By Andrew Leibs
Getting regular physical activity can be a difficult part of managing diabetes, especially if you are more used to being sedentary. Making the effort to be active is worth it, however, because exercise can improve the body’s sensitivity to insulin in people with either Type 1 or Type 2 diabetes. This can translate into better blood glucose control and possibly into a need for less insulin or oral diabetes drugs.
If you have a physical disability or limited mobility because of your diabetes (or any other reason), however, starting and maintaining a physical activity routine can seem daunting. Fortunately, a boom in accessible recreation has provided opportunities for exercise and enjoying the outdoors that can make living an active life easier and more fun for people with limited physical abilities.
A few factors have led to this growth. First, the Americans With Disabilities Act, passed in 1990, implemented specific rules that have made places like pools, parks, and gyms (both public and private) more accessible. It has also undoubtedly sparked a wider “inclusion-consciousness.” As a result, programs like Wounded Warriors — which teaches disabled U.S. veterans adaptive skiing, cycling, and other forms of recreation — have been created in the wakes of the conflicts in Afghanistan and Iraq. Growth of the Paralympics (“para” for parallel), which brought 4,000 disabled athletes to London in 2012, has created an expanding industry of adaptive products, athletic programs, and opportunities for recreation and competition that can accommodate any number of physical limitations.
This article profiles 10 types of recreation that are either accessible to or adaptable for people with a variety of mobility impairments.
When starting a new activity program, your first stop should be your health-care provider’s office. The American Diabetes Association recommends that most people with diabetes have a medical exam that screens for the presence of uncontrolled high blood pressure as well as any diabetes-related complications such as diabetic retinopathy (eye disease) and neuropathy (nerve damage) before beginning an exercise program. This is especially important if you are over 35, have Type 2 diabetes, or have had Type 1 diabetes for more than 15 years. If you have any complications, your health-care provider may advise against certain types of activities.
While you’re having your exam, ask your doctor about preventing and treating hypoglycemia (low blood glucose) while being active. If you take insulin or oral pills that cause your pancreas to release more insulin, you will most likely be advised to eat or drink some carbohydrate before exercising if your blood glucose is lower than 100 mg/dl. You should also anticipate the need to consume at least 15 grams of carbohydrate for each 20–30 minutes of moderate-intensity activity to avoid hypoglycemia during exercise.
Once you know what forms of exercise are safe for you and how to maintain blood glucose control during physical activity, it’s time to pick an activity. Think about which activities you enjoy, what would fit easily into your life, what you are able to do, and what kind of help you can get if you need it.
If you have not been physically active for a while, plan to start your activity at a low intensity and to do it for short periods. As your body adapts to being more active, you can increase both the intensity and the time you spend being active.
For many people, home is the most comfortable place to begin exercising. Fortunately, most public libraries have instructional books, CDs, and DVDs that teach aerobics, yoga, kickboxing, and other sports. Look for ”basic” or “beginner” versions to get started.
A resource with a specific audience in mind is Real Fitness for Real Women by Rochelle Rice (Grand Central Publishing, 2001). This book contains an exercise program that is tailored, physically and psychologically, to plus-size women. It outlines 25 different exercises designed to achieve physical and mental well-being — not necessarily weight loss — while emphasizing that improving one’s fitness to feel better is possible at any weight.
Yoga is rigorous, yet relaxing; it works all muscles, increases strength and flexibility, and can improve circulation and blood pressure. It can also be taken up at any skill level and in any place, including a bed or wheelchair. Bed Top Yoga (Yoga Enterprises, Inc.), a DVD by certified Kripalu and Bikram instructor Carol Dickman, guides users through a series of breathing exercises, simple stretches, and basic yoga postures, followed by relaxation exercises — all designed to be done lying on one’s back.
“I believe that whatever you want to change in your life, yoga can help you do it,” says Dickman, who has spoken to numerous diabetes groups. “My programs give people who might feel they have little control over their illness an opportunity to contribute to their well-being; the practice of yoga helps support a healthy lifestyle.”
Swimming is a great low-impact exercise and among the most popular of Paralympic sports. It’s easy to do on your own, or, if you’d like more structure and a chance to meet others, as a participant in a masters swim club (a program for adults of all ability levels).
