Lure patients with instant gratification
Kathy Mullooly, MS, CDE, director of exercise physiology at the Joslin Diabetes Center in Boston, has a few suggestions to encourage patients to exercise.
The one she’s found most effective plays right into what she calls a cultural hunger for instant gratification: She takes blood sugars before and after an exercise session to show patients how quickly their sugars are affected.
"They see their sugars change after just 20 minutes of simply moving around the gym or riding the exercise bike or walking on the treadmill — something they consider easy. It’s immediate, and it reinforces why activity is good, so they make an informed decision to continue it," Mullooly says.
She recommends moderate exercise with incremental increases in the activity levels. "If you tell people they’re going to have to exercise every day for the rest of their lives, they’ll run away," she says. "But if you get them from zero exercise to one day a week, they’ll begin to see the improvement; they’ll feel better, maybe even lose a little weight."
An exercise program can be as simple as encouraging patients to walk up stairs or park their cars at the outskirts of a parking lot so they have to walk farther. "Go with what they like to do. If somebody likes hunting or cycling, encourage that," Mullooly says. "Keep the level where it doesn’t overwhelm them. Take a more reasonable approach."
Mullooly’s clinic also offers small rewards for patients. Those who accumulate stars next to their names for 10 or 15 sessions at the gym are rewarded with a small gift to help them manage their condition, perhaps some lancets or a sharps disposal container. "They have a lot of fun with this," she says. "It can be adapted for people working at home, if they put a dollar in a jar every time they exercise and then at a certain point they treat themselves, perhaps with a new shirt or a night out at the movies."
A French study reported in the January issue of Diabetes Care showed that those who can’t exercise due to medical conditions face a high risk of death from heart attacks.
The subjects at the University of Grenoble were all Type 2 diabetics with two or more of these cardiac risk factors:
- over 65 years of age;
- active smoking;
- high blood pressure;
- hypercholesterolemia;
- history of coronary artery disease;
- peripheral vascular disease;
- abnormal resting EKG or microalbuminuria.
Some patients had as many as six risk factors. About half the patients in the study couldn’t exercise for a variety of reasons: extreme obesity, chronic fatigue, peripheral neuropathy, pulmonary disease, peripheral vascular disease, heart failure with exertional dyspnea, or previous cerebrovascular accident.
Those who could not exercise had a mortality rate seven times higher than those who exercised.
Most people, however, do not have clinical reasons to avoid exercise. Experts agree few people can use that excuse to keep them from doing some sort of medically recommended activity. "We are very much in favor of walking," says Thompson. "Anybody can do it anywhere, and it doesn’t require any equipment."
[Contact Kathy Mullooly at (617) 732-2400.]
Some exercise protection can last for years
A Japanese study shows that fitness early in life provides protection from diabetes decades later.
Researchers at the Juntendo University School of Medicine in Tokyo studied army officers between 30 and 39 years old who ran a 1,500-meter event. The ones who completed the course in about six minutes were three times more likely to go on to develop impaired glucose tolerance in their 50s than those who had completed the course in 5 minutes.
A Widely Accepted Exercise Program
1. Aerobic exercise for 30 to 45 minutes at least three times a week — include gradual warm-up section, main exercise section, and winding-down (or warm-down) section.
2. Stretching for five to 10 minutes after exercise.
3. Resistance training at least three times a week, repetitive lifting of weights using major muscle groups.
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