Do You Respect the Current Exercise Guidelines?

Sorry for missing two days, but the medical procedure I under went, left me fuzzy and not thinking clearly.  I am not sure I clear headed, but felt this article is important.

While exercise is important for our health, but I find the guidelines do not provide adequate exercise for the return in the amount exercise. 

It is well known that regular physical exercise has a plethora of associated health benefits and has been shown to prevent and improve symptoms across all types of diseases, but are the current guidelines too challenging for the average person? We investigate.

Exercise has been hailed as somewhat of a miracle cure. It is free, easy to do, works immediately, and has little to no side effects. Scientific evidence has shown that, whatever your age, being physically active makes you happier and healthier.

The United States Department of Health and Human Services (HHS) 2008 Physical Guidelines for Americans report that for adults, the most substantial health benefits occur with at least 150 minutes (2 hours and 30 minutes) per week of moderate-intensity aerobic physical activity, or 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic physical activity.

Muscle strengthening (otherwise known as resistance training) physical activities that involve all the main muscle groups and that are moderate or high intensity should also be completed on 2 or more days every week.

The 2008 Physical Guidelines for Americans document that taking part in the equivalent of 150 minutes of moderate-intensity aerobic activity each week lowers the risk of: premature death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, and depression.

Stepping up physical activity from 150 minutes each week toward 300 minutes (5 hours) not only further lowers the risk of heart disease and diabetes, but also reduces the risk of colon cancer and breast cancer, and prevents unhealthy weight gain.

Moreover, increasing physical activity to more than the equivalent of 300 minutes per week of moderate-intensity aerobic physical activity further increases the benefits. For example, people who complete 420 minutes (7 hours) each week have an even lower risk of premature death, compared with individuals completing 150 to 300 minutes every week.

There are multiple ways to meet the recommended 150 minutes of exercise. In fact, research conducted by the University of California, Los Angeles Medical Center and the University of Pittsburgh showed that participating in a variety of activities - from walking and dancing, to gardening - improves brain volume and may reduce a person's risk of developing Alzheimer's disease by 50 percent.

It sounds easy enough: by working out for 30 minutes on 5 days of the week, those recommendations can be met. You would expect that with all the potential health benefits, the whole population would be following the recommendations and taking to the streets to walk briskly.

However, a huge proportion of the population is falling short. According to the Centers for Disease Control and Prevention (CDC), around 49 percent of adults meet the aerobic physical activity guidelines, and only 20.9 percent of adults meet the physical activity guidelines for both aerobic and muscle-strengthening activity.

So what is going wrong? With our busy lives, 30 minutes of moderate physical activity can be a challenging task to fulfill and may even be regarded, by some, as impractical or unobtainable.

Many of us claim that we do not have the time, energy, or inclination to fit in exercise. So not only are the guidelines and long-term health benefits failing to engage the population, but they are also being dismissed and ignored, and they even appear to be discouraging individuals to participate in any physical activity at all.

The HHS guidelines were released nearly 10 years ago, and in that time there has been considerable research into physical activity duration, frequency, and intensity. Do we really need to accumulate 150 minutes of physical activity every week? We take a look at some of the most recent findings.

The good news is that some health benefits can be gained with as little as 60 minutes of moderate-intensity activity each week, and some research has shown positive results with even less exercise.

One moderate exercise session of 20 minutes stimulates the immune system and sets off a cellular response that may help to suppress inflammation in the body, found a study published in Brain, Behavior, and Immunity.

These findings could help with treatment strategies for chronic diseases such as fibromyalgia and arthritis, as well as obesity.

"Our study shows a workout session doesn't actually have to be intense to have anti-inflammatory effects. Twenty minutes to half an hour of moderate exercise, including fast walking, appears to be sufficient," said Suzi Hong, Ph.D., in the Department of Psychiatry and the Department of Family Medicine and Public Health at the University of California, San Diego School of Medicine.

"Feeling like a workout needs to be at a peak exertion level for a long duration can intimidate those who suffer from chronic inflammatory diseases and could greatly benefit from physical activity."

Please read the full article here.

Help in Diabetes Management Education – Part 9

Part 9 of 12

Exercise can be a contentious topic for some people. I agree because too often the doctor or other healthcare professional just orders exercise and suggests walking or jogging. I even become upset when they do this to me and I ask them if they have heard of weight lifting, dancing, swimming, or other types of exercise.

