10 Ways to Get Motivated to Exercise (When You’re Not)—Part 1 of 2

Unmotived guy lying downDiabetes is a complex metabolic condition, and your blood glucose levels can impact you not only physically but also emotionally and mentally. Often, feeling depressed or anxious about diabetes management can be demotivating for taking better care of yourself. Whether that care involves getting more physically active or making more healthful food choices, getting and staying more motivated can only benefit you and your blood glucose.

Remember: Exercise can lessen your feelings of stress, anxiety, and depression, among other mental benefits. In many cases, treating anxiety or mild to moderate depression with regular exercise is at least as effective as, if not more effective than, using medications to treat these symptoms; even just five minutes of aerobic exercise can stimulate anti-anxiety effects. And the side effects from being regularly active are much more positive. Being active can also positively affect your self-confidence, body image, and self-esteem.

But some days knowing all those benefits may not be enough to get you going. We’ve got you covered. Check out the following sections for ideas for those days where you just can’t seem to get moving.

#1: Check Your Blood Glucose

When you start a new exercise, checking your blood glucose before, during (if you’re active more than an hour), and after your workout pays off. A reading that changes — especially in the direction that you want it to — can be very rewarding and motivating. If you don’t check, you may never realize what a positive impact you can have on your diabetes simply by being active.

For example, say your blood glucose is a little high after you eat a meal, and you want it to go lower without taking (or releasing) any more insulin. You can exercise after your meal and bring your blood glucose down within two hours after eating and taking insulin, or you can avoid or lower post-meal spikes in your blood glucose. You wouldn’t know the extent of the effect you can have without using your blood glucose meter to check.

#2: Start with Easier Activities

Start slowly with easier activities and progress cautiously to working out harder. Exercising too hard right out of the gate is likely to make you end up discouraged or injured, especially if you haven’t exercised in a while.

Remember: If you often complain about being too tired to exercise, your lack of physical activity is likely what’s making you feel sluggish. After you begin doing even light or moderate activities, your energy levels rise along with your fitness, and your physical (and mental) health improves.

#3: Pick Activities You Enjoy

Most adults need exercise to be fun, or they lose their motivation to do it over time. It’s human nature to avoid doing the things you really don’t like to do, so try to pick activities you truly enjoy, such as salsa dancing or golfing (as long as you walk and carry your own clubs). Having fun with your activities lets you more easily make them a permanent and integral part of your diabetes management. If you haven’t found any that you enjoy much yet, choose some new ones to take out for a test run (so to speak).

Tip: Choose an exercise that suits your physical condition and overcomes or works around your limitations.

#4: Spice It Up

An essential motivator involves mixing your workouts up with different activities. People commonly complain about exercise being boring. Feelings of boredom with your program can be the result of repeating the same exercises each day. To make it more exciting, try frequently doing different physical activities for different durations and at different intensities. Knowing that you don’t have to do the same workout day after day is motivating by itself.

#5: Have a Plan B

Always have a backup plan that includes other activities you can do in case of inclement weather or other barriers to your planned exercise. For example, if a sudden snowstorm traps you at home on a day you planned to swim laps at the pool, be ready to walk on the treadmill or substitute some resistance activities. You can always distract yourself during your second-choice exercise to make the time pass more pleasantly. Read a book or magazine, watch your favorite TV program, listen to music or a book on tape, or talk with a friend on the phone while you’re working out.

Check back soon for the final five ways to get motivated to exercise—when you’re not!

                                                                                                                                               

Excerpted from Colberg, Sheri R., Chapter 22, “Ten Ways to Get Motivated to Exercise (When You’re Not)” in Diabetes & Keeping Fit for Dummies. Wiley, 2018.

Getting and Staying Motivated to Be Physically Active

Walking a dog in snowThis time of year, all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?

Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.

Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:

  • Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
  • Get yourself an exercise buddy (or a dog that needs to be walked).
  • Use sticker charts or other motivational tools to track your progress.
  • Schedule structured exercise into your day on your calendar or to-do list.
  • Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
  • Reward yourself for meeting your goals with noncaloric treats or outings.
  • Plan to do physical activities that you really enjoy as often as possible.
  • Wear a pedometer (at least occasionally) as a reminder to take more daily steps.
  • Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
  • Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
  • Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
  • Do not start out exercising too intensely or you may become discouraged or injured.
  • If you get out of your normal routine and are having trouble getting restarted, simply take small steps in that direction.