But one need not swim to make use of a pool; many health clubs, YMCAs, and community recreation centers offer Aquacise classes, in which participants perform aerobic exercises in the pool. Because the water helps to support your weight, exercising in water can reduce the stress on your feet and joints. At the same time, water provides resistance, which helps to strengthen muscles. Simply walking in the water can provide a workout that improves mobility, gait, and balance — all of which are especially vital for seniors.
For people with very limited mobility, wheelchair lifts can be found in most community and university pools.
Biking works some of the body’s largest muscles, so it can burn a lot of calories (depending on how long and how intensively you pedal). Stationary bikes have the advantages of requiring less balance than a regular bicycle and of allowing the user to stop at any time, with no worries about traffic. They are also usable when it’s raining, snowing, or too hot to exercise outdoors. Putting a stationary bike in front of a TV is a great way to encourage movement during a normally sedentary activity.
For people who cannot use their legs, handcycles can provide a great upper-body workout. (Even some people who can use their legs like to use a stationary handcycle to build upper-body strength.) Pedaling a handcycle can be made less monotonous with the GameCycle, a device that combines a handcycle with video-game capabilities. Developed with a grant from the National Institutes of Health, it lets users play Nintendo GameCube racing games while they exercise. The arm cranks control speed and steering, and since both arms must work in unison, its maker (Three Rivers Holdings) claims that it offers therapeutic benefits such as improving strength asymmetries, muscle coordination, hand–eye coordination, and balance. An Americans With Disabilities Act tax credit for small businesses can cut the GameCycle’s $5400 price tag in half. (Your gym or health club may be more willing to buy one if the management is aware of this.)
For people who want to be outside and moving, cycling can be made accessible with tandem bikes (on which blind cyclists race in the Paralympics). The front cyclist on a tandem, called the pilot, needs good vision, agility, and patience. The rear cyclist, called the stoker, needs only energy and trust.
Mounting a tandem can be tricky for both parties. Normally, the pilot stands over the crossbar and steadies the bike while the stoker climbs on. When the stoker is set, the pilot pushes off and begins to pedal as if on a single bike. If the stoker is blind, the pilot should communicate what is ahead on the bike’s path, including hills, bumps, and turns.
Accessible recreation providers — businesses and organizations that provide specialized training, adaptive equipment, and recreational opportunities for persons with disabilities — may give the opportunity to try a tandem before buying one. The Schwinn Tango ($820) is among the least expensive tandems and may be a good place to start. The United States Association of Blind Athletes (www.usaba.org), which fields the U.S. Blind Cycling Team, can help interested blind cyclists find pilots.
Kayaking is a great way to enjoy the outdoors while getting a workout that strengthens the shoulders, arms, back, and abdominal muscles. It requires good balance but no use of the legs. For people with vision loss, there are tandem kayaks that, like tandem bikes, are a great way to have a more collaborative and worry-free workout. Opportunities to try kayaking exist through camps, adventure learning outfitters, and many parks and other recreation providers. Kayaks range in price from $400 to $3,000. The Pelican Pursuit 140T ($649) is an inexpensive tandem kayak suitable for lakes and ponds.
Nordic skiing is considered one of the most effective cardiovascular exercises, working the entire body.
One of the most successful accessible recreation programs is Ski for Light, a weeklong program that pairs people with vision or mobility impairments with guides to learn cross-country skiing. Those who have mobility impairments can use sit-skis, with which only the arms are used for propulsion. Guides in the program teach proper technique and describe the surroundings for blind participants. Ski for Light is headquartered in Minnesota, but its annual flagship event moves among major U.S. Nordic ski areas.
Ski for Light draws hundreds of skiers from many countries, with abilities ranging from beginner to Paralympian. Participants learn at their own pace in a highly supportive environment that features a host of social activities, including a talent show and an authentic Nordic race at the end of the week. However, while the race is officially timed, skiers compete primarily with their own predicted finish time.
As an alternative to specific programs, most Nordic ski centers rent cross-country ski equipment and offer individual instruction. For those who would like to start in the backyard or on a nearby field, many recreation centers and adventure learning outfitters also rent skis.
Walking is the most popular exercise in the world and can provide one of the simplest fitness programs for beginners. It works large muscles to burn calories, enhances aerobic fitness, and increases insulin sensitivity. If done after a meal, it can also curb blood glucose spikes.
