Benefits and Complicating Factors of Exercise in Patients with Diabetes

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Answer

Benefits of Exercise

In older adults, research has shown that regular participation in exercise:

• Improves cardiovascular fitness, decreases hypertension, improves lipid profile
• Contributes to weight loss
• Increases muscular strength, endurance, power
• Improves balance and flexibility, reduces the risk of falls
• Increases patient participation levels
• Improves functional abilities and quality of life
• Prevents or delays the development of Type 2 DM
• In patients with Type 1 DM, enhances the sensitivity of insulin receptors; decreases the requirement for administered insulin
• In patients with Type 2 DM, reduces insulin resistance in the liver and muscles

We have talked about exercise being our go-to. We all know that exercise holds many benefits for individuals of all ages, but in older adults, who are the majority of our diabetes patients, research has shown particular benefits from participation in exercise. I will not go over all of those because you already know most of them. I would encourage you to review those. A diabetes-related benefit of exercise is that it helps to prevent or delay the development of Type 2 diabetes mellitus. In patients with Type 1, it enhances the sensitivity of insulin receptors and decreases the requirement for administered insulin. Additionally, in patients with Type 2, it reduces insulin resistance in both the liver and the muscles. Exercise is definitely something we want to be doing with almost all of our patients who have diabetes unless there is some particular reason they cannot.

Complicating Factors With Exercise

• Risk of hypoglycemia or hyperglycemia
• Decreased cardiac responsiveness to exercise
• Postural hypotension
• Impaired thermoregulation
• Impaired night vision
• Risk of retinal damage
• Decreased sensation of feet
• Other factors

Prescribing exercise for adults is not always easy, especially if they have diabetes. There are complicating factors for individuals with diabetes when they exercise. There can be a risk of high blood sugar or low blood sugar. It can go either way. They can also have decreased cardiac responsiveness to exercise where you would not see the expected increase in heart rate and so forth.

They can have postural hypotension where they get dizzy if they move or stand up too fast. Thermoregulation can be a real problem with them getting overheated. For exercising outside at night, there might be impaired night vision. And with certain types of exercise, there can be a risk of retinal damage, such as during heavy weightlifting and that kind of thing. They may have problems with decreased sensation of their feet. There could be many other factors that are involved, and why exercise is particularly tough for individuals with diabetes.

Precautions With Exercise

• Patients with uncontrolled hypertension, severe autonomic neuropathy, severe peripheral neuropathy, or unstable proliferative retinopathy should be assessed by their physician before entering an exercise program (per Rodner).
• General precautions:
  • Check blood glucose prior to exercise; adjust insulin or carb intake as needed
  • Avoid exercising in extreme heat or humidity
  • Avoid sauna, hot tub, steam room post-exercise
  • Avoid alcohol

What are some of the precautions we need to take with our patients who are going to be exercising? According to Rodner, any patient who has uncontrolled hypertension, severe autonomic neuropathy, severe peripheral neuropathy, or unstable proliferative retinopathy should be assessed by the physician before they enter an exercise program. If your patient has any of those things, make sure you check in with the physician to make sure what you are prescribing is safe.

As general precautions for exercise, you want to check their blood glucose level prior to exercise and then adjust the insulin or carb intake as needed. Patients should avoid exercising in extreme heat or humidity. They should avoid the sauna, hot tub, or steam room after exercise. They should also avoid alcohol because that can worsen all of these other complications when they are exercising.

For more on this topic, please check out this course, Diabetes in Adults: Current Guidelines and Evidence