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How to Exercise With Diabetes Complications

With modifications, you can safely exercise with diabetes complications

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Exercise is like medicine. That heart-pumping high you feel after a great workout is proof it can boost your mood, but the benefits go much deeper. Regular physical activity improves blood glucose, heart health, blood pressure, and cholesterol levels. It also helps with weight loss and management, lessens depression, and keeps older adults functioning well with activities of daily living, says Matthew Corcoran, MD, the founder and president of the Diabetes Training Camp Foundation.

But what if you have diabetes-related complications? With proper modifications and an appropriate level of intensity, you can still safely work up a sweat. “You are going to have to start very slowly and ramp up slowly,” says Corcoran.

The first step to any workout program is to talk with your health care team, including any specialists you see, about how exercise may affect your specific health issues. Then, depending on the severity of your complications, you may need to seek out a certified exercise professional who has experience working with people with diabetes. “They can give you advice on how to exercise safely,” says Jackie Shahar, MEd, RCEP, CDE, an exercise physiologist and manager of the Exercise Physiology Department at the Joslin Diabetes Center in Boston. Look for an exercise physiologist or physical therapist to get you started.

Keep these general exercise guidelines in mind if you have one (or more) of these complications:

Peripheral Neuropathy

If nerve damage (neuropathy) has resulted in a loss of sensation in your feet, walking may be difficult and you may be at higher risk for falls. Peripheral neuropathy can also appear as pain in the hands and feet, which may make you hesitant to do anything—including exercise—if there’s a chance it might increase the pain. But, says Patricia Kluding, PT, PhD, chair of and professor in the Department of Physical Therapy and Rehabilitation Science at the University of Kansas Medical Center, that’s not always the case. “It doesn’t necessarily increase pain, and [activity] sometimes helps you live with the pain or decreases your pain,” she says.

If you have numbness or tingling in your hands, another sign of nerve damage, you may have trouble gripping items, such as dumbbells. “[They] could slip and drop on your foot,” says Kluding.

While most people with neuropathy can still walk, be careful if you experience numbness because you may unknowingly develop blisters or abrasions on your feet. Without the ouch of an open wound, it may go untreated and become infected, says Kluding. And if your gait has changed, walking or running may put you at risk for falls.

Pick: Workout machines that let you sit back while engaging your arms and legs (such as the recumbent bike or stepper) reduce your risk for falls. Swimming or water aerobics (with proper water shoes) allow you to be active without adding pressure to your feet. Tai chi and yoga work when you want to move through low-impact poses and increase flexibility, says Kluding. For resistance training, use the weight machines at the gym, which have built-in safety mechanisms so the weights can’t drop on your feet if your hands slip. For all exercise, be sure to wear the proper footwear and check your feet daily.

Autonomic Neuropathy

This type of neuropathy damages nerves that control body functions, such as heart rate, blood pressure, temperature regulation, and digestion. Because this condition affects how your heart responds to activity, you’ll want to clear any exercise program with your doctor. “Autonomic neuropathy may cause you to have a blunted heart rate response to exercise,” says Shahar. What that means: During activity, your body is working harder than your heart rate indicates. For this reason, you need to measure the intensity of exercise based on how you feel—rather than your heart rate—and try to exercise at a low to moderate level.

You may also experience erratic blood pressure during exercise, which could make you feel dizzy or faint. To prevent that, Shahar recommends that people with the condition “avoid any rapid changes in posture, such as quickly changing positions in yoga or going from standing to sitting too fast.” Lastly, be wary of extreme hot or cold environments during physical activity. “You may not be able to regulate sweat sufficiently, and you could become dehydrated,” she says.

Pick: It’s typically safe to use a stationary bike or do water aerobics for cardio exercise. For strength training, try light weights or resistance bands.

Charcot Foot

Sometimes neuropathy can lead to structural damage in the foot. The bones may weaken and fracture without your feeling pain. You risk further injury by continuing to walk around, says Shahar. While being treated, you’ll likely wear a cast and use crutches, a wheelchair, or a special device to keep pressure off the foot and help with the healing process. As a result, you’ll need to skip any weight-bearing activities, such as jogging, lunges, or squats. Even walking to and from your car puts too much pressure on the feet. Some seated exercises, such as the leg press, also can do potential harm.

