The idea that exercise is prohibited for those with a chronic illness has long been outdated. It is known today, with all the scientific evidence, that practicing regular physical exercise is especially good for those who are sick. It's just a matter of making sure you do what needs to be done. For a long time, having a chronic disease, such as cancer, cardiovascular disease, diabetes or autoimmune diseases, among many others, often meant being condemned for the rest of your life to being nothing more than a patient, as these are associated with disabling conditions and even fatal. Advances in medical science, the knowledge we have today of how the human body responds to certain circumstances and, above all, the opening of medicine itself to new areas of intervention have brought new perspectives to the monitoring of chronic disease. One of these new approaches is the role of physical exercise in managing diseases such as diabetes or other chronic diseases. This is the theme of another episode of SPORTCAST , the Hospital da Luz podcast about sports medicine, with Hugo Pereira , exercise physiologist at the Sports Medicine Center at Hospital da Luz Lisboa. The role of exercise in managing diabetes Physical exercise is extremely important in the management of diabetes, whether type 1 or type 2. In addition to facilitating the entry of glucose into cells and thus sparing the pancreas and the cells themselves from the action of insulin, it has a high potential for preventing cardiovascular and reduction of body fat, helping to balance the body. Exercise is essential for the long-term survival of people with diabetes. The quality of life of these patients, especially in the last years of life, depends enormously on the management of blood glucose levels, the management that the patient himself makes of his daily life – the consumption of carbohydrates, etc. Regular exercise can help to maintain everything this in balance for as long as possible, thus delaying the effects that this disease causes in the body. Exercise plan depends on the type of disease? The exercise plan for diabetics must be tailored to each patient and their specific characteristics . It depends, for example, on how long diabetes has been diagnosed and the patient's glycated hemoglobin levels. In someone younger, with a recent diagnosis and low or controlled hemoglobin, it is possible to prescribe an exercise plan without special care. In an older person, with a late diagnosis, but already with obesity and cardiovascular problems, exercise prescription must consider all comorbidities associated with diabetes, such as the risk of vision, balance or sensitivity problems, neuropathies, etc., making it necessary to evaluate each of these problems at each moment and choose the type of exercise that best suits what needs more care. It means making a conservative and, above all, safe prescription. For example, if a person has myocardial ischemia, let's forget that the person has diabetes, to treat the person (the same person) with myocardial ischemia. When comorbidities are present in the same subject, we must opt for the most conservative prescription possible, considering, of all the pathologies, the one that is most likely to create an acute adverse response to physical exercise. Another example: in a person who has had diabetes for a long time, another complication may already be present - the degradation of circulation, the loss of vitality of peripheral tissues, especially the feet, which suffer daily overload due to weight and walking. Therefore, it is essential, when prescribing exercise, to take this into account and not opt, for example, for activities that cause great wear and tear on the extremities of the lower limbs. Otherwise, a person with diabetes can do any type of exercise. But we favor strength exercise, to maintain muscle mass and functionality, and aerobic exercise, to increase energy expenditure and to increase glucose intake. To optimize glycemic management, you can start the session with strength exercise followed by aerobic exercise. May include dynamic stretching before strength exercise. It's important to exercise! And vary the type of exercise practiced. There are those who can exercise without restrictions and there are those who need a little more special care. But this is something that people who have diabetes usually know. They know that they need to buy sneakers or flats that do not cause any type of friction and that they should wear seamless socks (preferably white, to take care of any wounds that may appear). They know the risks associated with vascular deterioration, such as diabetic retinopathy and poor vision, to avoid exercises that increase the risk of shocks or hinder healing. Warning signs for people with diabetes when exercising In addition to taking care of your feet and taking precautions to avoid exercises that may involve blows to the head , for the reasons already mentioned, it is necessary to be aware of complications caused by neuropathy, because they can silently affect the ability to manage the heart rate. Therefore, a person with diabetes should always do a longer warm-up period, in which they gradually increase the intensity of the exercise, as well as a longer cool-down period. Exercise, yes. But how regularly? First, whatever the clinical condition of a person with diabetes, they should not start exercising without consulting their doctor. So, depending on what your doctor says, you should consult an exercise physiologist to determine what types of exercise, modes of exercise, and intensities you can train at to feel good. If, during exercise, you experience unusual pain or discomfort or sudden decompensation, you should stop and consult your doctor before resuming. As for exercise regularly, the answer is: Every day! Because, as the World Health Organization says, ‘every movement counts’. The basic exercise prescription is the same for those who have diabetes and those who do not: per day, 150 to 300 minutes of moderate aerobic exercise or 75 to 150 minutes of vigorous exercise; plus, two or three times a week strength training, associated flexibility exercises and neuro-motor training, if the person is older. At what stage of the disease is exercising not recommended? Everything plays into blood glucose management. One of the most common acute complications in diabetes, type 1 or type 2, is hypoglycemia. Now, without good management of carbohydrate and medication intake, physical exercise can facilitate the occurrence of hypoglycemia episodes, which is not advisable. And are there any sports that are not recommended for people with diabetes? All sports that cause a lot of wear on the extremities, all activities that involve very close and intense contact, such as rugby and combat sports, are not recommended for people with more advanced diabetes. Exercise physiology and diabetes. There are still many people who, faced with the diagnosis of a chronic disease, avoid physical exercise. It should be the opposite: physical exercise is really an important part of therapy, in all diseases, ‘exercise is medicine’. It makes perfect sense that when you talk about diabetes therapy or diabetes management, you talk about exercise. And, in this context, the intervention of the exercise physiologist, as a professional trained and trained to deal with exercises in populations with pathologies, makes perfect sense. Monitoring of people with diabetes at the Sports Medicine Center of Hospital da Luz. In addition to the exercise and performance consultation, where, depending on the medical reports that accompany these people, we carry out the empowerment program for physical exercise, Hospital da Luz has a specific exercise program available for people with diabetes , in which exercise is done in a group context. It is a multidisciplinary program, which, in addition to sports medicine specialists, also includes exercise physiologists, and has the support of endocrinology, cardiology and other clinical specialties essential for monitoring diabetes. Author: Hugo Vieira Pereira Meet the Sports Medicine clinical team at the Hospital da Luz network The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
