Person often wonders – how much physical activity is needed “for health”? When a person decides to lose weight – she/he is thinking about having a diet (i.e. how to reduce calorie intake), but neglects physical activity (i.e. how to increase burned calories). In order to get the right answer, it is best to know the recommendations for physical activity for people who have pre-diabetes or diabetes.

What kind of physical activities increase health?

• Aerobic exercises
• Resistance exercises
• Balance exercises
• Stretching exercises
• Motor exercises: Thai chi, yoga

Aerobic exercise

Aerobic exercise is the rhythmic activity of the major muscle groups, repeated in order to improve the shape of the body, speed up breathing and increase heart rate. These include: walking, running, stair climbing, swimming, cycling, exercising and more.

What are the benefits of aerobic physical activity?
Aerobic physical activity reduces insulin resistance, which is a disorder brought up by modern way of life. Muscles, adipose tissue and the liver are organs that are “sensitive” to insulin. Insulin draws glucose and free fatty acids from the blood into these organs, to be used for energy. If there is insulin resistance, the pancreas secretes more insulin to “break through” the tissue resistance. Excess insulin in the blood (which is often detected by measuring during oGTT) raises the pressure, affects the work of the ovaries, increases hirsutism and has a number of harmful vascular effects.
That is why aerobic physical activity, even simple stair climbing and walking, reduces the morning sugar level, as well as the level of cholesterol in the blood. Also, it reduces arterial blood pressure, improves the activity of the lungs and heart, tolerance to stress and raises immunity. What is important for people who have some chronic disease, such as type 2 diabetes, obesity or cardiovascular disease, is that aerobic activity prolongs life.

How much aerobic exercise is needed?
2 hours and 30 minutes of moderate aerobic physical activity per week
or
1 hour and 15 minutes of strenuous activity per week.
Children and adolescents should have 60 minutes of moderate or strenuous aerobic activity, each day.

What determines whether physical activity is “moderate” or “strenuous”?
Heart rate.
First, it is necessary to determine the maximum heart rate. It is calculated by subtracting the years of life from the number 220. The heart rate to be achieved for moderate physical activity is 50 – 70% of maximum heart rate. This can also be calculated by multiplying the maximum heart rate by 0.5 or 0.7
Example: The person is 59 years old and has decided to “exercise”. Her maximum heart rate is 220-59 = 161. During moderate physical activity, she should keep the heart rate at (161 x 0.5) 81/min. It seems easy. But “the catch” is to achieve that rhythm. In the beginning, the heart is not trained and it beats much faster. With exercising, the response improves, the heart calms down and the pulse is kept steady at 81/min. For moderate physical activity, the heart rate may rise up to 112/min.
Heart rate for strenuous physical activity is greater than 70% of the maximum heart rate (maximum heart rate x 0.7). Example of the same person aged 59: 161 x 0.7 = 112/min. So, when you exercise intensively, the heart rate should be over 112/min, but should not create a discomfort in the chest, or shortness of breath.
The number of heart beats is easily registered by modern devices worn around the arm. These devices measure steps and heart rate.

Is it necessary to make a “plan” for aerobic exercise?
Definitely yes!
The first 10 minutes are used for preparation – through stretching the muscles. This is followed by 20 minutes of exercising. After that comes 10 minutes of cooling. That is in total 50 minutes. For moderate physical exercise, this should be repeated 3 times a week. Exercise time can be gradually extended, so that a person exercises 2 times a week (150 minutes moderately, weekly).
It’s not important just to make a plan. It is also necessary to determine the time for exercising. For many people, this is a big problem. In general, it is not good to exercise up to 3 hours after a larger meal and 2 hours before bedtime. In an accelerated lifestyle, it’s hard to fit everything in, but it’s not impossible.

What is the easiest solution for aerobic exercise?
Walking and stairs climbing.
Each person should do 10.000 steps daily. This is registered by a pedometer or a device worn as a watch (fit-bit). Normally we make 3.000 – 6.000 steps a day. 10.000 steps means another 4.000 – 6.000 steps more each day, which is equivalent to 30 minutes of fast walking or 6 km of walking.

