Everyone, not just people with diabetes, needs to exercise regularly. Being active is an important part of diabetes management. Benefits of physical activity are:

• helps to lower your blood glucose, pressure and cholesterol
• reduce your risk to heart disease and stroke
• helps your body to respond better towards insulin
• helps to reduce your dosage or eliminate the need for medication/insulin
• burns calories and reduce fat to help you lose or maintain weight
• strengthens your heart, muscles and bones
• improves your blood circulation
• improves your posture, flexibility and balance to prevent falls
• reduces stress and helps to improve the quality of sleep

Exercise helps you to use the insulin in your body more effectively and lowers your blood sugar levels. To understand the impact of the exercise test your blood sugar before, during, and after exercise for a few days.

Do the same type of exercise, at about the same time, each day. Keep track of what happens to your blood sugar. Discuss your test results with your health care team to plan your food and medicine to work with your exercise plan.

If you’re a sedentary person and starting activity routine for the first time then it’s important to get a complete medical screening and evaluation (e.g. glucose control, physical limitations, medications and complications related to eyes, feet, heart, kidney and nervous system) done from your healthcare provider. If you’re already active and looking to start a new activity then also can discuss with your healthcare team first whether it’s suitable or safe for you.

The different aspects of an exercise plan are:

• Frequency: How often will you do this activity? How many days a week.
• Intensity: How hard should you be working? Either mild, moderate or vigorous.
• Time: How long will you do it?

Type of Activity: What kind of exercise you will be doing? Either aerobics, resistance, flexibility or recreation.

The main types of exercises are given below:

Cardiovascular/Aerobic exercise helps to strengthen heart and bones, improves circulation and relieve stress. Examples include walking, swimming, cycling, aerobics, gardening, climbing, jumping, dancing, skating etc.

Strength/Resistance exercise helps to improve insulin function, strengthen and tone bones and muscles and improve balance and posture. Examples include lifting, pulling, or pushing heavy weights, sit-ups, push-ups, and exercise with elastic bands.

Stretching/Flexibility exercise which helps to keep your muscles and joints relaxed, supple, toned and mobile and increases flexibility. Examples are yoga, working with an exercise ball.

Not having enough time is a problem for many of us. If you find it hard to exercise at the same time and no. of minutes every day, here are a couple of things you might want to try:

Make exercise a priority. Schedule time to exercise and write it on your calendar. If you stick to your schedule, it will become a habit in time. Find ways to move more during your daily routine or make it interesting by following ways:

• take your dog/pet for a walk
• walk in the garden or play with kids
• clean your house, do household chores by yourself
• take the stairs instead of the elevator
• get up from your desk during the day to stretch and walk around or do exercise in your chair
• get off the bus one stop before your regular stop and walk the rest of the way
• walk at lunch/dinner or while talking over the phone
• dance to your favorite music or play badminton or other outdoor games
• reduce your TV/computer or sitting time
• plan active weekends, with family and friends

Recommendations for aerobic exercise is 30-45 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week or a total of 150 minutes per week (50–70% of maximum heart rate). But don’t go more than two consecutive days without exercise, or its effect on insulin sensitivity will wane. And if you want to lose weight, you’ll probably have to work out more. A recent study found that 50 minutes of moderate-intensity exercise five days a week was necessary for significant weight loss.

Either aerobic exercise (jogging, biking, or swimming) or resistance training (like weight lifting) can improve your glycemic control. But according to a study on exercise in people with type 2 diabetes that doing both will generate better results and reduced their A1Cs more than those who did either exercise alone. Recommendations for resistance exercise is to do 15-30 minutes in length or total 60 minutes per week of 8-10 repetitions with 1-2 minutes rest between sets. It is preferable you should strength train three times a week, skipping a day between each session. Reason being weight lifting causes minor damage to the muscles, and you’ll need a full day of recovery.

To get your heart really pumping, one can combine moderate-intensity cardio with spurts of vigorous activity. If you work out on a stationary bike, for example, punctuate a steady cruising speed with a minute or two of extra-fast pedaling every five minutes. You can also interval train outside: Every few minutes, try to walk/jog faster followed by your usual speed in between.

If time is a concern or you’re not able to exercise at one go due to time constraint any health condition then you can split your 30 minutes of daily exercise as you please—say, 20 minutes after lunch and 10 minutes after dinner—but keep each session at least 10 minutes long.

Exercise isn’t synonymous of running endlessly on a treadmill. Go for a walk, hike, swim, or bike ride to get into nature and burn some calories. Find something you love. Try dance classes, spinning, outdoor games, and martial arts — whatever but make it something you enjoy doing, and you’re more likely to stick with it.

Yes, one should add five minutes of light aerobic activity to the start of your workout and close with five minutes of stretching. The warm-up is meant to literally heat your body up, to help you avoid injury by creating more elasticity in your muscles and tendons. The cooldown is to help your heart recover and to stretch out tight muscles.

Working up a sweat when it’s sweltering out can lead to dehydration in anyone. But people with diabetes should take extra caution in extreme temperatures. If you have autonomic neuropathy, which can thwart the body’s ability to regulate body heat.