Pick: Believe it or not, you can get a good workout even if you can’t put pressure on your feet. Instead, focus on activities you can do while seated. For cardio workouts, try the upright or recumbent bike or stepper—both put you in a reclined position while working your legs. Swimming is also a good option. For strength training, go for exercises that engage the muscles of your upper body, including bicep curls, shoulder presses, and triceps extensions. 

Retinopathy

High blood glucose can affect blood vessels in the eyes, causing them to weaken and bleed more easily, which leads to fluid buildup and vision problems. Most people with mild to moderate retinopathy can exercise without restrictions, says Emily Chew, MD, director of the Division of Epidemiology and Clinical Applications at the National Institutes of Health’s National Eye Institute. But if you have more severe retinopathy, with weakened blood vessels growing on your retina, certain exercises that increase eye pressure could cause those vessels to bleed and can lead to other complications, such as a detached retina. These include activities that jar your head, such as jumping jacks or running, and yoga poses that involve putting your head below your waist or bending over. Take caution when strength training, too: Avoid heavy weights (typically above 10 pounds), and don’t lift weights above your shoulders. These activities can cause you to strain or hold your breath, says Chew, which also increases eye pressure and bleeding risk.

Pick: Try walking, water aerobics, cycling, and light weight-lifting below the shoulders. You’ll get the benefits of exercise, including lowering blood glucose, without the risk of increased pressure in the eye. 

Kidney Disease

When it comes to physical activity, people with chronic kidney disease aren’t restricted by specific activity or movement types. “Aerobic exercise and resistance training would both be excellent,” Corcoran says. The catch: People with kidney disease are often limited by fatigue and muscle loss. For anyone with kidney disease, it could be helpful to go to a certified exercise professional, who can provide a baseline assessment of your capabilities, and then prescribe an appropriate program for you, he says.

Pick: No exercises are off limits with kidney disease, but if you find you get fatigued fast, try easier exercises, such as walking, light strength training with resistance bands or 1- to 2-pound free weights, or a stationary bike. These low- to moderate-intensity exercises are good for those with low energy levels, says Shahar. Another option is to cut those 30 minutes of activity a day into smaller bursts. “Patients can break down the exercise routine to short bouts of 5 to 10  minutes,” she says. “It’s a great way to build up endurance.”

Heart Disease

People with diabetes often have underlying heart disease, says Barry Franklin, PhD, director of preventive cardiology and cardiac rehabilitation at William Beaumont Hospital in Royal Oak, Michigan. High-intensity exercise, particularly if you’re not accustomed to it, can trigger a heart attack or stroke, or may cause angina (chest pain that occurs if your heart doesn’t get enough blood). “Inactive middle-aged and older people should avoid high-intensity or strenuous unaccustomed exercise,” Franklin says. “That’s where many of the complications in gyms around the country occur.”

Avoid lifting heavy weights or holding your breath while lifting, which can increase heart rate and blood pressure and could lead to a cardiovascular issue. Research has linked high-intensity competitive racket sports to an increased risk for heart-related events. But activities such as shoveling snow and hunting deer can also pose risks, says Franklin. If you have heart disease, ask your health care provider whether you need a stress test before beginning an exercise program.

Pick: Franklin says it’s generally safe to walk at a speed of between 1½ and 3 miles per hour, as long as you are symptom-free during exercise. Opt for resistance training with light weights, which won’t increase blood pressure the way heavier weights do. By doing more repetitions, you’ll strengthen your muscles the same way you would with heavier weights and fewer repetitions. Just remember: When lifting, exhale during the strenuous part.

Peripheral Artery Disease (PAD)

Narrowing of the blood vessels in the legs, known as peripheral artery disease, limits blood flow to the calves and feet. The most common symptom—pain or cramping in the calves that goes away with rest—may make physical activity more difficult. “Most of the early limitations are going to relate to the functional impairment, and just how long they can [exercise],” says Corcoran.

