Conditions That May Interfere with Exercise

  • Susan Herzlinger Botein
  • Aristidis Veves
  • Edward Horton
Chapter
Part of the Contemporary Diabetes book series (CDI)

Abstract

Exercise often has many positive effects on diabetes management, including improved glycemic control, assistance with weight maintenance, increases cardiorespiratory fitness, and general sense of well-being. However, as diabetic patients can also have other conditions that can be invest affected by exercise, such as cardiovascular disease and neuropathy that makes them vulnerable to foot problems and retinopathy, exercise should be carefully monitored by the health provider, especially during the initiation period. Therefore, careful evaluation of patients for complications that may present incremental risks or interfere with the capacity for exercise is an important first step in planning an appropriate exercise program. This chapter will review the currently available guidelines and will provide practical information regarding the implementation of exercise programs in all diabetic patients, including those with conditions that may interfere with exercise and will need additional attention.

Retinopathy Neuropathy Cardiovascular disease Exercise 

References

  1. 1.
  2. 2.
    Saydah SH, Fradkin J and Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291: 335–342.PubMedCrossRefGoogle Scholar
  3. 3.
    American Diabetes Association. Clinical practice recommendations 2007. Diabetes Care 2007; 30S1: S12–S14.Google Scholar
  4. 4.
    Steppel JH and Horton ES. Exercise. In: Therapy for Diabetes Mellitus and Related Disorders, 4th edition. American Diabetes Association, Alexandria, VA, 2003: 149–156.Google Scholar
  5. 5.
    Marliss EB and Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation. Diabetes 2002; 51(S1): S271–S283.PubMedCrossRefGoogle Scholar
  6. 6.
    O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80: 234–244.PubMedCrossRefGoogle Scholar
  7. 7.
    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106: 3143–3421.Google Scholar
  8. 8.
    Haffner SM, Lehto S, Ronnmaaa T, Pyorala K and Laakso M. Mortality from coronaty heart disease in subjects with diabetes type 2 and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229–234.PubMedCrossRefGoogle Scholar
  9. 9.
    Miettinen H, Lehto S, Salomaa V, Mahonen M, Niemela M, Haffner SM, Pyorala K and Tuomilehto J. Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care 1998; 21: 69–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Aiello LP, Cahill MT and Wong JS. Systemic considerations in the management of diabetic retinopathy. Am J Opthalmol 2001; 132: 760–776.CrossRefGoogle Scholar
  11. 11.
    Sigal RJ, Kenny GP, Wasserman DH and Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004; 27: 2518–2539.PubMedCrossRefGoogle Scholar
  12. 12.
    Benn SJ, McCartney N and McKelvie RS. Circulatory responses to weight lifting, walking and stair climbing in older males. J Am Geriatr Soc 1996; 44: 121–125.PubMedGoogle Scholar
  13. 13.
    Matthews CE, Pate RR, Jackson KL, Ward DS, Macera CA, Kohl HW and Blair SN. Exaggerated blood pressure response to dynamic exercise and risk of future hypertension. J Clin Epidemiol 1998; 51: 29–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Aiello LP, Wong J, Cavallerano J, Bursell FE and Aielle LM. Retinopathy. In: Handbook of Diabetes in Exercise, 2nd edition. American Diabetes Association, Alexandria, VA, 2002: 401–413.Google Scholar
  15. 15.
    Graham C and Lasko-McCarthy P. Exercise options for persons with diabetic complications. Diabetes Educ 1990; 16: 212–220.PubMedCrossRefGoogle Scholar
  16. 16.
    Anderson B. Activity and diabetic vitreous hemorrhages. Ophthalmology 1980; 87: 173–175.PubMedGoogle Scholar
  17. 17.
    Cruickshanks KJ, Moss SE, Klein R and Klein EK. Physical activity and the risk if progression of retinopathy or the development of proliferative retinopathy. Ophthalmology 1995; 102: 1177–1182.PubMedGoogle Scholar
  18. 18.
    Huttunen NP, Kaar M, Puukka R and Akerblom HK. Exercise-induced proteinuria in children and adolescents with type 1 diabetes. Diabetologia 1981; 21: 495–497.PubMedCrossRefGoogle Scholar
  19. 19.
    Bognetti E, Meschi F, Pattarini A, Zoja A and Chiumello G. Postexercise Albuminuria does not predict microalbuminuria in type 1 diabetic patients. Diabetes Med 1994; 11: 850–855.CrossRefGoogle Scholar
  20. 20.
    O'Brien SF, Watts GF, Powrie JK and Shaw KM. Exercise testing as a long-term predictor of the development of microalbuminuria in normoalbuminuric IDDM patients. Diabetes Care 1995; 18: 1602–1605.PubMedCrossRefGoogle Scholar
  21. 21.
    Kruger M, Gordjani N and Rainer B. Postexercise albuminuria in children with different durations of diabetes mellius. Pediatr Nephrol 1996; 10: 594–597.PubMedCrossRefGoogle Scholar
  22. 22.
    Dash R and Torffvit O. How to predict nephropathy in type 1 diabetic patients. Routine data or provocation by exercise testing. Scand J Urol Nephrol 2003; 37: 437–442.PubMedCrossRefGoogle Scholar
  23. 23.
