Sat, 25 Oct 2008 Opinion

Managing Diabetes With Exercise: 6 Tips for Nerve Pain

By WebMD Feature

What kind of exercise is safe - and fun - if you have nerve pain from diabetes, called diabetic neuropathy? And how can you stay motivated after that first flush of inspiration fades?

"It depends on where you're starting," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. "For the person who has been doing nothing, you would certainly want to start doing something that's comfortable and enjoyable and can be maintained."

If you have diabetic nerve pain in your feet, legs, arms, or hands, consider this: research published in The Journal of Diabetes Complications in 2006 showed significant benefits of exercise in controlling peripheral neuropathy. The study showed that for people who took a brisk, one-hour walk on a treadmill four times a week, exercise slowed how quickly their nerve damage worsened. There's no quick fix here, though; the study lasted four years.

Let's face it: when it comes to managing a lifelong condition like diabetes, it makes sense to think long-term. It's all about lifestyle changes to protect yourself from diabetic nerve damage. Becoming more active can help you control blood sugar levels, feel good, and lighten the load on painful feet and legs, especially if you're overweight. These tips can help you start and stick with an exercise plan for more than the first few days.

Before You Start: Safety First

If you have nerve pain, get the go-ahead to start any new form of exercise from your doctor. You don't want to make diabetic neuropathy worse - and most diabetic people are at higher risk of heart and circulation problems, so your doctor may want to check your heart, eyes, and feet.

Be cautious about exercising if your blood sugar is over 250, says Trence. "For some people it may be a little higher or lower," she says, "but it's an approximate number above which, clearly, we want people to watch and see what happens. See what your own body does."

Check your blood glucose before and after exercise so you learn how your body and medications responds to different kinds of activity, advises the American Diabetes Association (ADA).

Tip 1. Go for Low-Impact Exercise

Knowing you're doing something safe -- especially if you have painful neuropathy or loss of sensation removes one barrier to exercise: fear. Change to something that would be low-impact or even non-weight-bearing, says Trence, such as aerobic classes where you're sitting in a chair or using an exercise ball. Other options:

Swimming. Water supports your muscles, bones, and joints as you swim, especially helpful if you're overweight or have diabetic nerve pain in your feet. A longtime favorite of exercise experts over the years, swimming avoids the pounding on your feet, knees, and hips from a high-impact sport like jogging.

Yoga. "I think yoga is underutilized in people with diabetes," says Trence. "It's a wonderful exercise, particularly for people who need to be more controlled in their movements and not be pounding the pavement."

Cycling. Biking is safely low-impact - as long as you stay safely aboard - and you can ride outside for a change of scenery, or ride with a friend on stationary bikes in a health club.

Tip 2. Shoot for 30 Minutes, 5 Days a Week.

The American Diabetes Association (ADA) advises being active for 30 minutes a day, five days a week. The good news? Vigorous yard work like raking leaves and housework like vacuuming count as "activity."

Start with a short warm up period to help prepare your muscles, heart and lungs. Gentle stretches for five to 20 minutes help reduce injury.

Build slowly over time, so you keep feeling successful and having fun.

Don't worry if, some days, you can't do a full 30 minutes all at once. You can meet your daily goal of 30 minutes with 10 minutes of yard work in the morning, 10 minutes of vacuuming after lunch, and a brisk 10-minute walk after dinner.

Start with simple things, says Trence, like parking farther from the door or using the stairs when you can.

Tip 3. You Don't Have to Sweat.

All exercise isn't alike. Aerobic exercise raises your heart rate, helps you lose weight, and does make you sweat. But all your exercise doesn't have to be so hard that you need to sweat to reap the benefits. Try strength training, like lifting weights, and working on your flexibility by stretching or taking a yoga class.

Mix it up. Try a combo of activities that build your aerobic fitness, strength, and flexibility. You'll get more benefits - and be less prone to injury and boredom.

Modification is the key. If you can't do a regular push-up, for instance, you can do a few push-ups against a wall, so it's a lot less work for your arms and shoulders. Go for a sense of success: if you feel successful, you're more likely to stay with it.

You don't have to spend money for club dues. With so many exercise videos and DVDs out now, says Trence, people can exercise at home and try new things.

Tip 4. Make It Fun.

Choose activities you enjoy - or at least enjoy some aspects of. Otherwise, it's a cinch you'll back out when your commitment flags. So don't join the dance workout at the Y just because your wife loves it - though if you're a music lover, a dance class could be just your style. Bowling might be right up your alley. But if you've never had any hand-eye coordination or "ball sense," then taking up tennis or volleyball may not be your thing.

Think back to high school or college: what did you love to do back then? Were you a great softball player, golfer - or love to shoot hoops? Look for a club, gym, or community center where you can join a pick-up league.

Find people at your fitness level, so you won't feel overly frustrated.

Fun is unique to each person. For you, something may be fun because it's new. For others, pleasure is something familiar and comfortable. Know thyself, and trust thyself.

Tip 5. Make It Social.

Behavioral medicine experts all agree: social support helps keep you going when the going gets tough. And what's tougher than trying to make lifestyle changes?

Make regular weekly dates with a friend, neighbor, or family member to walk or exercise with you. You may be more likely to stay committed since you won't want to let the other person down.

Consider joining a local walking or hiking club, so you get outside, get some fresh air, and meet new people. You may find it's easier to exercise when you let others do the planning.

Check out groups like a softball team, volleyball team, or cycling club. Your local might have a swim team for adults. Or a local school may need a volunteer coach.

Tip 6. Try Something New

In the wake of the fitness boom, you have more choices than ever for new forms of exercise. Avoid boredom or feeling like exercise is a chore by trying something new.

Try a water aerobics class or other swim class at your local pool.

Take a class in a new sport or activity, like golf, badminton, kayaking, or ballroom dancing.

Try yoga, tai chi, and other exercise that enhances your mind/body connection, encourages relaxation, and brings on a sense of well-being.

The bottom line? The more fun you have with it, the more likely you'll create a healthy, active lifestyle that invigorates you and helps you manage diabetes for a lifetime.

By Rebecca Buffum Taylor

WebMD Feature

Reviewed by Brunilda Nazario, MD

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