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Nearly 12% of the Indian population has diabetes - a set of conditions in which the body is unable to make or properly use the insulin hormone for controlling blood glucose levels. Union Ministry of Health and Family Welfare data show that an estimated 72 million people in India were living with diabetes by 2017. Further, according to one estimate, one in six Indians is prediabetic. Both these sets of people - prediabetics and diabetics can benefit greatly from exercise for different reasons.

  • Prediabetes is a state when fasting blood sugar levels are between 100 and 125 milligrams per deciliter (mm/dL) - or a little over the normal range (80 - 100 mm/dL). At this stage, exercise and diet control can help patients to reverse the condition.
  • Diabetics can benefit from exercise as exercise increases blood circulation, helps in weight loss and reduces stress. All of which helps to

A sedentary lifestyle has been closely linked with the spread of diabetes, and incorporating a more active routine can, of itself, benefit those afflicted by the disease greatly: The National Health Portal of India recommends at least 150 minutes of light to moderate aerobic activity in a week for adults. Additionally, diabetes exercises can vary in intensity and skill level, to make it easier for older patients as well as those with other ailments to cope.

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  1. Importance of exercise for diabetes
  2. Benefits of exercises for diabetes
  3. Types of exercises for diabetes
  4. How much exercise is needed for diabetes patients?
  5. Exercise tips for diabetics
  6. Takeaways for exercising with diabetes
  7. Doctors for Exercises for Diabetes

"The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes and prediabetes," according to a position statement of the American Diabetes Association (ADA).

The ADA recommends light activity every 30 minutes as well as a structured exercise programme. The reason: a sedentary lifestyle, poor eating habits and obesity are among the chief causes of this health condition.

Of course, advancing age, gender, family history and race (for example, studies show that South Asians including Indians are more likely to develop diabetes than Caucasian populations, and Asians are also more likely to get diabetes at a younger age) are also linked to diabetes risk. But factors such as lifestyle, diet and healthy body weight are the ones within our control - while we can change our age, genes or family history, we can focus on these to improve health outcomes.

This is why exercise remains a critical weapon against managing the symptoms of diabetes as it helps regulate the body’s blood sugar levels by increasing insulin sensitivity and converting the sugar in the body into energy.

Regular exercise has always been recommended as one of the first lines of defence against the disease, particularly for those with symptoms of type 2 diabetes. Here is why doctors often suggest adopting a more active lifestyle:

  • Decreases insulin resistance: Type 2 diabetes is prevalent among the younger populations due to leading sedentary or inactive lifestyles and is commonly linked to obesity as well. Regular exercise helps the body in maintaining a healthy body mass which in turn leads to a higher sensitivity towards insulin in the body. Insulin is the hormone that converts sugar into energy in the body for it to be used by cells all across the body, like in the muscles and bones.
  • Prevents heart disease: Daily exercise is known to improve heart health and prevent complications arising out of Type 2 diabetes, including various forms of heart disease, by lowering blood pressure and reducing the chances of a heart attack or stroke.
  • Maintains body weight: Unchecked weight gain or obesity is one of the leading causes behind the rise of diabetes among patients. Regular exercise promotes a healthier lifestyle and helps in regulating body weight, losing excess fat as well as driving muscle growth.
  • Positive effect on mental health: Regular physical activity is one of the effective ways to alleviate symptoms of various mental health problems, including stress, anxiety and depression by producing endorphins in the body that stimulate feelings of positivity.

The American Diabetes Association recommends three different types of exercise for diabetics:

  • Aerobic exercises increase "mitochondrial density"; mitochondria are the energy powerhouses of each and every cell in the body. They help to break down glucose for energy. A higher density of mitochondria indicates the ability to use up more glucose and therefore lower levels of sugar circulating in the blood. Regular cardio exercises such as running, cycling and swimming also reduce insulin resistance, help in weight loss and improve lung function and immunity.
  • Resistance exercises or strength training improve strength and muscle mass - an important factor to boost metabolism, reduce weight and become healthier overall.
  • Flexibility and balance exercises improve joint mobility - significantly reduce the risk of falling, provide relief from symptoms of neuropathy and improve the mood.

