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What Does It Take to Break the Cycle?

May 29, 2007

Dr. Sheri Colberg, author of The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, has her own take on what Dick and Steve are recommending. Be sure to read What Does It Take to Break the Cycle, and find out more about the best replacement.

What Does It Take to Break the Cycle?

By Sheri Colberg, Ph.D., FACSM


Sheri_ColbergImagine my surprise (not!) when I read in the February 2007 issue of Diabetes Care that people with diabetes (or lots of risk factors for developing it) actually exercise less than the rest of the adult population.  I wish I were more surprised actually, but the results only confirmed what we already know about this insidious disease.
In this latest survey-based study (which was reported on in Diabetes In Control), researchers asked a total of 23,283 American adults whether they were physically active, defined as engaging in moderate to vigorous exercise for at least 30 minutes three times a week, on average.  For the purposes of the study, moderate exercise was described as causing “only light sweating or a slight or moderate increase in breathing or heart rate and would include activities such as fast walking, raking leaves, mowing the lawn, or heavy cleaning.”  Vigorous activities were ones that cause “heavy sweating or large increases in breathing or heart rate,” including activities like running, race walking, lap swimming, aerobic classes, or fast bicycling. Since these activities were “self-reported,” they were considered to have a moderate validity, although in my experience, when it comes to things that people know that they should be doing and aren’t, most people tend to stretch the truth a little (so the news might actually be worse than the study says).

So, who claimed to be meeting the minimum of 90 weekly minutes of such activities?  Overall, 56 percent of all adults said they met this minimal level of moderate or vigorous activities.  Physical activity levels were reportedly higher among males, whites, and people with higher education and income levels.  In addition, in the general population, people reported exercising more when they had been given previous advice by their doctor or other health care provider to do so.  Anyone who perceived himself or herself as not having any physical limitations to exercise was also more active. 

People with diabetes—the ones who absolutely need to be more active for a whole slew of health reasons, blood sugar control being just one of them—were far less physically active.  In fact, only 39 percent of diabetic individuals were physically active on a regular basis, compared with 58 percent of their non-diabetic peers.  When people didn’t have diagnosed diabetes but had a lot of risk factors for it—again, a group that could really benefit from exercise, as it could even help keep them from getting diabetes in the first place—they also exercised less.  In fact, “high risk” individuals exercised about the same as anyone with diabetes, and since a third of people with diabetes are undiagnosed, it’s likely that some of these sedentary individuals actually already had diabetes and just didn’t know it yet.  What’s even worse is the fact that in the diabetic group, people who had been given specific advice to exercise more were not any more likely to be exercising than people who never were advised to.  In the people without diabetes, as mentioned, the medical advice to be more active had sunk in for many.

Due to the way this study was conducted, the researchers admit that they can’t say for certain why it is that people with diabetes are less active than anyone else.  People with diabetes usually have the same motivational barriers—namely, lack of perceived time for or interest in exercise—as their non-diabetic counterparts.  The authors conjectured that perhaps the diabetic individuals have the inertia of a lifetime of bad habits when it comes to being active.  That may be a contributing cause, but other people change their habits, so why can’t you even if you have diabetes?  They also suggested that perhaps the people with diabetes perceive more discomfort when exercising or have a decreased exercise capacity.  While both of these situations are possible, they shouldn’t be insurmountable problems since a little physical conditioning goes a long way when the only way you have to go is up.  Finally, they surmised that depression itself may be a problem for the diabetic group.  Depressed people are less interested in exercising or taking care of themselves, even though exercise is oftentimes a cure for mild to moderate depression.  In this study, adults who were depressed were one third as likely to be physically active, but obviously, it wasn’t a deterrent for everyone.  Although people with diabetes suffer higher rates of depression, not everyone with diabetes is depressed.  The cure?  I advise a little exercise to chase away the blues, improve your stamina, enhance your self-esteem, and alleviate guilt about not doing what you’re supposed to do for better health. 

If you’re hard pressed for time or enough money, you can still become more physically active.  I have written other columns that specifically address way to increase your “unstructured” physical activity (including one earlier this month), which can increase the number of calories you use up in a day and keep you from gaining as much weight.  Really, the whole reason I want to get you up and moving more, though, is really that you can’t possibly know how much better exercise will make you feel until you start doing more of it.  So, start with standing up whenever you can, on the job or wherever your life takes you.  Even standing involves muscular activity, and it’s a good place to start.  Next, take just an extra couple hundred steps every day until you’ve upped your daily steps by at least 1,000 to 2,000 a day.  Stay with that for a while, and see if you start having more energy.  If nothing else, you may sleep better at night.

It’s obvious that something needs to be done for everyone, not just people with diabetes, given that over 40 percent of the American population is technically inactive.  It’s a vicious cycle of moving less and weighing more, and the more you weigh, the less you feel like moving.  Break the cycle now, and just start standing up and taking more steps every day.  When you’re ready for something more challenging (which I assure you will happen if you make the effort to get started), read some of my previous columns for ideas on how to move even more or start doing other types of activities.  Remember, it’s your health we’re talking about.  It’s never too late to start reaping some of the health benefits of being more physically active.


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:  
You only have one body to live in, and it’s up to you to keep it in good working order—whether or not you have diabetes. Start by simply making the pledge to become more physically active on a daily basis. It’s the best medicine for your body.