To learn more about exercise for diabetes, we spoke with Danine Fruge, MD, ABFP, the medical director at Pritikin Longevity Center.
Physical activity is beneficial for all adults, and that includes individuals with diabetes. “Exercise has many important benefits for diabetes including increasing insulin sensitivity, improving blood sugar control, building muscle, losing body fat, building bone and muscle strength, improving balance and flexibility, decreasing triglycerides, and blood pressure, decreasing risk of cardiovascular disease complications such as heart attack stroke and dementia,” says Dr. Fruge.
When fitness experts talk about how to program workouts, they often use something known as the FITT principle, which stands for frequency, intensity, time, and type. These four components characterize what your workouts should look like in your fitness plan for optimal effectiveness.
Frequency refers to how often you are working out, intensity is the effort or exertion level of the workout, the time is the duration or how long you are training per session, and the type is the mode of exercise you are doing, such as running, walking, some type of strength training, yoga, etc.
Dr. Fruge says that when trying to use exercise to control diabetes, the most important programming factor is frequency—you want to aim to be as consistent as possible with your fitness routine.
“Daily is best, but try not to miss two days in a row. Aim for 15 minutes per day minimum. At the Pritikin longevity center, we recommend walking or light exercise 15 minutes after every meal or snack,” she says. “We encourage two-a-day exercise sessions, a.m. and p.m., which yields amazing health benefits such as lowering blood sugar, blood pressure, and cholesterol, as well as increasing energy, mood, and mental alertness.”
Dr. Fruge says intensity is less important, especially at first. “Start slow,” she suggests.
In terms of the best type of exercise for people with diabetes, Dr. Fruge says that your workout program should be well-rounded with different types of exercise, just as it should be for someone without metabolic diseases.
She advises to follow a hybrid training protocol: “It is best to add muscle-building activities along with cardio/aerobic activities, which together give the most benefit for long-term blood sugar control and healthy body composition and weight.”
The good news is that Dr. Fruge says that as long as your diabetes is being managed properly, you should not feel limited or restricted in the types of exercise you can do.
“If your diabetes is well-controlled and you don’t have any major complications, you can enjoy all types of exercise,” she says. “I played Division I college tennis semi doubles. My partner was a fit, well-controlled type 1 diabetic who knew exactly what she needed to do to perform well. I also ran the Disney marathon along with a group of all different ages and types of diabetics who finished the 26.2 miles without complications.”
Furthermore, Dr. Fruge says the type of diabetes you have doesn’t affect the type of exercise you can enjoy, as long as your condition is under control and you do not have any serious complications such as organ damage.
Although you should feel relatively unrestricted in your choices of exercise if your diabetes is being managed, Dr. Fruge says that there are some precautions for people with diabetes who have uncontrolled blood sugar levels or other residual conditions from the disease.
“It is wise to avoid straining, high-intensity, isometric exercises for diabetics with uncontrolled blood sugars, uncontrolled hypertension, moderate to severe heart disease, and/or complications such as peripheral neuropathy,” says Dr. Fruge. “And those with retinopathy should avoid exercises that involve hanging the head down.”
There aren’t too many types of exercise that involve hanging your head down, but if you suffer from retinopathy, a complication of diabetes that affects the eyes, you may need to take special precautions with many yoga inversions or stretches where you hinge at the hips and bend down (such as forward fold). Strength training exercises such as deadlifts may also be contraindicated.
Particularly if you have type 1 diabetes, it is important to be properly fueled before your workout with the right nutrients to help control the release of glucose into your bloodstream.
“A type 1 diabetic should consume carbohydrates, such as fruit, oatmeal, or sweet potato, paired with fiber from low-starch veggies, beans, or proteins to maintain a stabilized blood sugar especially during cardiovascular exercise,” she advises. “At The Pritikin Longevity Center, we offer tasty fresh small cups of fruits and vegetables in side-by-side coolers at the entrance of the gym to encourage our participants to eat fruit with a veggie, because fruit alone raises blood sugar quickly, but may not sustain for the duration of the workout.”
She also suggests utilizing the wearable technology continuous blood glucose monitoring systems that give real-time feedback to help guide your workout plans and pre-workout fueling to optimize the safety and effectiveness of exercising with diabetes.
Dr. Fruge says the nutritional and fueling considerations before a workout are slightly different for people with type 2 diabetes.
“A type 2 diabetic can eat the same; however, if well-controlled and interested in weight loss, pre-workout have low-starch vegetables such as celery with carrots, cucumber, peppers, jicama, radishes, broccoli, cauliflower, etc. and skip the fruit or starchy carbs,” suggests Dr. Fruge. “[For] higher-intensity or longer workouts, or for diabetics taking hypoglycemic medicine, such as sulfonylureas or insulin, adding a healthy starch for a pre-workout fuel may be beneficial.”
If you have diabetes and have concerns about exercising, you should speak with your doctor or endocrinologist for personalized recommendations to get you started on a healthy fitness routine. It can be intimidating and overwhelming at first to start exercising with diabetes, but Dr. Fruge says the benefits can be transformative both for your body and mind.
“Working 20 years with patients, I have had the honor and joy to witness not only remission, but also the reversal of type 2 diabetes, and have seen many type 1 diabetics without long-term complications [largely because of their physical activity habits], which I never saw in the hospital setting.”
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