Pick:  Walking programs that allow for breaks can increase blood flow and reduce pain, which in turn increases how far and for how long you can walk, says Corcoran. You are also good to go with strength-training moves, such as lifting weights.

Other Conditions

People with diabetes often have these conditions, which may require special care when exercising:

Arthritis

Stiffness and pain are most common in the knees, hips, and spine but can occur in any joint. A growing body of research suggests that exercise is good for arthritis. Strength training can help support and protect the joints, while aerobic activity can reduce weight, lessening the pressure on your joints. Stretching and flexibility exercises also help improve stiffness and pain. The key to exercise is to work around the affected joints. If you have pain in the hip or knee, two of the most commonly affected joints, avoid jogging, stair-climbing, or high-impact sports, such as tennis and basketball.

Pick: Range-of-motion exercises—including gentle stretching and movements that take the joint through the full range of motion—can eliminate stiffness and improve flexibility. Non-weight-bearing exercises, such as recumbent biking, water aerobics, using an elliptical, and swimming, are good for your heart and weight loss and go easier on your joints. Light resistance training can strengthen the muscles around your joints, which stabilizes them and helps reduce pain. Prep your body for aerobic and strength exercises by beginning with a warm-up, such as range-of-motion exercises.

Osteoporosis

Osteoporosis is a disease in which the bones lose density and become fragile, increasing the risk of breaks and fractures. Exercise can prevent osteoporosis, but it’s also good if you have the condition. If you have osteoporosis, pick exercises that build up the muscle around the affected bones and restore or maintain bone density. “Strength-training and weight-bearing exercises are good for this,” says Shahar.

Skip activities that could result in falls—and broken bones—such as biking or running and opt instead for exercises that improve balance, which can help prevent falls. Shahar also advises people with osteoporosis of the spine to avoid yoga poses, stretches, or weight-training motions that involve twisting the spine. “[You] risk breaking the vertebrae,” she says. Once you know where you have lost bone density, you can figure out which exercises are safe to do—and which you’re better off avoiding.

Pick: Walking, use of the elliptical, and strength-training moves can help maintain your bone density, and prevent osteoporosis. Try step-ups, leg presses, chair squats, or upper-body lifting with light weights. Exercises that improve balance can help decrease the risk of falls (and fractures).

4 Preventive Medicine Tips

Regular physical activity has been shown to reduce the risk for certain diabetes-related complications

  1. Get fit to protect your eyes. Exercise brings down high blood glucose. Lowering glucose levels to within target range can prevent retinopathy from developing and help reduce existing retinopathy, says Emily Chew, MD, deputy director of the Division of Epidemiology and Clinical Applications at the National Eye Institute at the National Institutes of Health.

  2. Hit your targets for good health. People who exercise for at least 30 minutes a session, four to five days per week have a lower resting heart rate and lower blood pressure than people who do not do regular exercise, which markedly reduces their risk of future heart attacks by up to 50 percent, says Barry Franklin, PhD, director of preventive cardiology and cardiac rehabilitation at William Beaumont Hospital in Royal Oak, Michigan.

  3. Take a stroll a day to keep PAD away. Studies have shown that walking programs can improve your fitness level, muscle strength and endurance, and blood flow for people with peripheral artery disease (PAD), says Matthew Corcoran, MD, founder and president of the Diabetes Training Camp Foundation

  4. Exercise for nerve function? Patty Kluding, PT, PhD, chair and professor of the Department of Physical Therapy and Rehabilitation Science at the University of Kansas Medical Center, is studying whether exercise can repair damaged nerves in the legs. Participants with neuropathy are enrolled in an 18-month exercise program, and skin biopsies are taken both halfway through and at the end of the study. Kluding and her team look at the biopsies under a microscope and count the number of nerve fibers. While the research is still in the early stages (it won’t be complete until 2020), they’ve seen encouraging results. 

Keep It Up

Now that you know you can safely work out with complications, the goal is to make regular physical activity a cornerstone of your lifestyle. If you feel yourself slipping, remember all the good you’re doing for your body. “An exercise program will help you well beyond what it does for glucose control,” says Corcoran.

 

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