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Wednesday, December 16, 2015

Physiotherapy and How to do Exercise for Diabetic

What we need to know
q  It is now generally considered that
physical activity should play a key role
in the management of individuals with
diabetes 1,2.                   
q   However there are a
number of factors that people with type
II diabetes should be aware of prior to
beginning an exercise program or
increasing activity levels.

You should not begin an exercise program and you should seek medical advice if you have
v  Unstable angina
v  BP >200/100
v  Significant drop in BP during activity
v  Febrile illness
v  Uncontrolled glycaemia
Recommendation One
A medical history and physical
examination should be performed
by your GP prior to commencement.
¨  Reasons: Different stages of Type II
¨    diabetes can present unique problems that may need to be highlighted prior to an exercise routine so that appropriate modifications can be made. For example peripheral and autonomic neuropathy.

Physical activity programs
        For those with type II diabetes without significant complications or limitations should include arrange of endurance and resistance exercises.The following recommendations will help you to decide
¨  how much exercise you need,
¨  how hard it should be,
¨  how often you should do it and
¨  what to expect as you become more physically active.

Frequency (How much is enough?)
¨  Research suggests at least three
Non consecutive days and up to five physical
activity sessions each week to improve
cardiovascular endurance

Intensity (How hard?)
¨  Research suggests low-to-moderate
intensity physical activity (RPE 10-12)
¨  Due to potential autonomic changes or
medications is may not be appropriate to use
heart rate as a guide of intensity therefore the
BORG rate of perceived exertion scale is
suggested as an easy means of self


Example of exercise

Time (How long?)
¨  New to exercise or long lay off ?– start with
10-15mins. Gradually increase this over the
coming session until you can manage 30
¨  If weight loss is a goal then gradually increase
the sessions to 60 mins of low-moderate

Type (what sort of exercise ?)
Should be enjoyable but allow for good control
over intensity.
¨  Combining with personal
hobbies/interests is better. E.g. bird watching –
may involve long varied walks at the weekend.
¨  Walking is the most popular activity but such
conditions as peripheral neuropathy or
degenerative arthritis may require alternatives.
¨  That are non-weight bearing such as swimming
and cycling Resistance training to improve muscle mass,
muscle strength and endurance also has been
shown to decrease risk factors for
cardiovascular disease

Guideline for exercise
¨  Guidelines suggest 2 days a week of 8-10
exercises involving major muscle groups.
one set of 10-15 repetitions to near fatigue is
suggested as a good place to begin.
¨  However as poor technique or unfamiliarity with
machines is common then appropriate screening
and supervision is recommended prior to
commencing. Particular caution should be taken
with retinal and cardiovascular complications

Recommendation Before and After Exercise
¨  Ensure you have proper fitting footwear that is suitable for the activity you are doing.
¨  Monitor your feet before and after exercise for signs of blisters or damage
¨  Get your feet checked regularly.

¨  If taking insulin you need to be aware of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), both of which have implications for exercise
¨  Factors affecting low blood sugar levels are the intensity and duration of the exercise, dose and timing of insulin , time of day and environment
¨  Make sure you monitor glucose levels before and after exercise and during exercise of greater than 60 mins. 1 You may need to alter insulin levels or increase carbohydrate.
¨  For high blood sugar (blood glucose levels above 15mmol/l) prior to activity it is suggested physical activity should be postponed until normal levels return.
¨  Don’t forget to adequately hydrate prior to, during and after exercise. D R I N K.


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