Tag Archives: physical activity

November 22, 2013 · 8:30 AM

Should Diabetics Exercise?

 

Women, don't worry about getting too bulky with muscles: you don't have enough testosterone for that

Women, don’t worry that weight training will get you too bulky with muscles: you don’t have enough testosterone for that

Read on for the potential benefits of exercise, then decide for yourself.

GENERAL EXERCISE BENEFITS

Regular physical activity postpones death, mostly by its effect on cancer, strokes, and heart attacks.

Exercise is a fountain of youth. Peak aerobic power (or fitness) naturally diminishes by 50 percent between young adulthood and age 65. Regular exercise increases fitness (aerobic power) by 15–20 percent in middle-aged and older men and women, the equivalent of a 10–20 year reduction in biological age.

Additional benefits of exercise include: 1) enhanced immune function, 2) stronger bones, 3) preservation and improvement of flexibility, 4) lower blood pressure by 8–10 points, 5) diminished premenstrual bloating, breast tenderness, and mood changes, 6) reduced incidence of dementia, 7) less trouble with constipation, 7) better ability to handle stress, 8) less trouble with insomnia, 9) improved self-esteem, 10) enhanced sense of well-being, with less anxiety and depression, 11) higher perceived level of energy, and 12) prevention of weight regain.

EFFECT ON DIABETES

Eighty-five percent of type 2 diabetics are overweight or obese. It’s not just a random association. Obesity contributes heavily to most cases of type 2 diabetes, particularly in those predisposed by heredity. Insulin is the key that allows bloodstream sugar (glucose) into cells for utilization as energy, thus keeping blood sugar from reaching dangerously high levels. Overweight bodies produce plenty of insulin, often more than average. The problem in overweight diabetics is that the cells are no longer sensitive to insulin’s effect. Weight loss and exercise independently return insulin sensitivity towards normal. Many diabetics can improve their condition through sensible exercise and weight management.

Muscles doing prolonged exercise soak up sugar from the blood stream to use as an energy source, a process occurring independent of insulin’s effect. On the other hand, be aware that blood sugar may rise early in the course of an exercise session.

EXERCISE RECOMMENDATIONS

You don’t have to run marathons (26.2 miles) or compete in the Ironman Triathlon to earn the health benefits of exercise. However, if health promotion and disease prevention are your goals, plan on a lifetime commitment to regular physical activity.

Kayaking combines exercise and recreation

Kayaking combines exercise and recreation

For the general public, the U.S. Centers for Disease Control and Prevention recommends:

  • at least 150 minutes per week of moderate-intensity aerobic activity (e.g., brisk walking) and muscle-strengthening activity at least twice a week, OR
  • 75 minutes per week of vigorous-intensity aerobic activity (e.g., running or jogging) plus muscle-strengthening activity at least twice a week. The muscle-strengthening activity should work all the major muscle groups: legs, hips, back, abdomen, chest, shoulders, arms.

I’m working on a program of combined aerobic (high intensity interval training) and strength training for just 70 minutes a week, but it’s not yet ready for prime time.

STRENGTH TRAINING

What’s “strength training”? It’s also called muscle-strengthening activity, resistance training, weight training, and resistance exercise. Examples include lifting weights, work with resistance bands, digging, shoveling, yoga, push-ups, chin-ups, and other exercises that use your body weight or other loads for resistance.

Strength training just twice a week increases your strength and endurance, allows you to sculpt your body to an extent, and counteracts the loss of lean body mass (muscle) so often seen during efforts to lose excess weight. It also helps maintain your functional abilities as you age. For example, it’s a major chore for many 80-year-olds to climb a flight of stairs, carry in a bag of groceries from the car, or vacuum a house. Strength training helps maintain these abilities that youngsters take for granted.

According to the U.S. Centers for Disease Control and Prevention: “To gain health benefits, muscle-strengthening activities need to be done to the point where it’s hard for you to do another repetition without help. A repetition is one complete movement of an activity, like lifting a weight or doing a sit-up. Try to do 8–12 repetitions per activity that count as 1 set. Try to do at least 1 set of muscle-strengthening activities, but to gain even more benefits, do 2 or 3 sets.”

