Author Archives: Sheri Colberg, PhD

About Sheri Colberg, PhD

Dr. Sheri Colberg is an exercise physiologist with a world of experience with diabetes, exercise, and more. As a diabetic exerciser and researcher, she knows the latest about physical activity and its effects on your body, whether you have diabetes or not.

Engage in Cross-Training to Get More Fit

SB pool side view.jpgIf you’re like a lot of other people, you may get bored doing the same physical activities day after day. More than half people who start exercise training programs drop out in the first six months. So, what you do to keep your workouts fresh sometimes matters more for getting the most out of training and staying with it. For these reasons (and more), you may want to consider doing cross-training.

Cross-training covers a lot of ground, including combining different types of activities (like cardio and resistance training) in one workout, doing both during the week, or including other types of training in your routine. For example, you may want to do a variety of activities on a weekly basis. For example, you can walk on Monday, Wednesday, and Friday but swim on Tuesday and take dance classes on Saturday.

Cross-training is recommended because it:

  • Uses several different activities to help you reach your exercise goals
  • Adds variety to your workouts
  • Helps fight insulin resistance
  • Leads to lower doses of diabetes medications for many people
  • Gives you flexibility in your program (for example, substituting indoor machines for outdoor walking if it’s raining outside)
  • Reduces injuries because you don’t repeat the same movement all the time
  • Minimizes boredom because you’re always changing up your exercises
  • Uses different muscles so more of them get the benefit of exercise training
  • Makes your daily activities easier on your joints and body
  • Keeps your body challenged to adapt and improve in different ways
  • Allows you to rest some muscles so they can recover from workouts without stopping you from exercising altogether on other days
  • Helps you develop new exercise skills and proficiencies

What cross-training ensures above all else is the ability to continue being active for the rest of your life and more motivated to move your body. Nothing is worse than getting sidelined from your regular training due to overuse or acute injuries caused by being active. Constantly stressing your body in the same way can lead to tendinitis in joints, bursitis, tendon ruptures, muscle tears and pulls, and possibly acute injuries. Each activity you do stresses your muscles and joints differently, so doing a variety lowers your chances of getting an injury.

In addition, cross-training helps you deal with any activity-related injuries without losing all your conditioning while waiting for the injury to heal. If you have lower leg pain, you can still work out your upper body doing other activities and vice versa. Try to alternate weight-bearing activities like walking with non-weight-bearing ones (for example, swimming and stationary cycling) to avoid injuring another part of your body while waiting for an existing injury to heal.

You also add variety to your exercise program when you include activities like walking, cycling, rowing, swimming, arm cycling, weight training, yoga, and more. You have more flexibility to choose different options based on your time constraints, the weather, and other factors. Mixing up your activities allows you to work a variety of muscles. Each activity recruits either different muscles altogether or the same ones in different patterns, allowing you experience a wider use of the muscles in your whole body.

Many people do find that when they engage in a variety of activities — some of them more enjoyable to them than others — they’re more willing to put up with the ones they don’t like just to be able to do the others on alternate days. So, in addition to making your workout routines more enjoyable, cross-training can help you fend off the boredom that’s more likely to pop up when you don’t like doing activities you feel forced to do.

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Avoid Weight Gain From Treating Lows and From Insulin Use

Weight gain

It’s possible to gain weight from treating too many bouts of hypoglycemia. I addressed this topic over a decade ago, but it remains relevant and worth revisiting, along with addressing some new insights on weight gain in general with insulin use.

Weight Gain from Treating Lows

Although you can’t avoid treating a low, everything you use contains calories (at least until mini and nasal doses of glucagon are available) and those extra (albeit medically necessary) calories can still end up as excess body fat. Some heavily training athletes have reported gaining fat rather than getting leaner from all their workouts due to chasing a lot of exercise lows. Avoid gaining extra body fat by treating each low precisely to limit calories. Don’t just grab the nearest candy bar when it may take just one glucose tablet to bring your blood glucose back to normal if you have a minimal amount of insulin on board.

