Exercise for everybody!

It is important for all of us to have regular exercise and to move more in general. If you have  any type of diabetes, or are at risk of type 2 diabetes, exercise and regular movement are very important in staying healthy.

We know that people are generally a lot less active than we used to be. Life is made easier by a range of tools that keep us sitting! This means that building both physical movement (for example taking the stairs, parking further away from work or the shops etc) and scheduling regular planned exercise, are very important in your overall diabetes management, but also for general health and wellbeing. Exercise not only assists with physical health but is very important in maintaining mental health.

Here are the current Physical Activity Guidelines for all Australians 

Physical activity helps your insulin to work more efficiently and assists with your blood glucose lmanagement.

If you have type 2 diabetes and still produce some of your own insulin exercise can help to reduce your insulin resistance as the muscles find it easier to uptake the insulin your pancreas makes.

If you inject insulin it is also easier for your body to make use of this. People with type 1 diabetes in particular will need to manage their insulin doses, food intake and exercise, to achieve the best possible balance. It can be tricky to avoid low or high blood glucose during and following exercise.

Exercise and High Blood Glucose

If you have type 1 diabetes and have high blood glucose levels - usually recommended as greater than 14 mmol/L with ketones - then it is best to avoid exercise until your blood glucose has settled. Exercise in these circumstances can actually elevate blood glucose and increase ketone production. Read more here

 Benefits of Exercise

Exercise can help:

• your insulin to work better, which will improve your diabetes management
• manage your weight
• lower your blood pressure
• reduce your risk of heart disease
• reduce stress
• manage depression and anxiety
• sleep better
• feel generally happier and more balanced
• gives you a sense of achievement

It is important to remember not to participate in strenuous physical activity if you are feeling unwell or have ketones present in your blood or urine. This can lead to higher blood glucose and dangerous levels of ketones. If you are not sure about how to manage this, chat with your diabetes team to develop a plan for exercise and management of ketones.

Starting a new exercise programme

Before commencing a regular exercise program see your doctor for a full medical examination.

Diabetes Australia recommend there are also two things you have to be careful of:

- Take it slow: You don’t want to start off too hard because if you are not used to the exercise you will be sore the next day and this will not make the exercise experience an enjoyable one! Always increase the intensity of the exercise very slowly.

- Get checked out. If you have any health problems such as diabetes complications like retinopathy (problems with your eyes from diabetes), nephropathy (problems with your kidneys from diabetes), you should talk to your doctor or an accredited exercise physiologist before you start increasing the intensity of your exercise.

Exercise and wellbeing

Exercise is very important in overall wellbeing and mental health. It can assist with management of depression, anxiety and stress. It also helps us to sleep better and gives us an overall sense of peace. Human's are however very good at avoiding exercise and putting in barriers and excuses as to why we can not exercise!

Some of these include:

• It is too hot
• It is too cold
• It is too dark
• I am too busy
• I am too tired
• It is not helping anyway
• I have nobody to exercise with
• I can not afford it
• I have a sore knee, arm, hand, leg, foot, toe, elbow, etc
• It makes me hypo all the time
• I have to eat more to exercise so what is the point
• I just hate exercise
• I am too embarrassed to get into bathers or exercise gear

What exercise should I do?

This really depends on you and what you enjoy! What is really important is to choose something you will enjoy, look forward to and be able to maintain.

What you do for exercise is really as varied as your imagination. Ideally, it is beneficial to do about 30 minutes of exercise every day. If this is not possible, then this time can be divided in 3 x 10 minutes sessions which may include a Television workout as below!

You do not need to puff to gain the benefits of exercise. Aim for moderate intensity. This means you should still be able to talk as you exercise without becoming breathless.

 Some ideas include:

• Walking - one of the best options, it costs nothing, you can do it anywhere and you can vary the track you walk so you do not get bored
• Swimming or exercise in water - great for people with joint problems or restricted exercise options
• Dancing - grab a partner and learn some moves or just put on your favourite track in the lounge and go for it!
• Water aerobics and other water classes - many group classes are now on offer in pools and sometimes can be run by a physiotherapist or exercise physiologist. As well, gyms and pools often have instructors leading things like areobics and even water Zumba!
• Gardening - it is amazing how much energy gardening can use! In fact it is important to treat a heavy session of gardening as exercise and prepare to avoid hypos if you are on insulin or oral medications that can lead to a low blood glucose. Keep an eye on the time as an hour or more can pass in the garden without noticing!
• Golfing - a lovely day out and can be a great way to manage stress as well in particular if it is a scenic course!
• Yoga and Thai Chi - these kinds of exercise can help your body, mind and soul. The relaxation component of these activities, as well as the physical health benefits, are well known. You can join in with classes, or buy or hire DVD's and CD's which you can do at home.
• Cycling - this may be on a stationary exercise bike or a real bike, getting out in the fresh air. Some people use their bike to run errands and get to work and so on, making this an easy way to build into their day.
• Walking machine - you can access these at a gym, or buy or hire one for home and is a great way to go walking when the weather is not so good.
• Playing with your children in the park - kicking or throwing a ball, playing a game of chasy or other outdoor game with your family is good for all of you and also gives you quality time together which is a good thing for your wellbeing!
• Television Workout! - yes you can develop an exercise regime that you can do while watching your favourite show! This might include sit to stand exercises in the first ad break, followed by bench-top push ups next ad and finished with some star jumps at the end. Talk to an exercise physiologist about developing a plan for a 30 minute programme you can do in the ad breaks!

Things to remember

• Drink extra fluid before, during (in particular if prolonged exercise) and after exercise to avoid dehydration. The fluid may be water or a sweetened drink if extra carbohydrate is required. 250 ml every 15 minutes or one litre of fluid per hour is recommended.
• Take care of your feet when exercising by wearing comfortable and well-fitting shoes - see a podiatrist if you have particular issues with your feet to make sure you have the right shoes for what you are doing.
• If you have problems with sensation in your feet in particular, have a look at your feet before and after exercise to make sure there are no blisters or ulcers, or other issues.
• Ulcers or other sores on the feet are a serious problem for people with diabetes and in particular type 2 diabetes.
• It is also very important to avoid foot damage especially for middle-aged and elderly people.
• It  is sensible to avoid exercise that causes stress to the feet (e.g. running).
• Exercise which is not stressful on your feet is a good choice such as riding an exercise bike , swimming, or brisk walking in good footwear.
• Have some extra carbohydrate foods before and during exercise to prevent hypoglycaemia if you are on insulin or an oral medication that can lead to hypoglycemia.
• Extra carbohydrate is often needed after exercise if it is particularly strenuous. Discuss adjusting carbohydrate intake with your doctor, diabetes educator, or dietitian.
• Monitor your blood glucose levels before, if possible during (at least when you first start exercising or when changing your diabetes management), and after exercise to see if you do need extra food for your exercise sessions.
• It may be necessary to reduce your insulin dose prior to exercise  as well. Insulin adjustment varies with each individual. Discuss appropriate adjustments to suit your exercise schedule with your doctor or Credentialed Diabetes Educator.
• Don't forget to wear sun block when exercising outdoors.

And finally - have fun!! Being active for life means it should be enjoyable most of the time.