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Cardio Diabetes Medicine 2017 575

of skeletal muscle that substantially increases ener- It is appropriate to know one’s maximal heart rate
gy expenditure above resting expenditure. Exercise (MHR) while discussing on intensity of the program.
is the subset of planned structured and repetitive The more accurate equation of Garber (2011) for es-
bodily movements done with the intention of de- timating MHR, especially in older population utilizing
veloping and maintaining physical fitness which in- 70% of age rather than full age can be utilized.
cludes cardiovascular strength and flexibility training MHR = 208-(0.7 x Age)
options. Physical fitness has been defined as a set
of attributes that people have or achieve relating to Benefits Of Exercise:
their ability to perform physical activity. It includes
cardio respiratory fitness, muscle strength body com- Regular physical exercise is recognized to have sev-
pensation and flexibility. Aerobic exercise means that eral benefits to health, not only for those with DM
uses primarily aerobic energy producing system and but for everyone. Moderate intensity, sustained ex-
involves repeated and continuous movement of the ercise in patients with either type 1 or type 2 diabe-
same large muscle groups for extended periods of tes may be used to help day to day basic regulation
time at last 10min at a time. If performed with suf- of glucose may be the mechanism by which regular
ficient intensity and frequency, aerobic exercise in- physical exercise assists in achieving improved long
creases cardio respiratory fitness. This type includes term metabolic control. The benefits of exercise for
walking, cycling, jagging, swimming, calisthenics, etc. patients with diabetes are listed in Table 1. Regular
Anaerobic exercise is short, high intensity exercise physical exercise lowers blood glucose concentra-
involving anaerobic energy producing systems. This tions during and after exercise and also results in
type if, performed with sufficient intensity and fre- lower fasting and post meal insulin concentrations
quency can increase the body ability to with stand and increased insulin sensitivity. In T DM, increased
1
acid-base imbalance during high intensity exercise. insulin sensitivity results in lowered insulin require-
ments. In T DM, the improved insulin sensitivity is the
2
Resistance exercise major importance in improving long term glycemic
control. Several studies have shown that both aero-
means as strength training or weight training which bic and resistance exercise programs improve insulin
involves the use of muscular strength to work against sensitivity and glycemic control as evidenced by im-
a resistance load or move a weight. This includes lift- provement in HbA c levels.
ing free weights or using weight machines. Regular 1
resistance exercise at sufficient intensity increases Another major benefit of regular physical exercise is
muscular fitness. Dose in exercise physiology means reduction in cardiovascular risk factors which is dis-
the total amount of energy expended in physical ac- cussed in detail. Physical exercise is effective adjunct
tivity. Intensity refers to the rate of energy expendi- to diet for weight reduction and weight maintenance.
ture during such activity which classified as absolute Regular and sustained physical exercise, because
or relative. of increased energy expenditure, increased fat loss
Absolute intensity occurs with preservation of lean body mass. Several
studies have shown that regular physical exercise is
reflects the rate of energy expenditure during exer- an important part of the life style modification pro-
cise and in usually expressed in metabolic equiva- gram and especially important for achieving weight
lents or METS maintenance after weight loss goal, have been
achieved besides cardiovascular conditioning, exer-
Relative intensity cise improves physical working capacity in terms of
refers to the percent of aerobic power utilized during increased strength and flexibility. Finally, psycholog-
exercise and is expressed as percent of maximal ical benefits of exercise such as an improved sense
heart rate or percent of Vo max. of well being, improved self esteem and an enhanced
2 quality of life are also important for persons with di-
Moderate physical activity or exercise is those per- abetes, who have to cope with the anxieties and lim-
formed at a relative intensity of 40% to 60% of Vo itation of living with a chronic disease.
2
max, whereas vigorous ones are there performed at a
relative intensity of > 60% of Vo max. Flexibility exer-
2
cises improve range of motion around joints. Balance TABLE 1.
exercises benefit gait and prevent falls. Activities like BENEFITS OF EXERCISE FOR PATIENTS
tai chi and yoga combine flexibility balance and re-
sistance activities.

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