Exercise for Diabetes Patients

Exercise for Diabetes Patients

Diabetes is a group of metabolic diseases characterized by high fasting blood sugar levels (hyperglycemia) due to reduced insulin secretion or impaired pancreatic function. It often presents symptoms such as polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger), fatigue, and weight loss, showing the "three highs and one low" features, which can lower the patient's quality of life, reduce life expectancy, and increase mortality rates. The etiology and pathogenesis of diabetes are not fully understood. According to different causes, it can be classified into four clinical types: type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific types of diabetes. Gestational diabetes and other specific types of diabetes are secondary diabetes induced by other diseases. Both type 1 and type 2 diabetes are primary diabetes with different causes and affected populations. For a long time, exercise has been considered a cornerstone of the treatment for type 2 diabetes, and traditional endurance exercises are recommended as the most suitable exercise for preventing and treating type 2 diabetes.

(1) Objectives of Exercise for Diabetes Patients

The main objectives of exercise for diabetes patients are to reduce peripheral tissue resistance to insulin, improve glucose and lipid metabolism, increase muscle utilization of glucose, lower blood lipids, and reduce blood sugar and urinary sugar. It aims to increase the patient's sensitivity to insulin receptors and gradually reduce the need for oral hypoglycemic drugs and insulin. Exercise also enhances physical fitness and resistance, promotes patient health, and prevents and controls the occurrence of infections and other complications.

For type 1 diabetes, the most direct objective is to improve the overall functional level of patients. For type 2 diabetes patients participating in exercise, the main objectives are weight control and increased blood sugar clearance rate. Specific prescriptions should be formulated based on the patient's complications and specific conditions.

(2) Key Points for Exercise in Diabetes Patients

First, exercise therapy for diabetes patients has strict indications and contraindications. Therefore, before starting exercise, a detailed physical examination and endurance exercise test should be performed in the hospital to determine the optimal exercise heart rate range to ensure safe and effective exercise. Afterward, exercise should be performed under the guidance of a doctor.

Second, perform 5 to 10 minutes of warm-up activities before exercising to adapt the body to exercise. During exercise, medical supervision should be enhanced, and exercise should be stopped immediately if there are fluctuations in blood sugar, complications, or difficulties in recovering from fatigue. After exercise, at least 10 minutes of cool-down activities should be done to allow the heart rate to recover to 10 to 15 beats per minute higher than at rest. Avoid stopping exercise suddenly to prevent accidents.

Third, because exercise increases muscle glucose uptake and utilization, hypoglycemia frequently occurs in diabetes patients during exercise. Hypoglycemia-related exercise accidents, such as fainting and falls, can be more severe than hypoglycemia itself. Therefore, exercise should be avoided during the peak action of hypoglycemic drugs, and patients should carry candy as a backup during exercise. Regular physical examinations and close monitoring of changes in blood sugar, urinary sugar, and symptoms are also necessary. Pay attention to weight changes to evaluate the effects of exercise and continuously adjust the exercise program.

Fourth, adopt a healthy lifestyle, strictly control the diet, and recognize the significance of exercise as a basic therapy for diabetes. Develop a habit of regular exercise. Master suitable exercise intensity and choose appropriate exercise programs and methods. Exercise emphasizes gradual progress, starting with a small amount of exercise and gradually increasing it. Exercise therapy must be persistent and adhered to in the long term to achieve the desired effect.

Fifth, for diabetes patients with diabetic retinopathy, there is a higher risk of retinal detachment and vitreous hemorrhage associated with high-intensity exercise. Therefore, avoid breath-holding and strenuous exercises.

Sixth, control complications. Diabetes patients with peripheral neuropathy should take foot protection measures to prevent foot ulcers. Patients with kidney disease should engage in tolerable moderate-intensity exercise. Patients with severe 2 type diabetes with obvious acidosis, high ketone blood levels, or severe cardiovascular and renal complications should avoid exercising if their condition is not well controlled.

(3) Selection of Exercise for Diabetes Patients

The best exercise for diabetes patients is whole-body exercise, which is beneficial for improving glucose and lipid metabolism and enhancing physical function. For diabetes patients who cannot allocate specific time for exercise, it is recommended to cycle to and from work if possible, or get off the bus or subway one stop earlier than the destination and walk to work. Encourage taking the stairs instead of the elevator and minimize using escalators. For diabetes patients with hyperinsulinemia, low-intensity strength exercises can be added to aerobic exercises to reduce insulin resistance and increase muscle volume and strength. However, attention must be paid not to excessively burden the cardiovascular and musculoskeletal systems.

Suitable exercises for type 2 diabetes patients mainly include moderate-intensity rhythmic aerobic exercises such as walking, jogging, swimming, and cycling; moderate-intensity aerobic exercises involving all muscle groups, such as medical gymnastics, fitness aerobics, tai chi, and Mulan Boxing; appropriate recreational ball games such as gateball, bowling, and badminton. Exercise therapy for obese type 2 diabetes patients can also include the above-mentioned exercises, but exercise intensity should not be too high, and exercise duration can be appropriately extended. Avoid excessively intense and tense vigorous exercises.

The selection of exercise programs varies from person to person. Patients can choose according to their age, gender, physical condition, cultural background, personal lifestyle, exercise habits, and preferences. Exercise programs do not have to be singular; various forms of exercise can be alternated, with the main emphasis on moderate and low-intensity aerobic exercises. In 2003, the International Diabetes Federation proposed to integrate exercise into daily life, such as walking upstairs, doing housework, riding a bike or walking to work, spending more time gardening, avoiding using tools for tasks that can be done by hand, etc.

Many exercises can be chosen, but based on various situations and factors, the following is summarized:

(1) Elderly diabetes patients: walking, stair climbing, flat ground cycling, tai chi, gymnastics, light household chores, etc.

(2) Obese diabetes patients: brisk walking on flat ground, jogging, stair climbing, slope cycling, hiking, various ball training, floor cleaning, etc.

(3) Diabetes patients with mild diabetes and no complications: swimming, sports competitions, strength exercises, boxing, physical labor.