Diabetes Forecast

The Diabetes Advisor

By Shauna S. Roberts, Phd ,

Warming Up, Cooling Down: What's the Point?

If your schedule is tight, you may find it hard to carve out time to exercise. It can be tempting to save a few minutes by skipping pre-workout warm-ups and post-exercise cooldowns. Don't give in!

Warming up helps your muscles and heart get ready for the work of exercising. A good warm-up includes 5 to 10 minutes of less-demanding exercise. For example, if you are planning to go for a run, a walk is a good warm-up. If you are going to lift weights, you might start by lifting lighter ones.

After you feel loosened up, stretching will make your muscles more flexible. Warm-ups reduce injuries caused by tight joints and muscles and may improve your performance during the exercise session.

Warm-ups are particularly important for people with diabetes for four reasons:

  • They tend to lose flexibility faster than other people as they age.
  • They are more prone to injuries such as tendonitis
    and frozen shoulder.
  • They tend to heal slower once they get an injury.
  • Sudden strenuous exertion can trigger a heart attack. Warming up lets your heart adapt gradually to increasing demand.

Cooling down, on the other hand, helps keep your blood moving rather than pooling in your legs. A cooldown should last 5 to 10 minutes. One good cooldown is to continue the same exercise at a reduced intensity. Follow that with more stretches.

Cooldowns keep you from getting dizzy or fainting after exercise and reduce your chances of an after-exercise heart attack. They may prevent muscle cramps. The stretches increase your flexibility and make injuries less likely.

You can use the same exercises and stretches in both your warm-up and cooldown.

Remember, however, that these are just general guidelines. It's always a good idea to clear a new exercise plan in advance with your doctor.

Kegel Exercises and Incontinence

The muscles that control the bladder tend to weaken as women get older. Being overweight or having a baby can also weaken these muscles. The result can be dribbling of urine or outright accidents when you cough, sneeze, or bend over.

Kegel exercises may help. These simple exercises are designed to strengthen the pubococcygeus (pelvic floor) muscles. When these muscles are strong, you can hold your urine in until you reach the toilet. In medical terms, Kegel exercises can improve mild to moderate urge and stress incontinence. Strong muscles also may make sex more pleasurable.

To do Kegels, pull in your pelvic muscles and hold them for a count of three. Then relax the muscles for another count of three. Work up to doing 10 to 15 repeats at each session. (Your muscles may be too weak to start with this many repetitions; work up to it gradually.)

To make sure you are squeezing the correct muscles, try doing a Kegel exercise while urinating. If it slows or stops the urine stream, you have the correct muscles. (But don't do them routinely while urinating, which can cause infection.) Another way to tell is to put a finger in your vagina and squeeze. If you can feel the pressure on your finger, you are using the correct muscles.

Some doctors suggest working up to squeezing the muscles for 10 seconds at a time, with a 10-second rest after each. Some recommend also doing "fluttering" Kegel exercises—a series of hard, quick contractions separated by brief moments of relaxation. Don't squeeze your stomach or leg muscles during Kegels. You want all your effort going to your pelvic muscles.

The National Institute of Diabetes and Digestive and Kidney Diseases recommends doing Kegel exercises three times a day—once standing, once sitting, and once lying down. It may take three to six weeks to notice improvements.

These exercises can also be helpful when you feel a sneeze or cough coming on. Squeeze until after you have finished sneezing or coughing to prevent leakage and protect the pelvic muscles.

To learn more about Kegel exercises and controlling
incontinence, you can call the National Association for Continence at 1-800-252-3337 or visit them at www.nafc.org.

Stroke: How Big a Risk in Type 1 Diabetes?

Although diabetes elevates the risk of stroke, most studies of stroke risk have looked at people with type 2. Few have focused on people with type 1, particularly on those who are younger.

A study in the November 2006 issue of Diabetic Medicine looked at stroke risk in young adults with type 1 diabetes and found that it was many times that of their nondiabetic peers.

The participants were all the people in Sweden between the ages of 15 and 49 years old who were admitted to the hospital because of a stroke during the 15-year study. Of these people, 83 had been admitted to a hospital for type 1 diabetes between the ages of 15 and 34 years old; the 9,239 other people hadn't and were assumed not to have diabetes. The researchers compared the risk of stroke between the two groups.

Overall, the rate of stroke among people who did not have type 1 diabetes was 8 people per year per 100,000 people (person-years), with men having a higher risk than women. In contrast, the rate in the people with type 1 diabetes was 130.4 per 100,000 person-years—16-fold that of people without diabetes. Women had a higher risk than men; stroke risk rose with age.

The researchers then looked at people with diabetes who had complications versus people who didn't have diabetes. They discovered that men with diabetic kidney disease were 48.9 times as likely and women were 73.5 times as likely to have a stroke as men and women in the nondiabetic group. In addition, they found that men with diabetic retinopathy were 15 times as likely and women were 32 times as likely to have a stroke as men and women in the nondiabetic group.

They concluded that younger people with type 1 diabetes had a much higher risk of early stroke than people the same age without diabetes. However, they did not offer an explanation as to why.

Although your risk of stroke may be higher if you have type 1, doctors believe you can do many things to lower your risk. These include tightly controlling blood pressure, tightly controlling blood glucose levels, not smoking, drinking moderately or not at all, exercising regularly, eating a healthful diet low in salt, controlling cholesterol levels, reducing stress, and losing excess weight.

Shauna S. Roberts, PhD, is a writer in Riverside, Calif.



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