Exercise

Exercise meets meditation

Looking for a sport that’s relaxing and good for you? Yoga is not only a fantastic form of strengthening exercise, it’s also great for calming the mind – something most diabetics need! Here are some simple poses to try at home.

As a diabetic, the one thing you’re told over and over is that exercise is good for you. And it is! But sometimes exercise feels a bit too much like hard work. Now that the weather is colder it’s hard to get out for a walk or a run, and gym is not for everyone. That doesn’t mean you can sit back and wait for the weather to warm up, though! Yoga has just the right mix of strengthening, balancing and heart-racing poses, and you should take a few quiet minutes to lie down at the end of each class. Yes, that’s right! Exercise that makes you lie down!

There are specific reasons why yoga is good for people with diabetes, too. Yoga teacher Tasha Saha explains: “As well as better fitness and cardiovascular (heart and vein) health, yoga massages and increases the function of the internal organs, balances the endocrine system and has great effects on the release of stress hormones,” she says. “All of these are factors that affect blood sugar, so it’s no surprise that a number of big studies have shown that regular yoga can reduce blood sugar levels.” Another part of yoga that sets it apart from other exercise is that it increases body awareness – understanding how your body feels – which makes it easier to stay at a healthy weight and to make better food choices.

But which yoga to choose? In general, hot yoga (Bikram) and flow yoga (Ashtanga) are more difficult, so it’s better to begin with a slower practice like Hatha or Iyengar. Some poses (especially those that are active in the belly and lower back) are particularly good for diabetics because they target the pancreas, which can help to lower blood sugar levels. “But a balanced yoga session will work on every system in the body,” says Tasha, “as well as the mind and emotions too – lowering stress levels and helping you towards balance.” As every diabetic knows, balance is the magic word!

Here are a few yoga poses to try at home – these are very good for lowering blood sugar. If you can’t get to the full pose, go as far as you can. As you become more flexible, you will be able to stretch more. If something is sore, stop! Yoga should never be painful.

Seated twisting poses and forward bends

These stimulate the digestive organs and help the insulin work better in the system.

Seated forward bend

First: Sit on the floor with your legs out in front of you. Flex your feet and press down through your heels. Place your hands on the floor next to your hips and sit up straight, opening your chest.

Then: Take a deep breath in, and without curving your back, lean forward from the hips, not the waist. Either hold on to your feet or use a strap around the soles of your feet. Make sure your elbows are straight, not bent. Be careful not to pull yourself down – you want to lengthen the spine, not force it. Keep your head raised and aim to get your belly touching your thighs, and then your ribs. This might take a few months!

Finally: When you’re ready to come up, lift the body away from the thighs, take a deep breath in and slowly straighten up. Stay in this pose for: 1 to 3 minutes.

Half Lord of the fishes

First: Sit on the floor with your knees bent and your feet on the floor. Slide your left foot under your right leg to the outside of your right hip, with your left leg on the floor. Step your right foot over your left leg and place it on the floor outside your left hip. The right knee will point up to the ceiling.

Then: Exhale and twist your body towards the inside of your right thigh. Press your right hand against the floor behind you, and your left upper arm on the outside of your right thigh near the knee. Stay in this position, breathing deeply, then exhale and release.

Finally: Return to the position you started with, and repeat on the other side for the same length of time.

Stay in this pose for: 30 seconds to 1 minute. 

Standing poses and flow poses

Any pose where you have to stand or flow from one pose to another is excellent for the blood and heart systems.

Warrior

First: Stand up straight, with your feet together and your hands at your side. Breathe out, and step your feet apart, as wide as you can while still feeling balanced. Turn your left foot in 45 degrees, and your right foot out 90 degrees. Make sure the right heel and the left heel are in line with each other.

Then: Breathe out, and rotate your body till you are facing over the front foot. Raise your arms over your head, and reach towards the ceiling. Drop your shoulders and arch your upper back a little. With your back heel firmly pressing into the floor, breathe out and bend your front knee over your front ankle.

Finally: Reach through your arms and, if possible, bring the palms together. Keep your head looking forward or looking up at your thumbs.

Stay in this pose for: 30 seconds to 1 minute.

Poses which ground the body

These help to refresh the pancreas, liver and other abdominal organs.

Locust

First: Lie on your belly with your arms on either side, palms facing up, and your forehead resting on the floor. Turn your big toes towards each other and clench your butt.

Then: Exhale and lift your head, upper body, arms, and legs off the floor (this may take some practice!) Firm your butt and strengthen your legs. Raise your arms and stretch back through your fingers. Look ahead, but be careful not to stick your chin out. Keep the back of your neck long.

Finally: Breathe out and release. Take a few breaths and repeat (if you want to!)

Stay in this pose for: 30 seconds to 1 minute. 

Poses where the feet are higher than the head.

These direct the flow of blood towards the pancreas and relieve pressure in the feet.