Look into "body weight training" if weight machines and dumbbells don't appeal to you

Look into “body weight training” if weight machines and dumbbells don’t appeal to you

If this is starting to sound like Greek to you, consider instruction by a personal trainer at a local gym or health club. That’s a good investment for anyone unfamiliar with strength training, in view of its great benefits and the potential harm or waste of time from doing it wrong. Alternatives to a personal trainer would be help from an experienced friend or instructional DVD. If you’re determined to go it alone, Internet resources may help, but be careful. Consider “Growing Stronger: Strength Training for Older Adults” (ignore “older” if it doesn’t apply).

Current strength training techniques are much different than what you remember from high school 30 years ago—modern methods are better. Some of the latest research suggests that strength training may be even more beneficial than aerobic exercise.

AEROBIC ACTIVITY

“Aerobic activity” is just about anything that mostly makes you huff and puff. In other words, get short of breath to some degree. Examples are brisk walking, swimming, golf (pulling a cart or carrying clubs), lawn work, painting, home repair, racket sports and table tennis, house cleaning, leisurely canoeing, jogging, bicycling, jumping rope, and skiing. The possibilities are endless. A leisurely stroll in the shopping mall doesn’t qualify, unless that makes you short of breath. Don’t laugh: that is a workout for many who are obese.

But which aerobic physical activity is best? Glad you asked!

Ideally, it’s an activity that’s pleasant for you. If not outright fun, it should be often enjoyable and always tolerable. Unless you agree with Ken Hutchins that exercise isn’t necessarily fun.

Your exercise of choice should also be available year-round, affordable, safe, and utilize large muscle groups. The greater mass and number of muscles used, the more calories you will burn, which is important if you’re trying to lose weight or prevent gain or regain. (Exercise isn’t a great route to weight loss in the real world, although it helps on TV’s Biggest Loser show.) Compare tennis playing with sitting in a chair squeezing a tennis ball repetitively. The tennis player burns calories much faster. Your largest muscles are in your legs, so consider walking, biking, many team sports, ski machines, jogging, treadmill, swimming, water aerobics, stationary cycling, stair-steppers, tennis, volleyball, roller-skating, rowing, jumping rope, and yard work.

You dog needs brisk walking, too

You dog needs brisk walking, too

Walking is “just what the doctor ordered” for many people. It’s readily available, affordable, usually safe, and requires little instruction. If it’s too hot, too cold, or rainy outside, you can do it in a mall, gymnasium, or health club.

MEDICAL CLEARANCE  

Check this link.

SUMMARY

All I’m asking you to do is aerobic activity, such as walk briskly (3–4 mph or 4.8–6.4 km/h) for 30 minutes most days of the week, and do some muscle-strengthening exercises two or three times a week. These recommendations are also consistent with the American Diabetes Association’s Standards of Care–2013. This amount of exercise will get you most of the documented health benefits.

Steve Parker, M.D.

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April 5, 2013 · 2:28 AM

“Interval Walking” May Be Healthier Than Regular Walking For Diabetics

Not ready for this? Consider interval walking then.

Not ready for this? Consider interval walking then.

Compared to a regular continuous walking program, interval walking is superior for improving physical fitness, blood sugar control, and body composition (body mass and fatness), according to new research reported in Diabetes Care.

Study participants were type 2 diabetics. Training groups were prescribed five sessions per week (60 min/session) and were monitored with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: body composition, VO2max, and glycemic control (fasting glucose, hemoglobin A1C, oral glucose tolerance test, and continuous glucose monitoring).

I haven’t read the full report yet, but expect that the interval walkers walked as fast as they could for three minutes (4 mph?) then slowed down to a comfortable stroll (1–2 mph?) for three minutes, alternating thusly for 60 minutes.

This should easily do-able for nearly all type 2 diabetics.  The reported results are consistent with other studies of more vigorous and intimidating interval training.  The only caveat is that it was a small pilot study that may or may not be reproducible.

Steve Parker, M.D.

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October 17, 2012 · 6:05 AM

The Two Secrets to Prevention of Weight Regain

Researchers are constantly searching for safe, effective weight loss pills.  More helpful would be a pill that prevents weight regain.  Weight loss is relatively easier.

Regain of lost body fat is the most problematic area in the field of weight management.  Whoever solves this problem for good will win a Nobel Prize in Medicine.  Why do most diets ultimately fail over the long run?  Because people go back to their old habits.  Here are the two secrets to prevention of weight regain:

  1. Restrained eating
  2. Regular physical activity

“Successful losers” apply self-restraint on an almost daily basis, avoiding food they know will lead to weight regain.  They limit how much they eat.  They consciously choose not to return to their old eating habits, despite urges to the contrary.

