Exercise Guidelines

The following guidelines can help you increase your activity level safely. Be sure to work with your diabetes care team, too, so they can monitor you and provide specialized advice for your specific situation.

Screening

First, be screened by your doctor for any possible problems before you start any type of activity. This exam should include a treadmill test for people with diabetes who fit certain criteria, an eye examination for proliferative retinopathy, a urine examination for protein, and a medical evaluation of your feet.

Type of Activity

Once you've received your team's okay for exercise, you need to choose activities that fit your physical condition, lifestyle, and tastes. Many people with diabetes, especially those who have not been physically active for a while, find that easy, low-impact activities such as walking and swimming are perfect.

Whatever you choose, make sure the activities are enjoyable for you and take into account your abilities and condition. The activities don't even have to be "exercises" in the traditional sense, as long as they get you moving. Square dancing, taking your dog on long walks, riding your bike, gardening, and even walking the golf course all count.

Vary them so you don't get bored and fall prey to easy excuses. Choose some that can be done with others and some that can be done alone; some that can be done indoors, some that can be done outdoors; some that can be done when your schedule is light, and some that can be fit in when you're strapped for time.

Talking to your doctor is a good way to start an exercise program for diabetics.

A doctor can help you form an exercise program.

Time, Intensity, and Duration

Begin each exercise session with a five- to ten-minute period of low-intensity warm-up activity (such as marching in place) and gentle stretching. The warm-up will prepare your heart for increased activity. The stretching will help you avoid tendon and muscle problems, which are common in people whose tendons have become brittle after years of high blood glucose levels.

After you warm up and stretch, start the aerobic portion of your activity. An aerobic activity is one that works the large muscles -- those in the legs and buttocks or arms and shoulders -- continuously for an extended period of time. In so doing, it increases your body's demand for oxygen, forcing both your breathing and heart rate to speed up. One way to determine how hard your body should work during physical activity is to use something called a target heart rate range.

To help establish your target range, you need to first determine your maximal heart rate. To calculate this number, simply subtract your age from 220. The high and low ends of your appropriate target heart rate range will be percentages of this number. For example, you might aim for the moderate intensity range, which is between 55 and 70 percent of your maximal heart rate. It is important, however, to work with your diabetes care team to determine the intensity range that is most appropriate for you. You will also want to ask for specific advice regarding how often and how long you should exercise.

Diabetics need to find target heart rate for exercise to help manage diabetes

During the exercise, to determine if you are working in your target range, you will need to occasionally check your heart rate. To do this, count the number of heartbeats (by feeling the pulse on the inner side of your wrist) for six seconds and add a zero to the end of that number; that's the number of times your heart is beating per minute. And that's the number that should stay in your target range during the aerobic activity.

It's always best to increase physical activity slowly and build up gradually. If you find it uncomfortable to exercise near the higher end of your target range, talk to your diabetes care team. They will probably suggest that you shoot for a lower intensity but a longer duration. As time passes, you'll be able to maintain a higher and higher level of activity for longer and longer periods of time.

Regardless of the activity you choose, you should end each workout period with ten minutes of cool-down and more gentle stretching. You want to slowly decrease the pace of your activity for several minutes rather than stop abruptly. You also want to take advantage of the fact that your muscles are warmed up to do some gentle stretching. If you try to do some extra activity every other day, you will be amazed at the difference in your glucose control. Get moving every day, and the benefits will be even greater.

The final section will focus on how to avoid glucose problems during workouts.