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.

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.
Advertisements

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.

Get Off the Couch and Work Your Core

plank-fitness-muscular-exercising-163437.jpegIf you suffer from diabetes, you already know that staying fit greatly benefits your health. Yet, many of the complications caused by diabetes can make it difficult to get the exercise you need; in fact, they can make a normal exercise routine difficult or even dangerous. For example, peripheral neuropathy (numbness in the feet caused by nerve damage) may affect your balance and put you at risk for a fall, or could lead to slow-healing ulcers that keep you inactive. On top of that, diabetes patients may have heart disease symptoms or vision problems that make getting up and going for a walk more risky than helpful.

The good news is that these complications don’t have to prevent you from doing safe and healthy exercise. You can still get a beneficial workout—minus the risks—by exercising your core. Even though a lot of people with diabetes think having neuropathy or other complications means they have to be a couch potato, that’s just not true. Just because you can’t get outside for a brisk walk or run doesn’t mean you can’t get fit. Exercising your core is a safe way to improve your strength and stability so you can better handle your daily life—right from your own home.

Core exercises are an important part of a well-rounded fitness program for diabetes patients. Your body core, including the muscles around your trunk, is particularly important to keep strong so you can go about your normal daily activity and prevent falls and injuries, particularly as you age. The best part? They are easy to do on your own in your home, and you don’t even need to purchase any equipment to perform them. However, once you become more advanced, you can accelerate your workouts using a gym ball or dumbbells.

Ready to get a strong core and improve your stability and overall wellness? Here are ten core exercises that I recommend highly for people with diabetes (or anyone for that matter).

Look for illustrated versions of these core exercises in Chapter 21 (“Ten Easy Exercises to Build a Strong Core without Leaving the House”) in Diabetes & Keeping Fit for Dummies by Dr. Sheri Colberg available online at Amazon.com or Dummies.com.

(1) Abdominal Squeezes. This exercise is great for working your abdominals and getting your core as strong as possible. If you’re female and have gone through a pregnancy, getting these muscles in shape doing these squeezes is a must.

  1. Put one of your hands against your upper stomach and the other facing the other direction below your belly button.
  2. Inhale to expand your stomach.
  3. Exhale and try to pull your abdominal muscles halfway toward your spine. This is your starting position.
  4. Contract your abdominal muscles more deeply in toward your spine while counting to two.
  5. Return to the starting position from Step 3 for another count of two.

Work up to doing 100 repetitions per workout session.

(2) Plank or Modified Plank. Nobody likes doing planks, but they get the job done when it comes to boosting the strength of your core. Both planks and modified planks work multiple areas, including your abdominals, lower back, and shoulders.

  1. Start on the floor on your stomach and bend your elbows 90 degrees, resting your weight on your forearms.
  2. Place your elbows directly beneath your shoulders and form a straight line from your head to your feet.
  3. Hold this position as long as you can.

Repeat this exercise as many times as possible during each workout.

(3) Side Planks. A modification of regular planks, this side plank exercise works some of the same and some slightly different muscles that include your abdominals, oblique abdominal muscles, sides of hips, gluteals, and shoulders. Try doing some of both types for the best results.

  1. Start out on the floor on your side with your feet together and one forearm directly below your shoulder.
  2. Contract your core muscles and raise your hips until your body is in a straight line from head to feet.
  3. Hold this position without letting your hips drop for as long as you can.
  4. Repeat Steps 1 through 3 on the other side.

Switch back and forth between sides as many times as you can.

(4) Bridging. If you work on your abdominal strength, you also need to build the strength in your lower back to keep things balanced. Bridging is a good exercise to do that as it works your buttocks (including gluteals), low back, and hip extensors. Remember to breathe in and out throughout this exercise.

  1. Keeping your shoulders on the floor, slowly raise your buttocks from the floor with your stomach tight and your lower back straight.
  2. Gently lower your back to the ground.
  3. Repeat Steps 1 and 2.

(5) Pelvic Tilt. An easy exercise to do, the pelvic tilt works your lower back and lower part of your abdominals.

  1. Lie on your back on the floor with your knees bent and feet flat on the floor.
  2. Place your hands either by your sides or supporting your head.
  3. Tighten your bottom, forcing your lower back flat against the floor, and then relax.
  4. Repeat Steps 2 and 3 as many times as you can.

(6) Superhero Pose. Whether you want to leap tall building with a single bound or not, try doing this superhero pose exercise to get a stronger core. It works many areas, including your lower back, upper back, back of shoulders, and gluteals.

  1. Lie on your stomach with your arms straight out in front of your head on the floor.
  2. Rest your chin on the floor between your arms.
  3. Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can. Aim for at least three inches.
  4. Hold that position (sort of a superhero flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.

(7) Knee Push-Ups. Push-ups are hard to do if you haven’t built up the strength in your shoulders yet, so this knee version is an easier way to start for most people. This exercise works your chest, front of shoulders, and back of upper arms.

  1. Get on your hands and knees on the floor or a mat.
  2. Place your hands shoulder-width apart on the floor.
  3. Tighten your abdominal muscles to straighten your lower back and lower yourself down toward the floor as far as you can without touching.
  4. Push yourself back up until your arms are extended, but don’t lock your elbows.

(8) Suitcase Lift. This exercise is the proper way to lift items from the floor. Before you begin, place dumbbells or household items slightly forward and between your feet on the floor. You work the same muscles used in doing squats (lower back and lower body) with this activity.

  1. Stand in an upright position with your back and arms straight, with your hands in front of your abdomen.
  2. Bending only your knees, reach down to pick up the dumbbells.
  3. Grab the dumbbells or items in both hands and then push up with your legs and stand upright, keeping your back straight.

(9) Squats with Knee Squeezes. These squats are not your normal squats. They’re more like a combination of squatting and wall sitting with a twist. You work the front and back of thighs, inner thighs (adductors), hip flexors and extensors all with this one exercise.

  1. Stand with your back against the wall, with your feet aligned with your knees and straight out in front of you.
  2. Place a ball or pillow between your knees and hold it there with your legs.
  3. Inhale to expand your stomach and then exhale and contract your abdominal muscles.
  4. Bend your knees and lower yourself into a squat. To avoid injuring your knees, don’t bend them more than 90 degrees.
  5. Squeeze the ball with your thighs, drawing your stomach muscles more deeply toward your spine.
  6. Do as many squeezes as you can up to 20 and then return to the starting position.

(10) Lunges. Lunges are a common activity to work on the front and back of thighs, hip flexors and extensors, abdominals and lower back all with one exercise. Do them with proper form to avoid aggravating your knees, though.

  1. Keep your upper body straight, with your shoulders back and relaxed and chin up.
  2. Pick a point to stare at in front of you so you don’t keep looking down, and engage your core.
  3. Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle. Make sure your front knee is directly above your ankle, not pushed out too far, and don’t let your back knee touch the floor.
  4. Focus on keeping your weight on your heels as you push back up to the starting position.

Even though diabetes sometimes presents tough fitness challenges, you can use these core-strengthening exercises to maintain fitness in spite of any mobility issues you’re facing right now. Whether you still active or sedentary, working your core is a safe and smart way to improve your balance, keep you as fit as possible, and elevate your overall quality of life.

New book on fitness and diabetes

My latest book, Diabetes & Keeping Fit for Dummies, was released this week, just in time to help you start the new year out right. It covers everything you need to know about getting or staying fit with diabetes or prediabetes. Even if you don’t have diabetes and want to improve your insulin action and prevent type 2 diabetes, this book is for you! Check it out today! Available on Amazon.com or Dummies.com.