Starting an exercise program

I've always exercised and played sports, but when I start a new program, I often have questions about what exactly I should be doing to get the most health benefits. People with diabetes have special considerations to keep in mind when starting an exercise program. Here's an article written by my colleague, Dr. Howard Lewine, on what people with diabetes need to think about as they plan an exercise program. Of course, always check with your doctor before you start any exercise routine. 

If you are trying to manage your diabetes, there is one weapon in your arsenal you may not have considered — exercise.

In the earliest stages of type 2 diabetes, your body produces extra insulin to help keep blood sugar close to the normal range. But the cells in your body are not as responsive to insulin as they should be — a state called insulin resistance. The usual course of events is that you begin to gain weight as your pancreas produces more and more insulin to overcome the resistance. Blood sugar levels rise.

Exercise helps to counter the effects of high insulin production and revitalizes the pancreas as well as the rest of the body. Most type 2 diabetics have a decrease in blood glucose after mild to moderate exercise. Exercise improves glucose uptake by the cells and decreases production of glucose by the liver. Also, exercise burns up energy that is stored in the muscle cells. This makes cells hungry for more glucose. Thus, glucose moves from the blood into cells, preventing the conversion of glucose to fat.

If a person with diabetes is not exercising, a good way to start is to get 10 to 15 minutes of physical activity in three sessions during the day and build up to at least 30 minutes per session per day.

Walking is certainly a great exercise and requires little equipment or preparation. To control diabetes, the ideal is to walk three to five miles, five to seven days a week. Gardening is also a great exercise because it exposes you to sunlight and fresh air. By gardening, I don't mean just the casual pulling up of weeds, but the vigorous digging, hoeing, shoveling, kneeling, squatting, and stretching involved in maintaining or starting a garden.

What about people with diabetes who have trouble walking? An upper-arm exercise program can allow a person to engage in aerobic exercise without brisk walking. 

Finding the right time of day is important. You need to consider your eating and medication to avoid exercise-related low blood sugars (hypoglycemia). Ideally, periodically check your blood sugar right before and after you exercise. Write down what you ate that day and what times you took your diabetes medications. If you don't take any medications, it is very unlikely that exercise will cause your blood sugars to drop too low.

When exercising, always keep a sugary substance or beverage with you in case you start to feel lightheaded.

Exercise and a healthy diet can help you manage your diabetes and prevent its associated complications such as heart attack, stroke, blindness, dialysis, and limb amputation.

Have you recently started an exercise program? What do your workouts include? How often do you do them? How do you stay motivated?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Exercise: A program you can live with
Hundreds of studies conducted over the past 50 years show that exercise helps you feel better and live longer. Exercise: A program you can live with answers many important questions about physical activity, from how your body changes through exercise to what diseases it helps prevent. It will also help guide you through starting and maintaining an exercise program that suits your abilities and lifestyle. Throughout, you'll find advice on being a savvy consumer when it comes to fitness products, as well as useful tools and tips designed to help make exercise work for you.

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