When do people with diabetes need to measure blood sugar levels?
– Before exercising – if it is <6 mmol/l, 15 to 30 g of carbs should be taken before exercise.
– Type 1 with glycemia >15 mmol/l, check for ketones. If ketones are positive, DO NOT exercise.
– After exercising – immediately after and 2 hours after exercise
– During exercising if you feel “something”

Why is blood sugar increased, immediately after exercising?
Due to the action of hormones that are secreted during exertion. They “drain” all sugar reserves that are stored in the liver and muscles. When sugar is consumed, ketones, formed from fatty acids released from adipose tissue, are used for energy. That is the reason why people with diabetes find higher sugar or ketones in their urine by measuring immediately after exercising. But it must not disappoint them. That is normal!

Are ketones, formed during exercise, harmful?
They are not! Ketones are a reserve fuel for the heart. Besides, ketones reduce appetite. This is why people who exercise regularly have less need to snack and they put less quantity of food into their plate.

Resistance exercises
These include exercises with weights, theraband, on fitness machines. The series of exercises is repeated 2-3 times a week, but not day after day. When combined with aerobic, resistance exercises are performed first, followed by aerobic exercises. As a result, hypoglycemia is experienced less often.
Resistance exercises reduce sarcopenia, improve body composition and improve bone mineral density. These exercises stimulate the growth and development of the skeletal system of children and adolescents.

Stretching and balance exercises
Exercises are important for everyone, especially for the elderly. If the muscles are stretched before and after each aerobic exercise, there is less tissue trauma and the possibility of injury. In the elderly, stretching exercises maintain joint mobility. Balance exercises strengthen muscles and joints, therefore reducing falls.
Stretch and balance exercises should be performed 2-3 times a week, or more. It is best to set aside every morning for these exercises.
These exercises have no effect on glycemic control.

Motor exercises
These exercises include Yoga and Thai Chi. They can be learned from books, videos or with an instructor.
Yoga improves body composition, joint elasticity, balance, control of blood pressure, glycemia and lipids. It encourages endurance, moderation and both mental and physical balance in everyone. Yoga builds harmonious and correct posture, prevents the formation and progression of cellulite and keeps the muscles tense. This skill directs the proper flow of energy which can prevent the appearance or progression of many diseases. It is very undemanding in terms of time and space.
Thai chi exercise has similar effects as Yoga. One small study showed that it improves balance, glycemic control, symptoms of neuropathy and the quality of life for people with diabetes.

Breathing exercises
Hustle, stress and obesity have spoiled our breathing. It is good to remember what proper breathing means. One breathing cycle consists of a shorter inhalation and a longer exhalation. Proper breathing is 6 cycles per minute.
Breathing exercises improve gas exchange and blood circulation in the lungs. The feeling of shortness of breath and “tightening” in the area of the thyroid gland is reduced. Proper breathing helps regulate blood pressure and improves opportunities for physical activity.
Breathing exercises are performed at any time of the day, in a quiet place, at a length that a person determines. They can be performed in a sitting or lying position. They consist of:
1. internal “observation” – i.e. calming the mind
2. short breath with inhalation starting from the abdomen and spreading to the tips of the lungs
3. extended exhalation with slow, audible exhalation through the nose, with retraction of the abdomen.
When 6 cycles per minute are mastered, one can switch to focused breathing with exhalation “in place of tension” or pain.

In conclusion:
Exercise is not only “good” for cardiovascular health, for mobility and stability of the bone and joint system, but also for the prevention of vascular dementia.
Aerobic exercises + resistance exercises require metabolic energy. Cognition (memory, logical thinking) and cardiovascular fitness improve with the intensity of aerobic exercise.
Motor activities with stretching, balance and coordination require neuromuscular strength and directly, through the nervous system, affect cognition. The complexity of the exercise improves cognition.