Prescribing Exercise for Almost Anyone


I think clinicians actually play a huge role
in helping patients set goals for their physical activity, but they need to be smart goals. Oftentimes physical activity does get overlooked
when it comes to giving your patients advice on what to do. Exercise is important, not only for helping
the body manage and use blood glucose, but also just generally in health. The main thing that happens is that the muscles
are able to take up glucose out of your bloodstream directly when you’re exercising, just due
to contraction induced mechanism, which is completely separate from the effects of insulin
at rest. So, it gives you another way to actually reduce
blood glucose. I think the main thing that clinicians need
to know in order to prescribe exercise is that there usually isn’t any bad exercise
for someone to be doing. And certainly there are a number of recommended
ones. For example, there are four main categories—aerobic
activities, such as walking, if you can just simply get people to walk more; resistance
training, which doesn’t mean that people have to join a gym, but that they can use
their own body weight as resistance and do simple activities; balance training for anybody
over 40 with diabetes is really critical; and also stretching is also important, it’s
a part of what allows us to keep our balance, to be more flexible. And then simply there’s a fifth category,
which is lifestyle activity—and I think that’s one we don’t actually talk about
enough with our patients, and standing more. Taking more daily steps doing anything to
add activity into the day—there’s a lot of research now looking at just simply breaking
up sedentary time and how effective that can be on improving how well metabolism works. What you can do is just quickly ask them a
few questions like, “What types of activities do you like to do, or did you used to do,
or would you like to do again?” And try to focus their prescription around
what’s going to be enjoyable to them because that’s the only way they’re going to continue
to do it over time. Don’t just tell your patients, “You need
to exercise more.” Not only do they already know that, and they
aren’t doing it for some reason, but it doesn’t really give them a good measure
to tell if they are actually meeting that goal or not. What do you mean by “more active?” So help them say, “I’m going to take three
15-minute walks on Monday, Wednesday and Friday; and on Tuesday and Thursday I’m going to
do some body weight resistance training for 20 minutes.” And then have them try to meet those specific
goals. Then you say, “Great! What do you want to do next week?” and have
them set similarly attainable goals that are going to work for them. The physical activity becomes an integral
part that really needs to be discussed there because it allows people to manage their lifestyle
more effectively, so that any medications they do take will work more effectively. And the physical activity, not just planned
exercise—but being more active all day long—helps complement the changes they make in their
diet and their lifestyle, and all these things are going to help improve their diabetes management.

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