By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):
Our topic this session is “Diabetes – Exercise Up = Sugar Down” I’m Dr. Braman and I’m joined by medical student, Marc Anderson. Welcome, Marc.

MA (Marc Anderson):
Thank you, Dr. Braman.

So, question for you Dr. Braman, what kind of exercises should a diabetic do and how much should they do if they want to get the best benefit?

MB:
Well, even a twenty minute walk or bike ride or something similar every day can have huge benefits compared to no exercise at all, but ideally someone with diabetes should strive to get 30 minutes of moderate to vigorous aerobic activity in 5 days a week for a total of 150 minutes, or thereabout or in other words, 2 ½ hours, a week. Now it’s important to understand that moderate means you can talk but not sing, vigorous activity means you can get a few words out but you’re not carrying on a normal conversation. It is also recommended that you engage in strength training exercises like lifting weights, doing resistance bands, home things like push-ups or sit-ups on a regular basis. For most people this would look like strength training at least twice a week for at least 20 minutes at a time but that could vary.

MA:
So what is the most important part of one’s exercise plan?

MB:
Good question. So most people are going to be thinking in terms of the specific parts of exercise. What exercises you actually do doesn’t really matter as long as they allow you to meet the recommendations. The most important part is actually often what is not talked about and that is, that it’s enjoyable, that it’s safe and that it’s something you will want to keep doing long term. Changing one’s exercise-style, as well as sleep-style, nutrition-style and other lifestyle components, to those that the human body is designed for, will typically improve symptoms, greatly reduce one’s need for medication, and often get rid of diabetes completely.

MA:
Wow, that’s amazing, but what if someone, say, doesn’t have 30 minutes at a time to spare?

MB:
That’s OK. The research is showing that you can divide it up. Just divide your time into short ten or fifteen minute bursts of potentially more intense exercise or not, 2 or 3 times a day. You still get the same benefit even if you break it up. Do what works for you.

MA:
OK, that makes sense. So is strength training or aerobic exercise better for diabetes control?

MB:
Well they’re actually both fairly important. Studies have shown that both help to reduce weight and body fat, lower blood sugars and increase the body’s sensitivity to insulin. It is recommended that a combination of both be done for the best results and the best benefits. This was supported by data from multiple studies that were analyzed in a large review done by a team of European researchers. They concluded that along with combining different types of exercise, vigorous intensity for a shorter period of time, say 20-30 minutes, was slightly better at lowering A1c, or average blood sugar levels, better than light to moderate intensity for longer periods of time, like 35-45 minutes. Though, again, the most important things is that your exercise should be enjoyable, safe and something you will keep doing long-term.

MA:
OK, so if a diabetic, say, who wasn’t in very good shape wanted to make some changes and start exercising how should they go about getting started?

MB:
They should start with following the new updated American College of Sports Medicine’s guidelines for starting an exercise program which we discuss in another video. And they should work with their doctor as needed, of course. If they are making a big change or have known medication issues, it is especially good to be in communication with their doctor. Significant lifestyle changes often need fairly aggressive medication management. As the lifestyle causes get corrected, people often end up overmedicated, which can create significant problems.

MA:
But, what about the exercise itself. Is there a way that is generally good to get started?

MB:
It is generally a good idea to start with lighter intensity exercises like walking and gradually build in intensity as one’s body gets more fit. This will reduce the likelihood of injury and burning out due to soreness and fatigue. There are also some pretty interesting things that can be done with certain kinds of what is called “interval training” to take people from couch potato to getting great exercise benefit without the pain relatively quickly. It can also help to attend group fitness classes, enlist the help and support of friends and family and keep a journal of progress and goals. We will put some links to resources at the end of this video to help our listeners.

MA:
OK, that’s great information, Dr. Braman. Now, is there anything that might keep someone with diabetes from exercising safely?

MB:
There can always be risks of injury associated with exercising but hypoglycemia, or low blood sugar, during exercise can be especially concerning for a diabetic. There are a number of other issues that may apply to specific individuals. Fortunately the ADA has created some simple tips to help guide people in exercising safely with diabetes. We’ll put that link at the end of the video also.

The good news is that exercise is medicine for diabetes, and our patients can have a lot of control over their diabetes. And many making major changes to address the cause may not have it at all any more.

MA:
Well thank you so much for that, Dr. Braman. It’s been a pleasure talking with you.

MB:
Thank you, Marc.

What We Recommend. (2015, May 19). Retrieved November 18, 2016, from http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-we-recommend.html

Exercise for the management of type 2 diabetes: A review of the evidence. Zanuso, S., Jimenez, A., Pugliese, G., Corigliano, G., & Balducci, S. (2010, March 10). Acta Diabetologica, 47(1), 15-22. doi:10.1007/s00592-009-0126-3.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created LifestyleFACTS.org. He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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