I ask if aerobics is not considered exercise or if because it is recommended to do some resistance exercise with aerobics that they don't consider this exercise. I sort of get in their face and ask why they only consider walking and jogging as exercise. Do they even know that the person is capable of jogging or the area in which they can walk is even safe? I then ask if they know that the person will enjoy walking or jogging and why they do not recommend the period of time for walking and jogging.

I am probably the last person they want talking about this, as they know now that I just don't let it go. One doctor asked me to write something up for his office to use. I was a fool for not making copies of what I wrote for him more than three decades ago. I did a lot of research and talked to several people in the business side of training people and those that supplied different equipment. It amounted to more than 15 typed and double spaced pages. I thought all had been lost when the doctor died about 13 years ago, until last month when another patient of his asked me one day if I knew of a paper on exercise written by a person with the same name.

I asked him which doctor he had received it from and when he said the doctor's name, I asked if I could get a copy of it. I now have a copy and it is what I had written with a few notes and other references added. Now I can rewrite it and keep it.

An important part of any exercise regimen is doing something you enjoy, as this will help you maintain it. Please read this by Tom Ross. This is not his normal place for exercise, but he makes use of it.

When it comes to changes in lifestyles, my blog about components of lifestyle changes is a good blog to read. This will vary from person to person as not everyone will need to change every component, but others will need to change many of the components,  This blog may also help. The last blog is also about lifestyle changes, but emphasizes lifestyle changes over medications, which is refreshing.

Food plan changes and exercise seem to be the changes most often emphasized. I do believe that these are necessary, but there are other changes that can help as well. Please be careful with stress, as this is one of the most damaging and can cause any food plan to blow up and cause weight gain and make diabetes more difficult to manage.

Stress in managing your diabetes can be very upsetting for some. Another term for this is burnout as you are the only person in charge of managing your diabetes. Yes, your doctor can give your tips and advice, but in the 15 minutes that you see him or her, this will not be a lot of help. Consider that about half an hour or an hour out of the year, that you see the doctor, the responsibility rests on you, the person with diabetes.

This can cause stress and even depression. This needs to be recognized and if you have family, they can help reduce the stress by supporting you. Unfortunately, they can also increase stress. Exercise can reduce and possibly eliminate much stress.

Lessons for People New to Type 2 Diabetes, Part 5

There is more to food and finding your own food plan than meets the eye. I would urge readers to read some of the mistakes I made shortly after diagnosis. The first link is this, the second link is this, and the third link is here. Before I start with the next subject, I would appreciate you taking time to read this on lifestyle change. Why this you ask? Because effectively to manage your diabetes, some lifestyle changes often need to be made.

The components of lifestyle does start with exercise which in the topic for this blog. To start exercising, if you have not been a regular exerciser, please talk to your doctor for his approval as he may have something that could limit you. He may know from your history and lab reports that you need to be more careful at the beginning before really becoming a regular at exercising. If you are not medically able to do some exercises, your doctor may suggest some forms of exercise that you can do.

While discussing exercise with the doctor, do not forget to talk about blood glucose levels and learn that you do not exercise if the reading is over 250 mg/dl. Some doctors will suggest not over 200 mg/dl for an upper level. On the lower end, a reading below 100 mg/dl will be discouraged. Now this can vary if you are limited in what you can do for exercise.

One person that I know was discouraged from exercising by his doctor, but in talking with the doctor, he was allowed to do some weight lifting up to 25 pounds in each hand while sitting in his wheel chair and was later able to increase the weights to 50 pounds. After two operations on his legs and two years of therapy, he was finally allowed to do some walking and swimming. He is hoping to do more this coming summer. The doctor has set 200 mg/dl as his upper limit and he is not supposed to exercise above this. Since he keeps his blood glucose levels below 140 mg/dl on a regular basis, the doctor is very happy and has allowed longer periods of exercise.

I know that some people exercise below the minimum and too many exercise above the 250 mg/dl level. Those that exercise above this level are flirting with danger and other problems.

The type of exercise you decide to do should be something you enjoy and will do. Consider walking, jogging, swimming, aerobics, resistance exercises, jumping rope, weight lifting, bicycling, and using various types of treadmills in the winter or at times when you don't want to be out in bad weather.

