Ideally, you should exercise every day, but if this is not possible, it has been shown that for exercise to have a beneficial effect, it should be done for at least five days in a week.

Each exercise session should be of around 40-45 minutes which should include the time for warming up and cooling off. You may break up the sessions into two, but each must have a warming up and cooling off period. At the same time, try and avoid breaking up the daily exercise schedule into many small parts. Often, most of these never get done!

Is there a time of day when it would be preferable to exercise so that one could get the maximum long term benefit? The short and simple answer is NO, so you can exercise at a time convenient to you.

EXERCISE……SPECIAL ASPECTS AND PRECAUTIONS

What should I wear?

There seems to be some craze for wearing track suits during the exercise. These are usually made from impermeable materials and are totally unsuited for our climate. They prevent heat loss from the body and also stop the sweat from evaporating. This could lead to a dangerous increase in the body temperature and in some severe cases, may even cause a heat shock. There is absolutely no need to spend any money on special clothes for the exercises. You should choose loose comfortable clothes (which allow the free circulation of air). After the exercise, especially if the weather is cold, it would be preferable to cover oneself more thoroughly in order to avoid catching a chill.

What you should do is buy yourself a good pair of shoes for your exercise. Here are some tips on how to buy shoes which are the most suitable for you.

Does my blood glucose levels have any thing to with my starting to exercise?

Your pre-exercise blood glucose level will affect whether or not you should exercise:

The Advantage of exercising daily is that you die healthier

Can exercise be dangerous for me?

As we have said before, the aim of your exercise is to train your body and not strain it! One of the most important aspects of your exercise program is to start slowly and build up the intensity level gradually until you have reached your targeted level of intensity.

One of the major areas of danger is sudden, vigorous exercise undertaken when your body has not been trained for it, or if the exercise you perform is way beyond your targeted limits. You should listen to your body for early warning signs that you may be overdoing your exercise or if anything is going wrong. Exercising too much can cause injuries to joints, feet, ankles and legs. So don't make the mistake of exercising beyond early warning pains in these areas or more serious injuries may result. Fortunately, minor muscle and joint injuries can be readily treated by rest and aspirin

• Pain or pressure in the left or mid-chest area, left neck, shoulder or arm during or just after exercising. (Vigorous exercise may cause a side stitch while exercising - a pain below your bottom ribs - which is not the result of a heart problem.)

• Sudden lightheartedness, cold sweat, pallor or fainting. Ignoring these signals and continuing to exercise may lead to serious heart problems.

• Should any of these signs occur, stop exercising and call your doctor,

If you have eye problems

Please ask your doctor about the exercise if you have been told that you have an eye complication.

We have already discussed that any patient who has a severe degree of proliferative retinopathy should get the eyes treated with laser therapy before embarking on any exercise. Any diabetic who has retinal problems should avoid any sudden and vigorous spurt of exercise. The reason is that in an unfit and uncontrolled diabetic, this could lead to a sharp rise in blood pressure and cause a bleed in the eye. This is also the reason why patients should avoid isometric forms of exercise as these tend to raise the blood pressure. This does not mean that a diabetic with even a small degree of retinal problem should never exercise.

If you have autonomic neuropathy

Quite a few of the patients also suffer from involvement of the autonomic nerves. These are nerves that have a myriad of functions, one of which is to regulate the blood flow to the different regions of the body. During exercise, more blood flows to the peripheral areas, like the skin and the exercising muscles. This is the blood that is diverted from the internal organs. The autonomic nerves finely regulate this change in the blood flow such that the periphery gets the additional blood, and at the same time, the internal organs are not starved of their blood requirements. In patients with a severe degree of diabetic autonomic neuropathy, sudden and vigorous exercises may divert so much blood to the periphery, that the internal organs may not get sufficient blood. Diabetics with nephropathy may, in exceptional cases, have so much of a decreased blood flow to the kidneys that these may "shut down". In some others, blood flow to the brain may decrease such that the patient may get quite faint.

Once again, I would like to make it clear that this usually occurs in patients who undertake very sudden and vigorous exercises without being trained to with- stand such stress.

Here again, the key words are slow and steady!

Look after your feet!

When you have diabetes you are at greater risk for foot injury when you exercise. Nerve damage may decrease your ability to feel an injury to your feet. Impaired circulation can mean slow or poor healing when injuries do occur. Prevention of injury to your feet is very important. When you talk to your doctor about starting an exercise program, you will be advised about whether your legs and feet can safely tolerate the type of exercise your are planning.

