By Richard M. Weil, MEd, CDE
With summer just around the corner, now’s the time to start planning how to take advantage of the longer days and warmer temperatures. In particular, it’s time to start thinking about how you will stay active this summer and how you might take your physical activity program to new heights by exercising outdoors, scheduling active weekend outings, and perhaps even planning an activity-oriented summer vacation such as a bike tour or walking tour.
Outdoor activities can be a lot of fun, and they’re also good for your health. Working regular physical activity into your lifestyle can help reduce your risk of heart disease and high blood pressure, as well as help you manage your blood sugar. Important data from a study published in the journal Diabetes Care showed that stationary biking three days a week for 45 minutes improved insulin sensitivity by 46 percent.
Regular physical activity can also help prevent diabetes, so if your friends or family members need a little extra encouragement to join you in your physical activities, let them know what a great thing they’re doing for their health. The Diabetes Prevention Program, a major three-year clinical trial conducted by the National Institutes of Health, showed that in 3,234 people with impaired glucose tolerance (often called prediabetes), those who walked or exercised five times a week for 30 minutes (150 minutes total per week) lost 5 percent to 7 percent of their body weight (approximately 12–15 pounds) and reduced their risk of diabetes by 58 percent. For people over the age of 60, the reduction in diabetes risk was a whopping 71 percent.
If you’ve made physical activity a priority this year and have improved your conditioning, what better way to put all that fitness to good use than to take an active holiday or enjoy an active weekend? For those of you who haven’t quite reached the get-up-and-go stage, the prospect of an active summer weekend or vacation might be just the motivation you need to lace up your sneakers and start exercising.
Before you call your travel agent, take a few moments to think about the type of activity you’d like to do and what you’re capable of doing. Would you enjoy a guided nature walk or group bird-watching outing on gentle paths? Or would you prefer a rugged hike in the woods or mountains? Are you fit enough for a bike tour through the vineyards of northern California? Or would a historic walking tour through the villages of Vermont suit you better? There are dozens of activities to choose from in your own hometown, across the United States, and throughout the world.
Perhaps the simplest, safest, least expensive, and most convenient form of physical activity is walking. You can do it anywhere, anytime, with just a pair of sturdy shoes. You can do it alone, with a partner, or with a group in structured or informal walking activities. Here are some of the many choices.
City parks are wonderful places to walk and enjoy nature close to home. Urban park rangers in most city parks lead theme tours throughout the year, and many are free of charge. Call your local recreation department or park headquarters for details.
Clubs offer the chance to meet new people and to try new walking or biking routes. All major cities and some smaller ones have them. Most clubs sponsor events (walking clubs sometimes team up with local running events), and many offer instruction for free or for a small charge. Contact your local running, biking, or sporting goods store, or attend a local walking, running, or biking event to find out about clubs in your area. Clubs and stores are also great resources to find out about biking vacations and walking tours.
Volkssport clubs in every state organize noncompetitive walk, bicycle, swim, and cross-country ski events for people of all ages. They are not contests of speed or endurance, but rather family-oriented activities that promote participation in recreational activities for fun, fitness, and friendship. Participants can walk, jog, run, or use a wheelchair. Each event is given a trail rating, and routes are set out so that you finish at the starting point. The most common distances are 5, 10, and 20 kilometers (3.1, 6.2, and 12.4 miles).
An estimated 60 million Americans consider themselves birdwatchers. In general, bird-watching is not too vigorous, although the equipment — binoculars, cameras, tripods, zoom lenses, etc. — can get heavy after hours of walking. The amount of walking depends on the group and its goals, but almost all trips involve a fair amount of standing in one place to watch (or look for) birds.
The American Birding Association is the largest bird-watching organization in North America. Although they don’t run field trips themselves, they endorse tours run by operators who have a proven record of competence and quality. There are many tours to choose from, both nationally and internationally.
The National Audubon Society, an organization with over 600,000 members, 508 chapters in the Americas, and 100 Audubon Sanctuaries and nature centers nationwide, organizes field trips through local chapters — many of which are open to nonmembers for a nominal charge — and guided bird-watching vacations through local chapters and the national organization. Call or visit their website to find a chapter near you.
