Tag Archives: physical activity

When Do You Need a Checkup First Before Starting Exercise?

BP checkHow do you know if you need to get a checkup or medical clearance before you start any exercise training? You should have regular checkups at least annually with your doctor or another healthcare provider if you have any type of diabetes. This helps you keep on top of any problems that may pop up over time that have nothing to do with being physically active.

However, you probably don’t need to see a doctor before you start doing easy workouts or moderate activities like brisk walking. Requiring anyone with diabetes to get medical clearance before starting any type or intensity of exercise is recommended by the American College of Sports Medicine, but is not recommended by the American Diabetes Association because it sets too big of a barrier to participating in regular activities.

On the other hand, having a checkup before you begin more vigorous workouts is a good idea. It also depends on your age, your general health, and your physical activity level. If you’re already doing intense exercise, it’s not necessary, but it is advised for almost everyone with diabetes who is not already exercising at that level—just to be safe.

If/when you do have a checkup, get your blood pressure, heart rate, and body weight measured. If your doctor recommends that you do an exercise stress test, you’ll have to do walking on a treadmill or riding a stationary bike for around ten minutes. Your checkup may also include lab tests (urinalysis, kidney function testing, serum lipid evaluation, and electrolyte analysis) and screening for any diabetes-related complications (including heart, nerve, eye, and kidney disease). Most complications will not keep you from being active, but you may need to take precautions to exercise safely and effectively in certain cases.

For most people, getting a diagnostic graded exercise test is really going too far. Having one is only recommended by the American Diabetes Association if you’re over 40 and have diabetes; or if you’re over 30, have had diabetes for 10 or more years, smoke, have high blood pressure, have high cholesterol, or have eye or kidney problems related to diabetes. If you’re planning to do vigorous training that gets your heart rate up high, these criteria are relevant. If you’re just planning on doing mild or moderate aerobic activity or resistance training, such extensive (and often expensive) testing is unnecessary if you’re reasonably healthy or already fit and don’t have any symptoms of heart or vessel disease.

If you have any pre-existing health complications, you may need to take extra care to prevent problems during exercise. If your blood glucose has been in check, you’ve already been physically active, and you don’t have any serious diabetic complications, then go ahead and keep doing what you’re doing. If you’re very active, getting an extra checkup before you replace your current exercise regime with another exercise routine is neither necessary nor advised.

You still may need to take certain precautions when you exercise, particularly related to getting low blood glucose during and following the activity, going too high, and getting dehydrated. If you have any concerns, check with your healthcare provider at your next visit to discuss any precautions that may be important for your unique health circumstances when exercising.

Diabetes Motion: Practical advice about exercise and fatigue solutions

Whether you’rDiabetes Motione new to exercise or a sports enthusiast, diabetes can get in the way of being physically active. To deal with this problem, I founded a new information web site called Diabetes Motion (www.diabetesmotion.com), given that I’m one of the world’s leading experts on diabetes and exercise. The mission of Diabetes Motion is to provide practical guidance about blood glucose management to anyone who wants to be physically active with diabetes.

Without a doubt, being physically active is good for the body, heart, and mind. If you are already an avid exerciser, then you know the benefits of exercise for your health and diabetes control. If you are just thinking about getting serious about sports or fitness activities, then you have a lot of positive changes to look forward to.

Exercise can help you build muscle and lose body fat, suppress your appetite, eat more without gaining fat weight, enhance your mood, reduce stress and anxiety, increase your energy, bolster your immune system, keep your joints and muscles more flexible, and improve the quality of your life. For many people with diabetes, being physically active has made all the difference between controlling diabetes or letting it control them.

What you may not know is what type of exercise or physical activity you should you be doing or how much of it is recommended for optimal health and the best blood glucose control. The good news is that you can get different (but all good) benefits from doing a variety of types of daily movement, which gives you a lot of options. In fact, exercising regularly is likely the single most important thing you can do to slow the aging process, manage your blood sugars, and reduce your risk of diabetic complications.

Need help with revving up your exercise? If your exercise performance been less than you’d hoped recently, here are some potential causes of fatigue (and solutions):

Inadequate rest time: You may be getting through your workouts well, but then fail to perform when you have races and events simply because you didn’t take enough rest time to restore glycogen and fully recover. It’s critical to cut back on your workouts (“taper”) for at least 1-2 days before a big event and keep your blood glucose in good control so your glycogen levels will be as full as possible on race/event day.

