by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people make
their diabetes care fit their needs and their lives.
Almost everyone who has diabetes, and lives in an industrialized country, has been told it is a good idea to exercise regularly. Exercise is good for everyone, and particularly good for people who have diabetes. But many people know that, and think about exercise -- without actually doing it. Knowing you should exercise, and actually maintaining some kind of exercise as a normal part of your everyday life are two completely different things. If you think you ought to exercise, and you want to exercise, but you haven't yet begun, this column is for you!
When most people think of exercise, they think of "working out" in some way--whether it's a running program, weight-lifting, jazzercise, or using some sort of exercise equipment. So you might be surprised to learn that, for the purposes of improving your health, you might not need to do so much. If such programs help you, fine. But even if you are not going to a gym, or buying any equipment, or participating in any organized programs, you still get many benefits from exercising. Research shows that you can get almost all the benefits of a full exercise program by instead having several shorter bouts of exercise throughout the day. What is most important is to MOVE YOUR BODY! So for the purpose of this column, the definition of exercise is moving your body, being physically active. I'll use these terms interchangeably throughout this column.
Before you begin planning your exercise, it's important to be really convinced that moving your body would be good for you. So first, let's look at the many reasons it's good for people with diabetes to be physically active.
Most people with diabetes notice some immediate benefits from moving their bodies. Generally, right after a period of physical activity, your blood sugar is lower than it was before you were active. For many people who have type 2 diabetes, your insulin resistance can be lowered for up to two or three days after physical activity. If this happens, your blood sugar can be in better control for that entire period of time. So for you people who have insulin resistance, regular exercise can work as well as adding a new and very effective medication to decrease insulin resistance. And it happens without the potential for new drug interactions and side effects. In fact, almost all the "side effects" of moving your body are good!
Some good effects of moving your body you may notice quickly. If you have a lot of stress in your life, moving your body can be a very potent stress management technique. If you are prone to feelings of depression, physical activity can help lift you, and help prevent future bouts of depression. And if you have trouble falling asleep, or staying asleep, or waking up feeling rested, exercising can help promote deep, restful sleep.
It's important to note here that if your high stress, depression, or difficulty sleeping is severe, you may need other help with these problems. It would be a good idea to talk this over with your primary care doctor. But even if you do need other help, physical activity can be an important part of treating severe stress, depression, and sleep problems.
Moving your body has many important long-term benefits, too. One of the most important ones is that it can help you lose weight and keep it off. Many people who start exercising are surprised to find that their appetite actually diminishes after a few weeks. But whether this happens to you or not, simply burning more calories and becoming more fit is likely to help you lose weight. And all the research on maintaining weight loss shows that being active is a very important part of maintaining a desirable weight.
Another important long-term benefit of moving your body is that it reduces your risk of cardiovascular problems--heart attack and stroke. Since everyone who has diabetes is considered to be at risk for these problems, it's a good idea for you to do everything you can to prevent them. We know that physical activity can help reduce blood pressure, and reduce total cholesterol, "bad" cholesterol, and triglycerides. It also raises the "good" cholesterol. In addition, exercising the heart helps keep it strong. All of this adds up to a much-reduced risk of heart and stroke problems.
Finally, people who are physically active generally feel better. You'll find after exercising for a few months that you have more energy and feel more alert. This is probably the result of all the above benefits added together. And "feeling better" is probably the most important reason of all to start moving your body.
Do you think you are ready now to plan how to increase your physical activity?
Many people have had the experience of beginning a physical activity, doing too much in the first few days, and then getting too tired or sore -- and stopping almost right away. To avoid this, it's a good idea for you to spend a little time thinking through a plan for increased physical activity.
First, before you begin, you should talk with your doctor about any physical limitations you might have. For example, if you have diabetic retinopathy, and you still have some useful eyesight, it's important to avoid activities that might start retinal bleeding. So you'd want to avoid any exercise with rapid, jerking movements of the head, such as basketball; or lowering your head below the level of your heart, like leaning over to touch your toes; or holding your breath and straining, as many people do with weight-lifting. If you have heart disease already, you will want to avoid straining your heart. It will be important for you to begin with gentle activities, and increase gradually over time. If you have foot injuries or ulcers, you will want to talk with your foot care specialist for advice about activities that will not add to your foot problems.