Not ready for walking outdoors? Many of America’s shopping malls have organized walking clubs, and many open their doors early for walkers. It’s a great way to get out of the weather and away from traffic, and restrooms and water are never far away. Membership is usually free. You can find out more by stopping by the mall office or contacting them by phone.
(For some ideas on how to enjoy walking safely, see “Walking Tips.”)
Hiking is a lot like walking, only it’s done on more rugged terrain, often farther from civilization, and it often requires different footwear. It may also require a little more advance planning since hikers must be self-sufficient: There are no stores or vending machines to rely on in the woods. Hikers must carry diabetes supplies, water, and enough food for snacks, meals, and treating hypoglycemia — plus a little extra just in case. Still, virtually anyone can do it, and there are opportunities in all 50 states to hike. Many beginning hikers prefer to hike with a hiking club, for safety and camaraderie.
Hiking clubs generally offer outings for people of all fitness levels, and they rate their hikes by level of difficulty. If you’re not sure what hikes are best for you, someone at the club should be able to assist you. Most clubs charge nominal yearly fees, and almost all offer supervised hikes. Some clubs also offer weekend trips.
The American Hiking Society, a national nonprofit organization dedicated to promoting hiking and to establishing, protecting, and maintaining foot trails in America, publishes The National Directory of Trail Organizations, in which they list more than 1,500 trail organizations and agencies, from the large national organizations such as the Sierra Club to neighborhood hiking clubs. If you don’t already know of a local hiking club, this is a place to start looking.
Whether or not you seek out a hiking club, the U.S. National Park System, operated by the National Park Service, is a treasure of opportunities for hiking and other outdoor recreation. The park system comprises 384 areas covering more than 83 million acres in 49 States, the District of Columbia, American Samoa, Guam, Puerto Rico, Saipan, and the Virgin Islands.
Forestland in the United States is also a gold mine of opportunities for outdoor activities. More than 191 million acres of forests and grasslands are administered by the U.S. Forest Service throughout the United States.
If you prefer flat surfaces to inclines, you may be interested in walking or biking on one of the many abandoned railroad corridors that have been converted into public trails. Much of this work has been done by Rails-to-Trails Conservancy, a grassroots organization. Since the 1960s, more than 15,000 miles of rail-trails have been created across the country, and as of September 2000, Rails-to-Trails Conservancy has identified more than 1,000 rail-trail routes. With at least one rail-trail in every state, there’s probably one near where you live.
How does hiking in Yellowstone, a country walking tour in Vermont, biking the boardwalks in the Everglades, exploring the rugged Rockies, or trekking across the glaciers in the Cascades in Washington sound? If you’re into even more exotic pursuits, how about a jungle safari in Thailand, or a trek up Mt. Kilimanjaro? These and hundreds of other active vacations are available for people of all ages and, more important, all levels of fitness.
Active vacations are big business these days, and several reputable active travel agencies make it easy to find the vacation that’s just right for you (see “Getting Out and About” for more details). You can check out these companies on the Internet, or call to speak with their travel counselors directly.
When searching for a biking or walking vacation, look for the following:
• Trips with lengths and difficulty levels that match your interest and ability.
• Trips that give you free time to explore on your own or with others.
• Trips that provide van support for when you need a break or would prefer to take it easy that day.
• Trips that allow you to engage in as much or as little activity as you like, always at your own pace. (Trips should not be forced marches, unless that’s what you’re paying for.)
• Two or three leaders to accompany your group.
Be realistic when matching your ability with the demands of the trip. Although it may sound charming to bike from one covered bridge in New England to another, if the distance is 25 miles and you’re only capable of 15, you’re not going to be a happy camper. Look for descriptions like the following to guide your decision (this description is for a level-one walking trip offered by the company Backroads): “For those who feel comfortable walking 3–7 miles per day. Enjoying a leisurely pace is often a priority for those who choose this route level. Approximately 2–4 hours of walking per day.” In making your final decision, always speak with a representative from the company for final confirmation of your choice.
How’d you like to bone up on your tennis game, or take those swimming lessons you’ve always dreamed about? Now’s your chance. The number of adults going to camp has risen in the last decade, and the website for Grownupcamps.com has a list of over 5,000 sports and activity camps for adults with everything from tennis, golf, and biking to hiking, backpacking, mountaineering, and wilderness survival. If you don’t have Internet access, check your Sunday paper for camp or vacation listings.
