Tricks of the Trade
I’ve worked with many clients with type 2 diabetes, ranging in age from 30 to 85 years old. Even though age and ability are different in each case, the challenge remains the same: Develop a safe and effective program that will be vigorous enough to improve muscle strength and provide cardiovascular benefit without inducing complications from the diabetes.
When I train these clients, I make sure I have medical clearance from a physician, in addition to obtaining the typical medical history. I also ask if they have any existing complications from the diabetes; the type of insulin they are using (if any); and how often and at what time of day they take insulin or medication. Since exercise has an insulin-like effect on diabetes, we establish a plan to know their blood glucose levels at the time of our exercise sessions, to make sure we maintain safe levels.
The biggest difference in the actual exercise programming for my diabetic clients is making sure they start every session with a long warm-up at very low intensity and follow that with stretching before they begin strength exercises. I then have them train larger muscle groups first. I plan a long-duration workout with low-intensity exercises. We monitor glucose levels every 30 minutes, and I have clients continue monitoring their glucose levels for an hour after the workout.
Other considerations for my diabetic clients are making sure they wear good shoes, checking often for blisters and having a snack nearby in the event of a drop in blood sugar.
With concentrated effort, planning and an encouraging atmosphere, clients with type 2 diabetes can get a great workout and great results from consistent exercise. Their improvements in quality of life and daily function are a true joy to observe. I gain huge satisfaction and validation from my clients’ success, which makes the extra work and time I spend on their programs and sessions worth every effort.
ACE-Certified Personal Trainer and
Medical Exercise Specialist and Health
Coach, Body Interiors
Colorado Springs, Colorado
I work with clients who have a variety of lifestyle risk factors and conditions, including type 2 diabetes, cardiovascular disease and pacemakers, menopause, obesity, fibromyalgia, pregnancy and myriad orthopedic conditions.
In working with a client with type 2 diabetes, it is critical to involve the client’s physician in the process, or at the very least to get the physician’s support, so as to provide a team approach that is both clinical and lifestyle focused. The workout regimen for this type of client is different from the regimen for an apparently healthy client. I need to know the client’s blood sugar levels prior to the workout so I know what intensity and duration I can push for during the session.
Since diabetes is a chronic condition, exercise alone is just one component of managing the disease. Diet is also critically important, which is why I encourage clients to keep a food journal. I ask them to track not only what they eat but also their feelings at the time. I have found that people eat for reasons other than hunger, including loneliness, boredom, depression or guilt. Getting in touch with their feelings is a powerful way for clients to understand why they make the choices they do with regard to food, exercise (or lack thereof) and more!
My key objective when working with these clients is to give them the skills and resources to exercise and eat well on their own. A personal trainer should be a short-term investment with long-term gains. I teach clients how to live a healthy life by providing them with the right tools and information specific to their lifestyle and goals, while involving other key people (physicians) as needed.
Dawn Lang, MA
Owner/President, Prescriptive Health
Clients with type 2 diabetes are my specialty. We’ve created a 13-week transformation program for them. We work as a team with each client and five of his or her close family members, friends and/or colleagues, who support the client in reaching and maintaining the ultimate goal—transformation.
We design a nutrition and exercise program that’s customized to the client’s lifestyle. At the beginning of the program, I cleanse the body of excess sugar and stabilize blood glucose levels from there onward. The nutrition plan from week 3 on marks the beginning of the lifestyle change process in the transformation program. We record all of the information on a customized online tracker that we provide to the client so he or she can not only monitor progress but also be more accountable for his or her actions and results.
I typically use the following exercise guidelines and tweak the program depending on the client’s medication, the doctor’s recommendation(s) and the client’s professional lifestyle:
Cardiovascular training. I aim for 20–60 minutes of moderate-intensity exercise 3–4 days per week. (Walking and non-weight-bearing activities, such as water aerobics and cycling, are good choices.) However, I highly recommend daily exercise.
Resistance training. Clients follow a lower-resistance, lower-intensity program with at least one set of exercises for the major muscle groups, with 10–15 repetitions, 3 days per week.
Stretching. After each workout, clients stretch their major muscle groups to the point of tightness (not pain) for about 30 seconds, 2–4 times per stretch.
The ultimate goal for clients is to exercise enough to expend a minimum of 1,000 calories per week for health benefits or 2,000 calories per week for weight loss. However, I do encourage some precautions. I ask clients to monitor their glucose before and after exercise to understand how they respond to certain types of activities. I have them always wear an ID bracelet that indicates their diabetic condition, and I ask them to exercise with a partner if possible.
Finally, I make sure clients regularly return to their doctor, who can assess any possible diabetic complications. If complications of the eye, kidney or heart are present, the physician will provide me with clear boundaries regarding exercise intensity.
Certified Personal Trainer and