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

Exercise in the Elderly

Evidence has accumulated suggesting the progressive decrease in fitness and muscle mass and strength with aging is in part preventable by maintaining regular exercise. The decrease in insulin sensitivity with againg is also partly due to a lack of physical activity. Lower levels of physical activity are especially likely in the population at risk for type 2 diabetes. A number of recent studies of exercise training have included significant numbers of older patients. These patients have done well with good training and metabolic responses, levels of adherence at least as good as the general population, and an acceptable incidence of complications. It is likely that maintaining better levels of fitness in this population will lead to less chronic vascular disease and an improved quality of life.

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Cite this: Diabetes Mellitus and Exercise - Medscape - Dec 01, 1997.

Introduction
Evaluation of the Patient before Exercise
Preparing for Exercise
Exercise and Type 2 Diabetes
Exercise and Type 1 Diabetes
Exercise in the Elderly
Conclusions
References

Table 1. Classification of physical activity intensity, based on physical activity lasting up to 60 minutes.
Endurance-type activity
Intensity	Relative intensity
Intensity	VO₂ max (%)	Maximal heart rate (%)*	RPE ^†*^‡
Very light	< 20	< 35	< 10
Light	20-39	35-54	10-11
Moderate	40-59	55-69	12-13
Hard	60-84	70-89	14-16
Very hard	≤85	≤90	17-19
Maximal*	100	100	20

Modified by Haskell and Polock from Physical Activity and Health: A Report of the Surgeon General (4)
*Maximal heart rate (Hr_max) = 220 [minus] age (Note: It is preferable and recommended that Hr_max be measured during a maximal graded exercise test when possible;
^†Borg rating of relative perceived exertion (RPE) 6-20 scale;
^‡Maximal values are mean values achieved during maximal exercise by healthy adults.

Table 2. Considerations for Activity Limitation in Diabetic Retinopathy (DR).
Level of DR	Acceptable Activities	Discouraged Activities	Ocular Reevaluation
No DR	Dictated by medical status	Dictated by medical status	12 months
Mild NPDR*	Dictated by medical status	Dictated by medical status	6-12 months
Moderate NPDR*	Dictated by medical status	Activities that dramatically elevate blood pressure: power lifting heavy Valsalva	4-6 months
Severe NPDR*	Dictated by medical status	Activities that substantially increast systolic blood pressure, Valsalva maneuvers, and active jarring: boxing heavy competitive sports	2-4 months (may require laser surgery)
PDR*	Low-impact cardiovascular conditioning: swimming walking low-impact aerobics stationary cycling endurance exercises	Strenuous activities, Valsalva maneuvers, pounding or jarring: weight lifting jogging high-impact aerobics racquet sports strenuous trumpet playing	1-2 months (may require laser surgery)