As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension. Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.

                                                                                                                                               

From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.

Carbohydrate Loading: Effective If Done Right for Even a Day

Pasta

What better topic is there to discuss after the gluttony most of us experience over the Thanksgiving and other fall/winter holidays than carbohydrate loading? (Actually, it probably should be excess calorie consumption in general, but you get the idea.) The following is excerpted from The Athlete’s Guide to Diabetes (2019) and gives you a better understanding of the topic from an exercise physiology (and diabetes) point of view.

Most athletes can benefit from taking in enough carbohydrate before long-distance events to start exercising with fully restored or even supercompensated glycogen stores. Traditionally, this loading technique consisted of 3 to 7 days of a high-carbohydrate diet combined with 1 or 2 days of rest or a reduction in exercise volume, a method known as tapering. For endurance athletes, loading is recommended to consist of taking in 8 to 10 grams of carbohydrate per kilogram of body weight (e.g., 560 to 700 grams for someone who weighs 70 kg, or 154 pounds)—but that is admittedly a lot of carbohydrate to handle if you have to match it with insulin or are very resistant, and it is not necessary.

Even a single day with enough carbohydrate and food intake and rest or tapering can effectively maximize your carbohydrate stores, so you do not need to spend a week, or even 3 days, overconsuming it. Maximal glycogen storage is dictated by how much muscle mass you have, but it is typically around 300 to 400 grams total in all your skeletal muscle, along with 75 to 100 grams of liver glycogen, for the average person. As long as you consume enough calories and taper or rest for a day, taking in up to 40 percent of your calories as carbohydrates is more than adequate to fully reload your glycogen. For someone consuming 2,000 calories and resting on a pre-event day, that amounts to around 200 grams of carbohydrate—more than enough if you are not starting out fully depleted. It’s also likely that you can fully restore your glycogen on far less carbohydrate, especially if you have been following a low-carbohydrate diet and are fully fat-adapted.

Training Tip: To maximize your glycogen stores, all you really need is 1 day and a combination of rest, enough calories in your diet, and good blood glucose levels for that day. You do not need to do traditional carbohydrate loading to make this happen.

The key for carbohydrate loading to be effective for exercisers with diabetes is to ensure that your muscles can take up any available glucose, which only happens if you have sufficient levels of insulin and enough sensitivity to it to prevent hyperglycemia and promote glucose uptake. Consuming higher-fiber carbohydrate sources and those with a lower glycemic effect will help prevent an excessive rise in your blood glucose and be effective for loading. In fact, a study showed that participants actually end up with higher glycogen stores when they maintain more normal blood glucose levels while loading with less carbohydrate (50 percent of calories from carbohydrate instead of 59 percent in that study). To optimize your liver glycogen replacement, keeping your blood glucose as close to normal as possible is also most effective.

From Colberg, Sheri R., Chapter 4, “Eating Right and Supplementing for Activity” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.

What Is the Best Time of Day to Exercise? The Answer Is…

woman girl silhouette jogger

Photo by Pixabay on Pexels.com

I often get asked, “What is the best time of day to exercise?” Like most things related to physical activity—especially with diabetes as an added variable—the answer often is, “It depends.” What is your goal for being active? Are you trying to better balance your blood glucose, or is weight loss your goal? Do you take insulin? What is your normal diet? How much time do you have? Which activities? There are so many questions that likely need answering before you may be able to ascertain the best time for you personally to be active.

A recent article on CNN (1) proclaimed, ”Exercising before breakfast burns more fat, study says.” That article starts out by asking, “Should you eat before or after exercise in the morning?” It then states, “In 30 obese or overweight men, those who exercised before breakfast burned twice the fat as men who ate breakfast before they worked out.”

Before even reading the CNN article or looking up the actual research it quoted, I already had issues with their approach. You have to understand that the fuel your body uses during exercise matters less when it comes to weight loss than the total number of calories you use. Most calories burned during moderate or harder exercise come from carbohydrate sources simply due to the body’s more efficient use of that fuel compared to fat (or protein) (2). Your muscles use fat when forced to or when activity is light—but using more fat during exercise doesn’t mean you lose more body fat, which is how the press always interprets it. What’s more, fat is the primary fuel your body uses during recovery from exercise, which lasts far longer each day than your workouts, no matter what time of day you exercise.