For people with type 2 diabetes, the length of the various exercises can vary. Walking can be for 30 minutes or for three periods of 10 minutes. There are variances for each type of exercise and the number of repetitions you need to do. As you condition yourself, consider increasing the time or number of repetitions. This can depend on the amount of weight you need to lose or even if you need to lose weight. Or it can depend on the need to reduce internal fat and convert it to muscle. These are all things that need discussion with your doctor.

Once you reach your goal, then you will need to schedule exercise to maintain that weight or muscle and not regain weight or lose muscle.

Lifestyle Changes More Important Than Medications

This blog from the Center for Advancing Health (CFAH) is written by a person that attended the Diabetes + Innovation 2013 conference. I found her blog most interesting and while I am generally not able to attend such conferences, there are many thoughts she put forward that I have known and thus am not surprised. The following are lifted from that blog:

#1. Diabetes management falls squarely on the patients' shoulders. While many patients with diabetes feel that they should be receiving more information from their doctors, time does not allow for this. People with type 2 diabetes on oral medications often see their doctors at most two times a year. This will vary by the level of their HbA1c, but often depends on the doctor. The better managed their diabetes is, the less time their doctor will want to see them. Many patients managing diabetes with nutrition and exercise will not see their doctors but once a year once they have proven they can do this.

#2. The responsibilities and tasks of diabetes management can seem overwhelming. The fact that there is no vacation from diabetes can cause this and leave patients feeling alone and otherwise isolated. This is one reason our diabetes support group works so well and we enjoy each other's input. If you are feeling isolated, search out a support group in your community. Or if needed consider organizing a diabetes support group.

The following are three patient themes highlighted by Milly Dawson, the blog author:

#3. The main caregiver for a person with diabetes or prediabetes is himself or herself.

Diabetes prevention and treatment efforts should make it easier for people to make choices, but not in isolation, but within families and communities. The goal should be to make good choices about food and exercise. This “default choice” involves healthy eating at work and at home. It also means finding the right exercise regimen that the person can accomplish and enjoys on a daily basis.

#4. Behavior or lifestyle changes should be the first in treatment plans. Review the lifestyle changes from my blog – components of lifestyle change. Be sure to include weight loss if needed. Many of the lifestyle changes also reduce a person's risk of heart disease, cancer, mental illness, severe depression, and other health issues.

#5. People often have a hard time changing habits. To succeed, people often need other support besides doctors. Again, a support group, family, and community support may be needed. Do not forget caregivers, social workers, nutritionists, health coaches, and even peers, trained or untrained, online connections, and social media.

Presently, primary care physicians (PCPs) are not in a position to give the needed assistance. Often your time with a PCP is very limited and your insurance carrier generally is of no help.

The blog author rightly emphasizes food and exercise over medications. The American Diabetes Association and the American Association of Clinical Endocrinologists do not and push oral medications heavily, even before insulin. Food and the right food plan is critical in the management of diabetes.

Back to Diabetes Basics – Part 6

Exercise Is a Key in Diabetes Management

Maybe some of us emphasize this too much and too often, but it is one truth that many people with diabetes just feel they can ignore. You will get tired of this as well; many type 2 people just say, “Apparently the doctor did not feel it was important as he/she did not talk about it.” I am beginning to believe these people need a hearing test, but I do know a few doctors that are afraid to say anything also. This is a deadly set of circumstances to work with in attempting to get people to exercise.

Always consult with your doctor before beginning any exercise regimen. If you are on medications, your doctor may want to give you different dosages to use under different circumstances to prevent hypoglycemia. Even if you are not on medications, the doctor may have other health concerns that you may need to consider. I have discussed blood glucose levels for safe exercising in my blog here. Knowing this information will save you from problems while you exercise.

I have more information about how a neighbor made me realize how important exercise is. He has had the second operation and is walking with a cane today. He is still unable to drive, but he walks just about everywhere and will not accept a ride. Yes, I have driven when he has too far to walk or needs to travel to another town. Even when he needs groceries, he walks and shops for only what he can carry. You have to admire him for his determination. If anyone could have given up, he could have been the person, but he has met every opportunity to educate others and show them what a person can do.

Lifestyle Changes

Do you know what this means? Many people have some idea, but it can be very general. This may be just semantics; however, I would like to clarify some parts of the term “lifestyle”. The definition from an on line dictionary says lifestyle is a way of life, the attitudes, tastes, moral standards, economic level, etc., that comprise an individual or group.