YMCAs and Jewish Community Centers are excellent resources for active day trips, two- to three-day getaways, and longer summer trips. Check your local center for what’s available.
Some people find that a charitable cause spurs them on to physical activity. Fund-raisers are nice ways to increase your physical activity and at the same time contribute to a worthy cause such as diabetes research.
Team Diabetes is a program where you team up with friends, family, and coworkers to walk or run a marathon in honor of someone who has diabetes. (Some events also offer shorter courses such as 5 or 10 kilometers or half-marathons.) It is a chance to experience the world’s most beautiful and well-known marathon courses while raising money to support diabetes research. Once you join Team Diabetes, you become part of a unique partnership with coaches from around the country who will help advise you about training for the event, whether you plan to walk or run.
Tour de Cure. Tour de Cure is a noncompetitive bicycle ride to raise money for diabetes research. The events offer a variety of routes and distances (10–100 miles) for everyone from the occasional rider to the more experienced cyclist. Events take place in almost every state, with volunteers, snacks, drinks, and support vehicles all along the way to ensure a safe and enjoyable day for riders of all abilities. You can find out more about Tour de Cure at the American Diabetes Association website.
Sponsored by the American Heart Association, the Heart Walk is a noncompetitive walking event that’s geared to businesses. Companies participate by forming teams of employees and their family members and friends to raise money to fight heart disease and stroke. Most walks are less than five miles. You can contact the AHA to find out where your local chapter is located and about an Heart Walk event near you.
No matter what your fitness level, it helps to do some physical conditioning prior to your trip. For example, if you’ve decided to take a walking tour, find out how much you’ll be expected to walk each day and then start to train for that. If you’re going to take a biking tour, get out there every weekend and pedal for a couple of hours (see “Weekly Walking Schedule” for a walking training schedule and “Weekly Stationary Bike Program” for a biking program). Training in advance of your trip will also help you get to know how your blood sugar responds to exercise and what you can do to manage it.
Here are some training tips:
• Start slowly and don’t expect too much too soon. If you’ve signed up for a walking tour that travels 5 miles per day, start training by doing your longest walk of the last few weeks and build up to 5 miles. Walk 3–4 times per week and increase your distance or time by 10% each week. For example, if your longest walk to date is 2 miles in 40 minutes, increase the amount of time you spend walking by four minutes each week. Following the 10% rule will get you to the next level of fitness quickly and safely.
• Set a weekly plan for training days and stick to the plan. Consistency is one of the hallmarks of effective training.
• If you need motivation and support, find a partner with similar abilities to train with. The person you plan to travel with is a good choice.
• Take breaks from training when your body is tired. At each workout, you should feel refreshed and stronger than, or at least as strong as, you felt at your previous workout. If not, you may be overtraining and need to take a few days off. Most people come back from a break stronger than ever, so listen to your body
Because walking, hiking, and other recreational activities involve exertion, there’s a chance that you’ll become dehydrated or that your blood sugar level will drop, particularly if you take insulin. Here are some guidelines to follow that will assure your safety.
It is critical that you stay well-hydrated, especially in warm weather, and particularly when you have diabetes and if you are over age 60 (but true for people under age 60, too). Proper hydration should begin before you exercise, continue once you’ve begun, and continue after exercise. Fluid replacement should approximate sweat and urine losses, and weight loss from activity should not exceed 2% of body weight. You can weigh yourself nude before and after exercise to get a sense of how much fluid you need. Some people can lose up to 2 liters of fluid per hour (1 liter of water weighs 2.3 pounds). Here are guidelines for proper hydration:
• Drink 17 to 20 ounces of water two to three hours before exercise.
• Drink 7 to 10 ounces of water 10 to 20 minutes before exercise.
• Drink 7 to 10 ounces of water every 10 to 20 minutes during activity.
• If you sweat heavily, you may need to drink more.
You should become familiar with the symptoms of heat illness. They are thirst, irritability, and general discomfort, followed by headache, weakness, dizziness, cramps, chills, vomiting, nausea, head or neck heat sensations, and decreased performance. Recognizing and treating dehydration early decreases the occurrence and severity of heat illness. Notice that some of these symptoms could be confused with hypoglycemia. Every effort should be made to stay hydrated, just as you would make every effort to avoid hypoglycemia.
