DM

1. Presented By,
Mr. Veeresh Kademani
Lecturer
Dept. of Medical surgical Nursing
NUINS
Unit-V
Physical Activity in
Diabetes
Management

2. Topics to be covered
DM
 Introduction
 Role of exercise in Diabetes
Management
 Components of Exercise
Prescription
 Exercise Needs Assessment
 Types of Exercise
 Benefits of Exercise, Yoga and
Physical Activity
 Strategies to Prevent
Hypoglycemia During or After
Exercise 2
Physical Activity in Diabetes Management

3. Introduction
Regular exercise produces health benefits beyond
improvements in cardiovascular fitness. These include
enhanced glycemic control, insulin signaling, and blood
lipids, as well as reduced low-grade inflammation,
improved vascular function, and weight loss. Both aerobic
and resistance training programs promote healthier skeletal
muscle, adipose tissue, liver, and pancreatic function.
Physical Activity in Diabetes Management 3

4. ROLE OF EXERCISE IN DIABETES MANAGEMENT

5. ROLE OF EXERCISE IN DIABETES MANAGEMENT
5
ROLE OF EXERCISE IN DIABETES MANAGEMENT
Exercise intensity, volume, and frequency are associated with reductions in HbA1c. The
most important consideration when recommending exercise to patients with type 2 diabetes
is that the intensity and volume be optimized for the greatest metabolic benefit while
avoiding injury or cardiovascular risk. In general, the risk of exercise-induced adverse
events is low, even in adults with type 2 diabetes, and there is no current evidence that
screening procedures beyond usual diabetes care are needed to safely prescribe exercise in
asymptomatic patients in this population. Future clinical research in this area will provide a
broader appreciation for the interactions (positive and negative) between exercise and
diabetes medications, the synergy between exercise and bariatric surgery, and the potential
to use exercise to reduce the health burden of diabetes complications, including
nephropathy, retinopathy, neuropathy, and peripheral arterial disease.
Physical Activity in Diabetes Management

6. COMPONENTS OF EXERCISE PRESCRIPTION

7. COMPONENTS OF EXERCISE PRESCRIPTION
Physical Activity in Diabetes Management 7
Recommendations
Frequency  Perform aerobic exercise spread out at least 3 days during the week, with no more than two consecutive days
between bouts of activity.
 Undertake resistance exercise at least twice weekly on nonconsecutive days, but more ideally 3 times a week,
along with regular aerobic exercise.
Intensity  Aerobic exercise should be at least at moderate intensity (e.g. brisk walking), corresponding approximately to
40%–60% of maximal aerobic capacity (VO2max). Relatively, moderate-intensity activity could be expressed
as a level of effort of 5 or 6 on a scale of 0 to 10 (where 0 is the level of effort of sitting, and 10 is maximal
effort) or 50–70% of maximum heart rate.
 Additional benefits may be gained from vigorous-intensity aerobic exercise (i.e. >60% of VO2max). Relatively,
vigorous-intensity activity could be expressed as a level of effort of 7 or 8 on a scale of 0 to 10 or 70–90% of
maximum heart rate.
 Resistance exercise should be moderate (>50% of 1-repetition maximum, i.e.1-RM – maximum amount of
weight one can lift in a single repetition for a given exercise) or vigorous (75–80% of 1-RM) at intensity.

8. Time  20 to 60 mins per day of aerobic exercise should be performed continuously or intermittently in bouts
of at least 10 mins accumulated to total 150 mins per week.
 3 sets of 8–10 repetitions on 8–10 exercises involving the major muscle groups may be an optimal goal
for resistance exercise.
Type  A variety of modes of aerobic exercise is recommended but any form (including brisk walking) that uses
large muscle groups and causes sustained increases in heart rate (HR) is likely to be beneficial. Exercises
like walking, swimming or cycling that do not impose undue stress on the feet are some appropriate
choices.
 Each session of resistance exercise should involve the major muscle groups (legs, hips, chest, back,
abdomen, shoulders, and arms). According to the literature, resistance exercise programme involving a
combination of bench press, leg extension, upright row, lateral pulldown, standing leg curl (ankle weights),
dumbbell seated shoulder press, dumbbell seated biceps curl, dumbbell triceps kickback, and abdominal
curls has been shown to improve glycaemic control in older adults with T2DM.
Physical Activity in Diabetes Management 8
COMPONENTS OF EXERCISE PRESCRIPTION

