Get help with exercise when you have diabetes

Exercise is especially important for people with diabetes. Aerobic exercise and strength training improve blood sugar control by increasing the amount of sugar burned by the muscles, and by helping with weight loss. Aerobic exercise may further reduce the risk of two diabetic complications: coronary disease, by increasing HDL (good) cholesterol, lowering blood pressure, and controlling weight; and poor circulation in the legs, by increasing blood flow.

While the best diabetes exercise is the kind you enjoy and do regularly, there are several choices that are especially good for people with diabetes, and several precautions that are particularly important for them, too.

Try these steps when starting a diabetes exercise program.

Take baby steps. "How do you get started from virtually zero?" asks James Hill, Ph.D., a co-founder of the National Weight Control Registry and director of the government-funded Center for Human Nutrition. "The answer is, you start slowly." Choose the stairs over the escalator. Park the car in the farthest spot in the lot. Take your dog for a walk. "All the little stuff begins to add up," he says.

Bring a buddy. It can be your dog or a pal. "It's always fun to have a friend, as long as they're kind of at the same level," says Richard Lampman, Ph.D., an adjunct associate professor of physical medicine and rehabilitation at the University of Michigan. And it passes the time to talk while you walk.

Plan ahead. "The day before, plan when you're going to work out, where you're going to go, what equipment you need," Lampman says. And if you have one, don't forget to wear your medical identification bracelet or necklace, a practice that's recommended by the American Diabetes Association.

Talk to people who exercise. Find out where they like to work out. "People who are successful in using peer support and family support are more likely to be successful," says Steven Blair, P.E.D., a professor in the department of exercise science at the University of South Carolina.

Here are some good options for a diabetes exercise program.

Walk. This was by far the most popular activity in our survey. The key to success: Do it regularly. Nearly half of the successful respondents walked every day, compared with about a third who did it just two days a week. That's because working out improves how well the body uses insulin, but only within 24 hours of activity. "Think of it as taking medicine every day versus skipping days or taking a lot at once," explains Gary Scheiner, M.S., a certified diabetes educator, Wynnewood, Pa. Whatever form of aerobic exercise you choose, aim for at least 30 minutes a day, five days a week. To help keep motivated, consider investing in an inexpensive pedometer to monitor your step count and distance. Or see our top-rated ellipticals and treadmills. Precaution: Make sure you get a good pair of shoes that fit well, especially if you have neuropathy (pain or numbness) in your feet, and don't wear the shoes if the cushioning or support is worn. See our top-rated athletic shoes. In addition, check your feet daily for calluses and sores, and avoid high-impact activities, such as jogging or aerobic dance, if you have neuropathy or leaky blood vessels in your eyes.

Bike. It's even easier on the feet than walking. Precaution: Beginners should try an exercise bike; those who also have bad backs should consider a recumbent bike, which offers back support and comfortable seat. See our top-rated exercise bikes.

Swim. This is another great option for people with nerve damage in their feet. See our advice for water workouts. Precaution: You may want to wear pool shoes, especially if you have a loss of feeling in your feet, since a rough pool floor can cause sores.

Strength train. Muscle is less resistant to insulin than fat, so the more muscle you have, the more efficiently you can move glucose out of the blood. Aim for two sessions a week. Precaution: If you have high blood pressure, focus on high repetition and low-weight exercises, which help minimize swings in blood pressure by decreasing the amount of strain. And don't overly strain or hold your breath during the lifting phase, since that can cause blood vessels to break in diseased eyes. Instead, exhale. It's always a good idea to meet with a certified trainer to learn proper techniques before beginning a weight-lifting program.

Stretch. That can improve your balance—which is especially important for people who have nerve problems—and help reduce the overall risk of injury through gains in flexibility. See our advice for exercises that promote flexibility, such as yoga and tai chi. Precaution: Don't forget to stretch after your workout's cool-down phase, when your muscles are still a bit warm. (Cooling down slowly helps prevent sudden and dangerous drops in blood pressure.)

People with diabetes should take these additional precautions when exercising:

Protect your heart. Consider an exercise stress test before starting to work out regularly, to check for cardiac abnormalities. During exercise, your target heart rate shouldn't exceed 70 percent of its maximum rate (220 minus your age).

Monitor your blood sugar levels. Wait at least one hour after meals before exercising. Check blood sugar levels before and after your workout; if necessary, adjust your diet or insulin dosage to prevent an excessive drop in sugar. Carry sugar packets during your workout in case you feel symptoms of low blood sugar. If you inject insulin, try to choose a site that won't be exercised and wait at least an hour before working out.

Watch the weather. Poor circulation and impaired nerve function increase the likelihood of numbness in your feet. Exposure to cold further increases that likelihood, which can lead to foot injuries during exercise.

For additional information about diabetes exercise, go to the following Web sites:

• The American Diabetes Association
• The Diabetes Exercise and Sports Association

See our complete guide to preventing and treating diabetes.