The greatest risk of exercise for people with diabetes is low blood sugar (hypoglycemia). Here are some simple measures you can take to assure your safety. If you have questions, consult your doctor or diabetes educator.
• Always check your blood sugar level before and after exercise and record the results. Your doctor or diabetes educator can help you adjust your insulin or snacks to account for any drop in blood sugar.
• Always have at least 15–30 grams of carbohydrate available to treat hypoglycemia (defined as blood sugar lower than 70 mg/dl). It’s best to keep more than 15 grams handy just in case you need more. Glucose tablets, raisins, and glucose gel will last for long periods of time in a backpack or fanny pack.
• If you suspect you are hypoglycemic, check your blood sugar level right away. If it is below 70 mg/dl, treat immediately with 15 grams of carbohydrate, rest for 15 minutes so that the snack can be absorbed, and then check again. If it is still below 70 mg/dl, have another 15 grams of carbohydrate. Fifteen grams of carbohydrate will raise your blood sugar approximately 30 mg/dl to 40 mg/dl in 10 to 15 minutes. Four ounces of juice, three 5-gram glucose tablets, one small box of raisins, or 4 ounces of regular soda (not diet), are a few examples of food servings containing 15 grams of carbohydrate.
• Certain medicines can mask the symptoms of hypoglycemia, so check with your doctor about any medicines you take.
• Exercise has some of the same symptoms of hypoglycemia (such as sweating and rapid heart rate). If you have hypoglycemia unawareness (inability to recognize hypoglycemic symptoms), be especially certain that you check your blood sugar level before and after exercise and are familiar with how your blood sugar responds to exercise.
• Exercise of long duration (longer than 30 minutes) or high intensity will cause blood sugar to drop more than shorter, less-intense exercise.
• Blood sugar tends to drop more during exercise in the afternoon or evening than it does in the morning.
• With guidance from your physician or diabetes educator, lower your preexercise insulin dose if you are sensitive to the effects of exercise. If you do not adjust your insulin before exercise, eat or drink 15 grams of carbohydrate for every 30 minutes of physical activity.
• Always carry money (preferably quarters) or a mobile phone in case you need to call for assistance, and always carry identification or wear a medical ID bracelet or necklace that says you have diabetes.
• If you have a sore throat, fever, or chest cold, postpone exercise until you feel better.
• Avoid exercise if your blood sugar is over 250 mg/dl and you have ketones in your blood or urine, and use caution when your blood sugar is over 300 mg/dl, even if no ketones are present.
• Do not exercise if you are currently experiencing frequent highs and lows, have a recent history of severe hypoglycemia, or have recently had diabetic ketoacidosis. In such situations, exercise can further destabilize blood glucose control and should be delayed until control is established.
• Wear shoes and socks that fit properly, and always inspect your feet before and after activity for blisters or sores. See tips for proper footwear. If you’re on a trip and suspect you have a blister, treat it immediately, even if it means asking the group to stop. If you wait, the blister will get worse and increase the risk of infection.
• Wear light, comfortable clothing and a hat to keep the sun off your head. Carry a bandana that you can soak in cold water to wipe off your face and neck.
• Even if the group leaders don’t take you through a stretching session, spend 5–10 minutes stretching before you walk, bike, or hike.
If you’re planning to hike, do a vigorous bicycle tour, or participate in a day-long walk, here are a few more things to keep in mind:
• Monitor your blood sugar before the hike, bike, or walk and several times during it. You should discuss with your doctor or diabetes educator what safe levels are for you and when and how to treat highs and lows.
• Speak with your doctor or diabetes educator about snack and insulin adjustments for the day of your outing. It may be necessary to reduce your long-acting insulin in the morning since you’ll be out and active for most of the day.
• Make sure you have food available at all times.
• If you’d like to hike but don’t have hiking boots, inquire about a hike that doesn’t require them. Many gentle hikes are possible with sturdy walking shoes.
An active summer weekend or vacation is a wonderful opportunity to put all your fitness to good use, explore new activities, meet new people, and enhance your health. There’s never been a better time to do it, and ample opportunities exist for everyone of every age and fitness level. Have a healthy, active summer!
Want to learn more about using physical activity to help manage your diabetes? Read “Exercise Myths and Facts,” “Making Exercise More Fun,” and “Picking the Right Activity to Meet Your Fitness Goals.”
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