The clinical challenge
There is irrefutable evidence from studies such as the Look AHEAD trial that physical activity or exercise not only improves blood glucose control in persons with diabetes, but also positively affects lipids, blood pressure, cardiovascular events, and quality and quantity of life. Nonetheless, this is one aspect of diabetes management that is greatly overlooked both by healthcare providers and persons with diabetes. Possible reasons for this include perceived difficulty taking part in exercise, fatigue, distractions, lack of time, and not being aware of the benefits.
A pragmatic solution
The benefits of exercise, especially in the prevention of diabetes complications, should be made known to the patients. Patients should be informed that physical activity is part of the “medicines” employed in the daily management of diabetes. To facilitate this, prescribed exercise should be within the usual routine of the patient. Walking, indoors (for those who feel it is cumbersome doing so outdoors) or outdoors, for at least 30 minutes daily is encouraged especially in older persons and where exercise facilities are lacking. For persons who are able, cycling, swimming, weightlifting, and aerobic dancing may also be prescribed. Targets should be set and the use of apps such as step counters that monitor progress employed.
Exercise should be done preferably about 30 minutes after a meal especially in persons on insulin or secretagogues as this not only reduces the occurrence of hypoglycemia, but also ensures postprandial glucose lowering.
Physicians should cultivate an exercise regimen; research has shown that physicians who exercise are more likely to counsel their patients to exercise.
A prescribed exercise regimen is part of the daily “medicines” required for management of diabetes. A practical approach will be from that of a healthcare provider who also engages in physical activity.
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