This of course says nothing about diabetes and managing diabetes. In my reading, blogging, and participation in a few diabetes forums, I have seen lifestyle described many ways. I have a slightly different perspective as most writers start with diet. I believe the elements of lifestyle change should start with exercise if you are physically and medically able. It is the key that generally makes the rest of lifestyle fall into place.

What you need to recognize is that all are interlinked and bypassing one part of lifestyle change will normally make other changes generally unachievable. What different writers choose of emphasize depends on their philosophy and how they view their career. Most that work in the medical profession, be they doctors, nurses, educators, dietitians, or licensed caregivers, must follow the guidelines of the American Medical Association, the American Diabetes Association, and other professional medical groups if they want to have their license updated and current.

Since I answer to myself and a few bloggers that agree exercise should be listed first, this is where I will start. This is the list I have pulled together from various sources. It may not agree with everyone's list, but for me, the list needs to be updated as changes are found that affect the way we look at diabetes and lifestyle.

The main elements of lifestyle should or must include the following: exercise, food, sleep, food, medication, weight loss, illness, hormones, stress, heart health care, and two other elements, alcohol and smoking.

Exercise – If you are physically and medically able, get your doctors okay to exercise, and remember to exercise good judgment and don't do something that will be wrong and cause injury. Start out slowly and build up gradually. Regular exercise helps make insulin more readily available and reduces insulin resistance. Find a form of exercise or a mix of routines that you enjoy and follow through with it.

Food – Healthy eating is important and even more important if you are medically unable to exercise. It is good to be consistent in eating times and amount of food. Whether you eat low carb or another way, learn to use your meter to determine how different foods affect your blood glucose. Learn to coordinate your food with the medication you are taking. Also, learn to eat to your meter and learn to trust it.

Sleep – Where did this come from? It is not included on most lists, but should be after a study I wrote about here. I keep being surprised how important sleep is to our well-being as a person with diabetes. That is the main reason I am adding it to lifestyle and encouraging all to get the sleep needed. If you are having trouble getting enough sleep, change your habits and if that does not help, talk to your doctor about doing a sleep study to determine if you have a form of sleep apnea.

Medication – Be sure that you follow the doctor’s instructions. Yes, I know that you want to avoid all medications. This is an excellent goal if you are diagnosed early on and can make this work. Remember that you need to consider getting the diabetes managed as soon as reasonably possible. Do discuss with the doctor getting off medications if you do it. If you do bring diabetes under good management and the doctor wants to keep you on medications, then ask yourself if a change in doctors needs to be considered.

Heart health care – Because people with diabetes are at 50 percent risk of having cardiovascular events, many of the same changes for diabetes help with heart health. It may still be necessary to consider medications for heart health. Exercise and food choices become primary for heart care and managing cholesterol and hypertension.

Weight loss – This is easy for some people, while others struggle with this every day. The first goal should be stopping gaining any weight. Then adapt your food intake to help start reducing weight. Generally if you are overweight, a high carbohydtate, low fat diet will not help you reduce weight. There are more and more writing about low carb, high fat. However, you need to find what works for you in assisting to bring down the weight. I will not suggest how, since I am still working on this myself.

Illness – This was a little surprising until I thought about how illness affects our diabetes management. Therefore, as an element of lifestyle change we need to learn to take our medications timely and know when to talk to the doctor about variations like illness which can cause problems unless we know not to take certain medication to prevent hypoglycemia. This means having a plan with your health care team of what medications to take or not take during an illness.

Hormone levels – This is normally for women who have problems with blood glucose swings related to the monthly menstrual cycle. I personally think the authors failed to talk about the change in life for women and problems some men can have when male hormones cause problems and can affect blood glucose as well. You need to talk about this with your doctor to be prepared for these changes.

Stress – This is definitely a lifestyle change that affects everyone with diabetes. When stressed, almost anyone can toss aside their usual good diabetes management practices, forget to eat healthy foods, and lose control of your blood glucose. Prolonged stress may prevent insulin from working properly which also creates additional problems. Some find logging your stress level (1 to 10 scale) each time you log your blood glucose level helps them see patterns and allow you to adjust accordingly. Learn about ways to relax and find ways to reduce stress.