The best advice is to start with 4 to 15 grams of a rapid-acting sugar (preferably glucose), and only take in more glucose or follow it with a balanced food or drink if your low doesn’t resolve itself within 10 to 15 minutes or if you anticipate needing protein or fat in your system to prevent later lows, such as after a long workout or if you took too much insulin. Overtreating your lows just leads to rebound hyperglycemia, more insulin to bring it back down, and potentially another low later — followed by more calories and potential weight gain.

Weight Gain from Insulin Use

In addition to lowering blood glucose, the hormone insulin promotes fat storage, and if you often end up taking too much, it can make you gain extra fat weight. You can adopt some strategies to keep weight gain from happening from insulin or other diabetes medications, regardless of what type of diabetes you have.

Why is using insulin often associated with weight gain? When you use it, your blood glucose is (usually) in a tighter range, and you stop losing some calories as glucose in your urine like you do when your blood glucose is running on the high side. Also, as mentioned, you can gain weight from having to eat extra to treat any lows caused by insulin or other medications. (Remember, even if you have no other choice than to treat hypoglycemia, calories are still calories.) You may find that cutting back on refined carbohydrates that require more insulin to cover them, exercising regularly, and checking your blood glucose to avoid taking too much of any weight-inducing medications will help you avoid gaining fat weight.

Most people diagnosed with type 1 diabetes gain some weight as soon as they start using insulin. Many of them lost weight before diagnosis — some of it muscle — so not all the weight regain is necessarily bad (some is from muscle mass). However, you can gain excess weight from taking too much daily insulin and treating lows or even from taking the right amount of insulin but eating too many calories.

It’s advisable to not give up exercise, but you should still avoid gaining extra fat if you can because it is often associated with being more insulin resistant and may require you to take even larger doses of insulin. You can lower your insulin needs by staying regularly active. Readjusting your ratio of basal to bolus insulin — specifically, lowering your basal doses and raising your pre-meal insulin — without increasing your total daily insulin dose may also prevent weight gain with type 1 diabetes.

Also, try to keep your insulin needs as low as possible because the more you take, the greater your potential for causing lows that lead to weight gain is. During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin. Following exercise, your insulin action is heightened for a few hours up to 72 hours. During that time, you need smaller doses of insulin to have the same effect. With that in mind, adjust your insulin doses downward to prevent lows after exercise that cause you to take in extra calories to treat them.

Finally, you may be able to avoid weight gain by looking at the type of insulins you’re using. For example, once-daily Levemir used by people with type 2 diabetes causes less weight gain and less frequent hypoglycemia than NPH insulin, even combined with use of rapid-acting injections of meal insulin. The same is likely true when using Lantus, Basaglar, Toujeo, and Tresiba. In type 1 diabetes, individuals end up eating less when using Levemir compared to Lantus, leading them to gain less weight. It also helps to dose with fast-acting insulins for the amount of food you actually eat rather than eating to match your pre-meal insulin doses.

Using Diabetes Technologies like CGM During Exercise

Daniele HargenraderA topic that comes up frequently nowadays is the use of diabetes technologies with exercise. When I surveyed close to 300 active individuals with diabetes, more than 60 percent used an insulin pump (which is well above the national average), but even more of these exercisers—over 75 percent—wear a continuous glucose monitoring (CGM) device (1). The technology fervor has grown even louder since the FDA recently granted approval in the United States to an implantable, three-month CGM sensor called Eversense (made by Senseonics). Can you benefit from using these CGM and other devices, especially when active?

Given the challenges associated with exercise, using almost any of the latest technologies can be beneficial for managing your diabetes and health. For example, blood glucose meters give you immediate feedback on your starting levels and single point-in-time exercise responses, whereas CGM devices offer the opportunity for making better decisions in real-time based on glucose values and trends. Insulin pumps offer a more fine-tuned ability to regulate basal insulin levels and bolus doses. Moreover, closed-loop systems (even hybrid ones) integrating pump and CGM use have the potential to allow you to avoid glucose lows and highs during and following workouts. All forms of technology have inherent drawbacks, but it’s possible to overcome most of their issues with planning and knowledge.

