Diabetes

Fifty-Plus Fitness Library

Library : Year 2 | Session 5: Wellness Through Understanding--Overweight, Diabetes, Hypertension

Diabetes

By Karl Knopf, Ed.D.

Studies suggest that exercise can positively influence the course of diabetes. The United States CENTER for DISEASE CONTROL estimates that 1 out of every 17 Americans has diabetes. Diabetic populations develop cardiovascular disease at an earlier age and with a greater severity than do people who do not have diabetes. It has long been recognized that diabetes accelerates the arteriosclerotic process and is considered an independent risk factor for heart disease right along there with obesity and high blood pressure. Diabetes not only can contribute to heart disease but can also contribute to blindness and the loss of limbs due to poor circulation. (I spent many years working with visually impaired people who had loss their vision secondary to diabetes, and as a young therapy intern I had to observe an amputation of a leg secondary to diabetes. The bottom line is that diabetes is not a simple and common condition to be dismissed as just a blood sugar imbalance.)

There are two distinct forms of diabetes: type 1 or insulin-dependent diabetes mellitus or type 2 non-insulin dependent diabetes mellitus. For those of us who work with the older adult population, it is important for us to be informed about type 2 diabetes since about 90% of the diabetic population has this form of the disease. Whereas type 1 is characterized by an absolute insulin deficiency caused by an auto immune destruction of the insulin producing beta cells of the pancreas, type 2 is characterized by a relative insulin deficiency.

Many experts in this field believe that proper lifestyle changes can and will positively influence the course of this disease. Many doctors suggest that the first course of treatment for a person with adult on-set diabetes is to get more active and lose weight.

THE ROLE OF EXERCISE AND ITS BENEFITS

The inter-play between exercise and diabetes is a critical one. This is because of the way that exercise influences metabolism such as glucose control, weight control, and stress management.

Exercise helps!

EXERCISE IMPROVES

Glucose uptake and helps control glucose levels.
Weight control. Reduction of excess body fat has been shown to decrease insulin resistance.
Stress level (or said another way it de-stresses the body). DIS-stress/bad stress can disrupt the diabetics ability to maintain the delicate balance of hormones, ketones, free fatty acids and urine output.

GENERAL CAUTIONS

Avoid stressful activities to the feet.
Avoid exercise when blood sugar levels are greater than 250 mg/dl. (see patient's MD for specific guidelines)
Avoid exercise if BP is elevated above 160 systolic/100 diastolic. (see MD for specific recommendations)
Avoid exercising in extreme weather conditions
Avoid heavy training with clients who retinopathy.

GUIDELINES

Aerobic exercise should be done most days of the week at a comfortable pace, as tolerated (50-70% max. VO2 for 20- 40 min).
Monitor blood sugar levels and BP.
Clients who experience hypoglycemia reactions should have quick sugar on hand.
Never exercise on an empty stomach and have plenty of fluids available.
Always warm-up and cool-down.
Always stay alert to the effects of hypoglycemia and diabetic coma.

TIPS

Have client get medical clearance and stress EKG
Make sure that your client is aware of the effects that their medicine will have on exercise.
Remind your clients to be mindful of foot hygiene and the healing process of cuts.
Encourage exercise and activity to become a way of life for your client.
Make exercise fun!

Resources

Adapted PE for Adults with Disabilities, Lasko & Knopf, Bowers Publishing, Dubuque Iowa 1994

Adults with Chronic Conditions, an FEOAA Training Manual 1998

American Diabetes Assoc. Alexandria, VA phone #703-549-1500

Center for Disease Control, Atlanta, GA phone # 770-488-5015

Karl Knopf, 408-450-1224, is President of Fitness Educators of Older Adults Association