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Helping your patients with diabetes exercise their options

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As pharmacists we are not trained in the area of exercise physiology or personal training, yet we are on the front lines to face questions from people living with diabetes about the appropriate amount and type of exercise for managing diabetes.

By Shelley Diamond, BScPhm

Illustration by Martin Bregman

On the flipside, we are also asked to counsel our patients on “lifestyle,” of which physical fitness is one important aspect. So what are the main educational tips regarding physical activity for patients living with diabetes?

Here are the key messages from the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes:

KEY MESSAGE 1:

  • Moderate to high levels of physical activity and cardiorespiratory fitness are associated with substantially lower morbidity and mortality in men and women with and without diabetes.
PHARMACIST RECOMMENDATION:

Ensure that patients understand that people with diabetes who perform 150 minutes per week of moderate-intensity aerobic exercise will experience substantially lower rates of cardiovascular disease and premature mortality. And specific to people with type 2 diabetes, supervised exercise programs have shown a benefit of better glycemic control, a reduction of medications and modest but sustained weight loss. Those are just the diabetes-related benefits.  Main benefits of exercise also include increased energy, relief of depression and anxiety, and maintenance of bone health.

KEY MESSAGE 2:

  • For most people, being sedentary has far greater adverse health consequences than exercise would. However, before beginning a program of physical activity more vigorous than walking, people with diabetes should be assessed for conditions that might place the individual at increased risk for an adverse event associated with certain types of exercise.
PHARMACIST RECOMMENDATION:

Make sure your patients are prepared before they start physical activity.  Recommend for those who have not begun an exercise program that is more intense than a brisk walk, to speak with their physician to ensure they learn about any physical activity limitations they may have based on their medical history. Some examples of these limiting conditions are severe autonomic neuropathy, severe peripheral neuropathy, pre-proliferative or proliferative retinopathy, or unstable angina.

Those who have never been engaged in a regular exercise program should begin with 5-10 minutes per day of brisk walking. Keep in mind, multiple short sessions of exercise are considered to be as effective as single longer sessions of equivalent length and intensity.

KEY MESSAGE 3:

  • Both aerobic and resistance exercise are beneficial for patients with diabetes, and it is optimal to do both types of exercise. At least 150 minutes per week of aerobic exercise, plus at least two sessions per week of resistance exercise, is recommended.
PHARMACIST RECOMMENDATION

Aerobic activity can be either moderate or vigorous.  Great examples of moderate intensity exercise include brisk walking, biking, dancing, swimming, climbing stairs. Examples of vigorous activity include running, gym workouts, and fast cycling.

Resistance exercise involves repeated movements with weights, weight machines, resistance bands, or one’s own body weight (e.g. push-ups) to increase muscle strength and/or endurance. It is important to have proper training on how to perform these exercises either through a certified trainer or through the use of instructional videos or DVDs.

Hypoglycemia and exercise

For patients with type 1 diabetes or those who are on insulin, there is a risk of hypoglycemia with moderate to vigorous exercise. They are recommended to monitor their blood glucose before, during and after exercise. It is important for them to carry a fast-acting carbohydrate (e.g. glucose tablets) to manage hypoglycemia that may arise as a result of their increased activity. If blood glucose levels are below 5.5mmol/L pre-exercise, a snack of 15-30g carbohydrate should be considered. This will depend on the amount of insulin administered, the duration and intensity of the exercise and the actual blood glucose level.

Pharmacists are in a unique and influential position to motivate non-active patients to begin and maintain an effective and safe long-term exercise program.  Why not consider expanding your cognitive services to include prescribing exercise?

Shelley Diamond BScPhm is the president of Pedipharm Consultants and Diabetes Care Community Inc. (www.diabetescarecommunity.ca)