The new guidelines give the green light to weekend warriors, but it may be better for people with diabetes to spread out their workouts.
December 13, 2018
Thereâs no question exercise is good for you, and for people with diabetes, the benefits go beyond simply trimming your waistline. If youâre living with diabetes, regular physical activity can help you better manage your blood sugar levels by relieving stress, aiding sleep, increasing energy, and more, per the American Diabetes Association. Exercise can even help reduce your risk for diabetes complications.
âExercise is the cheapest prescription,â says Osama Hamdy, MD, PhD, medical director of the obesity clinical program and director of inpatient diabetes program at the Joslin Diabetes Center at Harvard Medical School in Boston. âIt doesnât require copayments. It doesnât require insurance. I sometimes write âexerciseâ on my prescription pad and give that to my patients.â
Thatâs why itâs important to take note of the newly released second edition of the U.S. Department of Health and Human Servicesâ (HHS) Physical Activity Guidelines for Americans, which experts say have important takeaways for people managing diabetes. Namely, while most of the advice hasnât changed, the new guidelines, released in mid-November 2018, offer more options on how to reach minimum activity goals.
According to the HHS, 4 of every 5 people arenât exercising enough, and more than one-quarter of American adults arenât getting any physical activity.
For substantial health benefits, regardless of whether you have diabetes, the new guidelines encourage adults to exercise in one of the following ways:
âThe only thing that is really new is that before the guidelines really only talked about doing at least 10 minutes at a time of a planned exercise at a specific intensity,â says Sheri R. Colberg, PhD, the author of The Athleteâs Guide to Diabetes: Expert Advice for 165 Sports and Activities and a professor emerita of exercise science from Old Dominion University in Norfolk, Virginia. âNow there is no minimum requirement to do the activity at any one time. Itâs the cumulative amount over the week that counts.â
The guidelines recommend that people who have chronic diseases, including diabetes, who canât meet the recommended minimum of activity, still exercise according to their abilities and avoid being inactive.
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If you donât already work out, the idea of fitting in fitness may seem daunting. That can be especially so when youâre managing your blood sugar day in and day out. But you donât need to overcomplicate it by signing up for an expensive gym membership or enrolling in boutique fitness classes. âWhat matters is how much activity you accumulate to get you to 150 minutes per week,â says Betul Hatipoglu, MD, an endocrinologist at the Cleveland Clinic in Ohio. âCan you take a break and walk three or four minutes around the block, or at home, or at the office? You donât have to do tons of exercise to accumulate 25 minutes a day of exercise.â
Another change in the guidelines, Dr. Colberg says, may be welcome news to weekend warriors, in that the HHSÂ says people can get similar positive results if they pack all their activity into the weekend rather than spreading out their exercise over the week.
But youâll want to check with your doctor on this suggestion because your blood sugar level may be steadier if you spread out your physical activity. âI think it is more ideal for people with diabetes to spread out their physical activity as much as possible over the week, because the effect of exercise to improve blood sugars by improving insulin resistance lasts almost 24 hours,â Dr. Hatipoglu says. âSo if you exercise somewhat every day, youâre getting the beneficial effect every day.â Insulin resistance is the hallmark of type 2 diabetes, and a wealth of research, as detailed in aÂ review published in JulyÂ 2015 in the Journal of Obesity and Weight Loss Therapy, suggests exercise can help improve insulin sensitivity, thereby making blood sugar easier to control.
A key new guideline for adults is to simply move more and sit less. Hatipoglu says incorporating more motion in your everyday activities can help. She advises taking the stairs when possible, parking farther from your destination to walk more, standing up while taking notes, and figuring other ways to simply work movement into your everyday life.
The new guidelines suggest that adults do muscle-strengthening activities of moderate or greater intensity that involve all muscle groups on two or more days per week.
âKeeping muscles active is very important treatment for diabetes patients because it reduces blood glucose level and improves physical fitness,â says Dr.Â Hamdy. âWhen the muscles are active, the muscles take glucose without need for insulin.â
He adds that strength training is especially important for people with diabetes, as these individuals tend to lose muscle mass every year.
Experts also recommend stretching and balance activities for people with diabetes. Hatipoglu says that falling is common among those type 2 diabetes patients who have neuropathy, which is damage to the peripheral nerves, often in the feet. She recommends yoga as part of balance training. Although she says it may sound funny, one of her colleagues says you can improve balance every morning if you brush your teeth while standing on one foot.
Hamdy wishes the guidelines emphasized stretching more. âPeople with diabetes underestimate how valuable stretching is,â he says. âYou increase flexibility of your joints, you improve blood flow, increase range of motion, and you prevent injury.â
Another notable change in the guidelines, Colberg says, is that the more you exercise, the more health benefits youâll reap â even if itâs beyond the aforementioned recommendations.
But in the case of intense exercise, that may be risky for people with diabetes, says Hamdy. âPeople with diabetes shouldnât do continuous vigorous exercise,â he says. âThe best way to do vigorous exercise is interval training. So maybe do a very vigorous fast five minutes and then rest for another five minutes.â He cautions that vigorous exercise beyond a certain limit may cause the liver to push sugar into the blood circulation to compensate. âIf you push too much sugar from the liver, the blood sugar goes up.â
Overall,Â Hamdy, Hatopoglu, and Colberg all advise that exercise is one of the best promoters for health.
âI tell my patients if you leave the car in the garage it gets rusty,â Hamdy says. âTo live long, I give them three pieces of advice: Exercise, exercise, and exercise.â