Atkins Diabetes Revolution (41 page)

SPECIAL EXERCISE CONCERNS FOR PEOPLE WITH DIABETES

Some common complications of diabetes may impact your fitness choices. If you have diabetes, discuss your exercise plans with your doctor before you start.

Diabetic Retinopathy.
If you have this eye condition, you may need to avoid activities that raise your blood pressure sharply,such as strenuous weight training,or those that involve a lot of pounding and jarring,such as jogging, running, and racquet sports. Brisk walking and working out on exercise machines such as the elliptical trainer and exercise bike are almost always acceptable.

Peripheral Neuropathy.
A common complication of diabetes,peripheral neuropathy often causes a reduction or loss of sensation in the feet. Repetitive exercise involving the legs, such as long walks, jogging, running, using a treadmill, or doing step exercise, could cause hard-to-heal foot ulcerations and even bone fractures.You may have to stick to non- weight-bearing or
nonconcussive
exercise,such as swimming,water aerobics, riding a stationary bike, or using a rowing machine. Be sure to inspect your feet carefully on a regular basis for evidence of redness, blisters,or skin changes.

TWO TYPES OF EXERCISE

The kinds of exercise we are talking about can be divided into two basic types: one that improves cardiovascular fitness (aerobic) and one that builds and maintains muscle (resistance). Running, jogging, brisk walking, bicycling, in-line skating, and swimming are all aerobic exercise. Resistance exercise may raise your heart rate and respiration somewhat, but it mostly builds muscles. Weight training falls in this category, as do isometrics and the kind of circuit training that is popular at many health clubs and gyms.A good fitness plan includes both types of exercise. In the next chapter, we’ll tell you about ways to incorporate both types to get the most out of your exercise program, both enhancing your cardiovascular health and preserving or gaining strength.

TAKE IT EASY

If you are heavy and not used to moving much,or if you’re simply very out of condition, begin slowly, proceeding step-by-step to a more active lifestyle. This will reduce the likelihood of joint problems. Even if you are eager to see results, it is essential that you gradually increase activity to allow your muscles, joints, ligaments, and tendons time to adjust to a new level of use. Otherwise, you may injure yourself, sabotage your grand plan, and send yourself back onto the couch.

SETTING YOUR EXERCISE GOALS

Once you have made a firm commitment to exercise,the next step is to figure out how much is enough. A lot of researchers have looked at that question, and the answers pretty much come down to this:

1.At least half an hour of aerobic activity, such as brisk walking, at least three days a week.Four to six days is even better—as is longer duration. In fact, in recommendations made in 2002, the Surgeon General of the United States called for an hour of moderate-intensity physical activity every day. An alternative goal recommended by the Centers for Disease Control in conjunction with the American College of Sports Medicine is 30 minutes of “at least”moderate activity all or most days of the week.
4
You may not be able to start out at such a level, but it should be your goal, since research suggests a relationship between increased exercise and improved health benefits.
5
Whatever activity you choose, it should raise your heart rate.

2. Do additional strength-training exercise at least twice a week. A good whole-body strengthening workout takes only about half an hour, although you may not have the stamina for this duration initially. On the days you do this type of workout, you can reduce the amount of aerobic activity proportionately. Do not work the same muscle groups two days in a row.

3.Give yourself a day off from exercise once a week,although if you grow to enjoy exercise, as many people do, it would be fine to take a walk on your “day off.”

Do understand that you may not be able to achieve these goals initially—but that’s not a reason to skip exercising altogether. Even a small amount of exercise is better than none at all, and most people can gradually increase their exercise level.

FIND YOUR TARGET HEART RATE

Just like any other muscle in your body, the heart gets stronger when it is worked. When you do aerobic exercise, you make your heart beat faster and harder. You don’t want to overdo that, of course, so you need a way to determine just how much faster your heartbeat should get. There’s a simple formula you can use to figure that out.

1. Begin by finding your resting heart rate. This is your heart rate when you are relaxing. Sit quietly for 15 minutes (read or watch television), then locate your pulse either on the thumb side of either wrist or on either side of your neck under the angle of your jaw. Using a watch or clock that counts seconds, count your heartbeat for ten seconds. Multiply that number by six to get the number of beats in a minute. For most people, the resting heartbeat is between 60 and 80 beats per minute. (In general, the fitter you are, the more slowly your heart beats when you’re at rest.) Write the number down and label it “resting heart rate.”As you get fitter,you’ll see two things happen:Your heart will return to its resting rate more quickly after exercise, and your resting heart rate may slow down a little.

2. Next, subtract your age from 220. Write the number down and label it “maximum heart rate.” This step compensates for your age. If you’re 50, for instance, your maximum heart rate would be 170 beats per minute (220 – 50 = 170).

Important note:
You do not want to push yourself to your maximum heart rate.

3.Your starting heart rate goal during exercise is 60 percent of your maximum heart rate. So, take your maximum heart rate, as determined in step 2, and multiply it by 0.60. If your maximum heart rate is 170 beats a minute, then your exercise goal, which is called your target heart rate, is 102 beats a minute (170 × 0.60 = 102). But bear in mind that everyone’s heart rate is different, and your personal maximum heart rate could vary as much as 15 beats higher or lower than the formula. Use the numbers you get from the formula just as a guideline, not a firm target.