Delving into the research itself (3), they actually found that active muscles did use more intramuscular fat in these subjects during prebreakfast training—but after breakfast blood glucose spikes were unchanged after six weeks of moderate cycle training regardless of which time they trained. They released less insulin for breakfast eaten after training, but that is hardly a surprising finding given than eating a meal makes most people (who can) release insulin. Burning more fat during prebreakfast exercise also did not cause those men to lose more weight than those exercising afterward (again, this is unsurprising).

For anyone with diabetes, fasted exercise tends to prevent the typical drop in blood glucose during moderate aerobic exercise—due to higher levels of cortisol and other glucose-raising hormones released when fasting—but many people with diabetes find that exercising in the morning causes their blood glucose to rise, which can also be an issue. I know many people with type 1 diabetes who love to exercise before breakfast, but I personally hate exercising then because I am more insulin resistant for hours afterward and battle to lower my blood glucose. Research agrees with me and has shown this to be especially true for resistance or high-intensity exercise done in the morning in adults with type 1 or type 2 diabetes (4,5).

In all honesty, the best answer when asked what is the best time of day to exercise is: “When you have the time!” In other words, exercise whenever it fits best into your daily life—because no matter when you are active, it’s always better to do something than nothing at all when it comes to your overall health and long-term blood glucose management. Just make sure to adjust your diabetes regimen as needed to keep your blood glucose in check.

                                                                                                                                               

References:

  • LaMotte, S. Exercising before breakfast burns more fat, study says, October 18, 2019, https://www.cnn.com/2019/10/18/health/exercise-breakfast-fat-burn-wellness/index.html
  • Kerksick CM, Arent S, Schoenfeld BJ, Stout JR, et al. International society of sports nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 2017;14:33. doi: 10.1186/s12970-017-0189-4
  • Edinburgh RM, Bradley HE, Abdullah N-F, Robinson SL, et al. Lipid metabolism links nutrient-exercise timing to insulin sensitivity in men classified as overweight or obese. J Clin Endocrinol Metab, 2019 Oct 19. doi: 10.1210/clinem/dgz104 [Epub ahead of print]
  • Toghi-Eshghi SR, Yardley JE. Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study. J Clin Endocrinol Metab. 2019;104(11):5217-5224. doi: 10.1210/jc.2018-02384.
  • Savikj M, Gabriel BM, Alm PS, Smith J, et al. Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial. Diabetologia. 2019;62(2):233-237. doi: 10.1007/s00125-018-4767-z.

What Causes Blood Glucose to Go Down or Up During Exercise

Figure 1 Diabetes Motion Color (rev)

For all the time that I spend praising the “miracle” of being physically active to help better manage diabetes and health, there are times when exercising does lead to better manage blood glucose and times when it does not. It is not always possible to predict the glycemic outcomes in all cases either, although individual patterns and responses can be determined over time. It is helpful to know the main factors that are predictive of outcomes, however, as detailed below:

Exercise Generally Lowers Blood Glucose When:

  • Circulating levels of insulin are higher (such as after eating in those who make their own insulin and within 2-3 hours of the last bolus of mealtime or correction insulin in those who take insulin)
  • Prolonged and aerobic in nature (30 minutes or more when moderate in intensity, an hour or longer when easier)
  • Blood glucose levels are normal (or near normal) at start of activity
  • Muscle glycogen stores are insufficient (either to start or later during activity)
  • On a low-carbohydrate diet and not fully adapted to eating that way
  • Still recovering from recent prior physical activity
  • Done after a recent hypoglycemic episode (particularly if a more severe low)
  • Doing a new or unaccustomed physical activity (greater reliance on blood glucose)

Exercise Tends to Raise Blood Glucose When:

  • Active first thing in the morning when circulating insulin levels are low and cortisol levels are higher (before taking or releasing any insulin)
  • Short and intense (such as heavy weightlifting, sprinting, or high-intensity interval training)
  • Hyperglycemic, especially when ketones levels are also elevated (i.e., relative insulin deficiency)
  • Eating too much during physical activity (or a large amount right before starting)
  • Dehydrated to start or if get dehydrated while active
  • Exercising in environmental extremes (too hot or cold, high humidity, high altitude)
  • A cold, virus, or other type of infection lowers insulin action and raises physical stress
  • An exaggerated release of glucoregulatory hormones (epinephrine, norepinephrine, glucagon, cortisol, and/or growth hormone) occurs for any reason

Despite all the potential influences, the biggest overall impacts on glycemic responses arise from the timing of being active and the activity itself. Those two factors likely explain most of the variance, while the rest comes from people not being able to anticipate what insulin levels are likely to be during an activity and other unexpected environmental or bodily concerns.

