Diabetes Mellitus and Exercise

Bernard Zinman, MD; Neil Ruderman, MD, Phil; Barbara N. Campaigne, PhD; John T. Devlin, MD; Stephen H. Schneider, MD.


March 01, 2010

In This Article

Preparing for Exercise

Preparing the individual with diabetes for a safe and enjoyable exercise program is as important as exercise itself. The young individual in good metabolic control can safely participate in most activities. The middle-aged and older individual with diabetes should be encouraged to be physically active. The aging process leads to a degeneration of muscles, ligaments, bones, and joints, and disuse and diabetes may exacerbate the problem. Before beginning any exercise program, the individual with diabetes should be screened thoroughly for any underlying complications as described above.

A standard recommendation for diabetic patients, as for nondiabetic individuals, is that exercise includes a proper warm-up and cool-down period. A warm-up should consist of 5-10 minutes of aerobic activity (walking, cycling, etc.) at low intensity level. The warm-up session is to prepare the skeletal muscles, heart and lungs for a progressive increase in exercise intensity. After a short warm-up muscles should be gently stretched for another 5-10 minutes. Primarily the muscles used during the active exercise session should be stretched, but warming up all muscle groups is optimal. The active warm-up can either take place before or after stretching. Following the activity session, a cool-down should be structured similarly to the warm-up. The cool-down should last about 5-10 minutes and gradually bring the heart rate down to its preexercise level.

There are several considerations that are particularly important and specific for the individual with diabetes. Aerobic exercise should be recommended but taking precautionary measures for exercise involving the feet is essential for many patients with diabetes. The use of silica gel or air mid-soles as well as polyester or blend (cotton-polyester) socks to prevent blisters and keep the feet dry is important for minimizing trauma to the feet. Proper footwear is essential and must be emphasized for individuals with peripheral neuropathy. Individuals must be taught to monitor closely for blisters and other potential damage to their feet, both before and after exercise. A diabetes identification bracelet or shoe tag should be clearly visible when exercising. Proper hydration is also essential as dehydration can effect blood glucose levels and heart function adversely. Exercise in heat requires special attention to maintaining hydration. Adequate hydration prior to exercise is recommended (eg 17 ounces of fluid consumed two hours before exercise). During exercise fluid should be taken early and frequently in an amount sufficient to compensate for losses in sweat reflected in body weight loss, or the maximal amount of fluid tolerated. Precautions should be taken when exercising in extremely hot or cold environments. High resistance exercise using weights may be acceptable for young individuals with diabetes, but not for older individuals or those with long standing diabetes. Moderate weight training programs that utilize light weights and high repetitions can be used for maintaining or enhancing upper body strength in nearly all patients with diabetes.