Tips for helping people with diabetes, physical limitations become more active
Diabetes care and education specialists, even those without training in physical therapy, can help a person with diabetes and physical limitations increase activity and improve physical function, according to a speaker.
“This is as important as what we do in areas such as healthy eating, monitoring or taking medications,” Karen Kemmis, PT, RN, DPT, MS, GCS, CDCES, FADCES, education team leader at the Joslin Diabetes Center Affiliate at SUNY Upstate Medical University, told Healio. “Helping a person to function better in everyday activities and to be able to exercise can positively impact their life.”
People with diabetes and other chronic cardiometabolic conditions, including obesity, may have trouble rising from a chair, climbing stairs, squatting, kneeling and reaching, which can limit their ability to bathe and dress themselves, do housework and participate in recreational pursuits and exercise, among other activities.
Four key conditions often lead to physical limitations, according to Kemmis. Limited range of motion may be the result of adhesive capsulitis of the shoulder or hip or due to stiffness in the hands or other joints. Pain may be the result of osteoarthritis and exacerbated by excess weight. Decreased strength may both contribute to and result from pain and decreased range of motion. Balance dysfunction may result from decreased vision and sensory proprioception — common diabetes comorbidities — as well as decreased strength.
Evaluating limitations
During her presentation, Kemmis outlined steps for examining a person with diabetes and evaluating their limitations with an eye to developing a personalized exercise program.
“Asking a few questions and watching how an individual moves can give great insight into challenges and physical limitations,” Kemmis told Healio. “This can guide diabetes care and education specialists as we assist in the development of a physical activity/exercise plan that can be incredibly beneficial for how the person moves and lives.”
First, ask about limited mobility and pain: When and how did limitations begin? Who else is aware of this? Has the condition been diagnosed and treated? What helps or hurts?
Then observe the person as they move through a range of upper body, lower body and balance maneuvers, such as walking, sitting, standing from a seat, putting on and taking off a jacket, mounting stairs or a curb, and standing on one leg.
Options for increasing physical activity
A referral to physical or occupational therapy may be appropriate for people with limited range of motion, pain and balance dysfunction, Kemmis said. In addition, she recommended including both aerobic and resistance training in a personalized exercise program.
Aerobic activities can include walking, bicycling, swimming or interval training at moderate to vigorous intensity for at least 150 minutes per week broken up over 3 to 7 days per week, without more than 2 non-exercise days between exercise days.
Resistance training with eight to 10 exercises — such as with weight machines or free weights, resistance bands or bodyweight exercises — should be performed every other day, beginning at moderate intensity and progressing with increased weight or resistance, then increased number of sets and increased frequency.
Children with diabetes should engage in moderate-intensity to vigorous aerobic activities for at least an hour every day and vigorous muscle- and bone-strengthening activities at least 3 days per week.
Older adults can improve flexibility and balance with yoga or tai chi two to three times per week.
Someone with range of motion issues may be helped with yoga and tai chi as well as resistance training that requires moving through the full range of motion. Tai chi and yoga, stationary biking and swimming can relieve stress on joints for people with pain.
Kemmis recommended the NIDDK website Staying Active at Any Size www.niddk.nih.gov/health for more information about exercise for people with obesity.
“We should be asking people with diabetes and limited physical abilities about their exercise. How have they been successful? What options for exercise have they found? What have they done in their home or in their community?” Kemmis told Healio. “This can provide great options for others in similar situations.”
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Kemmis K. T09. Presented at: ADCES21; Aug. 12-15, 2021 (virtual meeting).
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