Alcohol – This can be a bad one if not thought out. First, you need to talk this over with your doctor. Alcohol can aggravate diabetes complications like nerve damage and eye disease. If your diabetes management is excellent, and the doctor agrees, an occasional alcohol drink with a meal may be okay, but a daily drink is generally discouraged.

Smoking - This is a habit that must be broken. Many writers do not want to cover this lifestyle change that needs to happen and the sooner the better. Not only does this increase the effects of neuropathy, but it can affect an increase in cardiovascular risks. Do not take this lightly; the effects of continuing to smoke do not make blood glucose management easier.

To sum up, these are the lifestyle changes that need attention for those of us with diabetes.

Series 6 of 12

Barriers to PA Counseling in PCP Setting

What other excuses will researchers come up with and doctors provide for not doing their jobs? We constantly hear about the time factor and how doctors are not reimbursed if they spend extra time with patients in need of physical activity (PA) counseling. This I cannot put entirely on the doctors as our medical insurance industry works hard to enforce time limits on doctors. Doctors working for certain type of practices and especially those doctors that are hospital employees are often so tightly managed that they can be docked pay for not staying within limitations of time spent with patients.

Before heaping too much blame on doctors working for hospitals, we need to understand what they are facing. Many hospitals have training areas and training programs, they want the doctors to refer the patients to PA. So far this sounds good, but considering that most insurance companies will not cover this unless it is part of a therapy program for certain medical conditions. Research has shown that physical activity reduces the risk of all-cause mortality in coronary heart disease, hypertension, type 2 diabetes, certain cancers and other chronic conditions. In addition, many patients may have a membership in the local YMCA or YWCA and cannot afford the hospital prices.

I have a difficult time with a hospital that disciplined a doctor employee for volunteering one evening a week to work with patients and other members at a YMCA for two hours. This just shows how greedy the hospital is, not considering that the doctor by volunteering his time may be bringing more patients to the hospital. The hospital was only concerned that he was not volunteering his time for the hospital therapy area where they could charge people for using the facility.

The study pointed out that lack of knowledge and training in health promotion also was a barrier causing a lack of effective physical activity counseling in the primary care setting. In many areas of the USA, there are few areas for people to be able to have exercise programs twelve months of the year. Summer heat in many states and winter snow in northern states make for restrictions to physical activity. Not everyone has room in their homes for exercise equipment or the ability to afford the equipment.

Yet in many communities, schools that have the facilities are underutilized and in general are off limits to the communities to use. Other communities have what used to be dance halls or roller rinks that would work but many are being demolished for lack of use and to make way for commercial buildings or houses. Sometimes there are people that have the training to work with people to assist them in getting physical activity, but the doctors are either unaware of them or prohibited from working with them by their employer or in a few instances the local medical association, because heaven forbid, anything that might take money away from the doctors is not allowed.

I do understand doctors not providing counseling when they will not be reimbursed for it, but to restrict what a doctor does during his off duty or after office hours on a voluntary basis is the height of greed by hospitals and some group practices. In November 2011, the Centers for Medicare and Medicaid Services added coverage for preventive services to reduce obesity. This covers counseling to promote weight loss using intense interventions on exercise and diet. What is stopping this from succeeding? It is the restrictions and guidelines that must be followed before the primary care provider will receive reimbursement. There are too many hoops to jump through for many to have incentives to make this succeed.

For those interested in the article, here is the link. If you are interest in finding a program that will not penalize a doctor or can afford a gym, YMCA, YWCA, or other activity center membership do this. Ask your doctor if he has the training and knowledge to assist. Some will find a way even if they will not be reimbursed, or you may need to find a doctor that can assist. Some do exist through telemedicine, concierge practices, and other types of medical practices. Even some specialty doctors are involved.

Exercise Is Good For Your Diabetes Health

I know that you are seeing this topic more and more often and I think you can stand another dose. If you think you have it tough, guess again! The gentleman that I wrote about in this blog is doing very well and loves to exercise. He has regained almost full use of his left leg over the summer and is looking forward to this December as the doctor is now convinced that the operation on his right leg is worth the effort.

Although he had been told originally that he would be confined to a wheel chair, he has proven those doctors wrong. Granted he is still on crutches and still uses his manual wheel chair, he now has hope for not using or depending on the wheel chair in the future.

This blog is about the exercises that people with different diabetes complications can accomplish and should provide possibilities. The key is talking with your doctor and getting his/her input about what you want to do. The link within this blog (repeated here) to the Joslin blog discusses exercise for those with diabetes complications. The author also repeats advice and has some excellent suggestions.

