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Maintaining adequate levels of physical activity—a feat many patients find most difficult to achieve—is a key component of managing diabetes, obesity, and cardiovascular disease.
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Patients whose mobility is limited by excess weight or painful arthritic joints often are frustrated by their doctor's advice to get more exercise. When discomfort sets in, patients are likely to give up and revert to sedentary lifestyles.
It doesn't have to be that way, says Karen L. Kemmis, PT, DPT, CDE, of the Joslin Diabetes Center at SUNY Upstate Medical Center in Syracuse, N.Y. "People want to be active, but they won't know what to do," Kemmis explained during a full-to-capacity afternoon session at the annual meeting of the American Association of Diabetes Educators (AADE), held August 10–13 in Washington, D.C. Kemmis discussed how to help patients with diabetes increase their physical activity without increasing pain.
Before any patient undertakes an exercise program, health care providers should make sure there are no conditions, such as heart disease, that might raise a warning flag. Kemmis says exercise stress testing is recommended for all patients with type 2 diabetes >35 years of age, patients with type 2 diabetes and cardiovascular disease risk factors, and patients with known or suspected cardiovascular disease.
Kemmis describes several common pain patterns that may limit physical activity—affecting the spine, shoulders, hips, knees, and feet. Arthritis is common among people who are overweight, and the discomfort of diabetic peripheral neuropathy often interferes with function.
MATCHING PATIENTS AND ACTIVITIES
No matter the patient's condition, a program of physical activity can be devised to meet his or her needs, according to Kemmis.
Walking is often health professionals' first suggestion. But although it is an inexpensive and convenient activity, walking may not be appropriate for all patients, she says. "There's an impact on weight-bearing joints, and that can be a problem with some people."
In this case, the health professional should suggest ways to "unweight the joint," such as swimming, riding a stationary bike, or using an elliptical trainer, all of which produce less stress on weight-bearing joints.
If necessary, patients can begin exercising in a chair, concentrating on the upper extremities, until they build up the capacity for more strenuous physical activity, Kemmis says.
MAINTAINING BALANCE
Balance is another common issue, particularly for older patients, for whom exercise on a treadmill may present problems and raise the risk of a fall. Aquatic activities may be preferable and less risky for a patient who has difficulty maintaining balance.
Kemmis says providers should ask questions to develop a picture of a patient's abilities, interests, and resources. Health professionals also should inquire about functional limitations and what sorts of activities make pain better or worse.
Consultation with a physical therapist or personal trainer can help match the needs and abilities of patients with a suitable regimen of physical activity. If such services are beyond the means of patients, discounted or free services often are available from the local YMCA or other community organizations.
"There are some pretty good options out there," Kemmis says.
"Patients just need our help to find them." 
Help Patients Move Around Pain
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