9. EXERCISE NEEDS ASSESSMENT

10. Physical Activity in Diabetes Management 10
Medical practitioners should use clinical judgment in this area. Certainly, high-risk patients should
be encouraged to start with short periods of low-intensity exercise and to increase the intensity and
duration slowly. Medical practitioners should assess patients for conditions that might
contraindicate certain types of exercise or predispose to injury, such as uncontrolled hypertension,
severe autonomic neuropathy, severe peripheral neuropathy or history of foot lesions, and unstable
proliferative retinopathy as well as take into consideration patients’ age and previous physical
activity levels. Exercise stress testing is not routinely recommended to detect ischemia in
asymptomatic individuals at low coronary heart disease (CHD) risk (age > 40, concomitant risk
factors such as hypertension, micro albuminuria, etc., or presence of advanced cardiovascular or
micro vascular complications (e.g. retinopathy, nephropathy).
EXERCISE NEEDS ASSESSMENT

11. TYPES OF EXERCISE

12. TYPES OF EXERCISE
Aerobic exercise involves repeated and continuous movement of
large muscle groups. Activities such as walking, cycling, jogging,
and swimming rely primarily on aerobic energy-producing systems.
Resistance (strength) training includes exercises with free weights,
weight machines, body weight, or elastic resistance bands.
Flexibility exercises improve range of motion around joints. Balance
exercises benefit gait and prevent falls. Activities like tai chi and
yoga combine flexibility, balance, and resistance activities.
Physical Activity in Diabetes Management 12

13. BENEFITS OF EXERCISE,YOGAAND
PHYSICALACTIVITY

14. BENEFITS OF EXERCISE, YOGA AND PHYSICALACTIVITY
Aerobic Exercise Benefits
Aerobic training increases mitochondrial density, insulin sensitivity, oxidative enzymes, compliance and reactivity of
blood vessels, lung function, immune function, and cardiac output.
Resistance Exercise Benefits
The health benefits of resistance training for all adults include improvements in muscle mass, body composition,
strength, physical function, mental health, bone mineral density, insulin sensitivity, blood pressure, lipid profiles, and
cardiovascular health.
Benefits of Other Types of Physical Activity
 Flexibility and balance exercises are likely important for older adults with diabetes.
 Limited joint mobility is frequently present, resulting in part from the formation of advanced glycation end products,
which accumulate during normal aging and are accelerated by hyperglycemia.
 Stretching increases range of motion around joints and flexibility but does not affect glycemic control. Balance
training can reduce falls risk by improving balance and gait, even when peripheral neuropathy is present.
 Group exercise interventions (resistance and balance training, tai chi classes) may reduce falls by 28%−29%.
 The benefits of alternative training like yoga and tai chi are less established, although yoga may promote
improvement in glycemic control, lipid levels, and body composition in adults with type 2 diabetes. Tai chi training
may improve glycemic control, balance, neuropathic symptoms, and some dimensions of quality of life in adults with
diabetes and neuropathy.
Physical Activity in Diabetes Management 14

15. STRATEGIES TO PREVENT
HYPOGLYCEMIA DURING OR AFTER
EXERCISE

16. STRATEGIES TO PREVENT HYPOGLYCEMIA DURING OR
AFTER EXERCISE
1. Exercise Timing
Exercising too late in the evening should be prevented. If an individual needs to exercise in the evening, excessive exercise
must be avoided, and blood glucose levels should be closely monitored before going to sleep.
2. Amount of Exercise (Exercise Intensity and Exercise Time)
Individuals with DM should always be cautious when suddenly increasing the amount of their exercise. If they want to
have a greater amount of exercise, their exercise time and exercise intensity must be gradually increased. Ideally, the
exercise time should be increased first, followed by exercise intensity once an individual has adapted to a greater exercise
time.
3. Changes in Drug Administration
Exercising while taking insulin at maximum doses can cause excessive blood glucose reduction due to the simultaneous
blood glucose-lowering effect of insulin and exercise. If exercise is initiated within 90 minutes of insulin administration,
then the drug dose must be accurately adjusted before an exercise according to the planned time and intensity of exercise.
4. Insulin Administration Site
If insulin is injected into the primary exercised muscle region, the absorption speed of insulin increases and so does the
risk of hypoglycemia. If ultrarapid acting insulin is injected into the arm or leg muscles, individuals should be cautious not
to exercise that muscle for 1 hour.
Physical Activity in Diabetes Management 16

17. CONCLUSION
Physical activity and exercise should be recommended and
prescribed to all individuals with diabetes as part of
management of glycemic control and overall health.
Specific recommendations and precautions will vary by the
type of diabetes, age, activity done, and presence of
diabetes-related health complications.
Physical Activity in Diabetes Management 17

18. Thank you
“Exercise Is A
Celebration
Of What Your
Body Can
Do.”
- Mr Veeresh K