1. Diabetes and Exercise Dr Jubbin Jagan Jacob MD Department of Endocrinology CMC Vellore

2. Exercise is the best insulin sensitizer on the market; better than any medication we currently have available" Bartol

3. Clinical Implications Even short-term (2-week), regular aerobic exercise in type 2 diabetic patients results in significant improvement in both aerobic capacity and whole-body insulin sensitivity.

4. Clinical Implications Long-term endurance training in diabetic patients markedly improves whole-body insulin sensitivity and the expression of key muscle enzymes regulated by insulin. However, the maintenance of this effect seems to require dedication to a regular and uninterrupted exercise regimen

5. Clinical Implications Intramyocellular lipid accumulation, which is associated with insulin resistance in muscle, can be acutely decreased by even a single bout of sustained endurance exercise, in a manner that depends on both duration of exercise and workload.

6. Clinical Implications Exercise is beneficial for both glucose uptake mechanisms and the antilipolytic effects of insulin.

7. THE EXERCISE PRESCRIPTION 1.Before beginning an exercise program, the individual with diabetes mellitus should undergo a detailed medical evaluation 2.A careful medical history and physical examination should focus on the symptoms and signs of disease affecting the heart and blood vessels, eyes, kidneys, and nervous system.

8. `Potential adverse effect of exercise Cardiovascular Microvascular Metabolic Musculoskeletal and traumatic

9. Cardiovascular Cardiac Dysfunction and Arrythmias due to silent IHD Excessive increments in Blood pressure Post Exercise Orthostatic hypotension

10. Microvascular Retinal Haemorrhage Increased proteinuria Acceleration of other microvascular lesions

11. Metabolic Worsening of Hyperglycemia and ketosis Hypoglycemia

12. Musculoskeletal and traumatic Foot ulcers Accelerated degeneration of joints

13. Preparing For Exercise proper warm-up consisting of 5–10 min of aerobic activity activity session, a cool-down should be structured similarly to the warm-up and should last about 5–10 min

14. Avoiding Complications Proper Footwear Avoid Exercise in extreme Heat or Cold Inspect Feet daily before and after Exercise Avoid Exercise when metabolic control is poor Maintain good water intake Prevent hypoglycemia

15. Practical considerations How much exercise? A good goal for many people is to work up to exercising 4 to 6 times a week for 30 to 60 minutes at a time. Remember, though, that exercise has so many benefits that any amount is better than no exercise.

16. How to get the patient started? Begin with a 10-minute period of light exercise or a brisk walk every day and gradually increase the duration of exercise.

17. Tips that will help the patient start and stick with an exercise program: Choose something the patient likes to do. Get a partner. Vary the routine. Choose a comfortable time of day. Forget "no pain, no gain." Make exercise fun.

18. Aerobic exercise Aerobic exercise is the type that moves large muscle groups and causes you to breathe more deeply and your heart to work harder to pump blood. It's also called cardiovascular exercise. It improves the health of your heart and lungs.

19. Aerobic exercise include Jogging Swimming

20. And also Walking Rowing Bicycling

21. Weight-bearing exercise The term weight-bearing is used to describe exercises that work against the force of gravity. Weight-bearing exercise is important for building strong bones.

22. Weight-bearing exercise Weight lifting Walking Jogging Climbing Stairs

23. What is the best exercise? The best exercise is the one that your patient will stick to Walking is considered one of the best choices because it's easy, safe and cheap. Brisk walking can burn as many calories as running, but is less likely than running or jogging to cause injuries.

24. What about weight training? Weight training, or strength training, builds strength and muscles. Calisthenics like push- ups are weight-training exercises too

25. Thank You