• Symptomatic individuals may benefit from diagnostic cardiac stress testing, both for diagnostic purposes and also to assist in safe and effective exercise.
• To date, no studies have addressed whether pre-exercise stress testing is necessary or beneficial before participation in resistance training (although likely it is not).
• Graded exercise testing may be undertaken in low-risk and other individuals to determine fitness levels or to obtain testing results for effective exercise prescription.
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Chapter 3 Daily Lifestyle Activity
Individuals with all types of diabetes frequently are deconditioned and live a sedentary lifestyle. Therefore, the first major step in assisting them to exercise more regularly is to focus on incorporating more activities of daily living and other less structured physical activity into their lifestyles (Levine 2005, Johannsen 2008). The U.S. Physical Activity Guidelines (2008) refer to such activities as “baseline activity,” defined as the light-intensity activities of daily life like standing, walking slowly, and lifting lightweight objects. Although individuals vary in how much baseline activity they do, those engaging only in baseline activity are considered to be inactive. For the purposes of this book, daily lifestyle activity includes any unstructured movement done during each day.
Significant health benefits, such as a reduction in coronary risk factors, can be obtained by incorporating frequent bouts of moderate-intensity activity on most, if not all, days of the week, even if this activity is not a traditional, planned (or structured) one (McBride 2008, Loimaala 2009). A single bout of low-intensity, as opposed to high-intensity, exercise has been shown to substantially reduce the prevalence of hyperglycemia throughout the subsequent 24 h postexercise period in individuals with type 2 diabetes (T2D), demonstrating that activities of daily living also can have a positive effect on blood glucose management (Manders 2010). Although lifestyle physical activity does not entirely take the place of a traditional structured exercise program, in most cases it can be highly effective in helping individuals increase their daily activity level and build a fitness base that will allow them to participate in other, more intense or structured physical activities and exercise programs (Garber 2011).
Case in Point: Finding Time for Daily Movement
DC, a 62-year-old woman who has had T2D for 15 years, wants to do more exercise, but cannot find the time or the motivation to do so. Her medications include a daily evening injection of 70 units of long-acting basal insulin (insulin glargine), as well as a daily antidepressant. DC does not test her blood glucose regularly because of the high cost associated with buying strips for her meter (although she does have one). She has never been regularly physically active, and she has been significantly overweight or obese all of her adult life. Although she knows she needs to exercise, she says she has no time or energy left at the end of the day to do any exercise.
Resting Measurements
Height: 63 inches
Weight: 252 lb
BMI: 44.6 (morbidly obese)
Heart rate: 95 beats per minute (bpm)
Blood pressure: 125/80 mmHg
Fasting Labs
Plasma glucose: 116 mg/dl
A1C: 6.7%
Total cholesterol: 210 mg/dl
Triglycerides: 85 mg/dl
High-density lipoprotein cholesterol: 44 mg/dl
Low-density lipoprotein cholesterol: 149 mg/dl
Questions to Consider
1.