4. When you first start exercising, you should aim for a heart rate that is 60 percent of your maximum rate. As your fitness level increases,challenge yourself to gradually raise your exercise heart rate to 65 percent, then 70 percent or even more (up to 80 percent) of your maximum heart rate. Since your primary goal is to achieve fitness, not compete in the Olympics, the key is to build to a level that you can maintain comfortably while gaining optimum cardiovascular benefit for your time exercising.A reasonable long-range goal is a target heart rate of 70 to 80 percent of your maximum heart rate. Building to this slowly will prevent injury as well as burnout from exercising at a level that is “too hard.” Some medications, such as beta-blockers for lowering high blood pressure,can limit how quickly your heart beats.Again, if you take any prescription medications, be sure to discuss your exercise plans with your doctor first.

5.Always remember that some exercise is better than no exercise,so don’t feel discouraged if you can’t exercise for long or can’t comfortably raise your heart rate to the recommended level. Congratulate yourself for doing what you can!

Use the chart below to estimate your heart rate during exercise at the level that is right for your age and level of fitness.

TARGET HEART RATES FOR EXERCISE

Your goal is to start your exercise program and work up to the point where your heart rate reaches your target minimum and stays there for 30 minutes three times a week. Eventually, you’ll be able to exercise at your target maximum every day if you wish—you may also be able to stay at that level beyond 30 minutes.

CHOOSE ACTIVITIES YOU ENJOY

Exercise may be mandatory, but it should also be fun. Find an activity you like and can do without strain, a lot of advance planning, or a lot of expense. For many people, walking fills the bill, but there are plenty of other ways to get your exercise. All you have to do is find one—or more—you enjoy and do it. Dr. Atkins loved to play tennis, for instance, so he played as often as he could.

For those of you who are hard-core exercise haters, find the activity you hate the least. Give yourself rewards for small improvements. For instance, buy a book you’ve been wanting and read it while you walk on the treadmill. Treat yourself to a new CD with energetic music to keep you motivated while working out. Check out an exercise video from the library.

Some of the activities you used to enjoy—running or basketball, for instance—may now be off-limits to you because of excess weight or joint problems, such as arthritis of the knee. That’s no excuse for not exercising. Swimming, water exercises, riding a stationary bike, using an elliptical training machine, and low-impact aerobics are generally easy on your joints. And as you lose weight and strengthen your body, you may well find that your aching joints improve and let you exercise in more varied ways. If you have inflammation in your joints, after following the ABSCP and taking supplemental essential fatty acids, you should find inflammation and aching is decreased, which will allow you to exercise more.

DRINK BEFOREYOU’RE THIRSTY

The very first thing you should do at the start of any exercise session is fill up your 1-liter water bottle, drink about a quarter of it, and keep it close by.When you’re sweating and breathing hard, you lose fluid rapidly. By the time you get thirsty, you may already be a little dehydrated—even in cold weather, when you’re not sweating that much. Drinking water before, during, and after your workout keeps you properly hydrated. The payoff is that you will be able to get through your workout more comfortably. When you have adequate hydration, your body can more quickly clear away lactic acid, the by-product of exercise metabolism that causes that aching sensation in your muscles. Becoming dehydrated makes it harder to exercise and produces no long-term benefit. This isn’t about sweating off water, it is about safely burning fat, increasing muscle mass, and developing cardiovascular fitness so that you can live longer.

EXCUSES, EXCUSES

For every antiexercise excuse, there is a rebuttal:

“I hate to exercise.”
I can’t tell you how often we’ve had a patient tell us,“I can’t stand exercising.It’s so boring.”Our usual reply: Unless you get moving, life as an invalid, barely able to leave the house, will be a lot
more
boring.Besides,exercise can be fun if you make it fun.Instead of walking alone, for instance, use that time to walk with family members and friends. Your walk stops being a chore and turns into family quality time or a pleasant visit with a friend—and everyone benefits from the exercise.

“I don’t have time to exercise.”
Really? The average American watches four hours of television every day. You can easily manage to do a home aerobics workout or your weight-training routine while watching just one half-hour sitcom episode. It’s certainly better than sitting there passively.

“I really don’t have time to exercise.”
If you are truly overburdened with things that must be done, it may be time to reconsider your priorities, because your exercise
must
be done as well. If you have to cut back on something else to be able to exercise, then do so—your health should be up there on your list of top priorities. And don’t forget that with a little imagination, you can almost always manage to work more exercise into your day (see Staying Motivated on page 283).

STAYING MOTIVATED

There are some days when the very idea of exercising seems overwhelm- ing.How can you overcome this and stay motivated? We suggest that you:

• Find a form of exercise that’s both convenient and enjoyable.
  When exercise is a hassle or unpleasant,it doesn’t get done.
  
• Many people find it helpful to plan to get exercise “out of the way”by working out first thing in the morning.
  
• Focus on the benefits of exercise—you know you’ll feel better afterward,even if it’s hard to get started.
  
• Plan to walk or exercise for just five minutes.Chances are good that once you get started,you’ll keep going for the full session.
  
• Find an exercise buddy.Walking and working out are more fun with some company, and you’re more likely to do it if you know someone is counting on you.
  
• Join a gym. Once you’ve paid to join, you’ll want to get your money’s worth.
  
• Sign up for exercise classes. When you’ve got a class schedule to keep,you’re more likely to go.
  
• Listen to your body.You may feel uninterested because you’re getting sick, are overtired, or have been exercising too much recently.Of course,you shouldn’t exercise if you’re ill,injured, or exhausted. It’s okay to take a day off now and then just to give yourself a break, but if you skip more than a couple of days, you’ll likely find it hard to get back into the exercise groove again.