Indications and contraindications for exercise therapy in diabetes

Indications and contraindications for exercise therapy in diabetes:

Exercise therapy, as commonly referred to, aims to control the condition through physical activity. This requires the rationality and scientific nature of exercise planning. Different types of diabetes and their stages of the disease have varying requirements for exercise therapy. To achieve the therapeutic goals of exercise, it is necessary to select indications appropriately.

Indications for exercise therapy:

1. Obesity-related type 2 diabetes: This group of patients mainly exhibits insulin resistance. Exercise can increase insulin sensitivity, reduce insulin resistance, and aid in weight loss, making it the most suitable indication.
2. Mild to moderate non-obese type 2 diabetes: Patients in this category still have a certain level of insulin secretion, and their blood sugar levels generally do not exceed 16.7mmol/L. Exercise can promote glucose uptake and utilization in muscle tissue while inhibiting hepatic glucose output, thus lowering blood sugar levels.
3. Stable type 1 diabetes: Exercise therapy can be considered for patients with stable type 1 diabetes. Patients with slowly progressive diabetes still have a small amount of insulin secretion, and exercise can promote glucose utilization in muscle tissue and hepatic glucose output, resulting in minimal changes in blood sugar levels. For patients dependent on insulin therapy and with severe lack of endogenous insulin, exercise therapy should only be implemented after achieving stable control with insulin treatment. The effects of exercise therapy on blood sugar control in type 1 patients require further evaluation but may be beneficial for improving physical fitness.

contraindications for exercise therapy:

1. Severe type 1 diabetes with absolute insulin deficiency: In cases where the disease is not well controlled without insulin therapy, exercise not only fails to promote glucose utilization in muscles but also enhances hepatic glucose output, increases fat breakdown, and may lead to ketoacidosis.
2. Patients with renal complications: Exercise can decrease renal blood flow, reduce glomerular filtration rate, increase proteinuria, and exacerbate diabetic nephropathy. Such patients are not suitable for exercise therapy.
3. Patients with cardiovascular complications: Individuals with severe hypertension or coronary artery disease may experience increased cardiac workload, elevated blood pressure, and a risk of angina or even myocardial infarction with exercise. These patients should undergo strict physical examinations before exercise, and if exercise is permitted, the intensity and mode should be strictly controlled. Monitoring various exercise response indicators closely and exercising under medical supervision is crucial, ensuring not to exceed individual capacity.
4. Patients with severe retinopathy: Exercise may worsen retinal conditions and increase the risk of bleeding.
5. Patients with diabetic foot complications: Exercise can worsen distal ischemia and hypoxia, exacerbating foot problems.
6. Patients with acute metabolic disorders: For example, those with diabetic ketoacidosis, exercise can exacerbate the severity of metabolic disturbances.
7. Elderly diabetic patients with the following conditions are absolute contraindications: Various infections; liver or kidney failure, heart failure; recent myocardial infarction, severe arrhythmias, premature beats, 2nd or 3rd-degree atrioventricular block, severe pulmonary heart disease, respiratory dysfunction.
8. Elderly diabetic patients with the following conditions are relative contraindications: Exacerbation of arrhythmias after exercise, left or right bundle branch block; recent history of cerebral ischemia in patients with pacemakers, severe varicose veins, past history of thrombophlebitis; neurological, muscular, joint mobility disorders; use of certain medications such as beta-blockers.