What people with diabetes need to consider before starting an exercise regimen.
1. I'M A 45-YEAR-OLD MAN. I WAS DIAGNOSED WITH HYPERTENSION AND DIABETES AND AM CURRENTLY ON MEDICATION FOR BOTH. IS EXERCISE SAFE FOR ME?
Exercise is not only safe but highly recommended as part of your treatment for diabetes and hypertension, together with diet control and lifestyle changes.
You should exercise for 150 minutes per week in moderate intensity (such as brisk walking) or 75 minutes of vigorous intensity (such as jogging), if your condition allows it.
Exercise will increase insulin sensitivity and improve blood glucose control. It will also help lower your blood pressure. It will also prevent heart disease and improve your overall wellbeing.
Please refer to "Stay fit for a longer life" (NST, Dec 5, 2017) on the effect of exercise on diabetes, hypertension and overall health.
To ensure safety, please refer to "Pre-exercise medical screening" (NST, May 23, 2017), before starting any exercise programme.
Consult your doctor for any complications of diabetes and hypertension you may have, and target organ damage.
Good control of diabetes and hypertension is important before starting any exercise programme.
2. WHAT PRECAUTIONS SHOULD I TAKE WHEN I WANT TO EXERCISE?
In most situations, low to moderate intensity exercise (e.g. walking and brisk walking) is safe for diabetic and hypertensive patients.
If you don't have any symptoms of heart disease or no end organ complications (e.g. kidney, eye or heart), you can gradually opt for high intensity exercises like jogging or running.
Hypoglycaemia (low blood sugar) is most common and is an acute concern for diabetics, during and after exercise.
Make sure you watch out for symptoms of hypoglycaemia (shakiness, weakness, abnormal sweating, anxiety, etc) while exercising or after exercise.
Monitor your blood sugar before exercise, especially if you are on insulin or any drug that stimulates increased insulin secretion.
Adjustment of the timing of exercise and carbohydrate intake is important for diabetics with insulin injection to prevent hypoglycaemia.
You may discuss with your doctor if adjustment of dosage is required. Please exercise with a partner and bring your medical ID, a mobile phone and glucose tablet.
Avoid exercise if you are not feeling well, have a very high blood sugar level (>16.7mmol/L) or if you have ketone in your urine.
Ensure proper foot care to prevent blisters and ulcers. Use comfortable shoes and ensure feet are dry. Inspect feet regularly.
Test your blood pressure before exercise. If blood pressure is >200/110, postpone exercise and seek medical attention.
Consider doing light intensity exercise if blood pressure is >180/110mmHg. It is prudent to maintain blood pressure below 220/105 mmHg during exercise.
Those with stage 2 hypertension — systolic blood pressure (SBP) 160mmHg or diastolic blood pressure(DBP) 100mmHg — or target organ disease (such as kidney or heart disease) may need proper medical evaluation and treatment prior to starting an exercise programme.
Some medication for hypertension may cause effects during exercise. Beta-blockers may blunt the effect on heart rate during exercise.
Use rate of perceive exertion (RPE) to measure intensity, instead of heart rate monitor. Beta-blockers may also reduce your effort tolerance of exercise.
Beta-blockers and diuretics may alter body temperature regulation and fluid and electrolyte imbalance during exercise, especially in a hot and humid environment. Ensure that you are well-hydrated. Wear proper clothing and reduce exercise duration in this type of weather.
For patients taking alpha blockers, vasodilator and calcium channel blockers, medications may provoke hypotension after exercise. Please extend your cool down period after exercise.
It is important that you continue the medication for diabetes and hypertension while doing exercise. Consult your doctor if you feel anything while exercising. Adjustment of medication can only be made after consultation with a doctor.
3. ARE THERE ANY CONTRAINDICATIONS FOR ME TO EXERCISE?
There are two types of contraindication of exercise, relative and absolute contraindication. Relative contraindication is a less threatening condition but is dangerous enough that it warrants supervision.
Relative contraindications can be superceded if benefits outweigh the risks of exercise. Absolute contraindications mean that under no conditions should you undergo exercise or exercise testing. Consult your doctor if you have any of these:
RELATIVE CONTRAINDICATIONS
*l Left main coronary stenosis.
*Moderate stenotic valvular heart disease.
*Electrolyte abnormalities (eg. hypokalemia, hypomagnesemia).
*Severe arterial hypertension (i.e. systolic BP of >200mm Hg and/or a diastolic BP of >110mm Hg) at rest.
*Tachydysrhythmia or bradydysrhythmia.
*Hypertrophic cardiomyopathy and other forms of outflow tract obstruction.
*Neuromuscular, musculoskeletal or rheumatoid disorders that are exacerbated by exercise.
*High-degree atrioventricular block.
*Ventricular aneurysm.
*Uncontrolled metabolic disease (eg. diabetes, thyrotoxicosis or myxedema).
*Chronic infectious diseases (eg mononucleosis, hepatitis, AIDS).
*Mental or physical impairment leading to inability to exercise adequately.
ABSOLUTE CONTRAINDICATIONS
*ECG suggesting significant ischemia, recent myocardial infarction (within two days) or other acute cardiac events.
*Unstable Angina.
*Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise.
*Symptomatic severe aortic stenosis.
*Uncontrolled symptomatic heart failure.
*Acute pulmonary embolus or pulmonary infarction.
*Acute myocarditis or pericarditis.
*Suspected or known dissecting aneurysm.
*Acute systemic infection, accompanied by fever, body aches or swollen lymph glands.
An avid sportsman who believes in the healing powers of exercise, Assoc. Prof. Dr. Ahmad Taufik Jamil is Universiti Teknologi Mara's public health consultant and exercise physician. Reach him at atjamil@gmail.com.