Exercise: Part 2… Where to Now

By Imagine_David | August 9, 2014 |

‘Exercise’ or ‘physical activity’ or ‘movement’ is something Australians are doing less and less of.

As a person living with diabetes finding the time, the motivation, the energy are often barriers to getting started.

Lets take a look at some of the evidence around exercise.

Exercise Can be Fun. More importantly it is good for your entire health – physical and mental.

The Transtheoretical Model

(TTM; Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) is an integrative, biopsychosocial model to conceptualise the process of intentional behavioral change. Whereas other models of behavioral change focus exclusively on certain dimensions of change (e.g. theories focusing mainly on social or biological influences), the TTM seeks to include and integrate key constructs from other theories into a comprehensive theory of change that can be applied to a variety of behaviors, populations, and settings (e.g. treatment settings, prevention and policy-making settings, etc.). Dr. DiClemente published Addiction and Change: How Addictions Develop and Addicted People Recover (2003) which goes into more detail about the development of the model and how to appropriately use the model in both research and clinical work.

Stage of exercise behaviour and appropriate strategies
Stage	Definition	Appropriate Strategy
Pre-contemplation	Inactive & do not intend to become active in the next six months	Information on risks of inactivity, benefits of activity
Contemplation	Inactive, but thinking about becoming active in the next 6 months	Decision balance (weigh up pros and cons of becoming active).Discuss and overcome barriers.
Preparation	Made some attempts to become more active	Develop realistic activity goals.Establish support.
Action	Active, but only began in the last six months	Re-enforce successful attempts.Re-emphasise experienced benefits, overcome experience barriers.
Maintenance	Active for longer than 6 months	Relapse prevention.Alternative activities.

Pre-contemplation

“Individuals in the Pre-contemplation stage are not thinking about or intending to change a problem behavior (or initiate a healthy behaviour) in the near future (usually quantified as the next six months). Precontemplators are usually not armed with the facts about the risks associated with their behavior. Additionally, many individuals make unsuccessful change attempts, becoming discouraged and regressing back to the Precontemplation stage. The inclusion of the Precontemplation stage represents a significant contribution of the TTM, as individuals in this stage comprise a large proportion of individuals engaged in risky or unhealthy behaviors. In comparison to many traditional, action-oriented theories of behaviour change, which view individuals in this stage as resistant and unmotivated, the TTM can be useful in guiding treatment and prevention programs by meeting the needs of these individuals, rather than ignoring them.”

We all have limitations. Does your limitations act as a barrier to exercise?

We all have limitations. Do your limitations act as a barrier to exercise?

Information on risks of inactivity, benefits of activity

“The scientific evidence is clear-regular physical activity has powerful positive effects on both physical and psychological health. Conversely, physical inactivity has a high human cost in terms of health. It shortens years of life, decreases quality of life, and limits functional independence. These health effects arise from physical inactivity’s contribution to cardiovascular disease, obesity, diabetes, osteoporosis, mental health disorders, and some cancers (i.e., colon and breast)”. From The cost of being couch potato. Michigan Health & Hospitals [Mich Health Hosp] 2003 Jul-Aug; Vol. 39 (4), pp. 24-7.

Physical inactivity was directly responsible for 3% of disability adjusted life years lost in the UK in 2002. The burden of physical activity-related ill health in the UK. (Journal Of Epidemiology And Community Health [J Epidemiol Community Health] 2007 Apr; Vol. 61 (4), pp. 344-8)

Performing resistance exercise before aerobic exercise improves glycemic stability throughout exercise and reduces the duration and severity of post exercise hypoglycaemia for individuals with type 1 diabetes ( Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care (DIABETES CARE), 2012 Apr; 35 (4): 669-75.)

So, if we explore the evidence further we can determine that you, the person with diabetes, has significant benefits to gain from participating in some exercise.

For a person with diabetes exercise some of the benefits include:

Insulin to work better, which will improve your diabetes management
You control your weight
Lower your blood pressure
Reduce your risk of heart disease
Reduce stress.

Did you know that your body uses less energy when you are watching tv than when you are asleep?

**Talk to your health care team about other specific benefits for you.**

Remember: If your diabetes is not well managed, i.e your Blood Glucose Level is elevated to over 15mmols then it is best to avoid exercise until your blood glucose ton down below 14mmols. If you have type 1 diabetes check for ketones and follow your sick day plan. Exercise in these circumstances can actually elevate blood glucose and increase ketone production.

For gold standard advice on creating your exercise self care plan consult with an exercise physiologist.

So, having a little information here might you be able to move into the contemplation stage ……. sometime soon?