The other glaring difference is that, compared to regainers, the successful losers are physically active.  Oftentimes, they exercised while losing weight, and almost always continue to exercise in the maintenance phase of their program.  This is true in at least eight out of 10 cases.  It’s clear that regular exercise isn’t always needed, but it dramatically increases your chances of long-term success.

Steve Parker, M.D.

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October 12, 2012 · 1:26 AM

Does Decreased Activity Explain Recent Overweight Trend?

Less active

Much of the globe has seen a significant decline in populaton-wide physical activity over the last few decades, according to Nike-sponsored research reported in Obesity Reviews.

Countries involved with the study are the U.S., U.K., Brazil, China, and India.  How did they measure activity levels?

Using detailed historical data on time allocation, occupational distributions, energy expenditures data by activity, and time-varying measures of metabolic equivalents of task (MET) for activities when available, we measure historical and current MET by four major PA domains (occupation, home production, travel and active leisure) and sedentary time among adults (>18 years).

The authors note the work of Church, et al, who found decreased work-related activity in the U.S. over the last half of the 20th century.

Inexplicably, they don’t mention the work of Westerterp and colleagues who found no decrease in energy expenditure in North American and European populations since the 1980s.

 

 

More active

My gut feeling is that advanced populations around the globe probably are burning fewer calories by physical activity over the last 50 years, if not longer, thanks to technologic advances.  We in the U.S. are also eating more calories lately.  Since the 1970s, average daily consumption by women is up by 150 calories, and up 300 by men.  Considering both these trends together, how could we not be fat?

Steve Parker, M.D. 

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July 20, 2012 · 2:00 AM

Random Thoughts on Fitness

A couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low-back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lung, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, leg stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises.  I did Core Performance religiously for 15 weeks—it’s a good program, requiring 5-6 hours a week.

Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

I recently complete a stint with the Hillfit program.  Here’s my current regimen.

Newbies to vigorous exercise should seriously consider using a personal trainer.

Steve Parker, M.D.

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July 10, 2012 · 2:00 AM

U.S. Army Physical Fitness Requirements: Are You As Strong As a Soldier?

I’ve written previously how it’s helpful to have some baseline physical fitness measurements on yourself. That post mentioned up to 14 different items you could monitor. In the comment section, I recognized that’s too much for some folks. For them, I suggested just doing the five-item functional testing: 1-mile run/walk (timed), maximum number of push-ups and pull-ups, toe touch, and vertical jump.

A few months ago, I was at a training session for adult Boy Scout leaders. One of the items covered was environmental heat illness: how to avoid, recognize, and treat. One of the risk factors for heat illness is “poor fitness,” defined as taking over 16 minutes to run two miles. Inquiring minds want to know where that number came from. No reference was given.

About.com has an article on fitness requirements for U.S. army soldiers, who are tested at least twice yearly. There are only three components tested:

  • Number of push-ups
  • Number of sit-ups
  • Time to complete a two-mile run

Fortunately, the Army doesn’t expect a 57-year-old man to perform as well as a 17-year-old. For instance, a 17-year-old has to run two miles in 19 minutes and 24 seconds or less; the 57-year-old is allowed up to 23 minutes and 24 seconds. Females and males have different performance standards: a 17-year-old woman has 22 minutes and 24 seconds to run two miles.

(An ex-Ranger a few days ago told me the Rangers have to meet or exceed the standard for 19-year-olds, regardless of age.)

The simplicity of the Army’s approach appeals to me. Check out the APFT tables in the About.com article if you want to see how you compare to Army soldiers.

Steve Parker, M.D.

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July 8, 2012 · 4:02 PM

Starting a Fitness Program? Get Baseline Measurements First

Impressive jump!

Before beginning or modifying a fitness program, it’s helpful to take some baseline physical measurements. Re-measure periodically. That way you’ll know whether you’re making progress, holding steady, or regressing. Improving your numbers also helps to maintain motivation.

Not taking measurements would be like starting a weight loss plan without a baseline and subsequent weights.

Eighteen months ago, I finished a home-based, 15-week, six-days-a-week fitness program called Core Performance, designed by Mark Verstegen. I was pleased with the results. The only problem is that it’s very time-consuming, 45-60 minutes a day. Perhaps fitness just has to be that way.

