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Exercise Therapy in Diabetes

Yoga exercises can be benefited for your health and it has been widely practicing by many people around the world. Practicing yoga is especially beneficial for diabetic patients.

‘Sushruta ‘ says in his ‘Samhita’ in which diabetic patients should do a daily walking exercise for a minimum of 6 kilometers to improve their overall health! Both Sushruta and Charaka emphasized the need for exercises like wrestling, sports, horse – riding, long walks, and digging wells.

Benefits of physical exercises

1. Regular exercises fortify the heart. It enables the cardiovascular system to deliver more oxygen to the body. It lowers blood pressure and reduces the levels of the ‘bad’ cholesterol – LDL. This in turn reduces the risk of heart attack, stroke, and coronary artery disease. Exercises strengthen the heart muscles. It increases HDL, the ‘good’ cholesterol. Exercises decrease the body’s resistance to Insulin.

diabetes patient
diabetes patient

2. Exercises stretch muscles and joints thus improving the flexibility of the body.

3. When we do exercises, need more and more energy. We use up more and more sugar. Hence sugar in the blood is consumed and the level is reduced. The action of insulin is stimulated. Therefore diabetic patients are very much benefitted.

4. Exercises control obesity because they help burning calories, faster, thus reducing weight. The body’s activities become stronger.

5. Exercises improve the metabolism of diabetic patients.

6. Blood pressure gets to normal. Blood clots are diluted and eliminated.

7. With exercise, the glucose needs of the body is increased and fully utilized. There happens a fall in insulin level and rise in the counter hormone levels glucagon, Cortisol, epinephrine levels. Glucose utilization in muscles during exercise is directly work – rate dependent. Exercises accelerate the hepatic gluconeogenesis depending on the duration and intensity of exercises. ( Gluconeogenesis is the biochemical process in which glucose is synthesized from non – carbohydrate sources such as amino – acids).

8. In general, exercises rejuvenate the body, increase Stamina, improve muscle strength, and promote health and well being. It helps in controlling stress & tension. The benefits of exercise in Type 2 diabetes are substantial. It has beneficial effects on Cardio – Vascular risk factors, improves insulin sensitivity, reduces triglyceride levels, and blood pressure.

There are two types of exercises:-
1. Aerobic
2. Normal exercises ( Anaerobic)

Aerobic exercises require more oxygen from the air to get to the muscles, forcing the heart and lung to work more than normal.

Jogging, Running, Table Tennis, Swimming, Biking, Cycling, Skating are examples of aerobic exercises.

Aerobic exercises burn a lot of calories and improve cardiac function better than Anaerobic exercises. But Aerobics is less effective at building strength and muscle mass.

Anaerobic exercises rely on energy sources stored in the muscle and unlike aerobics, are not dependent on oxygen from the air. Anaerobic exercise burns fewer calories than Aerobics; but it builds muscle strength and in the long run, a person becomes leaner and loses weight. Examples of anaerobic exercises are weight lifting and isometrics.

Before starting exercises
1. Consult your doctor before embarking on exercises, this is a ‘must’ requirement.
2. Pre-exercise evaluation is a must. The risk factors that are to be evaluated are.
(i) Age above 35
(ii) Duration of diabetic disease in both Type 1 and Type 2 patients
(iii) Diabetic patients with vascular diseases and neuropathy.
(iv) Risk of hypoglycemia.,
(v) Patients with a history of foot ulcers
(vi) Cardiac state of the patient must be assessed.
(vii) Before beginning any physical exercise program, diabetic patients should be screened thoroughly for any underlying complications.

Warming up:
All exercises must be preceded by warm-up exercises. The warm-up exercises prepare the body’s skeletal muscles, heart, and lungs for a progressive increase in intensity, duration of the main exercises. It should consist of 5 -10 minutes of aerobics ( Walking, Cycling) after which exercises for stretching of muscles for another 5 – 10 minutes, follow.

Cooling down:-
Just like warm-up before commencing main exercises, slowing down gradually at the end of the exercise, prevents dizziness and ‘pooling’ of blood.

Exercises for Type 1 diabetic patients:-

Exercises for the insulin-dependent Type 1 diabetic patients depend on the type of insulin administered, site of administration, metabolic status and presence of other diabetic complications. The blood glucose level should be monitored before, during, and after exercises, to avoid hypoglycemia and hyperglycemia.

Caution:-
1. If the blood sugar levels are above 250 mg/dl and ketones present, avoid exercises.

2. If the blood sugar is less than 100 mg/dl, the patient must be given additional carbohydrate foods to avoid hypoglycemia.

3. Exercise is avoided during peak insulation action.

4. Carbohydrate food should be readily available during and after exercise.

Exercises for type 2 diabetic patients

Type 2 diabetics on oral insulin or hypoglycemic agents should follow the same precautions as type 1 patients.
General guidelines

1. Although exercises are important do not rush and commence – the amount, type, and intensity of exercises depend on your diabetic and physical conditions, age, and condition of your heart. Increase the duration and intensity of exercises gradually.

According to the guidelines of the American College of Sports Medicine, the generation and maintenance of a good level of aerobic fitness require three exercise sessions per week, performed on three consecutive days. The duration of each exercise session should be between 20 – 30 minutes at approximately 70% of the age-adjusted maximal heart rate. Gradually the duration and frequency of exercise may be increased.

Exercising at 70 – 85% of maximal heart rate for 30 – 60 minutes three to five times in a week will result in greater calorie consumption ( 1000 to 3000 kcal per week). The type of exercise performed should be brisk walking, slow running, cycling, aerobic dancing, swimming, skipping, or rowing.