Despite any aggravations associated with balancing blood glucose during physical activity, it is still worthwhile to be regularly active to gain all the physical and mental health benefits associated with it. To help establish patterns and trends, check blood glucose levels before, during, and after various activities and circumstances until it is as predictable as possible.

Stay Hydrated Without Overhydrating for Exercise

glass cup with raspberry inside and outside

Adequate fluid intake is essential to living well at any age, and being dehydrated can impact your health and your athletic endeavors. While it is harder to stay hydrated when exercising in the heat, you can dehydrate under other conditions—even during exercise in cold temperatures if you wear lots of clothing and sweat underneath it. As people grow older, they also begin to lose some of their normal thirst sensations, thereby increasing the risk for dehydration unless they make a conscious effort to drink more.

Diabetes adds its own dehydration concerns. Elevated blood glucose levels (typically when above ~200 mg/dL) lead to glucose loss through urine, which takes extra water with it and can cause dehydration. In addition, taking some of the newer medications like SGLT2-inhibitors that increase urine output whenever blood glucose rises above that level may also lead to excess water losses. If exercising when your blood glucose is higher or after it has been elevated, take care to drink enough fluids to rehydrate. If you are older or have been diagnosed with autonomic neuropathy (central nerve damage), take extra care as your body’s ability to regulate your body temperature through sweating may be impaired as well.

Hydration Tips for Exercise

  • Drink cool water or other fluids before, during, and after you are physically active, especially during warmer or more humid conditions.
  • If you prefer fluids with some flavor, try flavored waters, sports drinks that have no added carbohydrates or calories, and add a pinch of salt if you want it to taste and be more like a sports drink.
  • Only drink regular sports drinks (containing glucose) when you need some carbohydrate to prevent or treat hypoglycemia during activities.
  • Drink only when you feel thirsty and only enough to satisfy your thirst to avoid water intoxication.

Whether you should drink water, sports drinks, or other fluids during exercise when you have diabetes depends on your blood glucose levels. For shorter activities (lasting an hour or less), plain water should suffice for hydration. If you need some carbohydrate, you can supplement and hydrate by using a sports drink like Gatorade or PowerAde or diluted fruit juice. Normally you do not need to replace electrolytes, like sodium, potassium, and chloride, unless you are exercising outdoors in hot weather for more than two hours at a time. Even then, in most cases you can wait to replace electrolytes naturally with your food the next time you eat.

You can also harm yourself by drinking too much fluid at any time, but especially during exercise. If you drink too much (leading to clear urine), you increase your risk of diluting the sodium content of your blood, potentially causing hyponatremia, or water intoxication, and raising the risk of seizures, coma, and even death. To avoid overhydrating, only start drinking when you feel thirsty during exercise. If you have hyperglycemia or autonomic neuropathy, start drinking small amounts of water as soon as you start sweating.

During physical activity, you will be sweating and losing water in other ways (like through breathing), so your body weight should decrease until you have a chance to rehydrate. After exercise, you can rehydrate with water or other non-caloric fluids but replace only the weight you lost. If you already took in a lot of fluid during an activity, wait until you start to urinate before drinking any more.

To hydrate effectively after exercise, consider taking in fluids containing protein and fat that may rehydrate you more effectively than plain water. Eating a piece of fruit (or likely anything) when drinking plain water may also promote more effective rehydration. What’s more, drinking small amounts more frequently instead of large volumes at one time (that is, a slow and steady approach to hydrating) helps you better retain the fluid that your body needs.

Luckily for all the coffee drinkers, caffeinated drinks usually hydrate you as well as caffeine-free ones if they contain enough fluids (so avoid expresso). Taking in too much caffeine can cause your bones to lose calcium, so the decaf options may be better ones. Dehydration also contributes to constipation and taking in enough fluids can help you stay regular.

How Your Hormones Impact Physical Activity

Insulin injection

The human body only has insulin to lower blood glucose but has five hormones that raise it (with some overlap). This hormone redundancy tells you is that, at least from a survival standpoint, your body is desperate to make sure you do not run out of blood glucose; it is not as concerned about you having too much. Insulin is an important hormone for regulating your body’s storage of fuels (carbohydrate, fat, and protein) after you eat. It tells your insulin-sensitive cells (mainly your muscle and fat cells but also your liver) to take up glucose and fat to store them for later as muscle and liver glycogen (the storage form of glucose) as well as stored fat. During exercise, any insulin in your bloodstream can make your muscles take up extra blood glucose. In people who have a pancreas that functions normally, insulin levels typically decrease during exercise, and levels of a hormone called glucagon (released from the alpha cells of the pancreas) rise to stimulate glucose release (1).