If you are using insulin, or any oral medication that works by increasing the amount of insulin your body makes, you need to watch out for low blood sugar. Most people can safely add a small amount of physical activity without having any blood sugar problems. But some people find that even a small amount of added physical activity is enough to give them hypoglycemia, low blood sugar. So as you begin moving your body more, it's a good idea to check your blood sugar before and after the exercise. And it's always a good idea to carry glucose tablets or some other portable source of carbohydrates to treat low blood sugar. Remember the rule of 15: If your blood sugar drops below 70, take 15 grams of carbohydrate (three or four glucose tablets, or one half cup of any juice or regular pop, or six or seven7 hard candies, or any other source of 15 grams of carbohydrate). Wait 15 minutes, and check your blood sugar again. If it's not coming up, take 15 more grams of carbohydrate.
Once you know whether you'll need to consider any precautions when you move your body, you're ready to make a specific plan. What physical activity do you want to do? And when do you want to do it?
It's important to choose a form of exercise that you can enjoy, so you'll keep doing it. If you choose an activity that feels like a chore, you're probably not going to keep it up. So think about what you might enjoy doing. Many activities qualify as "moving your body," not all of them traditionally considered "exercise." We all know, for example, that walking, swimming, and bicycle riding are good forms of exercise. So are dancing, gardening, doing housework vigorously, and playing active games with children. Let your imagination go! The idea is to do something that gets you breathing a little harder, and gets your blood moving around. In other words, the idea is to move your body.
If you are blind, you may feel that many forms of physical activity are no longer possible for you. It is true that many physical activities will take some adaptation. However, many blind people have found ways to safely do types of exercise others might think impossible. Of course, walking is still possible--with a white cane, a guide dog, by trailing a wall or a guide line with your hand, or with a sighted person as a guide. Swimming can work well in a pool with lane markers. Bicycling alone may not be safe, but riding an exercise bicycle or tandem bicycling with a sighted person can work. There are groups around the country organized for blind people to participate in all kinds of activities--beep-ball (an adaptive form of baseball), golfing, bowling, sailing, and many other sports. If you are interested in figuring out an adaptive form for a particular activity or sport, speaking with physically active blind people and blindness rehabilitation specialists may help you find other blind people who already participate in that sport. A lot of information is available. An internet search under "athlete" and "diabetes" or under "athlete" and "blind" brings up a lot. For more information, see the end of this article.
But suppose you just can't picture yourself doing any "sports," or setting aside much time at all for physical activity. You can still move your body. Research has shown that there are many effective ways to get the benefits of exercise. Several shorter bouts of moving around on most days can give you almost as much benefit as the traditional 30 minutes of exercise at least five days a week. Maybe you can't imagine yourself swimming for exercise, but you can imagine taking a few flights of stairs in your apartment building instead of riding the elevator. Maybe you'll never use exercise equipment, but you could turn on the radio and dance for ten minutes most afternoons. Maybe you'll never have a regular walking routine, but you can walk to a friend's house, or the grocery store, or a pharmacy, instead of riding the bus or taking a car. Maybe you can sweep and mop your floor a little more vigorously, or walk your dog an extra time every day, or add a little more gardening each week. If you take the time to think of all the ways you can add little bits of moving your body around all through the day, you'll probably be surprised to realize that it can amount to a substantial increase in physical activity.
After you have decided what kind of physical activity appeals to you, it's important to set a specific time to begin, and to decide how long you'll move your body the first time you begin your new level of activity. It really matters a lot less that you start with a very small amount of activity than it does that you actually start. For this reason, many people find it helpful to begin with a very low level of exercise--say, five minutes a day, three days out of the first week. Once you have begun, you can always increase from there. What is important is that you succeed in beginning, and that you build a habit of more movement in your life.
America's Athletes With Disabilities, Inc., National Headquarters, 8630 Fenton Street, Suite 920, Silver Spring, MD 20910; telephone: 1-800-238-7632; Web site: www.americasathletes.org.
Diabetes, Exercise, and Sports Association (DESA), P.O. Box 1935, Litchfield Park, AZ 85340; telephone: (623) 535-4593; Web site: www.diabetes-exercise.org.
United States Association of Blind Athletes (USABA), 33 N. Institute Street, Colorado Springs, CO 80903; telephone: (719) 630-0422; Web site: www.usa-ba.org.
Or you might find the following book useful: The Diabetic Athlete, by Sheri Colberg-Ochs, Ph.D., published 2001 by Human Kinetics, Inc.
[To be continued in the next issue--Moving Your Body: Increasing Activity]