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Cardio Diabetes Medicine 2017 577

A structured endurance exercise program, increased unusual intensity for them may precipitate angina
physical activity or both sufficient to maintain and pectoris, myocardial infarction, cardiac arrhythmias
enhance cardio respiratory fitness and multiple ma- or sudden death if there is underlying coronary artery
chineries involved. dieses. Degenerative joint disease in obese people
may be exacerbated by weight bearing exercise and
Risks of Exercise in Diabetes : also patients with sensory neuropathy may experi-
ence joint and soft tissue injuries while participating
There are various risks associated with exercise
for patients with diabetes and these risks must be in exercise.
weighed against the potential benefits. In type1diabe- A number of other complications of diabetes may be
tes either hypoglycemia or hyperglycemia can occur aggravated by exercise. The most important compli-
during exercise, depending on its intensity and dura- cation is proliferative retinopathy in which exercise
tion, the amount and timing of injection insulin and may result in retinal or vitreous hemorrhage. Ex-
the carbohydrate intake of the individual. Moreover, tremely strenuous exercise or exercise associated
after strenuous and prolonged, onset post-exercise Valsalva like maneuvers is particularly dangerous in
hypoglycemia can occur 6 – 15 hr after completion of patients with proliferative retinopathy. Also exercise
the exercise which may persist up to 24hrs. Further resulting in jarring or rapid head motion may precip-
when exercise is superimposed on the insulin defi- itate hemorrhage or retinal detachment. Physical ex-
cient state a rapid increase in good glucose concen- ercise is also associated with increased proteinuria in
tration and the development of ketosis may occur. patients with diabetic nephropathy due to changes in
Even with well controlled T DM, brief periods of high renal hemodynamics. In diabetic autonomic neurop-
1
intensity may cause hyperglycemia. athy , the capacity for high intensity exercise may
be impaired because of decreased maximum heart
Prudent screening for underlying cardiac disease
is mandatory for all diabetes, especially those with rate and aerobic capacity. In addition, there may be
T DM. In adults a vigorous exercise program with an impaired response to dehydration and problems
2 with postural hypotension.
TABLE 2. RISK O F EXERCISE FOR PATIENTS WITH DIABETES
1. Hypoglycemia if treated with Insulin or oral agents. 10. Worsening of long term complications of diabetes
2. Exercise induced hypoglycemia 11. Proliferative retinopathy
Vitreous hemorrhage
Retinal detachment
3. Late- onset post exercise Hypoglycemia 12. Nephropathy

Increased Proteinuria
4. Hypoglycemia after very sternous exercise 13. Peripheral Neuropathy

Decreased cardiovascular response to exercise
Decreased maximum aerobic capacity
5. Hyperglycemia and ketosis in T1DM patients 14. Impaired response to dehydration
6. Precipitation or exacerbation of CVD 15. Postural hypotension
7. Angina pectoris
8. Myocardial Infarction
9. Arrhythmias

With proper screening of the patients and selection of the type, intensity and duration of exercise most of
these complications can be averted.

Cardio Diabetes Medicine