Training Guidelines and Recommendations for Diabetic Clients
It is estimated that more than 29 million adults have Type I or Type II diabetes in the United States, with Type II diabetes accounting for about 90-95% of all diagnosed cases. The Centers for Disease Control (CDC) reports that of the nearly 30 million with the disease about 25% are unaware of their condition. Of added concern, another 86 million US adults are estimated to be pre-diabetic with the CDC reporting about 90% of these individuals being unaware of their risk. Clearly, greater knowledge and education is needed to combat further increases in the prevalence of Type II diabetes - as experts project nearly 1 in 3 adults could be diabetic by the year 2050. This is a growing concern both from a health and economic perspective as diabetics experience 6x the health costs as normal weight non-diabetics. The CDC estimates that taking part in structured lifestyle changes surrounding exercise, weight loss, and nutrition can reduce one’s risk for developing type II diabetes by more than half. Specific to exercise, for every 500 kcals expended per week via physical activity, the risk for type II diabetes is reduced by about 6%.
Major risk factors for Type II diabetes include being overweight, ≥45 years of age, race (African Americans and Latinos have a greater risk than Whites), family history, following a sedentary lifestyle, having suffered gestational diabetes, chronic stress, hypertension, and/or high cholesterol. Type I diabetes is an autoimmune disorder that is purely hereditary. For most sufferers the combination of physical inactivity and being overweight leads to the development of insulin resistance and glucose intolerance. Thankfully, an exercise professional can significantly improve a diabetic’s quality of life and metabolic health and help pre-diabetic individuals to reduce their risk for progressing to a diseased state. However, there are major physical activity precautions that must be addressed for the safety of diabetic exercisers.
Diabetics must have a medical examination prior to initiating an exercise program to rule out any factors that can lead to complications or injury. The reason for this is the disease has a major impact on the heart, kidneys, vascular system, eyes and nervous system. Screening criteria to determine risk during exercise includes various criteria such as greater age, presence of type I diabetes for >15 years, presence of type II diabetes for >10 years, additional risk factors for heart or vascular disease, foot wounds or neuropathy.
Training considerations for common microvascular complications.
If cleared for regular exercise by a physician, diabetics should engage in health-appropriate resistance and aerobic exercise. Exercise seems to work best when combined with guided dietary modifications. This combined approach can improve insulin sensitivity, carbohydrate metabolism and glucose tolerance via enhanced cellular uptake over time. Below are general training guidelines for type I and type II diabetics that an exercise professional should use to make sure they help the client improve their condition while keeping them safe from injury.
Appropriate weekly training can have a significant impact on a diabetic’s quality of life over time as they improve their insulin sensitivity and reduce their dependence on external insulin. Weight loss is critical for type II diabetics, while type I diabetics should focus on symptom management. In any case, this is a very large and growing population for exercise professionals to make a difference.