Let’s focus on the use of CGM devices. Their accuracy has been improving over time, but they’re all still limited by the fact that there’s a lag of at least six to 20 minutes between the glucose they measure in interstitial spaces (between your skin cells) and actual blood glucose. This lag can be even greater during times when your blood glucose is changing rapidly during exercise (2). CGM users may also have problems getting the device to stay in place, similar to issues experienced by pump users with adherence of their infusion sets to the skin (1). Other reported challenges include sensor accuracy (2,3), variability in performance between sensors, breakage of sensor filaments, transportation of the sensor display, and inability to calibrate CGM during exercise (4). (If given the option, use an integrated watch to display values during exercise.) Anecdotally, exercisers have reported a “compression effect” when wearing the CGM sensor under compression shorts (1). This results in a greater lag time, presumably due to a lesser blood flow to skin in compressed areas. Although technical failures during exercise are possible with the newer versions of these monitors, CGM is still likely to be the wave of the future when it comes to monitoring and managing blood glucose.

However, the cost of using CGM devices is another issue that may limit their widespread adoption. For instance, Dexcom, Medtronic, and Senseonics technologies all cost about $7 to $8 per day to use, but the Eversense implantable one additionally requires a physician office visit to get the sensors implanted and removed every three months (although if approved, the 180-day XL model will reduce these costs by halving the required physician visits). All three of these systems are more expensive than the FreeStyle Libre, which costs about $4 to $5 per day but doesn’t have a wearable transmitter (although some people have come up with a workaround for this using the Ambrosia BluCon device with app for mobile phones); the Libre also lacks real-time alerts.

Insurance reimbursement has gotten more reasonable since CGM devices were first introduced over a decade ago, but it’s still spotty and prejudicial. Currently, only one (Dexcom) model is covered by Medicare for anyone with type 1 diabetes age 65 and over. Although people with type 2 diabetes—especially those using insulin—can also benefit from using CGM, coverage for them has been an even harder sell to insurance companies so far. In any case, the number of model choices has declined recently, and their cost is still quite prohibitive for most people without insurance coverage and even for some with larger insurance copays.

If you don’t have access, can’t afford, or don’t want the hassle of wearing a CGM device, it is still viable for you to use a blood glucose meter to exercise safely and effectively. Remember, just having access to that simple monitoring tool can make all the difference in the world when it comes to managing exercise. Make the most of any tools at your disposal!

                                                                                                                                                           

 References:

  1. Colberg, S. Diabetic Athlete’s Handbook, 2nd Champaign, IL: Human Kinetics, 2019 (in press)
  2. Taleb N, Emami A, Suppere C, Messier V, Legault L, Chiasson JL, Rabasa-Lhoret R, Haidar A: Comparison of two continuous glucose monitoring systems, Dexcom G4 Platinum and Medtronic Paradigm Veo Enlite system, at rest and during exercise. Diabetes Technol Ther. 18(9):561-7, 2016
  3. Herrington SJ, Gee DL, Dow SD, Monosky KA, Davis E, Pritchett KL: Comparison of glucose monitoring methods during steady-state exercise in women. Nutrients, 4:1282-1292, 2012
  4. Bally L, Zueger T, Pasi N, Carlos C, Paganini D, Stettler C: Accuracy of continuous glucose monitoring during differing exercise conditions. Diabetes Res Clin Pract, 112:1-5, 2016.

Going Low-Carb as an Athlete with Diabetes

There has been a lot of interest recently in going “low-carb” to better manage diabetes, particularly type 1. At present, a large clinical study (1) is being undertaken in Scandinavia to examine the effects of very low-carb eating on blood glucose levels in adults with type 1 diabetes. For years, a very low-carb diet championed by Dr. Bernstein has been the main one followed by some with diabetes, until the last decade when fad weight loss plans like the LCHF (low-carb, high-fat, or Keto) and Paleo Diets have been become mainstream not just for losing weight, but also for their purported ability to boost to athletic performance and improve blood glucose management.

