Diabetes: how, when and how much to exercise

Diabetes: how, when and how much to exercise

Regular physical activity is also essential for those with diabetes. Nordic Walking and outdoor walking are recommended

Not just nutrition for those with diabetes. Regular physical activity is also important to control metabolism. This is confirmed by the experts of the Italian Society of Diabetology (SID) and the Association of Diabetes Doctors (AMD), who with the Italian Society of Motor and Sports Sciences (SISMES) have developed practical recommendations on how to prescribe physical activity, based on the evidence of the scientific literature. Here, in summary, is what the document proposes.

The strength of Nordic Walking

Physical activity is a real therapy. and as such it must be prescribed by the doctor. Never forget how much it takes to take the right steps every day. "There is an important need – explains Paolo Moghetti, associate professor of Endocrinology, University of Verona and author of the document representing the Italian Society of Diabetology – to change the lifestyle in diabetes because this is fundamental in therapy, as well as in prevention, of a disease that has very high costs for the person who suffers from it and for society. The path is a simple tool, easily applicable in different contexts and inexpensive which, used well, can represent, in most people with diabetes, a first step in this direction ”.

But here, in summary, the indications that emerge. People with diabetes should do at least 30 minutes of physical activity a day, at moderate or higher intensity, ideally every day of the week. Out of practice patients must of course start gradually.

As the training progresses, it is possible to insert periods of high intensity training alternating with recovery periods ('high-intensity interval training' – HIIT). Walking outdoors is better than walking indoors on a treadmill. Walking in a park, surrounded by nature, increases the psycho-physical well-being associated with motor activity.

Nordic Walking with poles used diagonally, as suggested by INWA (International Nordic Walking Association) increases the expenditure of walking by 20-25%, compared to ordinary walking (it also engages the muscles of the upper body). These Nordic Walking programs increase exercise capacity, functional status, quality of life, lipid profile, cardiorespiratory outcomes, reduce weight and chronic pain. But to carry out an effective and correct training, at least at the beginning, it is advisable to rely on expert supervision.

Exercise should be monitored, with the aid of a pedometer or rather a smart watch equipped with GPS which, in addition to the distance traveled, gives information on the type of route taken, on the acceleration of the body, on the heart rate, and on the speed. Even for diabetic people who are also overweight / obese, walking is perfect as a workout, but avoiding climbs or descents with a gradient of more than 5% and introducing an adequate rest period after every 15 minutes of exercise. Supervised Nordic Walking is therefore strongly recommended because it consumes more calories and puts some weight on the legs.

The twelve rules to follow

  • Walking improves blood glucose control in people with type 2 diabetes mellitus; it is therefore strongly recommended to do some aerobic activity. Walking is within everyone's reach.
  • Walking is also a therapy for many of the disorders associated with type 2 diabetes: it promotes weight loss, lowers blood pressure and helps you feel better.
  • Walking improves the cardio-respiratory fitness of people with type 2 diabetes
  • Walking can help with the chronic complications of diabetes, particularly in reducing cardiovascular risk
  • Supervised and protocol-based training is recommended
  • But unsupervised walking is also valid, especially when combined with motivational strategies
  • Interval training can be recommended for people with diabetes, especially the younger ones and with good fitness. Alternating 1 minute of brisk walking with 1 minute of slow walking (or 3 and 3) is more effective on glycemic control and cardiorespiratory fitness than continuous walking.
  • Nordic walking is more effective than simple walking because it sets in motion not only the legs, but also the upper body
  • In addition to the intensity and duration of the walk, the route (type of ground and slope) must also be 'prescribed'. Walking on sand or uphill involves an effort that not all patients can cope with.
  • The time of day must also be specified in the training prescription. Walking after a meal can help reduce post-prandial spikes in blood glucose and its variability. The interactions between anti-diabetes drugs and physical activity should also be considered.
  • To interrupt a sedentary lifestyle, in addition to physical exercise, short periods of brisk walking should be prescribed (for example 3 minutes every 30 minutes spent sitting) which have a favorable effect on blood sugar control.
  • Prescribing training based on walking in all people with diabetes should be preceded by a careful and personalized medical and functional evaluation.
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