Your blood glucose levels are managed by your liver, which would normally respond to the relative amounts of insulin and glucagon (see table that follows). Insulin and glucagon released from the pancreas go directly to the liver via the portal circulation: after a meal, high insulin and glucose levels tell the liver to store glucose for later use; fasting overnight or doing extended exercise leads to glucagon signaling the liver to release glucose. How people with type 1 diabetes respond hormonally to exercise is a major issue: the insulin and glucagon at the level of the liver are seldom perfectly normal because their insulin is injected or pumped under the skin rather than released directly from the pancreas. People with type 1 diabetes have an altered hormonal response to exercise when their peripheral insulin is relatively high; lowering the circulating level of insulin helps normalize their hormone response.

All exercise causes the release of hormones that increase the production of glucose by your liver and lower your muscular use, based on how long and hard you exercise. Easy and moderate activities only release a small amount of glucose-raising hormones (unless you do them for a very long duration), but intense exercise such as heavy resistance training, sprinting, or high-intensity intervals causes an immediate rise in your blood glucose and leads to an exaggerated release of hormones. These hormones include adrenaline (formally known as epinephrine) and norepinephrine, which are released by the sympathetic nervous system (allowing your body to respond to physical or mental stressors with an increased heart rate), as well as glucagon, growth hormone, and cortisol (also shown in table). The effects of these glucose-raising hormones can easily exceed your body’s immediate need for glucose, especially because high-intensity exercise may not last long. As a result, your blood glucose often rises during and after short bouts of intense activity. In fact, you should expect intense exercise potentially to cause a large increase in blood glucose because of your body’s exaggerated release of glucose-raising hormones such as adrenaline and glucagon. 

Hormones That Affect Blood Glucose During Exercise
Hormone Source Main Actions
Insulin Pancreas (beta cells) Promotes blood glucose uptake into muscle cells and adipose (fat) cells (the latter mainly during rest); stimulates liver uptake and storage of glucose; inhibits fat release from adipose
Amylin Pancreas (beta cells) Supplements action of insulin by slowing digestion and absorption of glucose from food; blocks glucagon release; promotes early satiety (fullness after eating); cosecreted with insulin from functional beta cells but absent in type 1 diabetes and in individuals with type 2 who produce a little of their own insulin
Glucagon Pancreas (alpha cells) Stimulates liver glycogen breakdown and new glucose production from precursors to increase blood glucose; is affected by changes in the insulin-to-glucagon ratio at the liver
Epinephrine (Adrenaline) Adrenal medulla Stimulates muscle and, to a lesser extent, liver, glycogen breakdown, and mobilizes free fatty acids from adipose cells
Norepinephrine Adrenal medulla, sympathetic nerve endings Stimulates liver to produce new glucose from available precursors; acts as “feed-forward” control of glucose during intense exercise along with epinephrine
Growth hormone Anterior pituitary Directly stimulates fat metabolism (release of free fatty acids from adipose) and indirectly suppresses glucose use; stimulates amino acid storage
Cortisol Adrenal cortex Mobilizes amino acids and glycerol as precursors for glucose production by the liver and releases free fatty acids for muscle use in the place of glucose (during fasting, starvation, and long-duration exercise)

You may be more insulin resistant immediately after intense exercise and for a few hours due to these hormones. In one study, after near-maximal cycling to exhaustion, one group of people with type 1 diabetes on insulin pumps experienced elevated blood glucose levels for nearly 2 hours. Similarly, in exercisers with type 2 diabetes, blood glucose also rose for 1 hour in response to maximal cycling, as did their insulin levels (because their bodies still produced their own insulin). You may need some supplemental insulin to bring your blood glucose back to normal (albeit less than normal), or it may drop slowly over time on its own. After these hormones wane, your blood glucose may easily drop later when your body is working hard to restore the muscle glycogen you used during the activity. Be on the lookout for later-onset lows in these cases.

Reference:

  1. Excerpted from Colberg, SR, Chapter 2, “Balancing Exercise Blood Glucose” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.