by Dino Paul Pierce CFT, CPT, RD, CDE
Different diabetic complications may require different modifications to your exercise routine, but if you can move you can still be active. The following are some general guidelines for safe physical activity with diabetic complications.
Cardiac Complications: If you have cardiac complications, such as heart disease, you should have an evaluation to measure your blood flow, heart rate, and blood pressure during exercise. Your doctor can then recommend the length and intensity of your exercise sessions. If you are not sure if you have cardiac disease, you should have a stress test. If a stress test is not available, you should follow a low-intensity program. You should definitely obtain the stress test if you are older than 35, have had type 2 diabetes for 10 or more years, have had type 1 diabetes for 15 or more years, or have any additional cardiac risk factors.
Peripheral Vascular Disease (PVD): PVD means poor circulation in your legs. The following are symptoms of PVD: cold feet, weak pulse in feet, numbness and tingling, weakness in the legs, burning or aching in the feet and toes, slow-healing leg and foot sores, and discoloration in the leg down to the toes. These occur because the lower leg muscles are deprived of oxygen and nutrient-rich blood. PVD is a risk factor for cardiovascular disease (CVD). If you experience these symptoms or have PVD you should be evaluated for CVD before exercising (1,2).
Retinopathy: Retinopathy, or eye damage, can be either “mild” or “severe,” and either “proliferative” or “non-proliferative.” Non-proliferative diabetic retinopathy occurs when the blood vessels in the eye leak fluid into the retina causing blurred vision. Proliferative retinopathy is present when the new, fragile blood vessels begin to bleed, which can cause scarring and vision loss. Either type of retinopathy will impose restrictions on your exercise program, as described below (1,3).
• No diabetic retinopathy: you can participate in any form of exercise, and you should have an eye exam yearly.
• Mild, non-proliferative retinopathy: you can also participate in any form of exercise, but you should get your eyes examined every six to 12 months.
• Moderate, non-proliferative retinopathy: you can participate in most exercises, with the exception of power lifting and other exercise that would cause a valsalva maneuver, which is increased chest and abdominal pressure by exhaling against a sealed mouth. Furthermore, you should have an eye exam every four to six months.
• Severe, non-proliferative retinopathy: you can participate in most exercises, but you want to avoid power lifting, valsalva maneuvers, and active jarring exercises like boxing. Additionally, you should have an eye exam every two to four months (1,4).
• Proliferative retinopathy: it may surprise you to learn that there are several exercises that are safe and highly recommended even for those with proliferative retinopathy. If you enjoy swimming, walking, low-impact aerobics, riding a stationary bike, or low impact endurance exercises, you can go ahead! On the other hand, you will want to avoid heavy weight lifting, jogging, high-impact aerobics, racquetball, tennis, and even playing strenuous wind instruments, which require a valsalva. In addition, you should have an eye exam every one to two months(1).
Nephropathy (kidney disease): Nephropathy is a risk factor and possible indicator of CVD. Therefore, patients with protein in their urine should have an examination to assess the heart. If you have high levels of protein in your urine, you should avoid high-intensity and strenuous exercise programs(1).
Peripheral Neuropathy: Peripheral neuropathy is loss of
feeling in the hands and feet. This can be especially dangerous if you cannot
detect injuries or pain in your feet. To avoid injury, limit weight-bearing,
repetitive exercises, such as running, prolonged walking, and step exercisers
all of which can lead to foot ulcers. Recommended exercises for patients with
sensory loss are swimming, bike riding, rowing machines, chair exercises/arm
chair fitness, elastic or resistance band arm and leg exercises,
and other non-weight-bearing exercises (1,5).
Gastroparesis: Gastroparesis is one of the least commonly discussed complications of diabetes. Also called delayed gastric emptying, gastroparesis means that the stomach takes too long to empty its contents. It occurs when nerves to the digestive tract are damaged or stop working. As a result, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.
Diabetics balance diet, insulin, oral medications, and exercise throughout the day to achieve optimal blood sugar levels. Gastroparesis unpredictability is a new factor in the already difficult equation. The gut might function properly, not at all, or at a very delayed rate (5). If you have gastroparesis, you may be much more likely to have highs and lows. It is therefore even more important to check your blood sugar before, during, and after exercise.
If you can move, you can exercise and improve your health. No matter what your complications, you can and should exercise. I encourage you to have a physical and a stress test, and start being a little more active. Remember, you cannot change the past, but you can be healthier today than you were yesterday.
1. Pendergrass M, Lynch CC, Myers E, Blake S. Exercise and diabetes. The University of Louisiana at Monroe School of Pharmacy Diabetes Series. 2004: P6.
2. Advocate Health Care. Exercise can help control a common circulatory problem. Available at: http://www.advocatehealth.com/system/info/library/sam/040801.html.
3. Medline Plus. Medical Encyclopedia. Diabetic retinopathy. Avaliable at: http:// www.nlm.nih.gov/medlineplus/ency/article/001212.htm.
4. Nason ET, Rehabworks. Valsalva’s Maneuver. Available at: http://rehabworks.ksc.nasa.gov /education/topics/valsalva.php.
5. American Diabetes Association. Diabetes and gastroparesis. Available at: http://www.diabetes.org/type-2-diabetes/Gastroparesis.jsp.
6. American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care. 2004, 27:S58-S62.