To strengthen the heart, exercise must be performed at a reasonably high intensity. Intensity can be assessed in several ways. In one method, the intensity is considered adequate ( that is, enough to be beneficial) if the heart rate ( measured in beats per minute) increases at least 20 beats above the resting heart rate.

In another more complex, method, the intensity is considered adequate if the heart rate is between 70% and 85% of a person’s estimated maximum heart rate, which is 220 minus the person’s age.

2. Prolonged walking, jogging, step exercises, and treadmill are prohibited for patients with peripheral neuropathy. They are recommended Cycling, Swimming, and other non – weight-bearing exercises.

3. Aerobic exercises or physical exercises involving the feet require special precaution. Wearing socks to prevent blisters and the use of silica gel are some precautions. Correct footwear is essential.

4. Do not exercise immediately after meals.

5. Do not overexert. That may lead to physical exhaustion. During menstruation avoid exercises.

6. Start with 10 minutes duration gradually.

7. Due to increased perspiration during the exercises, the body may lose fluids and dehydrate. Therefore drink plenty of water before and after exercise.

8. Do exercises at least 5 days a week.

9. If you find during exercises, the symptoms of fatigue, exhaustion, vertigo, tightness in the chest, chest pain, nervousness, breathing problems, stop exercising and see a doctor.

10. Whatever be the exercises you do, you do it under instruction & supervision of an instructor.

11. Do not eat snacks or drink water when you exercise.

Tips on walking
1. Walking is the best, simple form of exercise, suitable for most people, regardless of age. But one must walk fast.

2. Start with a target of 1 KM walk, then increase gradually.

3. Walking for 30 minutes a day will reduce blood sugar levels.

4. Do not walk on an empty stomach. Have some light food. Walking stimulants insulin production in the stomach and can get rid of LDL and increase HDL.

5. Wear clean socks, proper footwear

6. Persons with foot sores, the rigidity of feet, etc can not walk long. They may try swimming, aerobics, cycling, etc.

Swimming:
Swimming exercises the whole body without stressing the joints muscle. Often swimming is recommended for patients with muscle & joint problems.

However, swimming does not help in reducing weight, the reason being that water takes heat off the body, so that body temperative does not rise and metabolism does not remain increased after swimming exercises done out of the water, increases the temperature of the body and metabolism for up to 18 hours. This process helps burning calories.

Diabetic patients can gradually work up to 30 minutes of swimming.

Riding a bicycle is good for cardiovascular fitness. If you find it difficult to ride a bicycle in the city traffic you can try a stationary bicycle. It is a good choice for the elderly. Pedaling strengthens the upper leg muscles. There are some more forms of physical exercise, like Aerobic dancing, step aerobics, Water aerobics, cross – country skiing, rowing, etc.

Yoga and diabetes
Yoga is part of our culture. Its influence on the human body and metabolism has been recognized by modern scientists. Favorable effects of yogasanas on cardiovascular, endocrine, metabolic, and respiratory functions have been observed.

yoga exercise

Yogasanas suitable for diabetic patients are:-

1. Suryanamskaram

2. Yogasanas:
(i) Padmasana
(ii) Salabasana
(iii) Bhujangasana
(iv) Dhanurasana
(v) Halasana
(vi) Paschimothanasa
(vii) Vajrasana
(viii) Savasana

3. Pranayama.

Yogasanas can be done for 30 minutes ( excluding savasana).
Savasana can be done for 10 – 15 minutes.
The general guidelines given for exercises hold good for yogasanas also.

Effect on blood glucose level
The practice of Pranayama in normal healthy volunteers produces a significant fall in fasting blood sugar and postprandial blood sugar. This effect is also observed in both type 2 and type 1 DM patients with a reduction in the drug requirement, development of a sense of well being, and normalization of the insulin/glucose ratios.

Effect of yogic practices on blood pressure:
Significant reduction in systolic and diastolic blood pressure is achieved in hypertensive individuals with the practice of yoga. Blood pressure is maintained at normal levels with a significant reduction in the dosage requirement of antihypertensive. B.P. patients should avoid sarvans as on.

Effect on lipid profile:-
A significant decrease in the free fatty acids, LDL, and VLDL cholesterol, with an increase in HDL cholesterol, is noted after the practice of yoga in diabetic individuals.

Effect on insulin kinetics and other hormones:
Yoga produces a reduction in the fasting insulin levels and a shift of the peak level of insulin to the left. There is a normalization of the insulin/glucose ratio with a reduction in the free fatty acid levels suggesting a better peripheral utilization of insulin. There is also a significant rise in the number of insulin receptors, indicating a reduction in insulin resistance and improved insulin sensitivity.

Thus exercise/yoga plays a major role along with diet in the management of diabetes. Diabetes patients should take these physical exercises seriously and start in right earnest. Once the inertia is conquered with motivation, then continuing exercises will not be that difficult. The benefits are many.

CALORIES BURNT IN VARIOUS ACTIVITIES

Activity Calories burnt in 30 minutes

1. Aerobic exercises (medium) 200 – 270
2. Yoga 102 – 138
3. Walking (3.2 km/hour) 84 – 120
4. Walking (6.4 km/hour) 156 – 219
5. Sitting 36 – 54
6. Standing 42 – 51
7. Sleeping 30 – 39
8. Watching TV 39 – 51
9. Swimming (slow) 135 – 294
10.Swimming (medium) 240 – 321
11. Eating 42 – 51
12. Cycling 135 – 175
13. Sweeping the floor 51
14. Mopping the floor 126
15. Washing clothes 126

To lose 1 kg of body weight, you need to burn 7700 calories.

Read more:
Ayurvedic Medicine Treatments and Ayurveda for Diabetes

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