Safe and Healthy Exercise for People with Diabetes Fact Sheet

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Summa Health System developed this fact sheet for patients with diabetes. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook.

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Safe and Healthy Exercise for People with Diabetes Family Medicine Center of Akron

People with diabetes should exercise daily because exercise

• Helps control blood sugar.
• Helps controls body weight.
• Helps control cholesterol.
• Strengthens the heart, lungs and bones.
• Helps prevent heart attack and stroke.

You should check with your doctor before beginning an exercise program because

• Exercise can worsen some problems with eyes, kidneys, nerves and feet
• Blood pressure during exercise may rise higher than it does in nondiabetic persons
• Blood glucose can fall too low after exercise

General guidelines for safe exercise for people with diabetes

• Carry diabetic identification.
• Carry glucose tablets or a snack in case of low blood sugar.
• Do not increase your food intake just because you are exercising.
• If possible, exercise approximately one hour after a meal.
• Monitor your blood sugar before and after exercise.
  • If blood sugar is below less than 100, eat a healthy snack or take 2 glucose tablets
  • If blood glucose level is over 300 mg, but no ketones are present, exercise with caution, then, test both glucose and ketones after exercise.
  • If fasting blood glucose is over 250, and urine test is Positive for ketones, avoid exercise
• Do not inject insulin into a muscle that you will use heavily.

Precautions for people with known or possible heart disease

A stress test is often recommended before starting a moderate to high-intensity exercise program for people with diabetes who have one of the following criteria:

• Age >35 years.
• Type 2 diabetes of >10 years' duration.
• Type 1 diabetes of >15 years' duration.
• Presence of any additional risk factor for coronary artery disease.
• Presence of microvascular disease (proliferative retinopathy or nephropathy, including: microalbuminuria)
• Peripheral vascular disease
• Autonomic neuropathy

Precautions for people with Diabetic retinopathy

If you have retinopathy (changes in the eye caused by diabetes), certain types of exercise may aggravate your condition. Check with your eye doctor on the level of

Level of Retinopathy	Acceptable activities	Discouraged activities	Ocular re-evaluation
No retinopathy	Dictated by medical status	Dictated by medical status	12 months
Mild Nonproliferative retinopathy	Dictated by medical status	Dictated by medical status	6-12 months
Moderate Nonproliferative retinopathy	Dictated by medical status	Activities that dramatically elevated blood pressure Power lifting Heavy Valsalva	4-6 months
Severe NPDR	Dictated by medical status	Activities the significantly increase systolic BP, Valsalva maneuvers, & active jarring Boxing Heavy competitive sports	2-4 months (may require laser surgery)
Proliferative retinopathy	Low impact, cardiovascular conditioning Swimming Walking Low impact aerobics Stationary cycling Endurance exercises	Strenuous activities, Valsalva maneuvers, pounding or jarring Weight lifting Jogging High impact aerobics Racquet sports Strenuous trumpet playing	1-2 months (may require laser surgery)

Precautions for patients who have lost Protective Sensation in their feet

Contraindicated exercise	Recommended exercise
Treadmill Prolonged walking Jogging Step exercises	Swimming Bicycling Rowing Chair exercises Arm exercises Other non-weight bearing exercise

Safe and Healthy Exercise

Your doctor has recommended an exercise program. Exercise is helpful for people with certain health conditions such as high blood pressure, high cholesterol, diabetes, heart failure, coronary artery disease, poor circulation, and excess weight. The information here is general in nature, and is intended to help you begin a safe and successful walking program.

Safety Precautions:

• Walking is very safe, but if you have chest pain or shortness of breath that makes you stop walking or prevents you from walking, you should consult with your doctor before beginning a walking program.
• Once you start exercising, if you feel any chest pressure, severe shortness of breath, jaw pain, faintness or dizziness, you should Stop Exercising Immediately! Then, call your physician.

Why Walk?

Walking can be for everyone, regardless of age, lifestyle or physical condition. Walking is:

Healthy: Walking is good aerobic exercise. It improves circulation, relieves stress and builds strength and endurance.

Convenient: You can do it anywhere, anytime, by yourself or in a group.

Inexpensive: All that is necessary are supportive, comfortable shoes.

Injury Free: Walking is gentle on the body. Be sure to follow the rules of good foot care. Wear athletic socks and shoes that do not cause blisters.

Tips for Healthy Exercise

• Proper aerobic exercise routines consists of a 5-minute warm-up. Then a 20-40 minute aerobic exercise period within your target heart rate. Finish with another 5-minute cool-down period.
• Warm up with easy exercises like walking, stretching, and light calisthenics.
• Proper stretching will increase your performance and reduce the chance of injury. Proper stretching involves 1) Isolating the specific muscles, 2) Holding the stretch for at least 30 seconds, 3) There should be NO PAIN, just a good stretching sensation, 4) Finally, Do Not Bounce While Stretching!
• If you are involved in an aerobic activity, it is very important to take your pulse. Find your pulse at the base of your thumb close to your wrist. Take your pulse for 10 seconds and multiply by 6.

How to Determine Your Target Heart Rate

Heart Rate	Example
220-age = Max Heart Rate	220-50 = 170 bpm
MHR x 65% = Lower training zone	170 x 65% = 110 bpm
MHR x 85% = Higher training zone	170 x 85% = 145 bpm

• After exercising, you need to cool down your muscles by stretching again. This helps to decrease post-exercise muscle soreness.
• If you notice your joints or muscles are constantly sore, you need to back down on your exercise intensity and/or frequency. If you notice any swelling, that is another indication to slow down or stop exercising for a few days.
• To care for your injuries, stop exercising for a few days. Also, applying ice to the injured area will help keep the swelling to a minimum. Do this for 20 minutes every 2 hours. If you are still having problems contact your physician.
• If your activity is swimming, your target heart rate will be about 10 beats per minute lower due to the body's horizontal position.

Beginning Walking Program

Week	Time Per Session	Daily Distance	Average Walking Speed
1	15-30 mins	½-1 mile/days walked	30-45 spm
2	20-30 mins	½-1½ "	30-60 spm
3	25-35 mins	¾-1¾ "	35-65 spm
4	30-40 mins	1-1¾ "	40-70 spm
5	30-40 mins	1¼-1¾ "	40-75 spm
6	35-45 mins	1½-2 "	45-90 spm

* SPM – Steps Per Minute

Higher Intensity Walking Program

Week	Sessions Per Week	Aerobic Time/Mins	Total Walk Time/Mins	Distance Miles/Day
7-8	3-4	15-20	45-60	2-3
9-10	3-4	17-23	45-60	2¼-3¼
11-12	4	20-25	45-60	2½-3½
13-14	3-4	20-30	60-75	2¾-3¾
15-16	4-5	25-30	60-75	3-4
17-18	4-5	30-40	60-90	3-5

Questions About Exercise?
Call the Family Medicine Center at (330) 375-3584 or 1-800-460-2332.

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