Legs-up-the-wall

First: Lie with your back on the floor, in as straight a line as possible, with your legs up against the wall in a 90 degree angle (your body should form half of a square). Rest your shoulders on the floor and allow a small gap between your hips and the wall.

Then: Rest in this pose.

Finally: When you’re ready to come out of it, turn to the side for a few breaths and then come up into a sitting position.

Stay in this pose for: 5 to 15 minutes.

Want to give it a try? Many yoga studios offer free classes to beginners. Most gyms also offer yoga classes at a fraction of the price of private classes.

“Remember that everyone is different, so the range you will be able to work into will be different in each pose. It’s a good idea to start with a one-on-one yoga session so that you learn how your joints and muscles work within a safe range of motion. That way, you’ll be in control of the intensity and can adjust it for your fitness levels.”

– Sarah Hall, Biokineticist

Lift it!

Are you struggling to carry your shopping? Does moving boxes make you groan? Nicole McCreedy has the answer: simple weight training.

A simple weight training programme can make these everyday chores much easier for you – and get you in great shape. How? Well, lifting weights challenges your muscles, causing them to adapt and get stronger. Strength training builds strong muscles, bones and connective tissue. Not only does this help prevent osteoporosis and muscle loss as one gets older, it is also one of the most natural ways for people with diabetes to improve glucose tolerance and insulin sensitivity.

Weight training and diabetes

When you eat carbohydrate, it breaks down into smaller sugars (glucose, fructose and galactose) that get absorbed and used as energy. Any glucose that is not used gets stored in the muscles and the liver in the form of glycogen. Once the glycogen stores are filled up, any extra gets stored as fat. During exercise, the stored glycogen is transported to the active muscle to burn as fuel. Because muscle burns more kilojoules than fat, more muscle and less fat means better insulin use and glucose storage.

Lean muscle also boosts the metabolism and enables your body to burn kilojoules at a faster rate – even after you have finished exercising. A faster metabolism helps insulin to work better.

Getting started at home

Does the thought of weight training make you feel weak at the knees? Then start by learning the lingo before training at home.

A strength training workout is broken down into exercises, repetitions and sets. An exercise is a specific movement that works a muscle group. A rep, or repetition, is one complete motion. For example, to do a bicep curl repetition hold the weight or dumbbell at your shoulder then lower it in a controlled movement as you count to four. Lift the weight back to the starting or recovery position counting to six. A set is the number of repetitions performed together separated by a short rest period.

A workout plan

The next step is to set goals. Goals are a good way to keep yourself motivated. Do you want to tone your body, improve your strength or increase your endurance? Be realistic: results take time. Take photographs or simple body measurements every six to eight weeks to help you notice gradual changes.

Your aim in the beginning should be to develop the right technique. Maintaining the correct posture, while lifting a suitable weight, is important to prevent injuries. Try this side bend in front of the mirror: in one hand hold a weight along the side of your body. Slowly bend sideways sliding the weight toward your knees. Straighten up again. Check that you are not leaning backwards or forwards.

Weighing up the options

You can either buy hand-held (free) weights to use at home or you can improvise. Grab a tin of canned food from the cupboard to start. If that is too light, use a full 1 litre water bottle or a 2 litre milk bottle. Fill with sand to make the bottles heavier. If you are fairly strong, then fill two buckets with sand and try this squat: stand with your feet hip or shoulder width apart and hold a bucket by the handle in each hand.  Then bend your knees and lower yourself into a squat, as though you are about to sit in a chair. Stop when your thighs are parallel to the ground. Make sure your knees do not go beyond your toes. Exhale as you stand up slowly. Repeat without locking your knees.

The amount of weight you use depends on what you want to achieve and how strong you are. Choose a weight that allows you to do the repetitions you want to do without too much strain – only the last few repetitions in the set should feel like a struggle. The idea is that you give the muscle more to lift than it is used to. As the muscles grow stronger, you need to increase the weight until you reach your goal.

Stronger muscles will not only make your daily load feel lighter, but will also help prevent minor accidents from becoming serious injuries.

Ask the expert: Dr. Joel Dave, Endocrinologist

General advice for diabetics:

  • Before embarking on any weight- lifting programme, first discuss it with your doctor.
  • Do not lift any weights if you have proliferative retinopathy, severe non-proliferative retinopathy or a severe peripheral neuropathy
  • Do not lift weights if you have any foot injury or open skin lesions on the feet.
  • Wear adequate protective footwear at all times.
  • At your first session check how the exercise affects your blood glucose so that you will know what to expect in the future.
  • Check your fingerprick glucose before starting each session and proceed only if it is above 5.6 mmol/L.
  • Keep your glucometer and some kind of sugar nearby at all times.
  • It is best to exercise with a partner – do not lift heavy weights without a partner.
  • For the safest route, start with low weights and increase slowly under the guidance of an instructor.

Ask the expert: Sarah Hall, Biokineticist

Ask yourself the following questions when doing a weight-training programme:

– Are you training for strength, power or endurance?