All these eating plans are very low in carbohydrates, but differ in the types of non-carb macronutrients or foods they recommend. Dr. Bernstein’s plan advocates higher protein intake and only 30 grams of carbs daily. The LCHF Diet gets 70% of calories from fat, 15% from carbs. Paleo Diet eating focuses on “natural” foods that nomadic early man supposedly ate (higher protein). Honestly, LCHF diets remind me of the no-carb, starvation regimen that everyone with type 1 diabetes had to go on to survive for a few months or years after diagnosis back before insulin was discovered in 1921. Have we really come full circle back to that diet in mainstream eating for diabetes? This question is particularly relevant to athletic individuals with diabetes. We have often preached the importance of carb loading (think “pasta party”) for endurance athletes prior to events. Can they perform at the top of their game while eating very few carbs?

At least one study in type 1 diabetes has shown that it’s possible to balance blood glucose levels and prevent lows while doing long-duration endurance events and consuming 75 grams of carbs per hour, like many nondiabetic endurance athletes do (2). For intermittent sports like soccer and rugby, it also appears that ingesting 30 to 60 grams of carbs per hour has the greatest impact on performance when fatigue or hypoglycemia are more common, such as towards the end of a game (3) (although this has only been studied in nondiabetic athletes).

That said, it also appears possible to adapt to using more fat as a fuel after becoming keto-adapted from low-carb eating. Highly-trained, keto-adapted ultraendurance athletes have extraordinarily high rates of fat oxidation, but their use of muscle glycogen and its repletion during and after a 3-hour run are similar to athletes on high-carb diets (4). Some questions remain as to whether this improves performance in most events; likely, it does not, but performance is likely at least maintained (5). For instance, keto-adapted, off-road cyclists experience greater fat use, but higher heart rates at the same workload during training following LCHF diets containing only 15% of daily calories from carbs (6). With their average calorie intake, though, this amounts to nearly 150 grams of carbs daily, much more than many low-carb advocates allow in their diets.

To my knowledge, no studies to date have been conducted on keto-adaptation and performance in exercisers with diabetes. However, I recently surveyed over 275 active individuals with diabetes to collect information to update my 2009 book (7), Diabetic Athlete’s Handbook, as a second edition is coming out in Spring 2019. I was surprised by the large number of athletes claiming to be following very low-carb dietary regimens. Based on their responses, it appears entirely possible to undergo fat adaptation and exercise regularly—at least when engaging in endurance type training and events. These exercisers worry less about getting hypoglycemic during events as they have lower levels of insulin on board, but many others accomplished the same reduction in the risk of lows simply by not taking bolus insulin within a few hours of being active (even if eating more daily carbs).

There are several caveats to these survey results. All normal dietary patterns by these active individuals (most with type 1 diabetes) were self-reported, and I did not analyze their actual daily carbohydrate intake. Some claimed to eat only 20 grams of carbs a day, but it’s possible they weren’t including carbs from every food, including the many avocados (12 grams of carbs per medium one), olives (2-3 grams per 10 olives), and nuts they were consuming. Any carbs taken in during activities, even if taken to prevent or treat lows, count towards daily total intake. What’s more, if an average active individual consumes about 2,000 calories per day, getting 15% of calories from carbs (like most LCHF diets advocate) still equates to 75 grams per day, which is not nearly as low as the 20-30 daily grams many of these athletes claimed to be eating.

So, how low-carb do athletes with diabetes really need to go? In all likelihood, it depends on the sport and level of athlete. Sure, most of us can benefit from avoiding or limiting our intake of refined carbs and foods with a higher glycemic index to better manage our diabetes, but going to the extreme of avoiding nearly all carbs may not be necessary. If you do decide to try a lower-carb diet, keep in mind that adapting to training with fewer daily carbs requires several weeks, so don’t just cut carbs for a few days and expect to feel good during any type of exercise.