I regret that I didn’t take any fitness measurements before and after starting Core Performance.

For much of the last year, I modified Core Performance to a thrice weekly, then twice weekly program, until a couple months ago when I pretty much abandoned it. I miss the benefits now, but just didn’t want to put in the time to achieve them. In other words, I lost my motivation.

Who needs this much flexibility?

Intellectually, I know that regular exercise is important. I’ve read that you can be fairly fit with as little as 30 minutes of exercise a week. I’m not entirely convinced yet. I’ll be test-driving some of these time-efficient programs over the next 12 months.  One I’ve done already is Hillfit.

This new style of fitness is promoted by the likes of Dr. Doug McGuff, Chris Highcock, Skyler Tanner, Nassim Taleb, and Jonathan Bailor, among others.

What to Measure

  1. Weight
  2. Blood pressure
  3. Resting heart rate (first thing in the AM before getting out of bed)
  4. Waist circumference (upright and supine)
  5. Height
  6. Body mass index
  7. Mid-arm circumference, both arms, hanging relaxed at your sides
  8. Maximal calf circumference, both calves, while standing at ease
  9. Maximum number of consecutive pull-ups
  10. Maximum number of consecutive push-ups
  11. Run/walk one mile as fast as you can
  12. Maximum vertical jump (stand by a tall wall then jump and reach up as high as you can with one arm, noting the highest point above ground your fingers can reach)
  13. Can you touch your toes? Stand up straight, locking knees in extension, then bend over at your waist and touch your toes with your fingertips. If you can touch toes, can you flatten your palms against the floor? If you can’t reach your toes, measure the distance from your fingertips to the floor.
  14. Optional blood work for special situations: fasting blood sugar, hemoglobin A1c, triglycerides, cholesterols (total, HDL, LDL, sub-fractions)

The particular aspects of fitness these measure are strength and endurance in major muscle groups, cardiovascular and pulmonary endurance, a little flexibility, and a hint of body composition.

You may appreciate an assistant to help you measure some of these.

It’a long list.  If too long, just do what you think is important.  Record your numbers. Re-test some or all of these periodically, such as every six weeks after making a change.

If you’re in fairly poor condition at the outset, you’ll see some improved numbers after a couple or three weeks of a good exercise program. It takes months to build significant muscle mass; you’ll see improved strength and endurance before mass.

Am I missing anything?

Steve Parker, M.D.

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June 2, 2011 · 2:00 AM

Exercise, Part 10: What If I’m Markedly Obese?

The more overweight you are, the harder it will be to exercise.  At some point even light exercise becomes impossible.  Average-height women tipping the scales at about 280 pounds (127 kg) and men at 360 pounds (164 kg) aren’t going to be able to jog around the block, much less run a marathon.  These weights are 100 percent over ideal or healthy levels.  An actual “exercise program” probably won’t be possible until some weight is lost simply through very-low-carb eating, calorie restriction, or bariatric surgery.  The initial exercise goal for you may just be to get moving through activities of daily living and perhaps brief walks and calisthenics while sitting in a chair.

"I'll get started after I finish this cigarette."

Markedly obese people who aren’t up to the aforementioned extreme weights can usually tolerate a low-intensity physical activity program.  At 50 percent over ideal weight, an average-height woman of 210 pounds (95 kg) is carrying 70 excess pounds (32 kg) of fat.  Her male counter-part lugs around 90 pounds (41 kg) of unnecessary fat.  This weight burden causes dramatic breathlessness and fatigue upon exertion, and makes the joints and muscles more susceptible to aching and injury.  If you’re skinny, just imagine trying to walk or run a mile carrying a standard five-gallon (19 liter) water cooler bottle, which weighs only 43 pounds (19.5 kg) when full.  The burden of excess fat makes it quite difficult to exercise.    

If you’re markedly obese, several tricks will enhance your exercise success.  I want you to avoid injury, frustration, and burn out.  Start with light activity for only 10 or 15 minutes, gradually increase session length (e.g., by two to four minutes every two to four weeks) and increase exercise intensity only after several months.  Your joints and muscles may appreciate easy, low-impact exercises such as stationary cycling, walking, swimming, and pool calisthenics/water aerobics.  You may also benefit from the advice of a personal fitness trainer arranged through a health club, gym, or YMCA/YWCA.  Check out several health clubs before you join.  Some of them are primarily meat markets for beautiful slender yuppies.  You may feel more comfortable in a gym that welcomes and caters to overweight people. Hospitals are increasingly developing fitness centers with obese orthopedic, heart, and diabetic patients in mind.

