Healthy Activity for Patients with Diabetes
“Are you staying active?”
What a loaded question. I mean, I'm walking up and down my stairs to do my laundry – so, that's a yes, right?
We all know we are supposed to exercise. We all know it is good for us. We all know it will help lose weight and maintain that weight loss. And, we feel better when we do exercise. So WHY is it so hard to make it a necessary part of our day?
There are many reasons. Finding the time, experiencing pain, affordability of a gym membership, fatigue at the end of a long day, feeling weak, and just plain HATING exercise, are reasons I hear when I ask about activity. Most people are referring to planned and structured “workouts.” This usually requires changing clothes, special equipment, driving somewhere, a specific time-frame and a lot of energy expenditure! There is certainly a place for, and advantages to, this type of activity —but for those struggling to stay active, I want to broaden our definition to include everything we do, day-to-day, and how we optimize that for maximum benefit.
Activity vs. Exercise
All the advances in our modern world have us sitting many more hours a day than ever before. We sit in cars (or trains or buses), at desks, on couches, in school, and even the drive-thru lane for food. Most of us cannot quit our desk jobs or sell our cars and switch to walking or biking to work, however we all can begin to think about how to increase moving our bodies in our everyday lives.
For all of us, but especially for a diabetic, the first step is to become aware of how much time you spend sitting. Then we need to add movement, as being active makes your body more sensitive to insulin (the hormone that allows the cells in your body to use blood sugar for energy). This helps manage your diabetes!
Physical activity also helps control blood sugar levels and lowers your risk of heart disease and nerve damage. Additional benefits include losing weight or maintaining a healthy weight, feeling happier, sleeping better, improving your memory, controlling your blood pressure, lowering your “bad” cholesterol and raising your “good” cholesterol.
These are some tried-and-true ways you can instantly infuse your day with more steps and more movement:
Don’t sit for longer than 30-60 minutes at a time (set an actual timer!).
Park farther away from the door, on purpose.
Always take the stairs. Make a decision that the elevator is simply off-limits!
Walk the dog instead of just letting him/her out to pee — dogs are a natural motivator to extend your time outside, because they need it as much as you do!
Do one household chore or yardwork activity a day that involves going up and down stairs or walking around the house.
When you get up in the morning, put on sneakers. Being in sneakered feet lowers the gateway to walking around, getting the mail, etcetera, as opposed to being in socks or slippers.
When you step outside to go to the mailbox, take a lap around your house or block before you actually get the mail. Or, simply walk to the mailbox twice, for no reason other than to double the steps you take.
March in place during every commercial break while watching TV. You don't have to sweat, you just have to move.
Read a book, listen to a podcast, or watch a favorite TV series while on an exercise machine, extending the time to however long it takes to finish the episode or chapter.
If you take the train or bus, get off at an earlier stop and walk the rest of the way.
Turn on music and dance (when making dinner or for 5 minutes before getting dressed)!
Keep hand weights in the kitchen and do some bicep curls while the water is boiling. Add some squats, lunges or calf raises while your spouse tells you about their day! (Check out the 5-minute kitchen workout below.)
Remember that any movement that gets you up from sitting and burns some calories is a win! It doesn't have to mean that you intended to "exercise".
How do I Start?
Physical activity that requires moderate effort is safe for most people. However, if you have been inactive, have a disability, or are overweight, discuss vigorous-intensity physical activity (more than brisk walking) with your doctor before beginning. The risks associated with diabetes such as cardiovascular disease, neuropathy, retinopathy may require modifications to some activities.
Once you are cleared to move more, make your intention to move a reality, by:
• Finding something you like! This is super important, so that it’s easy to keep doing it.
• Adding Variety. Mix up what you are doing, so you don't get bored with it.
• Starting small. Add a 10-minute walk after dinner.
• Making it a habit. Pair it with something you love or must do every day.
• Setting goals and measuring progress. This is a sure-fire way to stay motivated – nothing is as encouraging as reaching your goals.
• Finding a partner. Share your goals and intentions out loud with your spouse or a friend or family member, and ask them if they'd like to partner up for some accountability and shared fun while working out.
Here is a link to the Centers for Disease Control and Prevention (CDC) website discussing ways to add physical activity to your life: https://www.cdc.gov/diabetes/managing/active.html
The Office of Disease Prevention and Health Promotion (ODPHP) offers this activity planner to get you started: https://health.gov/moveyourway/activity-planner
The CDC recommends:
At least 150 minutes per week of moderate-intensity physical activity (brisk walking, housework, mowing the lawn, dancing, swimming, bicycling, sports)
At least 2 days a week of activities that strengthen muscles
Flexibility and balance: adding stretching and balance exercises as we get older can help reduce the risk of falling.
I recommend that every person should know how many steps they take a day. Steps are easy to track, and make it easy to set goals. One often hears the goal of 10,000 steps a day which is a great goal, but if you are currently only getting 1,200 steps a day, 10,000 is too high a goal. You can set your goals at your own pace, as long as you are increasing the number in time by adding 100, 200, 500 more steps per day to tomorrow' s target. Most mobile phones have step-tracking features, but you have to always have your phone on you. Of course, there are simple (and fancy) fitness trackers you wear like a watch for as little as $20, and there are simple pedometers you can clip on yourself to track your daily steps without any extra bells and whistles. ALL are terrific solutions!