So rather than remain sedentary, consider exercise. Find what you can do daily, enjoy, and start exercising. Being sedentary will only assist diabetes in its control over you. Moving within your limits can only help and make your management of diabetes easier.

If you have no limitations, then not exercising should not be an option. Always discuss your plan with the doctor and then find something that you can enjoy even if it is only walking. Find a walking partner or if you have children that can keep up with you, get out there!

More on exercise appeared on the Joslin blog September 23, 2011 for those that are able to exercise and have little or no limitations. They have taken information from several recent studies and are emphasizing interval training. This means high intensity activity for a period followed by low intensity activity. It is a good read but mentions nothing about resistance training verse aerobic exercise.

The big reference they gave us is this link to many more discussions on exercise. These tip topics are for both type 1 and type 2. Included are some good do's and don’ts about exercise for people with diabetes.

To assist you with your choice and show that running or intense exercise is not for everyone, read David Mendosa's blog of October 4, 2011. I like his style. Exercise needs to include everyone.

Blood Glucose Levels for Safe Exercising

Because of all the blogs appearing about exercise, I felt it was time to discuss some problems people tend to ignore when they exercise. Yes, too many people ignore their blood glucose levels, especially the people with type 2 diabetes. Most people with type 2 diabetes don't even tell their doctors they are starting to exercise or even that they are exercising. Many are just plain lucky they have not developed hypoglycemia or had problems of having their blood glucose levels too high when they started their daily exercise.

Although most sources seldom discuss the problems involved, it is time to bring them to the front. Most people with type 1 diabetes know what happens if the blood glucose levels are too low or too high before they start their daily exercising. For some reason, many doctors just do not cover this with type 2 patients. Does this mean that we will not have problems. Just continue to push your luck and you may end up in the hospital.

In my research, it has been difficult to find conclusive answers for type 2 diabetes. Everyone agrees that a blood glucose level of 250 mg/dl (13.9 mmol/L) or higher means that you must not exercise until your levels have come down below this.

Read the American Diabetes Association Diabetes Care for guidelines and concerns before beginning a regimen of exercise. Type 2 diabetes people on insulin or sulfonylurea treatments need to be concerned at the same degree as people with type 1 diabetes. It is just that people with type 2 are less likely to have severe hypoglycemia. Exercise for people with type 2 generally improves insulin sensitivity and assists in bringing elevated blood glucose levels into the normal range.

I have said this before and it needs repeating – before beginning a regimen of exercise, please discuss this with your doctor. He may want to do some tests before allowing you to do any strenuous exercise regimens and may have other advice to assist in preventing problems. Many of these are also covered in the ADA Diabetes Care link above.

Generally the blood glucose guidelines for exercising for all types of diabetes are 100 to 250 mg/dl (5.6 to 13.9 mmol/L). For most people, this is a safe pre-exercise blood glucose range. If you are not on insulin or sulfonylurea treatments, then it is still necessary to discuss this with your doctor if you are about to start an exercise regimen after a long period of being sedentary. This applies to people controlling their blood glucose levels with diet and exercise as well to prevent possible cardiovascular problems.

There are those individuals with type 2 diabetes that do not follow the norm and their blood glucose increases with exercise. This should be discussed with the doctor and use the doctors guidance. Normally after a period of time, possibly a month or longer, depending on the type of exercise you should see your blood glucose levels dropping with exercise.

If you are a type 2 on insulin or sulfonylurea treatments, be sure to read this article from the Mayo Clinic as well. Another blog for your reading is this one.

Even this does not cover people with type 2 diabetes and prediabetes that maintain near normal levels. My advice would be to talk this over with your doctor and once you have established a pattern of safe exercise at lower levels than recommended, keep a close watch on your blood glucose levels.

Enjoy exercising for good health!

Exercise, Exercise, Exercise

Endorphins are released as a result of exercise and these cause good feelings and relaxation for your body. The amount of exercise needed to release these endorphins has not been measured and very little attempt has been made to do this.

Even with this knowledge, many people just do not see the benefits of exercising and do nothing about exercise. And people that have had diabetes for a long time and have developed any complications take this as a sign they should not exercise.

