Diabetes mellitus, a chronic metabolic disease, is characterized by an increase in the blood glucose level resulting from a relative insulin deficiency or insulin resistance or both.
Physical exercise has been considered as one of the cornerstones in the treatment of diabetes mellitus along with nutrition and medication since from the past 100 years ago.
Exercise training programs were alternative therapeutic regimens for both type 1 and 2 diabetes mellitus. Especially, the exercise management program influences type 2 diabetes mellitus more since it is an adult-onset disease and showed a promising effect on the community The mechanism of the role of exercise on diabetes mellitus is not clearly understood.
However, it can be determined that increase glucose uptake to the skeletal muscle during the exercise is responsible for reducing blood sugar level in type 2 diabetes mellitus patients.
Exercise not only improves the glycemic control, but it can also improve the insulin sensitivity and restore the diabetic associated complication such as cardiovascular damage, which considered as one of the major complications.
Exercise, including aerobic exercise, endurance-type exercise, passive exercise and resistance exercise are fundamental therapeutic effects towards type 2 diabetes mellitus.
Effect of aerobic exercise
Aerobic exercise is the exercise which improves oxygen consumption and increases the functioning of the cardiovascular and respiratory systems. Aerobic exercises comprise of swimming, cycling, walking, rowing, running and jumping rope.
Moderate aerobic exercise leads to maintenance of the blood pressure in diabetic patients. The high-volume aerobic exercise produced weight loss with significant improvement in insulin sensitivity.
Effect of Resistance exercise
Resistance exercise leads to develop proper glucose control and less insulin resistance among diabetes patients (type 2). Resistance exercises are exercises that have to be performed against the resistance. Examples of resistance exercises include weight lifting. Unlike aerobic exercise, resistance exercises have relied on the equipment.
Resistance training has been reported to enhance insulin sensitivity, daily energy expenditure and quality of life. Furthermore, resistance training has the potential for increasing muscle strength, lean muscle mass, and bone mineral density, which could enhance the functional status and glycemic control and assist in the prevention of osteoporosis.
Other types of exercises
Endurance exercise which increases the endurance of the muscles. ex; walking, running, cycling. Some studies are successful to report that yoga classes training could improve the glycemic control in diabetic patients.
Components of an exercise programme
Warm-up
Stretching
Main workout- Aerobics/Endurance exercise / Resistance exercise
Stretching
Cool-down
Warm-up
Warm-up exercises
for 5- 10 min of aerobic exercises (walking, cycling) at low-intensity level, brisk walking
Stretching
After the warmup, gentle stretching exercises are done for 5- 10 min
Main workout
For adults with diabetes mellitus; moderate aerobic exercises, muscle strengthening for 150 min, 3 days/ week.
Aerobics
Swimming
Cycling
Rowing
Chair exercises
Arm exercises
Other non-weight bearing exercises
Endurance exercises
Running
Cycling
Walking
Resistance exercises
Weight lifting
Thera band exercises
Cool-down
Cool-down exercises last about 5- 10 min and gradually bring the heart rate down to its pre-exercise level.
Contraindicated exercises for diabetic patients with loss of protective sensation
Treadmill
Prolonged walking
Jogging
Step exercises
Benefits of exercise
Improves blood glucose level and reduce insulin resistance.
Decrease blood pressure and reduce the risk of hypertension and cardiovascular diseases.
Weight loss and maintenance
Increasing muscle strength
Improve the quality of life, psychological wellbeing and decrease depression
Guidelines for a sound exercise program
If the blood glucose level is less than 100 mg/dl or greater than 250 mg/dl, do not exercise.
It is also helpful for the patient to have immediate access to necessary things to address hypoglycemia, hyperglycemia or diabetic ketoacidosis.
It is not reasonable to inject insulin close to the muscles to be exercised within 1 hour of exercise.
Patients ought to eat 2 hours before they go for exercise.
It is also important to drink an adequate amount of fluid before exercise.
They are recommended to have a carbohydrate snack such as a glass of orange juice or milk at every exercise session.
During prolonged exercise duration, 10–15 g of carbohydrate snack is recommended for every 30 minutes
Make sure exercise does not contribute unnecessary stress to the patient
It is recommended to exercise indoors instead of outdoor
Exercising at a comfortable temperature is worthwhile. Never exercise in extreme temperatures
Always wear proper footwear and exercise in a safe environment.
Avoid exercising late at night
Any known diabetes mellitus patient must not exercise alone as much as possible so as to call someone to help in unexpected situations.
This information provided is general and furnished only for educational purposes. Depending on diabetes mellitus type and stage exercises program should be changed from individual to individual. Therefore, consult your physiotherapist to get most appropriate exercises for you.
References
Thent, Z. C., Das, S. and Henry, L. J. (2013) ‘Role of exercise in the management of diabetes mellitus: The global scenario’, PLoS ONE, 8(11), pp. 1–8.
Kaur, J., Singh, S. K. and Vij, J. S. (2015) ‘Physiotherapy and rehabilitation in the management of diabetes mellitus : A REVIEW’, 6(2), pp. 171–181.
Gelaw, A. Y. (2018) ‘Provisional chapter Exercise and Diabetes Mellitus Exercise and Diabetes Mellitus’, (July).
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