Blood glucose and glycogen stores: It’s harder for your body to restore your muscle glycogen (stored carbs) between workouts unless you’re eating enough carbs and have functioning insulin available. Your carb intake doesn’t have to be tremendous—probably just 40% of your total calories coming from carbs will suffice—but your blood glucose absolutely needs to be in good control for your muscles to restore carbs optimally.

Iron: Having low iron stores can cause you to feel tired all the time, colder than normal, and just generally lackluster. You can get a simple blood test done to check your hemoglobin (iron in red blood cells) and your overall iron status (serum ferritins). If your body’s iron levels are low (due to diabetes or non-diabetes causes), taking iron supplements can help, along with eating more red meat with lots of absorbable iron.

Magnesium: You may have a magnesium deficiency, especially if you take insulin or your blood glucose levels are not optimal. Magnesium is involved in over 300 metabolic pathways. If you’re deficient, your exercise will be compromised and you may even experience some muscle cramping. To correct a deficiency, eat more foods with magnesium in them—such as nuts and seeds, dark leafy greens, legumes, oats, fish, and even dark chocolate—but taking a supplement may also help.

B vitamins: For people with diabetes, thiamin (vitamin B1) deficiency is also a likely culprit in exercisers and can be further depleted by alcohol intake. People who take metformin to control diabetes can also end up deficient in vitamins B6 and B12, both of which are essential to exercising well. Consider taking a vitamin B complex daily.

Thyroid issues: Having lower levels of functioning thyroid hormones can cause fatigue and poor exercise performance. Have your main thyroid hormones (TSH, T3 and T4), but possibly also your thyroid antibodies if your thyroid hormones levels are normal and nothing else is helping your exercise (specifically antibodies to thyroid peroxidase), especially if you have celiac disease.

Still stumped? If you’ve been through this list and had everything check out okay, then consider other possible issues like your hydration status, daily carb intake (adding even just 50 grams per day to your diet may help), other possible vitamin and mineral deficiencies (vitamin D, potassium, etc.), statin use (some statins taken to lower blood cholesterol cause unexplained muscle fatigue), and frequent hypoglycemia.

Please visit www.diabetesmotion.com for more helpful information about being active with diabetes.

Exercise can help tame type 2 diabetes, say new guidelines

ACSM, American Diabetes Association guidelines make strong case for physical activity

INDIANAPOLIS – New guidelines on exercise for people with diabetes are likely to open some eyes—and, for those who follow them, help prevent or manage diabetes, improve overall health and boost quality of life. A panel of nine experts developed the recommendations, published this month in Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM). ACSM and the American Diabetes Association issued the guidelines as a Joint Position Statement.

While research has solidly established the importance of physical activity to health for all individuals, the new guidelines provide specific advice for those whose diabetes may limit vigorous exercise. The recommendations call for at least 150 minutes a week of moderate-to-vigorous aerobic exercise spread out at least three days during the week, with no more than two consecutive days between bouts of aerobic activity. “Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations,” says Sheri R. Colberg, Ph.D., FACSM, who chaired the writing group. Hence, she explains, the group calls for a regimen of moderate-to-vigorous activity and makes no recommendation for a lesser amount of vigorous activity.

Strength training, too
Aerobic activity alone cannot give full benefit of exercise to diabetic individuals, say the experts. Recent research has shown that resistance exercise (strength training) is as important as—and perhaps even more important than—aerobic training in diabetes management. The latest studies, says Colberg, have reinforced the additional benefit of combining aerobic and resistance training for people with diabetes.

No excuses: Physicians should prescribe exercise
According to Colberg, “Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity.” In keeping with the philosophy of ACSM’s Exercise is Medicine® initiative, Colberg urges that physical activity be a conscious part of every person’s health plan, as appropriate for age and physical condition.

High stakes, high yield
The benefits far exceed considerations of an individual’s health and quality of life, say Colberg and other experts. Predictions that one in three Americans will have diabetes by 2050 (Centers for Disease Control and Prevention) are accompanied by estimates that diabetes and prediabetes in the U.S. will cost almost $500 billion a year by 2020 (UnitedHealth Group, Inc.). According to Colberg, “If current trends go unabated, we are in fact doomed to higher health care costs and drastically reduced quality and length of life due to diabetes-related complications such as heart disease and kidney failure. As individuals, as communities and as part of a nation and world, we have to work collectively to stop diabetes before it stops us.”