Not so, according to Jacqueline Shahar, MEd, RCEP, CDE, a clinical exercise physiologist and manager of Exercise Services in the Joslin Clinic at Joslin Diabetes Center. Patients with diabetes complications should definitely continue to find appropriate opportunities for physical activity. In the Joslin’s Easy Start program many patients have significant diabetes complications and are able to exercise regularly and safely as part of their diabetes self-management plan.

She also explains that there is always some type of exercise people with complications can do. Not remaining active can lead to developing additional complications. Without some exercise people with diabetes can lose functional capacity (the ability to do the activities of daily living).

Take time to read the blog here where the different exercises for different complications is discussed. She covers the main complications and what can be done in spite of the complications.

After you have read that blog, another blog by Victoria Kron may also help make you want to exercise. She does have a brief discussion about why it is so hard for people to start an exercise routine or regimen. “It’s the execution of the intention that loses something in the translation” is her explanation.

The one factor that both authors and often myself tend to forget is the necessity to mention talking to your doctor for approval. The doctor may have suggestions or objections to how you exercise. Start out slowly, make sure it is something that fits within the guidelines of the first blog above if you have complications. What are you waiting for?

Depending on the level of exercise you are capable of, be sure to know the blood glucose levels that are safe for exercising and test to be sure you abide by these guidelines. Again your doctor should provide you with the guidelines.

Now that I have covered the more difficult parts, this article should also encourage you to take what you have learned and give you even more reasons to exercise. We are all used to being told that adults should do at least 150 minutes (five days at 30 minutes per day) of exercise per week and this has been a good thing.

Now a study done in Taiwan shows that 15 minutes per day can reduce the risk of death by 14 percent and increase life expectancy by three years. While the study is based on self reported results over an eight year period, it included more than 400,000 people. Fifteen minutes per day equates to 105 minutes per week.

This study should help convince people about the need for exercise. Also read this blog about the same study.

Exercise – The Key to Managing Diabetes

I have said this before and will say it again – exercise. I have learned a few morsels to this in the last few years. Some have even told me to get lost as they are not medically able to exercise. Oh, really. A neighbor just reminded me of how false this is, except for a person that is a quadriplegic and others having some types of back injuries. Even another with a prosthetic limb said exercise is encouraged.

A neighbor is confined to a wheelchair with Type 2 diabetes and still exercises. He works very hard lifting five and ten pound or higher weights and once the snow is gone, I will see him out wheeling himself around several blocks in his wheelchair. He lost the use of his legs in an auto accident several years ago and has worked very diligently to build his muscles in his arms and body. He had an operation on one leg this winter and doctors are now hopeful that he may regain partial use of his left leg.

He has talked about this with me and he hopes that his right leg will be operated on next winter, and is hoping that the new procedure will give him full use. He did qualify for a powered chair, and has one for longer trips to the grocery store and other places, but he seldom uses it as he wants the exercise. I have seen him twice this winter and the second time he was standing on his left leg. Even that was an effort, but he wanted to show me the progress. The leg is still very stiff and it is difficult to stand on for lengthy periods, but he is working the leg and has a therapist in three days a week working with him.

So for my more sedentary friends, exercise generally is possible and for many people will require a doctors permission and developing a regimen with the doctors approval. Even lifting small weights can do good things for blood glucose control.

The main key is finding a type of exercise you enjoy and doing it can help. Many think running or jogging is the only exercise for them and if that works – great. Others have found that swimming is good for them and is something that they can do year round even here in the Midwest because the indoor pools are open. Others must use exercise equipment and if they do – good for them.

The idea is to be doing something that you enjoy, can do three to seven days a week and at varying times. Walking is always good for those that can't run or jog. Your management of diabetes will improve and you will not need to rely solely on nutrition (diet) to manage your blood glucose levels. Plus, if you want to reduce your chances of developing the complications of diabetes, exercise is an excellent tool.

I have to end this with an observation about what many people with diabetes seem to think is important. On one of the forums I participate on occasionally, one member was mourning the lost of carbs. In the responses to this, exercise was never mentioned. There were some excellent suggestions about cutting carbs and finding substitutes, but I am also surprised at the lack of nutritional advice as well.

This is an area of weakness in most forums and not just diabetes forums. A few forums have members that practice what they preach and will mention exercise without hesitation while others very seldom even think of exercise.

Most forums would be well advised to have a broad range of medical professionals, dietitians and nutritionists, and people that know exercise available to offer advice and answer questions.