                                                                                                                                                                   

References:

  1. Lennerz, B.S., A. Barton, R.K. Bernstein, R.D. Dikeman, C. Diulus, S. Hallberg, E.T. Rhodes, C.B. Ebbeling, E.C. Westman, W.S. Yancy Jr, and D.S. Ludwig. Management of type 1 diabetes with a very low-carbohydrate diet. Pediatrics May 7, 2018. doi: 10.1542/peds.2017-3349. [Epub ahead of print]
  2. Adolfsson, P., S. Mattsson, and J. Jendle. Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes. European Journal of Applied Physiology 115:2599–2607, 2015
  3. Baker, L.B., I. Rollo, K.W. Stein, and A.E. Jeukendrup. Acute effects of carbohydrate supplementation on intermittent sports performance. Nutrients 7:5733–5763, 2015
  4. Volek, J.S., D.J. Freidenreich, C. Saenz, L.J. Kunces, B.C. Creighton, J.M. Bartley, P.M. Davitt, C.X. Munoz, J.M. Anderson, C.M. Maresh, E.C. Lee, M.D. Schuenke, G. Aerni, W.J. Kraemer, and S.D. Phinney. Metabolic characteristics of keto-adapted ul-tra-endurance runners. Metabolism 65:100–110, 2016
  5. Burke, L.M. Re-examining high-fat diets for sports performance: did we call the “nail in the coffin” too soon? Sports Medicine Auckland New Zealand 45: 33–49, 2015
  6. Zajac, A., S. Poprzecki, A. Maszczyk, M. Czuba, M. Michalczyk, and G. Zydek. 2014. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 6:2493–2508, 2014
  7. Colberg, Sheri. Diabetic Athlete’s Handbook. Champaign, IL: Human Kinetics, 2009

Why Exercise Does a Body Good

How active are you? Unless you’re exercising more than several hours a day already, you probably have room to add more in for additional health benefits. Exercise is about the best medicine that there is for so many health conditions, including diabetes. Being active helps manage emotional stress and stave off depression—far better than antidepressant medications and with no bad side-effects. It naturally bestows your body with antioxidant effect, making you less likely to develop most types of cancer—or even the common cold.

When it comes to managing diabetes, the benefits are even greater. Many times, exercise can virtually erase your blood glucose mistakes. It acts as an extra dose of insulin by getting the glucose out of your blood and into your muscles without insulin (through an insulin-independent mechanism related to muscle contractions themselves). When you’re not active, your body needs insulin to stimulate that uptake. Being regularly active makes your muscles more sensitive to any insulin in your body as well, so it takes less to get the job done. What better way to help erase a little overeating of carbs (or a slight lack of insulin or insulin resistance) than a moderate dose of exercise?

One thing to know, though, is that exercise doesn’t always make your blood glucose come down, at least not right away. Intense exercise causes a burst of glucose-raising hormones (like adrenaline and glucagon) that raise your blood glucose instead, albeit usually only temporarily. But even if a workout raises it in the short run, over a longer period of time (2-3 hours), the residual effects of the exercise will bring your blood glucose back down while you’re replacing the carbs in your muscles. If you take insulin, take less than normal to correct a post-workout high or your blood glucose can come crashing down later. A cool-down of easy exercise (like less-than-brisk walking) can also help bring it back to normal.

How much muscle you have also matters to blood glucose management. Exercise helps you build and retain your muscle mass, which is the main place you store carbs after you eat them. Almost any type of exercise uses up some of your muscle glycogen, but if you don’t exercise regularly, your muscles remain packed with it. There is a maximal amount that fits in muscles, which is why building up your muscle mass helps with being able to handle the carbs you eat more effectively. Your liver stores some glucose as glycogen, but not much relative to your muscle storage capacity. Being sedentary ensures that no amount of insulin is going to be able to stimulate more blood glucose uptake into your muscles. Without regular exercise to use up glycogen, you really have nowhere to store carbs, so your blood glucose goes up and some of the excess gets turned into body fat instead. Doing resistance or heavier aerobic training is critical to maintaining the muscle mass you have and offsetting the effects of aging on muscles.

People with naturally lower levels of insulin generally live longer (think of centenarians and elite athletes, both with low insulin levels). Exercise helps you keep your insulin needs low, which makes it easier to either make enough of your own or get by with much smaller doses (resulting in less of a margin for big errors in dosing). Plus, it’s a lot harder to lose body fat if your insulin levels are high or you take large doses because insulin promotes fat storage from excess blood glucose. Both the last time you exercised and how regularly you’re active have an impact on the insulin sensitivity of your muscles, so aim to exercise at least every other day (although daily is likely better) and keep all those muscle fibers you have by using them regularly.