Steve Parker, M.D.

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March 20, 2011 · 7:41 AM

Exercise, Part 8: Warnings and Precautions for Diabetics

Exercise clearly has many benefits, as discussed in prior installments of this series.  Yet we shouldn’t overlook the potential risks to diabetics either. 

Diabetic Retinopathy

Diabetics with retinopathy (an eye disease caused by diabetes) have an increased risk of retinal detachment and bleeding into the eyeball called vitreous hemorrhage. These can cause blindness. Vigorous aerobic or resistance training may increase the odds of these serious eye complications. Patients with retinopathy may not be able to safely participate. If you have any degree of retinopathy, avoid the straining and breath-holding that is so often done during weightlifting or other forms of resistance exercise. Vigorous aerobic exercise may also pose a risk. By all means, check with your ophthalmologist first. You don’t want to experiment with your eyes.

Diabetic Feet and Peripheral Neuropathy 

Diabetics are prone to foot ulcers, infections, and ingrown toenails, especially if peripheral neuropathy (numbness or loss of sensation) is present. Proper foot care, including frequent inspection, is more important than usual if a diabetic exercises with her feet. Daily inspection should include the soles and in-between the toes, looking for blisters, redness, calluses, cracks, scrapes, or breaks in the skin. See your physician or podiatrist for any abnormalities. Proper footwear is important (for example, don’t crowd your toes). Dry feet should be treated with a moisturizer regularly. In cases of severe peripheral neuropathy, non-weight-bearing exercise (e.g., swimming or cycling) may be preferable. Discuss with your physician or podiatrist.

Hypoglycemia

Low blood sugars are a risk during exercise if you take diabetic medications in the following classes: insulins, sulfonylureas, meglitinides, and possibly thiazolidinediones and bromocriptine. Hypoglycemia is very uncommon with thiazolidinediones. Bromocriptine is so new (for diabetes) that we have little experience with it; hypoglycemia is probably rare or non-existent. See drug details in chapter four. Diabetics treated with diet alone or other medications rarely have trouble with hypoglycemia during exercise.

Always check your blood sugar before an exercise session if you are at risk for hypoglycemia. Always have glucose tablets, such as Dextrotabs, available if you are at risk for hypoglycemia. Hold off on your exercise if your blood sugar is over 200 mg/dl (11.1 mmol/l) and you don’t feel well, because exercise has the potential to raise blood sugar even further early in the course of an exercise session.

As an exercise session continues, active muscles may soak up bloodstream glucose as an energy source, leaving less circulating glucose available for other tissues such as your brain. Vigorous exercise can reduce blood sugar levels below 60 mg/dl (3.33 mmol/l), although it’s rarely a problem in non-diabetics.

The degree of glucose removal from the bloodstream by exercising muscles depends on how much muscle is working, and how hard. Vigorous exercise by several large muscles will remove more glucose. Compare a long rowing race to a slow stroll around in the neighborhood. The rower is strenuously using large muscles in the legs, arms, and back. The rower will pull much more glucose out of circulation. Of course, other metabolic processes are working to put more glucose into circulation as exercising muscles remove it. Carbohydrate consumption and diabetic medications are going to affect this balance one way or the other.

If you are at risk for hypoglycemia, check your blood sugar before your exercise session. If under 90 mg/dl (5.0 mmol/l), eat a meal or chew some glucose tablets to prevent exercise-induced hypoglycemia. Re-test your blood sugar 30–60 minutes later, before you exercise, to be sure it’s over 90 mg/dl (5.0 mmol/l). The peak effect of the glucose tablets will be 30–60 minutes later. If the exercise session is long or strenuous, you may need to chew glucose tablets every 15–30 minutes. If you don’t have glucose tablets, keep a carbohydrate source with you or nearby in case you develop hypoglycemia during exercise.

Re-check your blood sugar 30–60 minutes after exercise since it may tend to go too low.

If you are at risk of hypoglycemia and performing moderately vigorous or strenuous exercise, you may need to check your blood sugar every 15–30 minutes during exercise sessions until you have established a predictable pattern. Reduce the frequency once you’re convinced that hypoglycemia won’t occur. Return to frequent blood sugar checks when your diet or exercise routine changes.

