Dr. Sheri Colberg, author of The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, has the more help with your patients who need exercise. Exercising with Complications: Eyes and Kidneys This is a good one to print out add to your handouts.
Exercising with Complications: Eye and Kidney Disease
By Sheri Colberg, Ph.D., FACSM
Diabetic Eye Disease
People with diabetes are prone to developing all sorts of eye complications, including cataracts and retinopathy. While cataracts can obscure your vision and make participation in certain activities (such as cycling outdoors) more dangerous, they’re not usually considered a barrier to participation in physical pursuits. On the other hand, more severe forms of eye disease, such as proliferative diabetic retinopathy, cause your eyes to form weak, abnormal blood vessels in the back of the eye (the retina) that can break, tear, or bleed into the vitreous fluid in the center of your eye, filling it with blood that can obscure vision temporarily or permanently. If you have severe eye disease, you will need to make greater changes to your exercise regimen to prevent bleeding into your eye.
While exercise itself has not been shown to accelerate the proliferative process, certain precautions may be needed to prevent intra-ocular hemorrhages or retinal tears. If your eye disease is only mild or moderate, with no active bleeds, then you should simply avoid activities that dramatically increase the blood pressure inside your eyes, such as heavy weight lifting or activities during which your head is lower than your heart. If you have moderate to severe diabetic eye disease, you’ll want to avoid all jumping, jarring, or breath-holding activities, as they increase the pressure inside your eyes and can cause more bleeding and increase your risk of retinal tears or retinal detachment. Activities best avoided include boxing, competitive contact sports (such as basketball and football), jogging, high-impact aerobics, most racket sports, and heavy weight lifting. If you have an active retinal hemorrhage or notice sudden, dramatic changes in your sight, stop any activity you are doing immediately and check with your eye doctor for further guidance.
Diabetic Kidney Disease
Luckily, exercise does not appear to worsen nephropathy–otherwise known as kidney disease– common to diabetes. Intense or prolonged exercise would not usually be recommended for you if you have overt kidney disease, but only because your exercise capacity is likely to be limited. Light to moderate exercise is fine, though, and even patients requiring dialysis can exercise–even during their dialysis treatments, if they want to–with no ill effects. If you are undergoing dialysis, exercise would only be advised against if the levels of certain substances in your blood (hematocrit, calcium, or potassium) become unbalanced as a result of the treatments. People who have undergone kidney transplants due to end-stage kidney disease can safely exercise six to eight weeks after surgery, once they are stable and free of signs of rejection of the new kidney.
You may not be aware that exercise itself can increase the excretion in your urine of protein and/or microalbumin, which are traditionally used by your doctor as indicators of kidney problems. For your peace of mind, and to prevent false conclusions, abstain from exercising on any day that you are collecting your urine for either of these tests so that your results will not be erroneously skewed and misinterpreted as evidence of kidney damage or disease progression.
In two weeks, I will share more tips and ideas from my latest book, The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight (2006). Information about all of my books, my many articles, my research, and more is available on my web site: www.SheriColberg.com.