CE Course

Learning Objectives

This course, Exercise Prescription for the Diabetes Patient, will provide the clinician with the tools needed to develop an exercise plan that will be effective in helping to manage their client’s diabetes. We will focus on the role of exercise in diabetes care, examining some strategies for taking care to mitigate most of the potential risks often associated with physical activity, and discuss some tools for developing customized exercise plans for your clients.

Our learning objectives for today are as follows:

1. Describe the essential role physical activity plays in diabetes management.

2. Apply strategies to minimize risks associated with physical activity in people with diabetes.

3. Provide the tools necessary to design individualized physical activity plans for people with diabetes.

Amazing Medicine

Basal/bolus insulin

For people with diabetes, exercise helps mitigate several risk factors that contribute to cardiovascular disease, including improvements in the blood lipid panel, blood pressure, and reduced body fat. Exercise is one of the few therapeutic options for both reducing unhealthy “LDL” cholesterol and increasing healthy “HDL” cholesterol. Given that people with diabetes are at a greatly increased risk for heart disease, these are particularly important changes.

Diabetes Concern	Physical Activity Effect
Heart Disease	Collateral Circulation lower Atherosclerosis
Blood Lipids	lower LDL, Triglycerides higher HDL
Hypertension	lower Diastolic BP
Obesity	Calorie Burning increased Metabolism Appetite Suppression

Several “quality of life” issues faced by people with diabetes can be improved or resolved through regular exercise. These include improvements in range of motion (as people with diabetes are often affected by frozen shoulder, adhesive capsulitis, trigger fingers and other range of motion issues), reductions in chronic stress (often related to living with and managing a chronic health condition 24/7; and which contributes to hyperglycemia and insulin resistance), improved mood (as people with diabetes suffer from increased incidence of depression, anxiety and burnout) and decreased pain (which is particularly important for those with peripheral neuropathy).

Diabetes Concern	Physical Activity Effect
Disuse Syndrome	Conditioning Gains
Adhesive Capsulitis	Flexibility/Range of Motion Work Capacity
Stress	Tension Release More Restful Sleep
Depression	Sense of Control, Pride
Pain	Endorphin Production

Exercise directly and indirectly improves glucose control in people with type-2 diabetes. It accomplishes this through multiple pathways: immediate metabolism of glucose and improvements in insulin sensitivity. Exercise is more powerful than any medication for improving peripheral insulin sensitivity, and as we will discuss shortly, the benefits can last well beyond the time a person is actually exercising.

For those with type-1 diabetes, proper timing of physical activity can help reduce post-meal glucose excursions. Overall, physical activity reduces the need for insulin and other diabetes medications (oral and injectable).

Diabetes Concern	Physical Activity Effect
Insulin Resistance	increased Insulin Sensitivity Receptor Proliferation GLUT-4 Transport
Postprandial Hyperglycemia	Slower CHO Absorption increased Glucose Utilization Accelerated Insulin Action
Need for Insulin/Meds	Acute and Chronic Reduction