    Inserra F, Daccordi H, Ippolito J, Romano L, Zelechower H and Ferder L. Decrease of exercise-induced microalbuminuria in patients with type 1 diabetes by means of an angiotensin-converting enzyme inhibitor. Am J Kidney Dis 1996; 27: 26–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Poulson PL, Ebbelhoj E and Mogensen CE. Lisinopril rescues albuminuria during exercise in low grade microalbuminuric type 1 diabetic patients: a double-blind randomized study. J Intern Med 2001; 249: 433.CrossRefGoogle Scholar
  25. 25.
    Bognetti E, Meschi F, Pattarini A, Zoja A and Chiumello G. Postexercise albuminuria does not predict microalbuminuria in type 1 diabetic patients. Diabet Med 1994; 11: 850–855.PubMedCrossRefGoogle Scholar
  26. 26.
    Garg S, Chase P, Harris S, Marshall G, Hoops S and Osberg I. Glycemic control and longitudinal testing for exercise microalbuminuria in subjects with type 1 diabetes. J Diabetes Complicat 1990; 4: 154–158.CrossRefGoogle Scholar
  27. 27.
    Cheema BSB, O'Sullivan AJ, Chan M, Patwardhan A, Kelly J, Gillin A and Singh MAF. Progressive resistance training during hemodialysis: rationale and method of a randomized-controlled trial. Hemodial Int 2006; 10: 303–310.PubMedCrossRefGoogle Scholar
  28. 28.
    Kouidi E, Albani M, Natsis K, et al. The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol Dial Transplant 1998; 13: 685–689.PubMedCrossRefGoogle Scholar
  29. 29.
    Castaneda C, Gordon P, Uhlin K, Levey A, Kehayias J, Dwyer J, Fielding RA, Roubenoff R and Singh MF. Resistance training to counteract the catabolism of a low-protein diet in patients with chronic kidney disease. Ann Intern Med 2001; 135: 965–976.PubMedGoogle Scholar
  30. 30.
    Harris D, Thomas M, Johnson D, Nicholls K and Gillin A. Caring for Australians with renal impairment (CARI). Neprhology 2006; 11 (Suppl. 1): S30.Google Scholar
  31. 31.
    Estacio RO, Regenstein JGM, Wolfel EE, Jeffers B, Dickenson M and Schrier RW. The association between diabetic complications and exercise capacity in NIDDM patients. Diabetes Care 1998; 21: 291–295.PubMedCrossRefGoogle Scholar
  32. 32.
    LeBrasseur NK and Fielding RA. Exercise and diabetic neuropathy. Implications for exercise participation and prescription for patients with insulin-dependent and non-insulin-dependent diabetes mellitus. In: Veves A (ed), The Clinical Management of Diabetic Neuropathy. Humana Press, Totowa, NJ, 1998: 257–271.CrossRefGoogle Scholar
  33. 33.
    Vinik A and Erbas T. Neuropathy. In: Handbook of Diabetes in Exercise, 2nd edition. American Diabetes Association, Alexandria, VA, 2002: 463–496.Google Scholar
  34. 34.
    Hilsted J, Galbo H and Christensen N. Impaired responses of catecholamines, growth hormone, and cortisol to graded exercise in diabetic autonomic neuropathy. Diabetes 1980; 29: 257–262.PubMedGoogle Scholar
  35. 35.
    Hilsted J. Cardiovascular, hormonal and metabolic studies. Diabetes 1982; 31: 730–737.PubMedGoogle Scholar
  36. 36.
    Levin ME. The diabetic foot. In: Handbook of Diabetes in Exercise, 2nd edition. American Diabetes Association, Alexandria, VA, 2002: 385–399.Google Scholar
  37. 37.
    Barkai L, Peja M and Varmosi I. Physical work capacity in diabetic children and adolescent with and without cardiovascular autonomic dysfunction. Diabet Med 1996; 13: 254–258.PubMedCrossRefGoogle Scholar
  38. 38.
    Hilsted J, Galbo H and Christensen N. Impaired cardiovascular responses to graded exercise in diabetic autonomic neuropathy. Diabetes 1979; 28: 313–319.PubMedCrossRefGoogle Scholar
  39. 39.
    Veves A, Saouaf R, Donaghue VM, Mullooly CA, Kistler JA, Giurini JM, Horton ES and Fielding RA. Aerobic exercise capacity remains normal despite impaired endothelial function in the micro- and macro-circulation in physically active IDDM patients. Diabetes 1997; 46: 1846–1852.PubMedCrossRefGoogle Scholar
  40. 40.
    Veves A, Saouaf R, Donaghue VM, Mullooly CA, Kistler JA, Giurini JM, Horton ES and Fielding RA. Aerobic exercise capacity remains normal despite impaired endothelial function in the micro- and macro-circulation in physically active IDDM patients. Diabetes 1997; 46.Google Scholar
  41. 41.
    Hilsted J, Galbo N, et al. Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy. Diabetologia 1982; 22: 318–323.PubMedCrossRefGoogle Scholar
  42. 42.
    Hornung RS, Mahler RF and Raftery EB. Ambulatory blood pressure and heart rate in diabetic patients: an assessment of autonomic function. Diabet Med 1989; 6: 579–585.PubMedCrossRefGoogle Scholar
  43. 43.
    Radice MA, Rocca A, Bendon E, Musacchio N, Morabito A and Segalini G. Abnormal response to exercise in middle-aged NIDDM patients with and without autonomic neuropathy. Diabet Med 1996; 13: 259–265.PubMedCrossRefGoogle Scholar
  44. 44.
    Smith GDP, Watson LP and Mathias CJ. Cardiovascular and catecholamine changes induced by supine exercise and upright posture in vasovagal syncope. Eur Heart J 1996; 17: 1882–1890.PubMedGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Susan Herzlinger Botein
    • 1
  • Aristidis Veves
    • 2
  • Edward Horton
    • 3
  1. 1.Division of Endocrinology, Diabetes and MetabolismJoslin Diabetes Center, Harvard Medical SchoolMAUSA
  2. 2.Joslin-Beth Israel Deaconess Foot CenterMicrocirculation Laboratory Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical SchoolMAUSA
  3. 3.Clinical Research CenterJoslin Diabetes Center, Harvard Medical SchoolMAUSA

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