Diabetes and Exercise

What is Diabetes?

Insulin is responsible for allowing sugar to move from the bloodstream and enter the cells of the body where it is used as energy. In patients with diabetes, the cells become resistant to insulin and sugar builds up in the bloodstream instead of being moved into the cells. This causes many complications including cardiovascular disease, kidney damage, eye damage, as well as nerve damage with resulting poor sensation of the fingers or toes. Nerve damage to the feet, combined with diabetes-caused impaired foot blood flow, can combine in diabetics to cause persistent foot wounds that are slow to heal.

Preventing Diabetes

Physical inactivity is closely associated with an increased risk of developing type 2 diabetes. Research has shown that you can reduce your risk of type 2 diabetes with physical activity of any intensity (low, moderate, or vigorous) and any type¹. Other studies have shown that a program of brisk walking can reduce the risk of developing diabetes². The American College of Sports Medicine recommends that all adults get at least 30 minutes 5x per week of moderate intensity cardiovascular training, like brisk walking, or at least 20 minutes 3x per week of vigorous intensity cardiovascular training, like running. They also recommend resistance training 2-3x per week³.

Managing Diabetes

For those that already have type 2 diabetes, physical activity is considered a cornerstone of disease management⁴. Physical activity generally can improve blood glucose levels, reduce the risk for cardiovascular disease, contribute to weight loss, and likely reduce the risk of chronic diabetes complications⁵. Cardiovascular training increases the heart rate (brisk walking, bicycling, swimming, running, etc) and leads to improved cardiovascular fitness as well as blood glucose control⁶. Resistance training (including weight lifting, using resistance bands, and doing body weight activities) has been shown to improve blood glucose control and HbA1c levels (a measure of how well a patient is managing blood glucose levels)⁷. However, performance of cardiovascular exercises combined with resistance training in the week is even more effective in managing HbA1c and diabetes symptoms than either activity type individually⁸.

To manage diabetes, the easiest way to meet the cardiovascular exercise goal is with a walking program. It requires minimal equipment, just a good pair of supportive shoes. If it is too cold or wet to walk outside, another option is to walk in the house, mall, or community center. Again, ideally, any walking program would be at a brisk pace, last at least 20 minutes, and be completed 5x a week. However, a walking program of any duration or intensity is beneficial for the management of diabetes.

Diabetics can meet the resistance training goal of 2-3x per week using traditional weights, resistance bands, or just the weight of the body. Some examples of body weight activities are listed below:

1. Sitting to standing: Sit near the front edge of a chair without wheels. Reach out with your arms and lean forward at your hips until your rear end starts to lift off the chair. Move your body into a standing upright position, squeezing the front of the thighs and rear end cheeks together as you stand.  Then sit back down in the chair.  Throughout the exercise, try to avoid letting the knees come together.  The knees should remain in line with the feet throughout the exercise.  Do 1-3 sets of 10 repetitions.
   

2. Bridges: Begin lying on your back with your arms resting at your sides, your legs bent at the knees and your feet flat on the ground. Flatten your back against the bed or floor.  Tighten your rear end cheeks together and lift your hips off the floor a little bit, keeping your back flat.  The legs and rear end should be the main workers for this exercise. If you feel it working in the back a lot, try not to arch the back and don’t lift as high up.  Do 1-3 sets of 10 repetitions.
   
3. Straight leg raises: Begin lying on your back with one leg bent and your opposite leg straight. Turn on the tummy muscles and flatten the back.  Keeping your leg straight and the back pushed against the bed/floor, squeeze the front of the thigh and raise your straight leg up until your thigh is at the same height of your bent knee.  Slowly return to the starting position and repeat.  Keep the back flat and the tummy tightened while the leg is in the air.  Reset the stomach and the leg muscles each repetition.  Do 2-3 set of 10 repetitions for each leg.

4. Sidelying leg lifts: Begin lying on your side with your top leg straight and your bottom leg bent. Lie with the top hip rolled forward. Lift your top leg up toward the ceiling and slightly backwards on a diagonal, then slowly lower it back down and repeat.  You should feel this working in the side of the hip. If you feel it more in the thigh, try to lean the top hip slightly more forward or bring the top leg slightly farther back as you lift up to the ceiling.  Do not arch or move the back.  All of the movement should occur in the leg.  Do 2-3 sets of 10 repetitions.

In conclusion, all adults benefit from exercise to prevent diabetes as well as to manage symptoms once the disease is diagnosed.  Recommendations include performing cardiovascular exercise like a brisk walking program for at least 20 minutes, 5 days/week and to perform resistance exercise like body weight activity 2-3 days/week.  If you have never exercised or want additional guidance, the physical therapists at Weil Foot and Ankle Institute can help you to start a new program.  Please reach out to any of our Weil podiatrists or physical therapists with questions.

1. Aune D, Norat T, Leitzmann M, et al. Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015 Jul;30(7):529-42.
2. Jeon CY, Lokken RP, Hu FB et al. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007 Mar;30(3):744-52.
3. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334-1359.
4. American Diabetes Association. Standards of medi in diabetes-2012. Diabetes Care. 2012;35 Suppl:11-63.
5. Moghetti P, Balducci S, Guidetti L, et al. Walking for subjects with type 2 diabetes: a systematic review and joint AMD/SID/SISMES evidence-based practical guideline. Nurt Metab Cardiovasc Dis. 2020 Oct 30;30(11):1882-1898.
6. Toledo FG, Menshikova EC, Ritov VB, et al. Effects of physical activity and weight loss on skeletal muscle mitochondria and relationship with glucose control in type 2 diabetes. Diabetes. 2007;56:2142-2147.
7. Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002;25:2335-2341.
8. Sigal RJ, Kenny GP, Boule NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med. 2007;18(147):357-369.