If nothing else, start getting more active by standing up more, taking extra steps during the day, fidgeting, and just generally being on the move whenever and wherever possible. Knowing that hopefully takes away your excuses for not being more active. If you can’t get in a planned workout on any given day, you can certainly add in more steps or other activity all day long instead (or do it in addition to your usual exercise). Every bit of movement you do during the day counts, so fidget away as part of your daily dose of exercise!

Do Diabetic Athlete Survey by May 15

DiabeticAthleteHandbookWebcover

Are you physically active and do you have diabetes (of any type)? Now is your chance to share how you manage your diabetes regimen while doing a variety of activities!

A new edition of Dr. Sheri Colberg’s book, Diabetic Athlete’s Handbook, is coming out in Spring 2019. Please complete the diabetic athlete survey at the link below no later than May 15 for possible inclusion.

https://www.diabetesmotion.com/athlete-survey

Please pass the survey on to everyone else you know who is active with diabetes. Thanks for your time and input!

Get Motivated to Get and Stay Fit

Colberg ADA Workplace Photo 2You may have started the new year out with the best of intentions to increase your fitness and better manage your diabetes by exercising regularly. If you have diabetes or are at risk for developing the disease, deciding to commit to fitness could be a real lifesaver. That’s why it’s more important than ever that you make sure this decision sticks. Here are some motivational tips for getting started being more active.
Check Your Blood Glucose: When you start a new exercise, checking your blood glucose before, sometimes during, 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, if your blood glucose is too 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.
Start with Easier Activities: Start slowly with easier activities and progress cautiously to harder ones. 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. 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, physical condition, and mental health.
Pick Activities You Enjoy: Most adults need exercise to be fun, or they lose their motivation. 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, choose some new ones to take out for a test run (so to speak).
Spice It Up: It’s essential for motivation to mix 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 different physical activities for varying durations and at different intensities. Knowing that you don’t have to do the same workout day after day is motivating by itself.
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.
Get an Exercise Buddy (or Several): You don’t need to go it alone when being active. Having a regular (and reliable) exercise buddy increases your likelihood of participating, and it also makes your activities more social and fun. Get your spouse, family members, friends, and co-workers to join in your physical activities, regardless of what time of day you do them. Having a good social network to support your new or renewed exercise habit helps you adhere to it over the long run.
Schedule It: Put your planned exercise down on your calendar or to-do list like you would other appointments. You show up for your doctor appointments, so why should scheduling your physical activity be any different? Never make the mistake of assuming it’ll happen just because you claim that you want to do it a certain number of days per week or month. It takes some planning ahead and the commitment to make it a priority.
Set Goals and Reward Yourself: Setting goals helps keep your interest up. For instance, if you walk for exercise, you may want to get a pedometer and set a goal of adding in 2,000 more steps each day. Break your larger goals into smaller, realistic stepping-stones (such as daily and weekly physical activity goals) for all your active lifestyle changes, and use SMART goals. Trackers, activity logs, and other motivational tools are also widely available online. Tip: Reward yourself when you reach your exercise goals (but preferably not with food).
Get More Spontaneous Physical Activity: You don’t have to work out at a high intensity to help diabetes and weight management. You can also add physical movement all day long doing anything you want to, including gardening, housework, and many other spontaneous physical activities. For instance, if you have a sedentary desk job take the stairs rather than the elevator whenever you can. Walk to someone else’s office or the neighbor’s house to deliver a message instead of relying on the phone or email. Or park your car at the far end of the parking lot and walk the extra distance. Guess what? You’ve just gotten yourself more active without giving it much thought.
Take Small Steps: If you get out of your normal activity routine and are having trouble getting restarted, simply take small steps in that direction. You may need to start back at a lower intensity by using lighter weights, less resistance, or a slower walking speed. Starting out slowly with small steps helps you avoid burnout, muscle soreness, and injury. Even doing only 5 to 10 minutes at a time (rather than 30 or more) is fine. After you’re up and moving, you may feel good enough to exceed the time you planned on doing in the first place. The key is to begin by any means possible.