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Step 2: Get Up and Get Moving (Part 5)

Dec 12, 2006

Now that your patients are over their fear of activity, Sheri Colberg, Ph.D., FACSM helps you Choose Planned Activities-Strength and Flexibility for your patients, and how you can get your patients to do them.

Step 2: Get Up and Get Moving (Part 5)
Choosing Planned Activities—Strength and Flexibility

SheriBy Sheri Colberg, Ph.D., FACSM


Strength and toning moves keep you from losing it
Strength training is imperative to maintain the amount of muscle you currently have, to gain more, and to prevent losses of muscle and strength as you age. Inactivity also accelerates your loss of muscle mass (the old “Use it or lose it” adage is also true in this case). Even though aerobic training can help, only the muscle fibers that you recruit and use regularly will be maintained over time; unfortunately, moderate walking does not bring all of your muscle fibers into play. Only harder workouts can do that.

Muscle fibers run the spectrum from being very aerobic (slow-twitch fibers) to being mainly recruited for heavy lifting or near-maximal exercise (fast-twitch fibers); all types of fibers can exist within a single muscle. How many and which muscles you recruit during an activity depends on how much force your muscles have to produce. For example, for easy work, you use only the very aerobic (slow) fibers in the muscles you’re using. However, if you increase your workload, you’ll be recruiting not just the slow ones, but also some of the intermediate-speed fibers. To do a maximal weight lift or all-out sprint, you’ll be recruiting all of the ones we’ve discussed so far, plus your very fastest fibers, which are capable of producing the most power in the shortest amount of time.

It’s easy to tell when those fastest fibers are being recruited, because their work is fueled primarily by our first two energy systems, the phosphagens and the lactic acid system. If a heavy lift takes you only one to two seconds to complete, then you invariably just use the ATP (part of the phosphagen system) that you already had stored in your muscle ready for use. For activities lasting longer than 10 seconds but less than a minute (such as a resistance-training exercise), you should recognize the uncomfortable, “burning” sensation in your working muscles as the lactic acid system (which breaks down muscle glycogen) coming into play. This sensation is not harmful to your muscles, and it’s an excellent means of knowing whether you’re recruiting all of the faster muscle fibers that you want to keep.

The addition of resistance training can bestow extra health benefits. Such training increases muscle mass, which can enhance both your insulin action and your round-the-clock resting energy expenditure (and, thus, glycemic control), not to mention self-esteem and feelings of accomplishment. You will also experience measurable increases in strength in as short a time as one to two weeks (from neural changes, which occur before increases in muscle size), which will serve as additional motivation. Furthermore, major strength gains are possible even if you train as infrequently as one day a week.

Strength gains are the key to preventing injuries, particularly from falling, which occurs more often as people age. Increases in strength can also prevent the frailty that so often accompanies old age, enhance your ability to care for yourself, and improve your physical and mental health. Some people may be confined to a wheelchair simply because getting up out of it is too difficult, but the increased strength gained from resistance work can enable them to return to doing more activities out of their wheelchairs.

Living with chronic pain is also a reality for many people, and strength gains have been shown to alleviate pain associated with muscle weakness–such as is often the case with lower back pain. Humans do not have the structural advantage of walking on all fours; when you walk, your lower back must bear the brunt of your body’s weight. Our lower backs have also come to bear much of the increasing stress of daily living in a modern world, including poor posture, lack of exercise, and weight gain. As we become more sedentary, stress on our lower backs is only increased, since sitting is, in fact, an unnatural position. In addition to assuming a better posture, exercising more, and losing some of your belly fat, specifically working to strengthen your lower back is the best way to prevent lower back pain and injuries.

Flexibility work makes your joints mobile
Working on your flexibility also helps prevent injuries and is doubly important for anyone with diabetes. We’re all becoming less flexible over time–just compare the limberness of an infant with the inflexibility of an older adult–so some loss of flexibility is to be expected. However, an elevated blood glucose level by itself can speed up this loss of flexibility by binding to joint structures (collagen and the like) and causing them to become more brittle and less flexible. A loss of flexibility leads to a reduced range of motion for your joints, an increased likelihood of orthopedic injuries, and a greater risk of developing some of the joint-related problems often associated with diabetes. These include diabetic “frozen shoulder,” tendonitis, trigger finger, carpal tunnel syndrome, and others.

The American College of Sports Medicine (ACSM) recommends that you work on your flexibility a minimum of two to three days per week, but I recommend stretching before and/or after any exercise session or any other time that your muscles start to tighten up. Depending on the exercise that I’m doing, I may stretch before (running), during (after about five minutes of swimming, when my shoulders tighten up), or after (resistance training). It doesn’t seem to matter when you stretch, as long as you do it, but it’s usually easier to do once you’ve warmed up a little.

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: Carrying around extra body weight is harder on the joints in your lower extremities (i.e., your hips, knees, and ankles). Try out different activities until you find the ones that are the most comfortable for you to do, and stick with those. In addition, make certain to include adequate warm-up and cool-down periods, along with flexibility and strength exercises.

Learn more about the Steps to Health Program at STEPS TO HEALTH

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