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Step 2: Get Up and Get Moving (Part 1)

Last time Sheri Colberg, Ph.D., FACSM had some great insight as to why patients do not lose weight even though they exercise. This week she helps you give your patients a proper start. Learn what to do by reading Getting Started Is the Hardest Part. Check out this week’s tool for more help.

Step 2: Get Up and Get Moving (Part 1)
Getting Started Is the Hardest Part

SheriBy Sheri Colberg, Ph.D., FACSM

Has your doctor told you to be more physically active, but failed to provide any specifics other than to “exercise more”? If so, you’re not alone. According to recent research, 52 percent of doctors tell their diabetic patients to exercise, but only 14 percent actually “prescribe” it by giving them a specific exercise plan to follow. The medical profession’s stance really should be that exercise is an integral part of your daily regimen, just like brushing your teeth. I firmly believe that not only is it not optional, but it should be prescribed to everyone, along with dietary improvements and, as appropriate, diabetic medications.

Although exercising involves much more work than making adjustments to your diet or just taking medications to control your diabetes, it is well worth the effort for myriad health-related reasons. This section will teach you what you need to know about including appropriate physical activity in your daily regimen to achieve optimal health and fitness. In addition, it discusses how to exercise safely and effectively if you have any diabetic complications, other health concerns, or physical limitations.

Do you need to see your doctor first?
If you haven’t been very active lately, do you need to see your doctor before you begin exercising more? Well, it depends. Medical clearance for low-level exercise is usually not necessary. However, for more vigorous exercise, seeing your doctor before you begin is a good idea. The more risk factors that you have for heart disease, the greater your chance of having a cardiovascular problem during exercise, and prior knowledge of what you need to watch out for could be crucial. That is not to say that you should avoid exercising if you do have some preexisting cardiovascular problems; on the contrary, regular moderate to vigorous activity can actually reduce your risk of a heart attack, even if you have already had one.

You May Want to See Your Doctor First If You . . .
• Are planning on participating in moderate to strenuous activities, not just mild ones
• Are over 35 years of age
• Have been diagnosed with type 1 diabetes for more than 15 years or type 2 for more than 10 years
• Know you have heart disease, a strong family history of heart disease, or high cholesterol or lipid levels
• Have poor circulation in your feet or legs (or lower-leg pain while walking)
• Have retinopathy (diabetic eye disease), nephropathy (kidney disease), or neuropathy (numbness, burning, tingling, or loss of sensation in your feet and/or dizziness when going from sitting to standing)
• Have not consistently been in good control of your blood glucose levels

Most people with type 2 diabetes should undergo a thorough medical exam prior to starting most exercise programs; such an exam should include a physical exam, urinalysis, kidney function testing, serum lipid evaluation, electrolyte balance, and exercise stress testing. The point of such testing is primarily to screen for the presence of any diabetes-related complications, including heart, nerve, eye, and kidney disease. While having such health problems does not automatically preclude you from exercising, doing so safely and effectively with any of these complications may require special accommodations or precautions that will be discussed later. However, if you are just planning to do very low to moderate activities like walking, and you aren’t experiencing any symptoms like chest pain or other discomfort with mild exercise, it is likely fine for you to start doing easy exercise while you are waiting for your opportunity to meet with your doctor.

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.

Tip for the day: As far as your health is concerned, what really matters is expending those extra calories any way that you can. To start moving more, consider walking: simply increase the number of steps that you take during the day and/or add in planned walks.

See more features from Sheri Colberg, Ph.D., FACSM