Page 604 - fbkCardioDiabetes_2017

580 Exercise and Physical Activity in Diabetes Mellitus

of exercise. Apart from neuromuscular stability, walk- gradually from conditioning phase and for safe tran-
ing has accessibility, social companionship, lack of sition to original state.
special equipments, easily tolerable exercise in inten-
sity, fewer muscle skeletal and orthopedic problems Exercise Prescription :
of the legs, knee and feet.
This could specifically address certain questions like
Aerobic Exercise Recommendations : what type of exercise (mode), how much, (Intensity)
how long (duration) and how often (frequency) and
Aerobic exercise has been the mode of physical ac- rate of progression of the program (Progression).
tivity traditionally recommended for diabetes man- While these are interrelated and will vary depending
agement and prevention. The American college of on the goals of physical activity in the individual pa-
sports medicine (ACSM) recommends moderate – tient and the patients choices, needs, back ground
intensity training for at least 30min/day or 5 days and health condition. While imparting the exercise
/week (a total of at least 150 min/week), vigorous prescription to patients with diabetes safety rec-
intensity training for at least 20min/day on 3days/ ommendation should be incorporated concerning
week (at least 60-75 min/week). For patients with the mode, frequency, duration and intensity of the
T DM, exercise recommendations are closely aligned advised exercise. Timing of medications, food and
1
with those for apparently healthy people. Recommen- glucose monitoring in relation to exercise should be
dations for women with uncomplicated gestational discussed.
diabetes (GDM) include engaging in 30 min of mod-
erate intensity activity like brisk walking on most Guidelines and Recommendations for Exer-
days of the week (150 min/week) cise in Diabetes:

Each Aerobic Exercise Session Generally Has there are several guidelines and recommendation
3 Different Phases : from authorities like ADA and ACSM available which
incorporate the beneficial effect of all types of phys-
Warm-up phase includes 5-10 min of physical activ- ical training program suitable for all types of diabe-
ity done at a lower intensity such as cycling slowly. tes population. Before considering the recommen-
This will help to prevent muscle injury and facilitates dations, it is better to formulate certain facts before
a safe transition from rest to exercise by stretching presenting the particular exercise like discussing the
postural muscles, increasing blood flow elevating patient’s expectation, establishing the realistic goals,
body temperature and increasing O availability and mode, frequency, intensity and rate of progression
2
metabolic rate.
of the activity and developing a plan to keep track
Conditioning Phase of progress. Safety considerations like contra-indi-
cations, medication in relation to exercise, glucose
is the most important for achieving fitness and other monitoring, snacking, appropriate foot wear, identi-
goals like enhancing cardiac respiratory fitness, mus- fication tag or bracelet all be accounted for (Tables
cle strength and endurance or flexibility. 4 & 5)

Cool down Phase includes at least 3-5 min of doing
a lower-intensity activity to help the body to recover

TABEL 4: GENERAL GUIDELINES FOR EXERCISE IN DIABETES
Exercise used to reduce weight should be combined with dietary measures
Exercise should be appropriate to the person’s general physical condition and lifestyle.
Moderate intensity aerobic exercise should be part of the daily schedule, if possible accumulation 150 min
each week. More vigorous exercise (> 70% of VO2 max) undertaken 3-5 times per week. Pervious sedentary
patients may have to buildup exercise volume gradually starting with as little on 5-10 min/day.
Multiple shorter exercise sessions lasting at least 10 min/ day are probably as useful as a single larger
session
If vigorous exercise is taken, low intensity warm-up and cool-down periods to be included.
Resistance exercise to be performed 2 -3 times / week to be progressed to 3 sets of approximately &
resistance type exercise at relatively high intensity if scalable.
Use of proper footwear and if appropriate other protective devices

GCDC 2017