Before starting any exercise programme, it is always beneficial to seek a doctor’s advice about which kind or how much exercise one must do according to their underlying medical condition. There are a variety of exercises that help a person living with diabetes manage their symptoms more effectively and efficiently. Here are a few examples:

  1. Walking
  2. Cycling
  3. Strength training
  4. Swimming
  5. Team sports
  6. Yoga
  7. Dance fitness
  8. Climbing stairs

Walking

Walking at a brisk pace for at least 30 minutes a day during the course of a week is a great way to manage your health parameters and keep your overall stress levels under control. Walking is also a great way to take in the surroundings which also helps in breaking the monotony of sitting at a particular spot for several hours. Walking at a steady pace is good enough to keep your heart pumping blood to all parts of the body.

A study in south India found that 2.5 hours of walking in a week for six months significantly reduced fasting and postprandial (after eating) blood sugar levels though it did not have a significant impact on weight loss. The study participants were mostly women in the 40-60 age group.

Cycling

Done either indoors or outdoors, cycling at a moderate pace over a prolonged period of time is another effective aerobic activity in the fight against diabetes. It is also considered a low-impact exercise, and those with joint pain arising out of diabetes are also better off trying out this activity as it is easier on the body as compared to running.

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Strength training

Exercising with resistance or external weights is also an effective way to keep the symptoms of diabetes in check. Weight training is known to improve or stimulate muscle growth as well as regulate or reduce body weight, which is a well-known factor behind diabetes. Weight training also helps build immunity in the body to fight with infections and diseases as well as improving bone density.

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Swimming

Another effective aerobic activity that promotes heart and lung health, swimming is also kind to the joints, and therefore also suitable for patients who are older and/or obese. A study conducted in 2017 found that aquatic exercises were just as effective in lowering blood sugar levels as land-based physical activities such as aerobic exercises in adults with type 2 diabetes.

Team sports

Participating in sports such as cricket, football, ultimate frisbee, basketball or even playing tennis and badminton is a great way to get in shape and reduce the effects of type 2 diabetes.

Playing sports also helps you break away from the otherwise mundane routine of exercising on your own, and it keeps you motivated to turn up and engage with others, helping you achieve your individual goals of staying healthy.

Team sports are also a great way to build community and reduce the chances of depression. Diabetes and depression are closely linked - having either one increases your risk of having the other condition. A study in south India found that companionship also improves self-care in diabetics.

Yoga

Almost all parameters that are associated with type 2 diabetes are managed effectively with the practice of yoga. A study published in the Journal of Diabetes Research in 2016 found improvements in glycemic control, lipid levels and body mass. Yoga asanas are also known to lower stress and blood pressure levels, improve lung function, promote better sleep and overall quality of life.

Read more: Savasana or corpse pose to reduce stress

Dance fitness

Various forms of dance have become popular aerobic activities across the world, with Zumba and several other forms being marketed as an exciting fitness activity. A study published by the American Journal of Health Behavior in 2015 found out that women with type 2 diabetes or those who were overweight or obese saw a positive impact on their health after practising Zumba for 16 weeks. All the subjects reported losing weight and fat, besides improving their aerobic fitness and being motivated to continue their exercise routine.

Climbing stairs

Ditching the elevator to take the stairs can turn out to be a lifesaver, quite literally. Climbing the flights of stairs at home or at work or shopping centres improves your overall heart and lung health. The blood sugar in the body is greatly reduced by simply climbing up and down the stairs, especially two or three hours after consuming a meal.

While you can choose any of the above mentioned physical activity to reduce symptoms of type 2 diabetes, a combination of aerobic as well as strength training exercises are a great way to improve heart health as well as trigger muscle growth. Resistance training can be performed with the use of external weights or by just doing bodyweight exercises like push-ups, pull-ups or squats. These exercises can be combined with flexibility exercises like yoga as well.

Whether you’re in good physical shape or otherwise, adults are recommended to do at least 150 minutes of physical activity during the course of a week, which translates to about 30 minutes of activity in a day over five days. Depending on your schedule, you can even break these activities down to do 10-minute activities spread over three different times of the day.