Cardio or "aerobic" exercise uses large muscles and increases our heart rate and breathing rate. It strengthens our heart and improves our lung health. Traditional cardio exercises include walking, jogging, swimming, biking, exercise machines, jumping rope, etc. The recommendation for a diabetic is 150 “moderate-intensity” minutes a week without skipping more than one day. This can be broken down into 10-minute sessions!
Intensity of your activity can be measured several ways. Two common measurements are figuring your target heart rate range, or evaluating your perceived exertion.
How to calculate Target Heart Rate range for exercise: https://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm
The Rate of Perceived Exertion (RPE) scale (below) requires no calculations! Perceived exertion is based on how hard you feel your body is working during the exercise. Exertion is judged by the sensations you experience during exercise, including your heart rate, breathing rate, sweating, and fatigue. The scale gives you a gauge on how you feel at each level. How fast you are going or your exertion will be different depending on how you feel that day — it is not mph or a specific speed or incline on a machine. One person’s Level 2-3 may be another person’s Level 8-9, and one person’s intensity will vary from day to day depending on how they are feeling.
The talk test is a simple way to measure relative intensity. In general, if you’re doing moderate-intensity activity, you can talk but not sing during the activity.
In general, if you’re doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath. You won't be able to sing.
To put a number value on it, you can use the scale below for a 20-minute (or 10-minute!) interval workout for walking, treadmill, elliptical, step, jogging, cycling, etc. (see the 20-Minute Interval Workout at the end of this section). This often helps knowing you only have to stay at higher intensity for 1 minute and then you get to recover.
Rate of Perceived Exertion (RPE) Scale
Level 1: Very Light Activity (anything other than complete rest)
Level 2-3: Light Activity (feels like you can maintain for hours, easy to breathe and carry on
Level 4-5: Moderate Activity (feels like you can exercise for long periods of time, able to
talk and hold short conversation)
Level 6-7: Vigorous Activity (on the verge of becoming uncomfortable, short of breath, can
speak a sentence)
Level 8-9: Very Hard Activity (difficult to maintain exercise intensity, hard to speak more
than a single word)
Level 10: Max Effort (feels impossible to continue, completely out of breath, unable to
Strength training often brings to mind barbells and persons with large muscles and perfect physiques. In other words, it can sound intimidating to persons who have not participated in this type of activity!
In reality, strength training can be done in many different ways to fit anyone’s lifestyle. Working our muscles is essential to someone with diabetes because muscle helps burn more calories to maintain a healthy weight and improves insulin sensitivity. Regular strength training can decrease fatigue, build stronger bones, improve mood and make day-to-day activities like carrying groceries or playing in the park easier.
Strength training can be achieved in a variety of ways:
• weight lifting with free weights or machines
• resistance bands
• isometric exercises or calisthenics (jumping jacks, sit-ups, squats, push-ups, crunches, planks, lunges, wall sits, bridge)
Of course, one can go to a gym, take classes or use home equipment for strength training, but you can also start with a simple workout that requires no equipment or, for a small cost, you can add resistance bands:
The 5-Minute Kitchen Workout by Dr. Rangan Chatterjee: https://www.youtube.com/watch?v=jtZB95-AVZM
Resistance Band Workout for Beginners: https://www.youtube.com/watch?v=lm_30_1lTqU
Beginner Resistance Loop Band set from Amazon for $10.95: https://www.amazon.com/Fit-Simplify-Resistance-Exercise-Instruction/dp/B01AVDVHTI/ref=psdc_3407931_t2_B07CZTNY7T
Summing it all up
For those of you have never exercised, or if it has been a long time, I recommend checking with your provider and starting slow. We can consider ordering some sessions with a physical therapist to help evaluate your fitness level and appropriate exercise for you. Physical therapists can also help develop safe exercises for persons who have injuries or chronic pain. Please feel free to schedule an appointment with me or your provider to discuss in more detail!
Two other great options offered through CMMD and Associates are:
Pro+Active Fitness & Wellness with Kathleen Ruggeri - a personalized fitness and nutrition program, with details at https://www.christinemeyermd.com/proactive
ACAC P.R.E.P.- 60-day guided introduction to exercise at ACAC, with locations in Lionville and West Chester
Remember to take things day by day. If you don’t meet your activity goal today, let it go and start over tomorrow. One day of missing your walk isn’t “I’ll never be able to do this” or "I might as well have some ice cream”. One day is just that: one day. There are 365 of them in a year. How do you want to feel in May of 2022?
Ready to discuss your nutrition plan for your diabetes? Schedule an appointment with me at any time to discuss personalized goals. Send me a message in the patient portal, request an appointment here, or email firstname.lastname@example.org.
Get Active! | Living with Diabetes | Diabetes | CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved April 7, 2021, from https://www.cdc.gov/diabetes/managing/active.html
Cornell, S., Halstenson, C., Miller, D. K., & American Association of Diabetes Educators. (2017). The Art and Science of Diabetes Self-Management Education Desk Reference. In The Art and Science of Diabetes Self-Management Education Desk Reference (4th ed., pp. 139–167). American Association of Diabetes Educators.