Check your feet before and after exercise. Look for breaks in the skin, redness, blisters, or unusual swelling. If any of these problems occur, contact your doctor immediately. Wear shoes that fit properly and that are appropriate for the type of exercise you will be doing. Wear cotton socks, preferably white, and change them during exercise if they become damp.

The use of proper shoes is essential.

Should I worry about the weather when I exercise?

The climate in India can get very hot and in some parts this is often accompanied by high humidity. If precautions are not taken during hot, humid days, heat exhaustion or heat stroke can occur - although they are fairly rare.

Heat stroke is the more serious of the two. Their symptoms are similar:

Heat exhaustion	Heat stroke
Dizziness	Dizziness
Headache	Headache
Nausea	Nausea
confusion	Thirst
body temperature below normal	muscle cramps
	sweating stops
	high body temperature

The last two symptoms of heat stroke are important to know. If the body temperature becomes dangerously high, it can be a serious problem.

Both heat exhaustion and heat stroke can be avoided if you drink enough liquids to replace those lost during exercise

On hot, humid days:

• Exercise during the cooler and/or less humid parts of the day such as early morning or early evening after the sun has gone down.

• Exercise less than normal for a week until you become adapted to the heat.

• Drink lots of fluids, particularly water - before, during and after exercising. Usually, you do not need extra salt because you get enough salt in your diet. (And a well-conditioned body is better able to conserve salt so that most of the sweat is water.) However, if you exercise very vigorously for an extended time in the heat (for example, running a marathon), it's a good idea to increase your salt intake a little.
  
  

• Watch out for signs of heat stroke - feeling dizzy, weak, light- headed, and/or excessively tired; sweating stops; or body temperature becomes dangerously high.

• Wear a minimum of light, loose-fitting clothing.

• Avoid rubberized or plastic suits, sweatshirts, and sweat pants. Such clothing will not actually help you lose weight any faster by making you sweat more. The weight you lose in fluids by sweating will be quickly replaced as soon as you begin drinking fluids again. This type of clothing can also cause dangerously high temperatures, possibly resulting in heat stroke.

Heat-Humidity Index

Temperature Relative Humidity (%) °C °F 100 90 80 70 60 50 40 30 20 10 5 15 59 17.5 17.0 16.5 16.0 15.5 15 14.5 14 13.5 12.9 12.7 18 64 20.2 19.6 19.0 18.4 17.8 17.2 16.6 16.0 15.4 14.8 14.5 20 68 22.2 21.5 20.8 20.1 19.4 18.7 18.0 17.4 16.7 16.0 15.6 22 72 24.2 23.4 22.6 21.9 21.1 20.3 19.5 18.7 18.0 17.2 16.8 25 77 27.5 26.5 25.6 24.7 23.7 22.8 21.9 20.9 20.0 19.1 18.6 28 82 31.0 29.9 28.7 27.6 26.5 25.4 24.3 23.2 22.0 20.9 20.4 30 86 33.5 32.2 31.0 29.7 28.5 27.2 26.0 24.7 23.5 22.2 21.6 32 90 36.1 34.7 33.3 31.9 30.5 29.1 27.7 26.3 24.9 23.5 22.8 35 95 40.4 38.7 37.1 35.4 33.7 32.1 30.4 28.8 27.1 25.4 24.8 38 100 45.1 43.1 41.1 39.2 37.2 35.3 33.3 31.4 29.4 27.4 26.5 40 104 48.4 46.2 44.4 41.9 39.7 37.5 35.3 33.2 31.0 28.8 27.7

Low Risk | Medium Risk| High Risk |Very High Risk

The important point is that you should not let yourself get dehydrated and should drink lots of water before, during and after exercise.

Some parts of India can also get very cold.

On cold days:

• Wear one layer less of clothing than you would wear if you were outside but not exercising. It's also better to wear several layers of clothing rather than one heavy layer. You can always remove a layer if you get too warm.

• Use old mittens, gloves, or cotton socks to protect your hands.

• Wear a hat, since up to 40 percent of your body's heat is lost through your neck and head.

Do I need to adjust my food intake when I exercise?

Change may be necessary for some of the patients although this may not be something that you would need to do every time you exercise. The reason for this is that, if you have a regular exercise schedule, your diet and medications will have taken this into consideration and would rarely require adjustments. At the same time, you should be aware about the modifications that they may have to make during exercise schedule.

It is possible that you may have to carry out a vigorous activity unexpectedly, or on occasion, you may feel like exercising for a more prolonged period, or at a time which is not your usual time for exercise and therefore, this may not have been taken into account whilst planning the diet and treatment.

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