Our fast-paced, task-oriented society demands more and more from us each and every day, eating up the free time we strive to obtain and creating obstacles that we attempt to conquer. Having too many tasks to accomplish, too little free time to do them, a decreased quality of life as a result, and the barriers caused by chronic diseases place exercise on the back burner for most people.
As the prevalence of various disease states steadily increases in our culture, along with the amount of money currently spent on healthcare, never before have preventive measures been more important. To be sure, medications can help to lower or prevent many health risks, but one of the most important means of preventing and/or reducing the negative outcomes of chronic diseases is by incorporating modifiable lifestyle changes, such as exercise, into a daily routine.
The Value of Exercise for Patients with Diabetes
Although physical activity can improve many aspects of someone’s quality of life, one population that can benefit dramatically from a regular exercise routine is patients with diabetes. The Centers for Disease Control and Prevention (CDC) indicated in the National Diabetes Fact Sheet, 2011, that the chances of heart disease–related death and experiencing a stroke are both 2 to 4 times higher in patients with diabetes.1
The CDC also reported that from 2005 to 2008, 67% of adults aged 20 years or older with self-reported diabetes had blood pressure ≥140/90 mm Hg, the standard guideline for high blood pressure (eg, hypertension), or used prescription medications for hypertension.1
What do all of these disease states have in common? The risks for each can be reduced and/or prevented by exercising. A few benefits of exercising for patients with diabetes include reductions in blood pressure, decreases in A1c, increases in healthy cardiac activity, and weight loss. The benefit of weight loss through exercise also includes improving insulin sensitivity that may be secondary to increased fat tissue in patients with type 2 diabetes.
The US Food and Drug Administration (FDA) has recommended that adults aged 18 to 64 years should invest in at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes weekly of vigorous-intensity physical activity. The American Diabetes Association (ADA) parallels the FDA, further recommending that 150-minute, moderate-intensity physical activity be broken down into 30 minutes daily, 5 days weekly.2
A Safe Exercise Plan
When initiating a safe exercise plan, it is important for the patient with diabetes to know his or her limitations. If walking for 10 minutes daily is one’s limit, the patient should be advised not to push further than that. Instead, the patient should be encouraged to start at what is achievable and slowly increase his or her activity by a few minutes per day as recommended by the ADA.2 As the saying goes, “It’s better to do some than none.”
For patients with diabetes who have chronic complications such as neuropathy, or are obese, the limitations to exercise can be extensive; however, exercise is still important, as well as feasible. Exercises known as “chair exercises” can be used to maintain the recommendations of the FDA and the ADA. Not only is a chair used for balance to decrease the risk of falling, but essentially each main muscle group can be worked by just using a chair for a variety of exercises. More information on specific chair exercises can be found on www.diabetes.org and www.cdc.gov.3,4
Strength training is also recommended by the FDA, but only if the patient is capable of doing so. Safety is important. In fact, if a patient is worried that not being able to perform strength training or high-intensity workouts will hinder his or her ability to achieve maximum health benefits, you can reassure the patient that studies have shown that 150 minutes weekly of moderate-intensity physical activity is just as beneficial as 75 minutes weekly of vigorous-intensity physical activity. This is precisely why the FDA provides an “either/or” recommendation for physical activity.
Planning goals ahead of time can help the patient with diabetes to keep a consistent routine of exercising. The patient should write down goals, such as how many times he or she is going to work out in a given week, how long he or she is going to work out for each session, and what he or she needs to prepare for the exercising sessions. If being busy is a barrier, help the patient to contemplate how he or she can divide the 30-minute daily exercise session into smaller segments throughout the day. For example, 30 minutes of walking can be spread out over 3 sessions of 10 minutes.
Patients may also think that cost is a barrier to starting an exercise routine, whether it is joining a fitness club or purchasing exercise equipment. Remind your patient that exercise and money are independent of each other. Running, walking, hiking, and even dancing are all free ways to decrease health risks. Any physical activity is better than not exercising at all.
As pharmacists, we must strive to collaborate with our patients on lifestyle changes, understanding that barriers and constraints are unique to each individual. Ask your patients open-ended questions and dive deeper into their exercising habits. If they are not exercising, find out why. It may be because of physical constraints or lack of motivation, or because the patient may not have been educated on the importance of physical activity. Motivate your patients.
There are ways for all patients to fit their FDA-recommended amount of exercise into their daily routine. If a patient has just initiated their path to exercising, promote positivity. From a patient perspective, hearing that you are doing something right from one of the most trusted professionals can go a long way. It can create the motivation that the patient needs to keep pursuing their goals for exercising.
- Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed December 12, 2013.
- American Diabetes Association. Food & Fitness Fact Sheet. www.diabetes.org/food-and-fitness/fitness/. Accessed December 12, 2013.
- US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services. Updated March 11, 2013. www.health.gov/paguidelines/guidelines/default.aspx. Accessed September 2013.
- Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity/National Center for Chronic Disease Prevention and Health Promotion. Physical Activity. www.cdc.gov/physicalactivity/. Accessed September 2013.