American Diabetes Association Issues New Recommendations on Exercise Guidelines

The American Diabetes Association wants everyone with diabetes to get up and move around more often.

The ADA recently issued new recommendations on physical activity guidelines, among which is at least three minutes of moderate movement, such as walking, side lunges and stretching, every half hour of prolonged inactivity to help with blood sugar management. The ADA’s previous recommendation was movement every 90 minutes of idleness.

The new recommendation of movement every 30 minutes is especially for adults with type 2 diabetes, but the ADA’s updated position statement on physical activity address all types of diabetes, including prediabetes, a condition in which blood sugar levels are above the normal range but not high enough to warrant a diabetes diagnosis. Prediabetes affects more than 80 million Americans.

“We always tell our patients that exercise makes a big difference. The American Diabetes Association’s new recommendations reinforce the message that exercise—not just diet, not just medication—is a big part of diabetes management,” said Kelly O’Connor, a dietitian and diabetes educator at the Diabetes & Nutrition Center at Northwest Hospital. “Any activity helps. For example, we tell elderly patients that when they are watching TV and the commercial comes on to stand up and sit down during the commercials. The new recommendations validate the position that even minimal exercise makes some difference in your blood sugars and making people more insulin-sensitive.”

This is the first time the ADA has issued independent, comprehensive guidelines on exercise for all people with diabetes. The recommendations were based on an extensive review of the latest diabetes research as well as input from leaders at preeminent diabetes and exercise physiology research institutions in the United States, Canada and Australia.

In addition to movement that improves flexibility and balance, aerobic activity (jogging, cycling, swimming, etc.) benefits people with type 2 diabetes in that it helps them regulate blood sugar levels, reduce cardiovascular risk factors and lose weight. People with type 1 diabetes who engage in aerobic and resistance training activities (i.e. exercifemale-joggerses using weight machines or elastic resistance bands) can potentially improve their insulin sensitivity, cardiovascular fitness and muscle strength.

Physical activity “should be recommended and prescribed to all individuals with diabetes as part of management of glycemic control and overall health,” though recommendations and precautions will vary based on age, diabetes type and other health complications, the ADA’s position statement reads.

The ADA recommends that adults with diabetes complete 150 minutes or more of moderate- to vigorous-intensity exercise weekly, with no more than two consecutive days without activity. It is also recommended that children and adolescents with diabetes do at least 60 minutes of moderate- or vigorous-intensity aerobic and muscle- and bone-strengthening exercises at least three days a week. People with prediabetes are urged to combine physical activity and healthy lifestyle changes to delay or prevent a diagnosis. Structured lifestyle interventions that include at least 150 minutes of weekly exercise and dietary changes resulting in weight loss of 5 to 7 percent can help “prevent or delay the onset of type 2 diabetes in populations at high risk and with prediabetes,” the ADA says.

The ADA made specific recommendations on exercise during pregnancy, saying women with preexisting diabetes of any type should be advised to engage in regular physical activity before and during pregnancy, and that pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20 to 30 minutes of moderate-intensity exercise on most or all days of the week. Women in general who are at risk for or have been diagnosed with gestational diabetes are encouraged to incorporate aerobic and resistance exercise into their lives most days of the week to improve the effects of insulin and maintain consistent blood sugar levels.

The ADA also made recommendations for minimizing exercise-related adverse events. Insulin regimen and carbohydrate intake changes, along with short sprints, activity timing and resistance exercise prior to aerobics, can help prevent exercise-related hypoglycemia (low blood sugar), according to the ADA, which also says the risk of nocturnal hypoglycemia following physical activity may be lessened with “reductions in basal insulin doses, inclusion of bedtime snacks, and/or use of continuous glucose monitoring.” In addition, the ADA says physically active people with peripheral neuropathy, a nerve-damaging condition commonly caused by diabetes, need proper foot care to avoid ulceration and amputation, and that people with severe nonproliferative and unstable proliferative diabetic retinopathy should avoid vigorous exercises and breath-holding.

weight-liftingO’Connor, who regularly hosts free information sessions in the community on diabetes, says with some patients, the initial challenge for practitioners isn’t getting them to adopt new eating and exercise habits, but helping them come to terms with their diagnosis. “One patient told me recently she was in denial for a year about being diagnosed with diabetes,” O’Connor said. “Some patients are really angry because they have diabetes and they don’t want it, or they think they did everything right.”

There is also the matter of dispelling the belief that effective diabetes management is all about deprivation and seclusion.

“There is so much misinformation about diabetes. Some people have grandparents with diabetes who, perhaps because they didn’t have access to the advanced technology we have today, had a leg amputated or suffer from vision loss, and they think they will have a similar fate. But that never has to happen anymore,” O’Connor said. “The biggest thing I think most people think is, ‘l have to give up all my favorite foods, I’ll never be able to go have fun with my friends, and I won’t be able to have Thanksgiving.’ Yes, you should make some lifestyle changes, but you don’t necessarily have to give up your favorite foods or social activities entirely.”

Recognized by the ADA as meeting the national standards for diabetes self-management education, the Diabetes and Nutrition Center at Northwest Hospital has certified educators that help patients identify and reduce their risk for diabetes, and introduce those who are diagnosed to healthier lifestyles. Care strategies are customized according to each patient’s individuals needs and may include medication management, glucose monitoring, meal planning, foot care and physical activity. The center offers one-on-one counseling as well as free diabetes education classes.

In January 2017, LifeBridge Health will begin a free, monthly diabetes support group program at the Weinberg Park Heights Jewish Community Center of Greater Baltimore. The monthly group will be led by a team of certified diabetes educators from Sinai and Northwest hospitals. “I think it helps a lot for patients with diabetes to hear from each other. It’s encouraging to hear someone with the disease say, ‘I go out with my friends, my blood sugars are still good, and I still enjoy holidays.’ For someone who is newly diagnosed, it makes a big impression to hear that,” O’Connor said.

Check the community calendar for upcoming LifeBridge Health Diabetes Support Group meeting dates and times. For more information on the Diabetes & Nutrition Center or to schedule an appointment, call 410-521-8383. To learn more about the support group, call 410-701-4482.

To schedule an appointment with one of our highly trained physicians and find out why LifeBridge Health is Baltimore's premier health care organization, call 410-601-WELL.

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