Exercises for Type 2 Diabetes Patients

Abstract

DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York. Type 2 diabetes is becoming increasingly common in the United States across all ages and ethnicities. This kind of diabetes, which is not dependent on insulin, can be controlled in many people by better attention to exercise and weight management. Weight control is important for patients with type 2 diabetes, and walking is a safe exercise, even for many elderly people who are not bed-ridden. However, diabetes can predispose patients to aches and pains that can limit mobility and discourage them from physical activity. In addition to promoting problems such as high blood pressure, type 2 diabetes can affect the nervous system. Consequently, patients may have problems with walking and develop an ungainly gait. Patients with type 2 diabetes should begin gait exercises as soon as they notice a problem with walking. I recommend that caregivers mark the positions of several of the patient's normal steps on the floor and have the patient walk back and forth, stepping on the marks to improve his or her gait. An awkward gait can lead to tightness in calves, hamstrings, and hip flexors. Conversely, preexisting tightness in those muscles can contribute to the development of gait problems. Strong and supple hip flexor muscles and adductor muscles are very helpful for a smooth, efficient gait. In this column, I describe several exercises that patients with type 2 diabetes should do before and after walking. (See illustrations and instructions below.) Proper footwear will make patients more comfortable. I also recommend athletic socks, preferably those made with moisture-wicking materials, and sneakers with laces that can be adjusted as the feet swell. It is especially important for patients with type 2 diabetes to have well-fitting shoes with a wide toe box, because their nervous system complications may prevent them from feeling foot pain that might be caused by ill-fitting shoes. I also recommend that patients with type 2 diabetes or their caregivers inspect the patient's feet every day. Once foot infection occurs, it is difficult to cure. Patients who sweat excessively can put baby powder inside the socks before walking to absorb moisture and prevent sores. In addition, remind patients with type 2 diabetes that they must not smoke and that they should work hard to control weight. Maintaining a healthy weight will not only help to reduce blood sugar levels; it will also reduce stress on the legs and improve the patient's gait.