by Dr. Sheri Colberg, Ph.D., FACSM
Most of the best physical activities don’t require a gym membership, and you certainly don’t have to be able to run a marathon to gain health benefits that will allow you to live a long and healthy life, with or without diabetes.
As is widely known, the benefits of being active are innumerable, including prevention of type 2 diabetes, weight loss and maintenance, improved quality of life, longer self-care abilities, reduced arthritic pain in joints and increased mobility, better balance and falls prevention, stronger bones, and a better memory, just to name a few.
I recently read an online report promoted by the American College of Sports Medicine through social media outlets about five of the best exercises you can ever do. I agreed with them all in principle, but I just want to add my two cents as an exercise professional and diabetes expert about why these (and other) exercises are particularly good for people with diabetes. The online report stated that no matter your age or fitness level, these five activities can help you get in shape and lower your risk for disease: swimming, tai chi, strength training, walking, and Kegel exercises. For people with diabetes, however, I would change and update them to the following instead, including a new order of importance:
(1) Strength training
In recent years, the most compelling scientific evidence for diabetes management has been the inclusion of resistance/strength training as part of an exercise routine. Think of it this way: muscles are the main place we have to store excess carbohydrates that we eat, and the bigger the muscle “tank,” the more carbs we can store there.
Aging by itself causes some loss of muscle mass over time, and being sedentary and having diabetes both increase the rate at which we are losing muscle. We get more insulin resistant when our muscle carb stores (glycogen) are full, which happens when we eat a lot of carbs and remain inactive. Any carbs that are unable to go into storage in muscle (or the liver) are converted into and efficiently stored as fat.
Only strength training recruits and preserves muscle fibers that you would otherwise lose as you age or sit around too much. Start doing strength training at least two to three days per week, even if it’s only doing exercises using your own body weight as resistance (like planks, lunges, or wall push-ups). Resistance bands, dumbbells, and household items that can be used as resistance (e.g., water bottles and soup cans) will also all work.
(2) Daily walking
Since it’s an activity that most people can do, walking should be included as a daily part of almost everyone’s activity plan. Just simply taking more daily steps can help you lose weight and keep it off, lower blood cholesterol levels, keep your bones strong (since it’s a weight-bearing activity), reduce arthritic pain in your hips and knees, lower your blood pressure, and improve your memory. You just have to remember to walk more every day.
When you have diabetes, it is particularly important that most of your walking be done wearing good-fitting and supportive shoes and socks that keep the dampness of your feet to a minimum. It is imperative to inspect your feet every day (using a mirror on the floor to reflect the bottom of your feet, if necessary) to catch problems areas sooner rather than later. Walking has not been shown to cause ulcers to recur if they have healed properly, but any skin irritation discovered and treated early on has less chance of developing into a bigger problem in a diabetic foot.
If your fitness level is low, start by walking for up to 10-15 minutes at a time. As you are able, walk farther and faster until you reach a goal of at least 30 minutes most days of the week. If you do not have time to time a single walk for that length of time, it is perfectly acceptable to walk more times during the day for a shorter amount of time to add up to that total.
(3) Tai chi, yoga, stretching, and balance exercises
Tai chi is made up of a series of graceful movements that work on stretching, strength, and balance all at the same time, but most people have to sign up for a class to help get started and learn the proper form. You can find tai chi programs at your local YMCA, health club, community center, or senior center.
Equally helpful and important are other activities that also work on balance and flexibility, such as yoga, dynamic or static stretching, and balance training. The latter can be as simple as practicing standing on one leg at a time without holding on (or with minimal support), first with your eyes open and later with them closed. Stretching is easiest to do after warming up by doing a light aerobic activity first.
Improving both your flexibility and balance is critical to preventing falls, which are even more common in people with diabetes as they age or if they develop peripheral neuropathy. Diabetes also accelerates the loss of flexibility due to glycation of collagen in joints, and having less range of motion around joints increases the likelihood of injuries, falls, and self-imposed states of physical inactivity due to fear of falling. It never pays to neglect these important activities.
(4) Swimming or other aquatic exercise
When you swim or exercise in the water, your added buoyancy takes the strain off painful joints so you can move them more fluidly. Among the non-weight-bearing activities, it is probably the best one of all. The only drawback is that it does very little to stimulate better bone mineral density and should, for that reason, be combined with other activities that are weight-bearing.
While swimming is an excellent activity, engaging in aquatic classes (like water aerobics) in either shallow or deep water is also challenging and beneficial. Many of these activities incorporate both a stretching component and a strength-building element that can improve joint mobility, overall strength, and aerobic fitness all at the same time.
(5) Kegel exercises
Kegel exercises strengthen the pelvic floor muscles that support the bladder and help prevent urinary incontinence (which can be a deterrent to doing many other physical activities). More women than men are familiar with these exercises, but they benefit men equally as well.
You can practice your Kegels by squeezing and releasing the muscles you use to stop urination or prevent yourself from passing gas. Work up to doing three sets of 10-15 Kegel exercises every day, and alternate quick squeezes and releases with longer, 10-second contractions and relaxations. Work up to doing three 3 sets of 10-15 Kegel exercises each day for best results.
In conclusion, never forget that many other daily activities count as exercise, including yard work, gardening, ballroom dancing, playing with your kids or grandkids, walking the dog, doing housework, and standing up. It’s still recommended that you aim to do at least 150 minutes a week of aerobic exercise and a minimum of two days of strength training a week, but keep in mind that doing any activity at all (even if less than recommended) is better than doing none. So, get up and get active!