For a number of years now, exercise has been shown to be a simple treatment for a number of different ailments. Diabetes is no different, and studies have shown that diabetes control can be better achieved by people who follow the recommended diet and exercise regularly.
In the years to come, it is expected that the number of people in India with diabetes will increase to 101 million by the year 2030. In 2012, over 2 million children under the age of 5 years died from this condition. The magnitude of this condition and the rate at which it is growing is frightening.
These facts notwithstanding, it is worthwhile noting that we as people can actually do quite a lot to prevent us developing diabetes. If diabetes does develop, then regular exercise and diet can keep blood sugars under control.
So how can exercise control diabetes? Here we look at how exercise can help control diabetes.
The benefits of exercise
Exercise can improve the health of the heart and control diabetes at the same time. People who suffer from diabetes are at a higher risk of developing heart disease, so ensuring regular exercise can be a good way to prevent this from happening.
Exercise can improve the health of your heart
Exercise can help in the following ways –
- Improve overall fitness and stamina, giving you more energy to perform day to day activities.
- Reduce body weight. This can prevent the complications of obesity and diabetes.
- Reduce blood cholesterol levels. In particular, the good cholesterol levels may increase.
- Control blood pressure better.
- Increase muscle strength, allowing people to improve their day to day activity performance.
- Improve sleep. This can also increase efficiency and energy levels.
- Reduces stress. The exercise ‘high’ associated with aerobic activity cannot be beaten!
Exercise can improve your blood sugar levels
Regular exercise has the following effects on the blood sugar levels in patients with or without diabetes.
- Increases the sensitivity of cells to insulin, which in turn drives glucose into the cells providing them with the energy that they need.
- Improves the utilization of glucose by the cells and tissues in the body
- Decreases the level of insulin in the body (in early stages of diabetes, the insulin levels can be very high)
- Reduces the amount of glucose that is released into the blood stream from the liver
- The amount of medicine needed to control blood sugar also reduces
It is clear that exercise has benefits not just on reducing blood sugar levels, but also in reducing the number of medications needed to treat diabetes and the risk of heart disease.
So how much exercise is needed to control diabetes?
There are numerous studies that have been conducted that have looked at the effect of exercise on diabetes. They all say the same thing –
In a study conducted by Boulé et al, a structured exercise program that is conducted for more than 8 weeks can reduce the levels of glycosylated hemoglobin (HbA1c) significantly, even though there is no change in the body weight. What this means is that diabetes can be better controlled when exercise is performed in a disciplined manner on a regular basis.
In those patients who are already exercising and whose sugar is still not under control, increasing the intensity of the exercise can help achieve better blood sugar control.
Duration and frequency of exercise
Currently, there are no clear guidelines for Indians as to how much exercise is needed to control diabetes. The American Diabetes Association recommends at least 150 minutes of moderate intensity exercise (either aerobics, sports or brisk walking) a week. This amounts to 30 minutes a day, 5 days a week.
At HeartSense, we feel that this is insufficient for the Indian population, and maybe 45 minutes to 1 hour a day would be better, especially if one is looking to lose weight. Ideally, exercise is performed daily i.e 7 days a week.
Another study showed that aerobic exercise of moderate intensity can favorably control insulin levels for a period of 24 – 72 hours, depending on how long and how much exercise was performed. The positive effect rarely lasts >72 hours. Given this fact, it is recommended that exercise is never postponed for more than 2 consecutive days.
If you are looking to lose weight, then even greater amounts of exercise may be needed. Sometimes individuals who are overweight may have a hard time to reduce body fat levels just through exercise alone. The main reason for this is the diet performed along with the exercise plan may be poor. Studies have shown that just exercising without dieting can only bring down the weight by around 2kg.
In other words, exercise can control diabetes only if it combined with a strict diet plan.
Type of exercise
Newer research has shown that combining aerobic training with resistance training (using weights) can further reduce the body weight and blood sugar levels.
In other words, if you have completed a brisk walk, then using light weights to strengthen your muscles will go a long way to control your blood sugars.
Yoga has been proven to reduce and control blood sugars as well. If you wish to learn more on yoga and diabetes, click here.