Doctors or fitness trainers also encourage people to not keep sitting for more than 30 minutes at a place. Instead, people should get up from their desks and walk or move around to promote blood circulation in the body. It is also advised that one should not go without any physical activity for more than two days in a row.

It is important to keep some things in mind at all times before deciding to give exercise a go, especially if afflicted by diabetes or its symptoms.

  • Doctor's permission and advice: Always keep your doctor informed before beginning an exercise regime. Based on your medical history, the doctor can advise you on which type of physical training would be best suited to you.
  • Check your blood sugar often: Certain symptoms of diabetes, like a drop in blood sugar levels, can creep up suddenly on an individual, especially during intense physical activity. Your doctor can tell you if you need to check your blood sugar before, during or after pursuing an activity.
  • Exercise regularly: Along with proper diet and rest, it is imperative to put in the requisite hours and minutes of physical activity to keep your body’s vitals in check.
  • Choose which workout is best: You may have been an active sportsperson growing up or liked weight training before settling into a sedentary lifestyle. It is important to pick the right exercise that will keep you motivated - not just on a particular day, but throughout your journey towards fitness. Your physical state can also sometimes determine which fitness regime may suit you best at that point in time.
  • Carry something to eat for emergencies: Blood sugar levels can drop unannounced, so ensure that you have an energy bar, a fruit or a small snack with you for workout sessions. (Read more: Hypoglycaemia: symptoms, causes, prevention, diagnosis, treatment)
  • Weight training is important: Along with the aerobic exercise of your choice, factor in at least two days of resistance training into your schedule. Weight or strength training does wonders to control blood sugar levels and even bodyweight exercises can help in that regard.
  • Use proper footwear and right gear: Choose the right footwear for the job. Shoes that fit well allow you to train better without feeling discomfort. The fabric in the clothes you wear also helps in allowing you to breathe better besides helping in sweat absorption.
  • Hydrate yourself: Keep a bottle of water next to you at all times, especially while performing any fitness activity. 
  • Stop when the body tells you to: If you’re feeling tired or something hurts, it is always better to stop or at least pause. Continuing to play through the pain can result in workout injuries, which can derail your fitness plan and put you out of action for a few days or weeks.

Diabetes may be a severely debilitating or demoralising condition, but its symptoms can be effectively managed through timely medication, healthy diet as well as regular exercise.

Exercising has positive effects for diabetics as regular fitness activity ensures that your blood sugar levels are maintained, there is a greater sensitivity to insulin and your body weight is maintained, all of which are critical factors behind diabetes.

It is always a good idea to check with your doctor before beginning a fitness programme, but also ensure that you always properly warm-up before a workout, and follow it up with stretching exercises.

Dr. Tanmay Bharani

Dr. Tanmay Bharani

Endocrinology
15 Years of Experience

Dr. Sunil Kumar Mishra

Dr. Sunil Kumar Mishra

Endocrinology
23 Years of Experience

Dr. Parjeet Kaur

Dr. Parjeet Kaur

Endocrinology
19 Years of Experience

Dr. M Shafi Kuchay

Dr. M Shafi Kuchay

Endocrinology
13 Years of Experience

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References

  1. Colberg S.R. et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care, November 2016; 39(11): 2065-2079.
  2. Misra A., Alappan N.K., Vikram N.K., Goel K., Gupta N., Mittal K., Bhatt S., Luthra K. Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes Care, July 2008; 31(7):1282-7. PMID: 18316394.
  3. Sukla P., Shrivastava S.R. and Shrivastava P.S. A longitudinal study to assess the impact of exercise on clinical, biochemical, and anthropometric parameters among the type 2 diabetes patients of South India. Avicenna Journal of Medicine. January-March 2015; 5(1):16-20. PMID: 25625085.
  4. V. Gopichandran et al. Diabetes self-care activities: A community-based survey in urban southern India. The National Medical Journal of India, 2012; 25(1): 14-17.
  5. Rhee E.J. Diabetes in Asians. Endocrinology and Metabolism (Seoul). September 2015; 30(3): 263-9. PMID: 26435131.
  6. Gujral U.P., Pradeepa R., Weber M.B., Narayan K.M. and Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Annals of the New York Academy of Sciences. April 2013; 1281(1): 51-63. PMID: 23317344.
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