PHYSICAL ACTIVITY AND EXERCISE
Increased daily routine physical activity and regular exercise is recommended
as an important component of all lifestyle management regimens to prevent
and manage the metabolic syndrome as well as all diabetes management regimens.
Increasing physical activity assists in weight reduction, reduces insulin
resistance, has beneficial effects on metabolic risk factors; and importantly,
it reduces overall ASCVD risk beyond that provided by weight reduction
A REGULAR EXERCISE PROGRAMME, TAILOR MADE FOR EVERY INDIVIDUAL AND
UNDERTAKEN AFTER DUE FITNESS EVALUATION, WITH REGULAR MONITORING, IS AN
ESSENTIAL PART OF MODERN DIABETES MANAGEMENT!
All patients should undergo a complete history and examination to identify
cardiac, macro/microvascular and neurologic complications. The extent
of investigations would dependent on the risk level of the patient and
would need to be individualised.
Exercise should not be prescribed to patients with very high blood glucose,
and those in ketosis, unless treated adequately.
Patients with significantly retinopathy and renal dysfunction may also
need to undergo specific treatment before embarking on an exercise program.
Patients with foot infections should avoid exercise until adequately treated.
Patients with cardiovascular abnormalities should not undertake exercise
unless this is in close consultation with cardiologist.
The exercise should be aerobic and isotonic.
Although the patient may be allowed to choose his own form of exercise,
walking would appear to be the most appropriate, and safe, exercise for
Isometric exercises, such as weight lifting, etc., are not recommended
for most patients although they warrant consideration when total skeletal
muscle mass needs to be increased.
Patients should be encouraged to increase "every day" activities
such as taking the stairs instead of the elevator.
Regular moderate-intensity physical activity; at least 30 min of continuous
or intermittent (and preferably 60 min) 5 d/wk, but preferably daily,
with a five minute warm up and a five minute cooling off period. The duration
and frequency may be adjusted to individual needs.
The intensity of the exercise needs to be individualised.
For most patients, exercise should be initiated slowly, and the intensity
should be increased gradually. The exercise can be done all at one time
or intermittently over the day. Initial activities may be walking or swimming
at a slow pace. The patient can start by walking 30 minutes for 3 days
a week and can build to 60 minutes of more intense walking at least 5
days a week, preferably daily. Before more strenuous exercise, a warm-up
period of 5 minutes of stretching and other gentle activity is advised,
as is a final cool-down period of progressively decreasing vigor.
The intensity of the exercise should be increased gradually.
Intensity is usually measured in terms of the percentage of the patients
maximum heart rate (MHR). Initial exercise should be at a reduced intensity
which should be at a reduced intensity which should then be increased
to reach about 60-70% of the MHR. (MHR = 220 - age of the patient).
Limiting the intensity of the exercise such that the systolic blood pressure
does not exceed 180 mm Hg would seem prudent.
Any patient undergoing an exercise program, who complains of any signs
or symptoms which would have contraindicated such a program initially,
should discontinue the program, and have a detailed re-evaluation before
restarting the exercise regimen.
When the patient does start the exercise program again, the intensity
should be such as if the patient were beginning the exercise program anew.
The exercise program should never be restarted at the intensity at which
it was discontinued.
An excellent parameter to judge, is that the patient should be able to
carry out a normal conversation whilst exercising, without getting unduly
A Table on Calories spent on various activities and sports is given
in Appendix 4