A basic programme for each goal is:

Power:  4-6 reps, 2-3 sets;

Strength:  6-8 reps, 3-5 sets;

Endurance: 15-25 reps, 3 sets

– Do you have any previous injuries?

Previous injuries may rule out particular movements or ranges of motion in certain joints.

– Have you warmed up?

Do a light cardio warm up, stretching the muscles you are about to use so that you don’t strain.

– How much time do you have?

If you have limited time, rather focus on either upper body or lower body. That way you can target each muscle group in that part of the body and even do more than one exercise per muscle group for greater benefit.

– Have you allowed enough rest?

You need to rest for 40-60 seconds between sets, and 24-48 hours for each muscle group.

– Do you know how to practice good body mechanics?

Your body is the best machine you own.  Treat it like one and don’t abuse it!  Make sure that you move slowly and with control, breathe, and maintain a neutral spine. Never sacrifice form just to add more weight or repetitions.

A walk in the park

Do you want to know how to lose weight, feel better and control your blood glucose levels the easy way? Take a walk!

If your doctor keeps telling you to get active but you’re not sure what kind of exercise to do, why not take a walk? Walking is the one of the easiest ways to get fit because you need very little preparation – we all already know how to do it! Studies have shown that people with Type 2 diabetes who walk daily are able to store sugar and burn fat more effectively. The result: better glucose control and weight loss.

That’s not all. Because walking is relaxing it lowers your blood pressure. This decreases your risk of heart disease. At the same time fitness, lung capacity, stamina and mental alertness all improve.

Still not convinced? It can even make you happier―walking is an excellent way to naturally boost your mood.

Beginners

Because you don’t need special equipment, walking is ideal for beginners. A pair of well-fitting trainers will do the job. The International Diabetes Federation (IDF) recommends 30 minutes of brisk walking daily as part of a healthy lifestyle programme to manage diabetes. However, every journey begins with a single step. Start slowly with 5 or 10 minutes per day and try to add 5 to 10 minutes to your programme weekly.

What is the best technique? Watch your posture. Walk tall. Back straight. Look ahead and keep your chin parallel to the ground. Shoulders should be relaxed. Gently tighten your stomach muscles and tuck your pelvis in to bring it in line with your upper body. Feet must make contact with the ground heal first and then push off with the toes.

Need extra motivation? Use a pedometer, a small device that clips onto your waistband, to track the total steps you take during the day. With your pedometer at hand, find ways to activate your day as much as possible: walk the dog, window shop, use the stairs or walk to visit a neighbour. The end goal is 10,000 steps a day, but anything over 5,000 is a good start!

Advanced/Adventure

Want a challenge? Head off-road: go trail walking or hiking. Keep these points in mind when you’re going for an adventure walk:

Be wise. Hike in a group and choose your route according to the least fit person in your group’s abilities. Tell someone where you are going and when you will be back.

Be prepared. Hiking requires planning. Pack enough water for the trip to ensure that you are properly hydrated and take something sweet in case your blood sugar goes low. Avoid blisters and don’t hike wearing new shoes. Protect yourself from the sun: wear a hat and sunscreen.

Be aware of your surroundings. Check the weather forecast, be familiar with the route and carry a map.

Get moving

Walking is the most recommended and popular form of exercise. It is plain to see why. It can be fun, relaxing and a great way to spend time with people. You can do it practically anywhere and it is a good excuse to visit new places. Best of all anyone can do it and it is really good for your health. Start today― take a few steps in the right direction.

Ask the expert: Diabetic tips for walking
Dr. Zaheer Bayat, Endocrinologist

It is important to balance enthusiasm and common sense when beginning an exercise program.

  • Have a pre-exercise examination by your GP. This may include a stress test for patients over the age of 35 or have had diabetes for more than 10 years.
  • Discuss with your doctor whether or not your insulin dosage needs to be adjusted.
  • Choose an insulin injection site away from exercising muscles.
  • Eat a snack approximately 15 to 30 minutes before exercise, and again every 30 minutes during exercise. Choose a snack that’s a slowly absorbed carbohydrate.
  • Drink enough liquids before, during, and after exercise to prevent dehydration, which can upset blood sugar levels.
  • Test your blood sugar before, during, and after exercise to figure out your body’s typical response to exercise.
  • Be sure to keep some juice or sweets on hand in case your blood sugar goes low.

Ask the expert: foot care
Anette Thompson, Podiatrist

  • Go for a check-up with your podiatrist so that you know the status of your foot health.
  • Blisters, hot spots, breaks in the skin or blood flow problems to the feet may go undetected; foot numbness could also be present without your being aware of it. These need to be treated.
  • Wear well-fitting shoes that fit comfortably with at least 15mm length ahead of the longest toe and don’t rub at the heel. Try on new shoes, with socks, in the afternoon when your feet are at their biggest volume.
  • Invest in good socks. Diabetic socks are made so that they don’t cut off circulation around the ankle.
  • Check your feet after each walking session for cuts, blisters, hot red spots or abrasions.