A recent study performed in Australia showed that those people who spend more time standing than sitting reduce their risk of diabetes and heart disease. Replacing sitting by standing for 2 hours a day not only reduces blood sugar levels but also cholesterol levels as well (Healy, 2015).
What is not exercise
Regular household work, gardening and other daily chores do not count as exercise. So even if you are busy at home or at work, you are not exercising enough.
When you should and should not exercise
Whether or not an individual must exercise sometimes depends on the levels of sugar in the blood. There are 2 different situations when performing exercise is possibly harmful.
1. Very high blood sugars
In patients who are on insulin or tablets and have missed a dose, it is possible for the blood sugar levels to get elevated. In the past, experts have stated that those who have sugar levels of over 250 mg/dL must avoid exercise and only do so when the levels are reduced with medicine. High blood sugar levels can increase the levels of ketones in the urine, and presence of ketones is sometimes an indication to avoid exercise.
However, this stance seems to have changed now.
If you think about it logically, exercising should bring down the blood sugar level, and must be performed if the sugar levels are high. Given this, it is okay to exercise if the blood sugar levels are high, but it should not be done if the urine shows the presence of ketones.
If in doubt, always ask your doctor for advice and guidance.
2. Very low blood sugars
Patients who either take excessive insulin or eat insufficient food can sometimes drop their blood sugar levels. This phenomenon is called hypoglycemia (hypo = low, glycemia = sugar). Hypoglycemia is rare in patients who are not on insulin, but of course, it can happen if on certain medication.
Currently, the American Diabetes Association recommends that those patients who have a blood sugar levels of less than 100 mg/dL before exercise must eat some carbohydrates before setting off on their exercise routine. However, this recommendation is only applicable to those who are on insulin or drugs such as glimepiride, glipizide or glinides.
Again, if in doubt, speak to your doctor.
What are the exercise recommendations?
OK, before we discuss this, just be prepared as we might get a little ‘sciency’ here!
The recommendations we have mentioned come from the American Diabetes Association, who have laid down clear guidelines on how much exercise is necessary. We strongly recommend that all patients who wish to start any form of exercise speak to their doctor to ensure it is safe for them to go ahead.
Here are some of the recommendations that have been made.
1. Aerobic exercise
- 150 minutes of moderate intensity aerobic exercise per week (though we feel more is necessary). Exercises include –
- Brisk walking
- Light jogging
- Cross trainer
- Swimming/water aerobics
- Moderate intensity exercise is defined as reaching your heart rate around 70% of your maximum target heart rate
- Perform activity > 3 days per week, and don’t leave gaps of more than 2 days in between. A good idea is to exercise 5 days a week at least.
- If you can manage to exercise more than 4 hours per week, then you can reduce your risk of heart disease significantly.
- If you wish to maintain your weight loss and stay fit, make sure you exercise >7 hours per week.
- Always carry some form of carbohydrate with you if you are planning exercise for more than 60 minutes.
- Try and cover 10,000 steps a day. Take a look at how a pedometer can help you achieve this goal.
2. Resistance training
- Weight training can help lose weight faster, so must be combined with cardio training
- Use light weight, unless you are looking to build a lot of muscle
- Always use weights under supervision, and use the right technique to avoid injury. A personal trainer in a gym will guide you well.
Always monitor your sugar levels if you take up exercise. If you have a tendency to become hypoglycemic, then either reduce your medication dose (as advised by your doctor) or increase your carbohydrate intake.
Activities you should not take up if you are on insulin
Never take up a sport or activity that can place your life at risk. For example, activities such as rock climbing, swimming in the sea, motor racing, sky diving and scuba diving are examples of some activities you must avoid.
It is safe to drive if you have ‘hypoglycemia awareness’. This is a physical state where the individual is aware that their blood sugar levels are low. If your diabetes is poorly controlled and you experience frequent episodes of low blood sugar, then avoid driving.
Make sure you comply with the legal guidelines regarding driving and diabetes.
Diabetes can be effectively managed with a good diet and exercise plan. If you are serious about your blood sugar control, why not start your plan today?? After all, a good exercise can control diabetes well!
1. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286:1218–1227, 2001
2. Healy, Genevieve N., et al. “Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers.” European Heart Journal (2015): ehv308.
3. Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN: Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 132:605–611, 2000