It’s easy to set walking goals based on either time or distance and then to chart progress; this can be great for motivation. Walking can also be an opportunity to socialize if done with a regular partner or group.
Most 5K road races welcome walkers, and such events can be a great source of motivation as well as a chance to meet other exercisers. Participating as a walker in a 5K may even encourage you to incorporate some jogging intervals into your walks.
An accessible event where one can walk, jog, or run is the B.A.A. 5K, which takes place each June in Boston and is the national 5K road race championship for runners who are blind or visually impaired. It is one of two races for runners with visual impairment that award prize money to the top male and female finishers (the other is the Stampede for VIPS in Louisville, Kentucky). The race also features the Blindfold Challenge, in which anyone can be an entrant (many corporate CEOs participate) by donning a blindfold to experience running a 5K with a sighted guide.
Depending on what you’re doing, gardening can provide aerobic activity, strength training, and flexibility training. It can also fulfill the need to be outdoors, breathing fresh air in the sunlight. And like yoga, it promotes the focus of breath and energy on a task and promotes relaxation that can lower blood pressure.
“Gardening’s great for your body and for your brain,” says Haidee Merritt, an artist and gardener with Type 1 diabetes who lives in Kittery, Maine. “Getting your hands dirty and working in the earth is very soothing.” For Merritt, the physical activity of gardening makes managing her diabetes easier. “My metabolism changes dramatically when I’m working. My insulin requirements drop considerably,” says Merritt. “I can reduce my long-acting insulin, and I need a lot less of the quick.”
Because heavy tasks, such as raking or turning soil —or even lighter tasks, such as weeding, when performed for an extended period — burn energy and can lower blood glucose level, it’s important to check your blood glucose before, during, and after gardening the same way you would for any sustained physical activity.
Water can be an “equalizer” that is forgiving to people with many types of disabilities — not just in the pool, but also outdoors in sports such as surfing and waterskiing. The LOF Adaptive Skiers Club in Sandy Hook, Connecticut, teaches recreational and competitive waterskiing to adults and children with visual or physical disabilities for free each summer, providing all necessary equipment and adaptive devices. People who are physically disabled can use sit-skis, which are often equipped with outriggers for stability, while participants with visual impairments can ski next to guides who provide verbal instructions; whistles and tugs on the towline facilitate further communication between skier and boat.
A similar program is AccesSurf Hawaii’s monthly “Day at the Beach” at White Plains Beach in Kalaeloa. At this event, special wheelchair mats are placed across the sand, and adaptive beach chairs are set up, to help people with mental or physical challenges access the ocean to learn adaptive surfing and floatation swimming. Adaptive surfboards provide support, balance, and control with features such as backrests, contoured knee pads, and a more stable design for surfing in a sitting or lying position.
The motivation to exercise has different origins for different people. For many people, being diagnosed with Type 2 diabetes or developing another health problem provides strong motivation. But the feeling of being motivated rarely lasts very long. That’s why you need a plan to make regular physical activity a part of your life and to stick with it when you’re feeling less motivated.
According to Jill Garner, formerly a nurse and Certified Diabetes Educator at the Center for Diabetes and Endocrinology at Portsmouth Regional Hospital in Portsmouth, New Hampshire, it can help to first think through what’s preventing you from being active. Then you can develop strategies to overcome these barriers. Your diabetes care team can probably offer suggestions for overcoming barriers if you’re not coming up with solutions on your own.
Garner has also found that breaking a daily 30-minute physical activity goal into shorter sessions is helpful for some people. “You don’t have to do it all in one lump,” she says. “Walk 15 minutes in the morning and then 15 after dinner.”
Feeling accountable for results is also helpful, according to Garner. She asks her patients to keep a diary of their blood glucose levels, diet, and activity and to bring it to follow-up appointments. Knowing that she’ll be reviewing the diary provides motivation for some.
Garner also emphasizes the importance of having realistic expectations. “You have to go slow, take precautions, set small goals, and measure them so you can be successful. Otherwise, you’ll become demotivated and won’t want to exercise.”
For Haidee Merritt, following through with a planned activity comes down to acknowledging the difficulty of staying motivated and taking the first step. “Sometimes during my workout I just burst into tears because it’s so frustrating that I’ve lost feeling in my feet and can’t perform the activity well or for very long,” she says. “But once I finish a workout, I never regret doing it.”
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