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Diabetes - Physical Activity and Exercise

Diabetes - Exercise and Physical Activity

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Introduction

Physical activity is an important part in maintaining the overall balance of energy expenditure. It plays a key role in maintaining glucose control and body weight. Other benefits include reduction in cardiovascular risk and improved psychological and physical wellbeing. Ideally physical activity should be a regular part of lifestyle as unaccustomed or erratic exertion can be problematic.

Declining trends in daily physical activity (reduced calorie expenditure) over last 50 years have contributed to current epidemic of obesity and diabetes especially in children.

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Impact of Physical Activity on Glucose Control

Blood glucose is a key energy source that is used to maintain any physical activity or exercise, at least in short term. Therefore

Patients with diabetes should be advised that activity may cause changes in blood glucose: individual patterns may vary. Hypoglycaemia is the major risk and may occur up to 24 hours after the exercise.

Physical activity patterns should be considered when choosing diabetes treatments which may need to be flexible to accommodate the activity.

Factors that influence glucose control during and after exercise

Type of exercise & physical activity

Intensity and duration of exercise

Co-administration of insulin or sulphonylurea therapy

Carbohydrate consumption

Current level of blood glucose control

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General Principles for Safe Exercise

Avoid unaccustomed moderate to severe physical activity

Start with mild intensity physical activities for short periods

Progressively increase the duration

Progressively increase the intensity

For full health benefit use a range of physical activities

Blood glucose monitoring is advisable for patients who are at risk of hypoglycaemia (on insulin or Sulphonylurea treatment). Seeing the effects of regular exercise on blood glucose levels can be motivational.

 

Before Physical Activity

 

If activity is planned then it may be possible to reduce insulin or sulphonylurea doses or increase carbohydrate intake if experience suggests that it is likely to cause hypoglycaemia.  Patients should be advised to check blood glucose level if possible before exercise.  Type 1 patients should check for ketones if blood glucose is >14mmol/l.

 

During Exercise

 

Patients should carry diabetes identification and inform team members / opponents of their risk of hypoglycaemia and the appropriate action to take if it occurs or is suspected.

 

It may be necessary to take extra carbohydrate at intervals during extended exercise. Patients who are at risk should ensure they have ready access to quick acting glucose during exercise..

 

After Exercise

 

Some patients will require a reduction in dose of insulin or sulphonylurea or an increase in carbohydrate after exercise.  It is important to be aware of the risk of hypoglycaemia for many hours after exercise.

 

Over enthusiastic use of carbohydrate should be avoided as this can negate the benefits of exercise on body weight!  Individual response to exercise should be used to guide the optimum strategy.  In general overweight patients should not be advised to increase carbohydrate unless experience suggests that they are at risk of hypoglycemia; in that case if on insulin or sulphonylureas they should reduce this first.  Patients on metformin, glitazones or gliptins are at low risk of hypoglycaemia

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Specific diabetes related issues with exercise

Activities that increase the intraocular pressures such as lifting heavy weights can make diabetic eye problems worse.

Peripheral neuropathy may make foot damage more likely in certain activities such as running or walking: swimming or aquarobics may be better.  Good footwear and footcare is very important.

ABCD has produced a position statement on physical activity and exercise in diabetes
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Exercise Prescription Schemes

Active Luton - See Useful External Resources for Referral Form.

Bedfordshire Exercise On Prescription - Referral Form

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Useful External Resources / Links

View

Active Luton
View ABCD position statement on physical activity and exercise in diabetes
View NICE | PH35 Preventing type 2 diabetes: population and community - level interventions
View NICE| PH38 Preventing type 2 diabetes: risk identification and intervention for individuals at high risk
PDF File Bedfordshire Exercise On Prescription - Referral Form

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Active Luton Exercise Referral Criteria

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Active Luton Exercise Referral Form

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Declining Trends in Daily Physical Activity
Fact Sheet produced by the Health and Social Care Information Centre.
 

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