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©2013 by the American Diabetes Association, Inc.® All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.
Printed in the United States of America
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The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.
The paper in this publication meets the requirements of the ANSI Standard Z39.48-1992 (permanence of paper).
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American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311
DOI: 10.2337/9781580404853
Library of Congress Cataloging-in-Publication Data Colberg, Sheri, 1963- Exercise and diabetes : a clinician's guide to prescribing physical activity / Sheri R. Colberg, PhD, FACSM. pages cm Includes bibliographical references and index. ISBN 978-1-58040-485-3 (alk. paper) 1. Diabetes--Exercise therapy. 2. Diabetics--Rehabilitation. I. Title. RC661.E94C652 2012 616.4'620642--dc23 2012038644
eISBN: 978-1-58040-507-2
For my loving husband, Ray, and my three wonderful sons, Alex, Anton, and RayJ.Thanks for your nonstop support and boundless love.
Contents
I. Getting Started with Physical Activity
Chapter 1: Diabetes, Physical Activity, Exercise, and Fitness Overview
Chapter 2: Pre-Exercise Evaluation and Assessment
Chapter 3: Daily Lifestyle Activity
II. Prescribing Exercise by Activity and Diabetes Type
Chapter 4: General Principles of Aerobic Exercise Prescription
Chapter 5: Aerobic Exercise Rx for Type 2 Diabetes
Chapter 6: Aerobic Exercise Rx for Type 1 Diabetes and Latent Autoimmune Diabetes in Adults
Chapter 7: Aerobic Exercise Rx for Gestational Diabetes
Chapter 8: Resistance Exercise Rx for Type 1 and Type 2 Diabetes
Chapter 9: Combined Aerobic and Resistance Training for Adults with Diabetes
Chapter 10: Other Physical Activities for All Types of Diabetes
III. Preventing Acute Exercise-Related Problems
Chapter 11: General Diabetes Management with Physical Activity
Chapter 12: Hypoglycemia Treatment and Prevention
Chapter 13: Hyperglycemia and Dehydration Concerns
Chapter 14: Balancing Insulin Use with Physical Activity
Chapter 15: Other Medication Effects on Physical Activity
IV. Exercising with Comorbid Health Issues
Chapter 16: Obesity, Orthopedic Limitations, and Osteoarthritis
Chapter 17: Cardiovascular Diseases
Chapter 18: Peripheral Neuropathy, Ulcers, and Amputations
Chapter 19: Autonomic Neuropathy
Chapter 20: Retinopathy and Other Diabetic Eye Diseases
Chapter 21: Microalbuminuria, Nephropathy, and End-Stage Renal Disease
V. Staying Physically Active for Life
Chapter 22: Female-Only Concerns and Pregnancy with Preexisting Diabetes
Chapter 24: Children and Adolescents
Chapter 25: Behavior Change and Adoption of an Active Lifestyle
Appendix A: Generic and Brand Names of Current U.S. Diabetes Medications
Appendix B: Physical Activity Tools for Professionals
Myriad types of physical movement have a positive impact on physical fitness, morbidity, and mortality in individuals with diabetes, and although exercise has long been considered a cornerstone of diabetes management, many health-care providers fail to prescribe it. Many fitness professionals may be unaware of the complexities of including physical activity in the management of all types of the disease. Giving patients or clients a full exercise prescription that takes comorbid conditions into account may be too time-consuming for or beyond the expertise of many health-care and fitness professionals.
The purpose of this book, therefore, is to cover the recommended types and quantities of physical activities that can and should be undertaken by all individuals with any type of diabetes, along with precautions related to medication use and diabetes-related health complications. Medications used to control diabetes should augment, rather than replace, lifestyle improvements like increased daily physical activity.
Until now, professional books with exercise information and prescriptions were not timely or sufficiently interactive to easily provide busy professionals with access to the latest recommendations for each unique patient. Simply instructing patients to “exercise more” is not motivating or informative enough to get them regularly or safely active. Exercise and Diabetes is changing all that with its up-to-date and easy-to-prescribe exercise and physical activity recommendations and relevant case studies.
Read, learn, and quickly be ready to effortlessly prescribe effective and appropriate exercise to everyone. Your reward will be a collective increase in the health and fitness of all people with diabetes.
