activity. The ADA recommends using shoes with cushioned midsoles (gel or air) as well as polyester or blend (cotton–polyester) socks to prevent blisters and keep the feet dry. Monitor your feet closely for blisters and other potential damage both before and after physical activity, particularly if you have neuropathy in your feet.