• When it’s too hot prefer activity during cooler and less humid part of the day or in an air-conditioned gym. Wear light, comfortable, and breathable clothing and drink plenty of fluid before, during and after your exercise session
• If you are exercising on cold days prefer exercising in the warmer part of the day and wear clothes to protect your body from cold.

Yes you might, discuss this with your healthcare provider. Physical activity helps your body use insulin more efficiently and reduces the amount of glucose in your blood. Plus, the result of being active—bigger muscles—allows your body extra storage space for glucose. So, to avoid hypoglycemia during and after exercise, you may require lower your insulin dose as compared to a day when there’s no physical activity. For instance, if you plan to work out after lunch, you may need to reduce the insulin you take with your meal.

People who take insulin or have type 1 diabetes need to be cautious about low blood glucose, then those with type 2 who are on oral medications have less to worry about. It’s not that it never happens with oral medications, but that it happens less frequently. If you’ve just switched into a new routine and fear going too low, test your blood glucose pre- and post-workout to see how your numbers change for few days to understand the pattern.

As long as your blood glucose levels are under 250 mg/dl, you’re safe to exercise. If they rise higher, exercise with caution. People with type 1 should test for ketones once the meter reads 250. It’s not advisable to exercise if ketones are present.

This is a concern for people who take insulin. But it can also be a problem for people with type 2 diabetes who are in very good control and are taking diabetes pills to lower their blood sugar. If your blood sugar is less than 100 or has long gap between two meals, eat a small snack before exercising like a fruit, nuts, small sandwich with milk or buttermilk etc.

Blood glucose may continue to drop for several hours after activity and should be monitored before, during, and after exercise and should be followed by small snack right after (depending on intensity) and meal after 1-2 hour.

When you exercise, your muscles burn stored glucose for energy. After you’ve finished exercising, your muscles will continue to pull glucose out of your bloodstream until they replenish their glucose stores. This can go on for several hours. While this is happening, you might need more carbohydrate or less fast-acting insulin. To find out what you need, check your blood sugar, record the results, and see what your patterns are. Talk to a member of your health care team if you need help balancing your food, medicine, and exercise.

Regular exercise can help you have better balance, boost energy, maintain your independence, and manage symptoms of illness or pain and improve endurance. Regular exercise is not only good for your body, it’s also good for your mind, mood, and memory. However, it’s important to find activities that are safe for you some of the examples are:

• Aerobics to improve endurance and stamina like walk, household chores, water games or swimming, chair activities, cycling, dance, golf (walk the course).
• Resistance to increase strength and independence like gardening, lifting light weight, resistance bands, yoga or tai chi.
• Balance activity to improve balance, try walking heel to toe in a straight line, practice standing on one foot.

Extra weight can put pressure on your joints. Here are a couple of things to try:

• Find little ways to increase your activity slowly and, at the same time, start cutting down on calories. For example, walk whenever possible like after meals, for shopping, while talking over the phone, park your car little far so that you can walk more, take your pet for a walk, do possible household chores by yourself, don’t use remote or ask for water or food from someone do it yourself etc.  
• If you’re unable to walk long distance at one go then split your activity throughout the day and make sure you do minimum 10-15 minutes at a time 3-4 times/day.
• Try activities that aren’t weight-bearing, such as bicycling, swimming, water aerobics, chair exercises, lifting light-weight etc.

• To avoid injuries start your activity program gradually, and work up slowly. Exercising too much, too fast, can cause injuries.
• Use proper equipment’s, clothing and accessories for exercise to avoid any injuries like light and comfortable shoes with adequate cushioning or if cycling outdoors wears a helmet.

• As people with diabetes are more prone to foot related complications due to less sensitivity that’s why must wear seamless, lightly padded socks of breathable material and comfortable shoes that fit properly.
• Always inspect your feet after activity for blisters or sores or any other injury.

Many people have diabetes-related complications related to heart, eye, blood pressure, kidney or feet. They are advised to exercise caution as some exercises might worsen their problem further. Before starting exercising one need to consult with their healthcare provider to know the types of exercises which are safe for them.

It doesn’t matter whether you’re going for a short walk or hitting the gym for vigorous activity. If you use insulin or on oral medication will increase your risk of hypoglycemia. You should always carry:

• fast-acting carbohydrate to treat low sugars like glucose powder or candy, a packet of fruit juice or regular cold-drink
• carry a driver’s license or other ID
• wear or carry diabetes identification bracelet/ID tag/card
• glucometer and log-book; to check sugars and record readings
• your cell phone comes in handy in case of emergency

The hardest part of an exercise routine is continuing to do it. To keep up the motivation and make exercise an indispensable part of your life.

• Set realistic goals, keep it simple and interesting
• Keep a track of your weekly goals and progress
• Reward yourself for achieving your goal
• Exercise with a friend/partner or who motivates you
• Don’t lose hope if you don’t get immediate or early results
• Don’t be negative even if you miss a day or two; try to get back on track the next day
• Don’t forget to take a rest as they are as important as your exercise session
• If you have trouble in managing your sugars talk to your healthcare provider