Building Competency in Diabetes Education THE ESSENTIALS

5-48 | CHAPTER 5

TYPES OF EXERCISE: RECOMMENDATIONS

Studies have shown a benefit for both aerobic and resistance exercise in people with diabetes. The effects of resistance exercise and aerobic exercise are additive (204). The minimum amount of aerobic exercise recommended is 150 minutes per week. Smaller amounts of activity still provide some health benefit. Consider the goals of the individual when discussing activity levels. When weight loss is a goal, at least 250 minutes of activity per week is considered necessary to achieve significant weight loss (205). Brisk walking is the most feasible type of aerobic exercise and tends to be the most popular among overweight middle-aged and elderly people with diabetes. For those who experience pain upon walking, semi-recumbent cycling can be an option. At least two sessions of resistance training each week is recommended for all people with diabetes, including elderly people. Patients beginning a resistance exercise program should receive initial instruction and periodic supervision by a qualified exercise specialist to maximize benefits while minimizing risk of injury. Reducing sedentary behaviour Individuals with diabetes should be encouraged to reduce the amount of time spent doing sedentary activities. Sedentary behaviour is associated with adverse health outcomes, including premature mortality and an increase in A1C, central adiposity, BMI, fasting TG, systolic BP, C-reactive protein and hyperglycemia (206,207). Even people who do moderate-to-vigorous exercise are at increased risk of adverse health outcomes if they are highly sedentary (208,209). People should be encouraged to avoid prolonged sitting and to interrupt sitting time by getting up and moving around every 20 to 30 minutes. Previously sedentary patients may benefit from gradually increasing the duration of activity, starting with as little as five to 10 minutes. Including multiple, shorter exercise sessions (each lasting at least 10 minutes) each day can be as effective as a single longer session of equivalent length and intensity (210). More importantly, starting with shorter duration activity may seem less daunting for someone who has not exercised in the past, therefore increasing likelihood of success.

Promoting physical activity Health-care professionals should routinely promote the importance of regular exercise as a key component of therapy. The health-care provider and the person with diabetes