Aerobic exercise: Physical movement that results from rhythmic muscular contractions that are primarily fueled by the aerobic metabolism of energy in the body; oxygen-based generation of energy is usually the main source for any activity lasting longer than 2 min continuously.
Autonomic neuropathy: Disease affecting the nerves innervating the heart, gastrointestinal, and genitourinary tract; cardiovascular autonomic neuropathy (CAN) is the most common, studied, and clinically important type of this neuropathy.
Cardiorespiratory (aerobic) fitness: The ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained (aerobic) physical activity.
Continuous glucose monitoring (CGM): Newer technologies that allow for subcutaneous monitoring of glucose levels with frequent readings (usually every 5 min).
Daily lifestyle activity: All physical activities done during the course of a day involved with self-care, basic locomotion, and other movement other than planned exercise sessions (also called activities of daily living [ADL]).
Diabetic ketoacidosis (DKA): High level of blood ketones (e.g., β-hydroxybutyrate, acetoacetate, acetone), accompanied by hyperglycemia, that can result in coma or death if not treated in a timely manner.
Estimated average glucose (eAG): Alternate method to report hemoglobin A1C levels, as an estimated average glucose in mg/dl instead of percent (e.g., A1C value of 6.0% equates to an eAG of 126 mg/dl); the relationship between A1C and eAG is described by the formula (28.7 × A1C) – 46.7 = eAG. An online calculator is available at professional.diabetes.org/GlucoseCalculator.aspx.
Gestational diabetes mellitus (GDM): A hyperglycemic condition developing most often during the third trimester of pregnancy (when placental hormones decrease insulin action); although it usually resolves postpartum, it is associated with a greater risk for the mother of developing type 2 diabetes later in life.
Hemoglobin A1C (or A1C): Test to assess glycemic control that reflects a time-averaged blood glucose concentration (as a percent) over the previous 2–3 months; a normal value is ~4.0–6.0%.
Hyperglycemia: An elevated blood glucose level (i.e., blood glucose ≥126 mg/dl).
Hypoglycemia: An abnormally low blood glucose level (i.e., blood glucose <70 mg/dl).
Insulin resistance: A condition in which there is a relative lack of insulin action in insulin-sensitive tissues (primarily skeletal muscle) needed to maintain normal glucose levels.
Latent autoimmune diabetes of the adult (LADA): A form of type 1 diabetes that is often slower in onset and diagnosed in adults.
Metabolic syndrome: A syndrome characterized by a constellation of disorders, including insulin resistance, obesity, central adiposity, glucose intolerance or diabetes, dyslipidemia, and hypertension.
Muscular endurance: The ability of muscles to contract using submaximal force over a period of time, based on criteria such as the number of pushups that can be done in a minute.
Muscular strength: The maximal ability of a muscle to exert force, often measured as the amount of resistance that can be moved one time (one-repetition maximum).
Nephropathy: A microvascular disease affecting the kidneys, resulting in excessive urinary protein (microalbuminuria, followed by gross proteinuria) as a marker of end-stage renal disease.
Peripheral neuropathy: Disease affecting the nerves in the extremities, especially the lower legs and feet, resulting in pain or loss of sensation and increased risk of amputation.
Resistance (strength) exercise: Physical activity aimed at increasing muscular strength or muscular endurance through the use of resistance or weights.
Retinopathy: A disease caused by long-term damage to blood vessels of the retina caused by elevated blood glucose levels; the stages include nonproliferative (less severe) and proliferative (more advanced and severe form), the latter of which is the leading cause of new blindness in adults.
Self-monitoring of blood glucose (SMBG): The practice of using blood glucose monitoring devices outside of clinical settings to monitor changes in blood glucose levels.
Type 1 diabetes (T1D): Immune-mediated disease that selectively destroys the pancreatic β-cells, leading to a central defect in insulin release upon stimulation; although more commonly associated with youth, it can develop in individuals of any age and frequently occurs in adulthood as well as in latent autoimmune diabetes of the adult.
Type 2 diabetes (T2D): Disease directly related to insulin resistance, formerly thought to afflict persons older than the age of 40 years, which now has an increasing prevalence in younger children and adolescents; this type of diabetes accounts for 90–95% of all cases of the disease.