These general guidelines don’t apply across the board to each and every diabetic. Our metabolisms are all different. The best way to see what effect diet and exercise will have on your glucose levels is to monitor them with your home glucose measuring device, especially if you are new to exercise or you work out vigorously. You can pause during your exercise routine and check a glucose level, particularly if you don’t feel well. Carbohydrate or calorie restriction combined with a moderately strenuous or vigorous exercise program may necessitate a 50 percent or more reduction in your insulin, sulfonylurea, or meglitinide. Or the dosage may need to be reduced only on days of heavy workouts. Again, enlist the help of your personal physician, dietitian, diabetes nurse educator, and home glucose monitor.

Finally, insulin users should be aware that insulin injected over muscles that are about to be exercised may get faster absorption into the bloodstream. Blood sugar may then fall rapidly and too low. For example, injecting into the thigh and then going for a run may cause a more pronounced insulin effect compared to injection into the abdomen or arm.

Autonomic Neuropathy

This issue is pretty technical and pertains to function of automatic, unconscious body functions controlled by nerves. These reflexes can be abnormal, particularly in someone who’s had diabetes for many years, and are called autonomic neuropathy. Take your heart rate, for example. It’s there all the time, you don’t have to think about it. If you run to catch a bus or climb two flights of stairs, your heart rate increases automatically to supply more blood to exercising muscles. If that automatic reflex doesn’t work properly, exercise is more dangerous, possibly leading to passing out, dizziness, and poor exercise tolerance. Other automatic nerve systems control our body temperature regulation (exercise may overheat you), stomach emptying (your blood sugar may go too low), and blood pressure (it could drop too low). Only your doctor can tell for sure if you have autonomic neuropathy.

Steve Parker, M.D.

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March 6, 2011 · 2:00 AM

Exercise, Part 7: Could Exercise Hurt Me?

To protect you from injury, I recommend that you obtain “medical clearance” from a personal physician before starting an exercise program.  A physician is in the best position to determine if your plans are safe for you, thereby avoiding complications such as injury and death.  Nevertheless, most adults can start a moderate-intensity exercise program with little risk.  An example of moderate intensity would be walking briskly (3–4 mph or 4.8–6.4 km/h) for 30 minutes daily.

Men over 40 and women over 50 who anticipate a more vigorous program should consult a physician to ensure safety.  The physician may well recommend diagnostic blood work, an electrocardiogram (heart electrical tracing), and an exercise stress test (often on a treadmill).  The goal is not to generate fees for the doctor, but to find the occasional person for whom exercise will be dangerous, if not fatal.  Those who drop dead at the start of a vigorous exercise program often have an undiagnosed heart condition, such as blockages in the arteries that supply the heart muscle.  The doctor will also look for other dangerous undiagnosed “silent” conditions, such as leaky heart valves, hereditary heart conditions, aneurysms, extremely high blood pressure, and severe diabetes.

The American Diabetes Association’s Standards of Care—2011 states that routine testing of all diabetics for heart artery blockages before an exercise program is not recommended; the doctor should use judgment case-by-case.  Many diabetics (and their doctors) are unaware that they already have “silent” coronary artery disease (CAD).  CAD is defined by blocked or clogged heart arteries, which reduced the blood flow to the hard-working heart muscle.  Your heart pumps 100,000 times a day, every day, for years without rest.  CAD raises the odds of fainting, heart attack, or sudden death during strenuous exercise.  I recommend a cardiac stress test (or the equivalent) to all diabetics prior to moderate or vigorous exercise programs, particularly if over 40 years old. CAD can thus be diagnosed and treated before complications arise.  Ask your personal physician for her opinion.

Regardless of age and diabetes, other folks who may benefit from a medical consultation before starting an exercise program include those with known high blood pressure, high cholesterol, joint problems (e.g., arthritis, degenerated discs), neurologic problems, poor circulation, lung disease, or any other significant chronic medical condition.  Also be sure to check with a doctor first if you’ve been experiencing chest pains, palpitations, dizziness, fainting spells, headaches, frequent urination, or any unusual symptoms (particularly during exertion).

Physicians, physiatrists, physical therapists, and exercise physiologists can also be helpful in design of a safe, effective exercise program for those with established chronic medical conditions. 

Steve Parker, M.D.

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