A Workout Program for Diabetes

Exercise Training if You Have Type 2 Diabetes

This article applies to type 2 diabetes, gestational diabetes (within the limits of exercise for pregnancy), and pre-diabetes. Ask your doctor about exercise if you have type 1 diabetes.

Woman exercising in the house
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Type 2 diabetes usually occurs later in life and is mostly a lifestyle disease that results from obesity and lack of exercise, however, genetics may also be involved. Insulin may be insufficient or the cells that take up glucose may be resistant to the action of insulin. Ultimately, the result can be the same as in type 1 diabetes, which is a complete failure of the beta cells and insulin supply.

Gestational diabetes occurs in pregnancy, and although potentially serious, it is usually a temporary event with full recovery after childbirth as long as weight is controlled. It could suggest susceptibility to diabetes later in life.

Pre-diabetes is a condition in which blood glucose is abnormally high but not high enough for a diagnosis of type 2 diabetes. Without attention to diet, weight loss, and exercise, a progression to diabetes is often inevitable.

Lifestyle Approaches to Managing Diabetes

The Diabetes Prevention Program showed that people who are at high risk for type 2 diabetes can prevent or delay the disease by losing a modest amount of weight through lifestyle changes, including dietary changes and increased physical activity.

Other than weight loss, for people with diabetes and pre-diabetes, formal exercise programs help manage blood glucose by making insulin action more efficient and by using and enhancing the storage of blood glucose in muscle, thereby lowering abnormal blood glucose levels. This efficient function of insulin is described in the term “insulin sensitivity.”

Weight training can build extra muscle and therefore increase the storage capacity for glucose. Glucose is stored with water as “glycogen.” This aspect may be particularly important as we age and muscle mass has a tendency to decline.

How to Exercise for Diabetes and Pre-Diabetes

The first point to make is that if you have been diagnosed with diabetes or pre-diabetes, or you are overweight and sedentary and have other markers for possible pre-diabetes or metabolic syndrome such as high cholesterol and high blood pressure, you need to get your doctor’s approval for exercise.

If you use injectable insulin or drugs for lowering blood glucose, you also need to get good advice from your doctor or a diabetes specialist who has experience with exercise for diabetics. Some trial and error may be required because blood glucose can respond differently to individuals who exercise and use various medications or insulin.

While various forms of exercise have been suggested and evaluated for diabetics, neither weight training, aerobic exercise or more intensive interval type exercise has been shown to be clearly superior to any other. They all have their strengths. What is clear is that the exercise guidelines for health and weight loss from the American College of Sports Medicine are a good starting point.

A Comprehensive Training Program for Diabetes and Pre-Diabetes

Below is a weekly training program, with progression advice, that combines both aerobics and weight training. It does not assume much previous physical activity. A combination of aerobic exercise and strength training – as for healthy people – is likely to be the ideal combination of physical activity for diabetics but it should be followed under supervision for safety and best results.

Day 1. Aerobic exercise. Walk, jog, treadmill or outdoors for 30 minutes at moderate intensity. Moderate intensity means in the range 50% to 70% of maximum heart rate or at a pace at which you can still talk easily enough or recite a poem for example. Swimming and cycling are fine for aerobic conditioning, but you don’t get the advantage of bone building that you do with impact exercise. Generic, step and pump group aerobics classes are excellent.

Day 2. Weight training. Use the Basic Strength and Muscle program as a guide. You can do this at a gym or you can do most of the exercises at home with a home gym or even a set of dumbbells. The individual exercises are not that critical, but you need to work all of the major muscle groups including the upper and lower legs, arms, shoulders, back, chest, abdominals, and buttocks. The reason for this is that the more muscle you exercise and build, the more depots for glucose disposal and storage you create.

Do 8 to 10 exercises including 3 sets of 8 to 12 repetitions in each set. Adjust the load so that you can get through a complete set and that the final repetition, say number 10, is getting a little harder to do. At the end of the third set of any exercise, you should be working somewhat hard. Rest for two to five minutes before the next exercise.

When you’re starting out, it is important not to overdo things. Do fewer sets or repetitions and use less weight but do all exercises and progress to higher volumes and intensity. However, strength and muscle training needs to stress the muscles appropriately. Lifting light dumbbells for 20 repetitions, although not useless, is not what’s required here. Take it easy, but not too easy!

Day 3. Aerobic training as for day 1.

Day 4. Aerobic training as for day 1.

Day 5. Weight training as for day 2.

Day 6. Aerobic training as for day 1.

Day 7. Rest.

Exercise Progression

With increasing fitness, you can gradually increase the intensity and volume of your exercise program. This is best done under the supervision of a qualified trainer. Here are some tips on how to do that.

  • Increase the intensity of the aerobic workouts by increasing heart rate from 50% to 70% to closer to 70% or slightly above. At this intermediate pace, you should be able to talk less easily, although you should not be struggling for breath.
  • Increase the time of the workout from 30 to 45 minutes.
  • Include intervals in your walking or running by striding out at a very increased pace for a one-minute interval in every five minutes for the length of the session.
  • Gradually increase the weight load you lift in your weight-training program as you get stronger. You should struggle to do that last lift of the third set. Don’t increase the number of sets or repetitions; just increase the weight you lift as you get stronger. You can vary the exercises but remember to work all major muscle groups.
  • Add a third weight training session to your weekly program, preferably on one of the aerobics days so that you maintain at least one day of complete rest.
  • Be aware of niggling injuries of the joints, muscles, and tendons and don’t train through acute pain or persistent sub-acute pain. See your doctor. When weight training, be especially aware of shoulder impingement pain or discomfort in the rotator cuff, which can be an issue in older trainers. Go easy on the shoulder exercises if this gives you a warning.
  • Every month, take 3 consecutive days off to allow the body to recover and rebuild.

American Diabetes Association Consensus Statement on Exercise

In 2006, The American Diabetes Association issued a consensus statement recommending a combination of aerobic and resistance exercise. It was updated in 2019 and includes the following recommendations:

  1. Most adults with type 1 and type 2 diabetes should engage in 150 min or more of moderate-to-vigorous intensity aerobic activity per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity.
  2. Adults with type 1 and type 2 diabetes should engage in 2–3 sessions/week of resistance exercise on nonconsecutive days.
  3. Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes.

It is important to note that special exercise considerations may apply to individuals with the following complications. Consult your doctor on these conditions.

  • Uncontrolled blood glucose levels – high or low
  • Uncontrolled high blood pressure
  • Unstable heart conditions
  • Retinopathy (eye and sight condition)
  • Peripheral neuropathy (nerve damage to extremities, foot ulcers etc)
  • Autonomic neuropathy (nerve damage to internal organs)
  • Microalbuminuria and nephropathy (poor kidney function)

Summary of Training for Diabetes and Pre-Diabetes

  • Get a medical checkup and doctor’s clearance to exercise. If you have type 1 diabetes, ask your doctor if, and how, you should exercise.
  • For best results, employ an experienced trainer to supervise your program and a diabetes expert to adjust medications if required.
  • Do both aerobics and weight training.
  • Start slowly and increase volume and intensity over time as you get fitter. If you're on insulin or medications, don't suddenly and substantially increase or decrease your exercise volume or intensity without consultation.
  • Stop if you feel dizzy, acute or ongoing pain or discomfort and see your doctor.
  • Eat well in conjunction with any physical activity program.
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Article Sources
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