A REGULAR EXERCISE PROGRAMME, TAILOR MADE FOR EVERY INDIVIDUAL AND UNDERTAKEN AFTER DUE FITNESS EVALUATION, WITH REGULAR MONITORING, IS AN ESSENTIAL PART OF MODERN DIABETES MANAGEMENT!

… All patients should undergo a complete history and examination to identify cardiac, macro/microvascular and neurologic complications. The extent of investigations would dependent on the risk level of the patient and would need to be individualised.
… Exercise should not be prescribed to patients with very high blood glucose, and those in ketosis, unless treated adequately.
… Patients with significantly retinopathy and renal dysfunction may also need to undergo specific treatment before embarking on an exercise programme.
… Patients with foot infections should avoid exercise until adequately treated.
… Patients with cardiovascular abnormalities should not undertake exercise unless this is in close consultation with cardiologist.
… Other contraindications to exercise as seen in non diabetics also apply to patients with diabetes.

… The exercise should be aerobic and isotonic.
… Although the patient may be allowed to choose his own form of exercise, walking would appear to be the most appropriate, and safe, exercise for most patients.
… Isometric exercises, such as weight lifting, etc., are not recommended.

… The frequency should be around 3-5 days a week, at the least.
… The duration of each exercise session should be around 30-45 minutes, with a five minute warm up and a five minute cooling off period. The duration and frequency may be adjusted to individual needs.

… The intensity of the exercise needs to be individualised.
… Intensity is usually measured in terms of the percentage of the patients maximum heart rate (MHR). Initial exercise should be at a reduced intensity which should be at a reduced intensity which should then be increased to reach about 60-70% of the MHR. (MHR = 220 - age of the patient).
… Limiting the intensity of the exercise such that the systolic blood pressure does not exceed 180 mm Hg would seem prudent.
… Any patient undergoing an exercise programme, who complains of any signs or symptoms which would have contraindicated such a programme initially, should discontinue the programme, and have a detailed re-evaluation before restarting the exercise regimen.
… When the patient does start the exercise programme again, the intensity should be such as if the patient were beginning the exercise programme anew. The exercise programme should never be restarted at the intensity at which it was discontinued.
… An excellent parameter to judge, is that the patient should be able to carry out a normal conversation whilst exercising, without getting unduly breathless.

… Correct footwear is absolutely essential during exercise.
… The clothes worn by the patient should be loose and comfortable.
… Feet should be inspected daily and after an exercise schedule.
… Exercise during periods of poor metabolic control (blood glucose more than 250% mg and/or ketosis) should be avoided.
… Patients taking insulin will need to modify their insulin dosages and diet; this is true also for patients taking long acting sulfonylureas.
… There is a risk for developing hypoglycemia if extremely vigorous exercise is carried out on an empty stomach. It would appear prudent to take an extra snack of complex carbohydrates either, before or immediately after any unexpected vigorous activity or exercise in order to protect against hypoglycemia. If necessary an additional snack in the mid activity, may also be advisable.
… It is not generally widely known that the blood glucose lowering effect of any vigorous exercise may last for sometime even after the exercise/activity is completed. Thus, some patients may need to modify their subsequent dose of insulin or OHA, and also increase their food intake at the meal following the unduly vigorous exercise/activity.
… Such diet and drug modifications are usually required only whilst undertaking unexpected and unduly vigorous forms of exercise of activity.
EXERCISE PROGRAMMES WHICH ARE A PART OF ONE'S REGULAR DIABETES MANAGEMENT PLAN WOULD RARELY NEED SUCH MODIFICATIONS.

Patient education is the most important aspect in ensuring patient compliance. The patient must understand the benefits that can accrue from the exercise regimen, the potential hazards, the precise manner of carrying out his exercise and, importantly, the special precautions which he needs to take in order to get maximum benefit without being exposed to potential risks.