Clinical Application of Exercise Therapy in Diabetes

Fig. 18.1

Exercise therapy application criteria for patients with diabetes; after careful medical check, exercise prescription on the type, time, intensity, and frequency must be ordered according to the degree or extension of diabetic complications

Exercise should be prohibited or restricted in the following cases:

When metabolic control is extremely poor (fasting plasma glucose level over 250 mg/dl or urinary ketone bodies positive or above).
When new hemorrhaging in the ocular fundus caused by proliferative retinopathy occurs. Vigorous exercise can cause retinal hemorrhage or vitreous bleeding in patients with proliferative retinopathy.
When renal failure (serum creatinine in men over 2.5 mg/dl and in women over 2.0 mg/dl) proteinuria tends to increase with exercise in patients with nephropathy.
When there is a presence of ischemic heart disease and cardiopulmonary disorders.
When there is a presence of diabetic gangrene and bone or joint disease. Patients with sensory neuropathy should refrain from high-impact exercise to reduce the risk of soft tissue and joint injury.
When there is a presence of acute infectious disease.
When there is presence of severe autonomic neuropathy. The presence of autonomic neuropathy often decreases aerobic capacity and causes postural hypotension.

18.4 Practical Prescription for Exercise Therapy

After careful medical check, a prescription for exercise must be ordered. You should prescribe the following orders (5W1H):

Why (purpose of exercise)
What (mode of exercise)
When (frequency and duration of exercise)
Where (place for exercise)
Who (patients to be prohibited or restricted from exercise)
How (intensity of exercise)

18.4.1 Mode of Exercise

There are two typical types of exercise, aerobic and resistance. The former consists of exercise whose intensity is proportional to the consumption of oxygen and which, if performed regularly, increases insulin sensitivity. Exercises involving the whole body, such as brisk walking and jogging, belong to this category. Resistance exercise, on the other hand, if performed is anaerobic exercise against a force or resistance. If practiced effectively, this form of exercise can be expected to increase the mass and strength of the muscles.

Recently, physical activities are focused in addition to the above two exercises.

18.4.1.1 Increase of the Physical Activities (Life Activities)

In “the physical activity indicator for the making of health,” Ministry of Health, Labor and Welfare advice “Plus 10, let’s move bodies for ten minutes more than now.” It is said that 3 % of the risks of a disease and the care decrease by moving the body for 10 min.

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