1. Even with diabetes complications, it is important for people with diabetes (diabetics) to continue to exercise but do so in a safe manner.
2. For people with diabates with mild neuropathy (damage to nerves), they can do light to moderate lower limb weight-bearing exercises. Those with severe neuropathy can do low-impact activities such as swimming and tai chi.
3. For people with diabetes with autonomic neuropathy (damage to the central nervous system), they can do light-intensity aerobic exercises such as brisk walking and balance exercises like qi gong or tai chi.
Exercising safely with a neuropathic diabetes complication is possible if precautions are taken and by undertaking less intense exercises.
Staying physically active is important when you are living with diabetes. Along with a healthy diet and taking the diabetes medications compliantly as prescribed by your doctor, exercise is one of the main pillars of good diabetes self-management.
But what if having diabetes for a long time caused you to develop complications such as neuropathy, which limits your ability to exercise. Would it still be safe for you to exercise?
“Diabetes complications are no excuse to skip exercise. In fact, you may even need it more,” advised Dr Fadzil Hamzah, a Senior Staff Physician from Sport and Exercise Medicine at Changi General Hospital (CGH), a member of the SingHealth group.
“The benefits of exercise far outweigh the risk, even in the presence of complications. If you are unable to perform moderate or intense activities, there are still great benefits to less intense but regular exercise. There are always some types of exercises that people with diabetes complications can do and all that is needed is an exercise program that is customised to your capacity.”
Safe exercises for people with neuropathic diabetes complications
1. Peripheral Neuropathy
About the condition:
Diabetes can cause damage to nerves, especially in the limb extremities, causing tingling, pain or loss of ability to sense pain or extreme temperatures in your toes, feet and fingers.
Dangers of exercising wrongly with the condition:
- Repetitive weight bearing exercises on insensitive feet can cause you to unknowingly develop blisters, abrasions and even fractures of the feet. Damage from diabetes reduces blood flow and oxygen flow to the limb extremities therefore making it harder for any open wounds and ulcerations to heal. These can lead to serious infections that could ultimately necessitate amputation
- Peripheral neuropathy also increases the risk of loss of balance and subsequently the increased risk of falling. In addition, the pain and burning sensation in the feet can alter your gait thus making it difficult to walk
Exercises that are safe to do
Diabetes patients with mild neuropathy should be able to do light to moderate lower limb weight-bearing exercises. Those with severe peripheral neuropathy should avoid excessive lower limb weight bearing activities such as prolonged walking, or high impact lower limb activities such as running or jumping.
Recommended exercises include:
- Workout machines that let you sit back while engaging your arms and legs (such as the recumbent bike or stepper)
- Water-based activities such as swimming or water-aerobics
- Balance exercises such as tai chi and yoga
Exercise tips:
- When engaging in any land-based exercise, be sure to wear proper footwear and check your feet daily for any skin injuries before and after your activities
- Avoid any water-based activities if you are nursing an open wound and always keep your feet clean and dry
2. Autonomic Neuropathy
About the condition:
Autonomic (central) neuropathy occurs when there is diabetes-related damage to the central nervous system and the nerves that control involuntary bodily functions. It can therefore affect blood pressure, temperature control, digestion, bladder function and even sexual function.
Dangers of exercising wrongly with the condition:
- For those with autonomic neuropathy, the usual heart rate guidelines for exercise do not apply due to the significant cardiac changes. For example, you may have an elevated heart rate at rest as well as a lesser rise in heart rate during physical exertion.
- Severe autonomic neuropathy may make it difficult to change body positions (e.g., going from sitting to standing or from lying to sitting) without experiencing postural drop in blood pressure, which can result in dizziness or fainting.
- Another concern is hyperthermia (elevated body temperature beyond normal) during physical activity due to the dysfunction in the body’s temperature regulation and sweat gland activity, therefore potentially leading to severe dehydration
Exercises that are safe to do
Diabetes patients with autonomic neuropathy must approach any increase in physical activity levels with caution because of the role of the autonomic nervous system in hormonal and cardiovascular regulation during exercise.
Furthermore, exercise intensity should be monitored by means other than heart rate alone because it may no longer rise as much as expected or be the best way to monitor exercise intensity.
To know the level that you are exercising at, use the “Talk Test”:
- Light intensity exercise — you can sing or whistle while exercising
- Moderate intensity exercise — you can talk while exercising
- High intensity exercise — you are unable to talk while exercising
Recommended exercises include:
- Light intensity aerobic exercises that do not involve rapid changes in movements or posture (such as brisk walking, line-dancing or pilates)
- Workout machines that let you sit back while you engage your arms and legs, and yet avoiding prolonged standing postures (such as the recumbent bike or seated weights machines)
- Balance exercises (such as qi gong or taichi)
Exercise tips:
- Check your blood glucose more frequently as having autonomic neuropathy means you may no longer experience the symptoms of low blood glucose (hypoglycaemia)
- Ensure adequate hydration at all times as dehydration may worsen symptoms
- Engage in longer warm-ups and cool down periods especially with more intense workouts due to significant changes in blood pressure
Ref: M19
Related articles:
Foot Care for Peope with Diabetes: 10 Steps to Healthy Feet
Stay Healthy the Easy Way
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