Section Eight This section will tell you: EXERCISE The benefits of exercise How to exercise safely Effects of exercise on blood glucose levels How to prepare to exercise How to balance exercise with nutrition and medication to balance blood glucose levels. Exercise means being ACTIVE Getting your heart rate up and your muscles moving. 8-1
TYPES OF EXERCISE Walking Jogging Bicycling Dancing Yard Work House Work Bowling Chair Exercises Stretching Weight Lifting Yoga Tai Chi Playing with Children Gardening Swimming Martial Arts Aerobics Water Aerobics BENEFITS OF DAILY EXERCISE Lowers blood glucose Lowers blood pressure Reduces stress Improves lipid levels (blood fats) Promotes weight loss Lowers risk for heart disease Helps your body use insulin better May reduce the amount of insulin or oral antidiabetes agents you are taking Improves self esteem Strengthens bones (Reduces osteoporosis) 8-2
GOALS OF EXERCISE Improve oxygen delivery (circulation) Increase metabolic rate Greater flexibility, improve movement in joints and muscles. Build strength and endurance DIABETES AND EXERCISE Makes the body s cells more sensitive to insulin. Increases glucose utilization. Reduces blood glucose levels. May decrease your need for glucose-lowering medications. BEGINNING AN EXERCISE PROGRAM Before starting an exercise program, talk to your doctor. He or she may want you to have some special tests to see how safe it is for you to exercise. This is especially important if you are over the age of 35, have not exercised in a long time, have never exercised and/or you have a physical problem that may prevent you from exercising. 8-3
EXTRA EXERCISE PRECAUTIONS Wear Diabetes Identification Check blood sugar before and after Carry fast-acting carbohydrate Exercise consistently Don t exercise if you are not feeling well Wear good shoes Drink plenty of water STAGES OF EXERCISE 1. Warm-up (pre-exercise, low-intensity activity, and stretching) -Helps to loosen muscles and decreases the risk of injury -Should last 5-10 minutes. 2. Physical Activity -Should last at least 30 minutes (an hour is better) 3. Cool Down (post exercise, stretching, reduced intensity stretching) -Should last 5-10 minutes -Returns your breathing and heart rate to normal HOW MUCH EXERCISE DO WE NEED? 30+ minutes a day 30 continuous minutes or 3 ten minute sessions Most (5-7) days per week 8-4
FITT FACTORS Factors for an effective exercise program are Frequency, Intensity, Time, and Type or "FITT". F I T T FREQUENCY (how often you exercise) 5-7 times weekly INTENSITY(how hard you exercise) -If you cannot talk while you are exercising, you are exercising too hard. -If you can carry on a normal conversation while exercising, you are not exercising hard enough. TIME (how long to exercise) At least 30 minutes TYPE (aerobic, anerobic, strength training, or flexibiliity) walking, swimming dancing, weight lifting, and stretching. TYPES OF EXERCISE A variety of exercises including aerobic, anaerobic, and flexibilty training should be included in every blanced exercise routine. Aerobic Uses oxygen. Increases your heart rate. This is the kind of exercise that will strengthen your heart muscle. There are a wide variety of aerobic exercises including walking, home video exercise tapes, biking, stair climbing, jogging, dancing, exercise classes, or swimming Anaerobic exercises Do not use oxygen These are exercises that cause you to strain, such as lifting heavy objects. This type of exercise can increase your blood pressure and cause other health problems. Check with your doctor about anaerobic exercises. 8-5
Flexibility gentle stretches help keep you limber and prevent muscle injuries. Hold each stretch for at least 30 seconds. If you are not able exercise, know that even a little bit helps. You can: Park farther away and walk more. Take the stairs instead of the elevator. Walking in the house or in the mall. Do chair exercises (move your arms and legs while sitting in a chair, listening to music or watching T.V.). 8-6
GETTING STARTED (See your doctor before starting to exercise) Check blood glucose before and after exercise. Always record results. Start slowly. Gradually increase to at least 30 minutes a day. Know the signs and symptoms of low blood glucose. Carry glucose tablets or a simple carbohydrate with you. Always wear some form of diabetes identification. Wear appropriate clothing (good walking shoes). Drink lots of water before, during, and after exercise. Warm up before exercisng and cool down afterwards. Talk to your doctor about how hard you should exercise. Know the side effects of the medications you take. Some medications can hide low blood glucose symptoms and others can prevent your heart rate from rising. 8-7
EXERCISE DON TS: Drink alcohol before, during, or after exercise. Exercise if you are not feeling well. Exercise if you have pain (injury). Let your doctor know. Exercise when blood glucose is over 240 mg/dl and you have ketones in your urine. Exercise in hot, humid, or smoggy weather. Exercise when your insulin is peaking (working its hardest). Inject insulin into a part of your body that you are going to exercise. If you have low blood glucose reactions: Your insulin and/or antidiabetes agents doses may need to be adjusted. Talk to your doctor. The effect of exercise can last up to 24 hours or longer depending on the intensity of the exercise. Check your blood glucose before and after exercise. You may need to eat a snack before you exercise depending on your blood glucose reading (see Exercise Snack Guidelines). 8-8
EXERCISE SNACK GUIDELINES Type of Exercise If Blood Glucose Is: Added Snack Short (less than 20 minutes) Walking less than one mile or cycling at a slow pace Less than 100 mg/dl 100 mg/dl or above 10-15 g of carbohydrate No extra snack Medium (20 to 60 minutes) Tennis, swimming, jogging, cycling, vigorous vacuuming Less than 100 mg/dl 100-200 mg/dl 200-300 mg/dl 300 mg/dl or greater 30-45 g of carbohydrate before exercise then 10-15 g every hour of exercise 15 g of carbohydrate per hour of exercise No extra snack Do not begin exercise until blood glucose is under better control Difficult (60 minutes or more) Long distance running or cycling. Less than 100 mg/dl 100-200 mg/dl 40-50 g of carbohydrate to start, check blood glucose during exercise 30-45 g carbohydrate to start* 200-300 mg/dl 15-45 g of carbohydrate per hour of exercise* *You may need an additional snack every hour check your blood glucose. 8-9
Examples of 15 g of Carbohydrate One half of a banana 3-4 glucose tablets 6 crackers ½ c juice 5 lifesavers 2 tablespoons raisins 8 oz. of gatorade SUMMARY Exercise is part of the plan for almost everyone with diabetes. Check with your doctor before you begin an exercise program. Choose an activity that you like to do. Start slowly. Build up until you are exercising at least 30 minutes a day. Check your blood glucose often. Treat low blood glucose Be prepared. 8-10
My plan of exercise: What kind: How often: How long (minutes): How intense (How hard?): (initials) Week 1 10 minutes, 5 days a week Week 2 12 minutes, 5 days a week Week 3 15 minutes, 5 days a week Week 4 20 minutes, 5 days a week Week 5 20 minutes, 6 days a week Week 6 25 minutes, 6 days a week Week 7 30 minutes, 6 days a week Week 8 30 minutes, 7 days a week Week after Week Keep going! Add new exercises for variety SAMPLE EXERCISE PLAN 8-11