Melanie Cole, MS (Host): There are many things you can do at home to manage your diabetes, but today we're going to talk about exercise, why it's important, how to get started, and most importantly, how to keep it going. Welcome to Bryan Health Podcast. I'm Melanie Cole and joining me is Sarah Deets. She's a Licensed Clinical Social Worker at Complete Endocrinology with Bryan Health.

Sarah, I'm so glad to have you join us again today. As lifestyle management remains really basic to long term diabetes, I'd like you to speak about why exercise is so important because there is no one size fits all for people living with diabetes.

Sarah Deets, LIMHP: Hi, thank you for having me. So exercise is important for anyone and everyone. There are several benefits to exercise as we all know such as weight loss, lowering your blood pressure, lowering your cholesterol, and just overall mental health. But it's important because we, as humans need to focus on being more active in getting those positive results for lowering blood pressure and blood sugar and things like that.

So that's why it's so important for everyone to exercise.

Host: Can you tell us the relationship between exercise and things like blood sugar, blood pressure, those things? Because I know some people know that exercise is good for you, but they don't really understand why. Can you just speak a little bit about diabetes and blood sugar and how exercise helps to control those insulin levels?

Sarah Deets, LIMHP: So with diabetes, our pancreas either does not secrete or does not give adequate amounts of insulin. exercise actually jumpstarts your insulin production. So it makes more insulin so your body can absorb insulin, which is what we want. The other positive with exercise and diabetes is it actually increases our insulin sensitivity and what that means is our muscles can utilize more glucose if we have more insulin and so that's why it's so important for diabetics to exercise because we want the pancreas to secrete insulin, we want the glucose to be absorbed through the muscles to help with that lower blood sugar.

Host: Thank you. That was an excellent description. So now getting started, speak about goal setting, because I think that's such an important aspect. I'm an exercise physiologist, and I, I see that when people are just getting started, that one of the things that keeps them from keeping it going and the motivation is, the goals, the long term view of what this is actually going to do for them. So I'd like you, Sarah, to speak about getting started the easiest way and setting those goals so that you have a place to go.

Sarah Deets, LIMHP: And I think that's a valid point. I think everybody struggles with knowing how to get started and what to do. And everybody is needing to start at their own pace and I'm a former personal trainer and health coach and I would always say, you know, if I told you to go out and run a marathon and you hate running; the likelihood of you doing that, probably slim to none, and you would not like it the entire time. So I think with goals, the most basic principle is just kind of figuring out where you are at, and going from there. And even if it's just five minutes, And you choose to walk for exercise because you like to walk.

That's perfect. I encourage my patients to start where they're at and then we slowly increase either the amount of time they're exercising or what they're doing for exercise. And then we go into, where do we want to go in three months, six months? How do we want to increase those goals and that progression?

Host: Excellent. So now we're getting there. We've set our goals, we're starting slow, not trying to run a marathon right off the bat, but safety's an issue. And certainly for people living with diabetes, we think about foot issues, eye health, you know, but shoes. And now there's even diabetes shoes, specifically, you can get at a podiatrist's office. What do you think about safety and what are some of the red flags you want people to think about when they start exercising?

Sarah Deets, LIMHP: So, safety is always our number one concern. Whenever I meet with patients to talk about exercise, I always say, I want you to meet with your doctor first and just make sure that you're clear to exercise. I always reiterate how important it is that the doctor knows what that person is going to be doing and is okay with that.

With regards to safety and shoes, I really do want patients to have the best shoes possible, not only for diabetics, but people in general. So I refer people to the running company here in Lincoln or Fleet Feet or Capital Foot and Ankle or any place that is competent in shoe fitting and knowing what best to do for people with diabetes.

 Mm

Host: I agree with you. When you find a good shoe store, there's nothing like it. When they know what they're doing, they know how to fit your feet, they get you a good pair of running shoes, even if you're a walker and you feel the difference, you can really tell. Now, when we think about exercise, there's so many different types, Sarah. So how often, how intense? Tell us about some of the types of exercise that you like your patients to concentrate on.

Sarah Deets, LIMHP: There are a million different ways to exercise, and again, starting with where you're at. I do follow the American Heart Association and the American Diabetes Association. They do recommend 150 minutes a week of moderate to intense exercise. Now that can be really overwhelming to people, especially if they've never exercised before.

So I always go back to the goals and we say, let's start with five minutes, or I'll even say, what can you start with? What are you comfortable with? And then, like I said, we gradually progress time. And with that, we go back to the goal saying, what are your goals? And so if I have someone say, I want to lose weight, then we do follow those exercise prescriptions of 150 minutes a week, and so I really do encourage my patients to do cardio, whether it be walking, or an elliptical, or a New Step, or a bike, anything to get that heart rate up for a long period of time, and then I also do encourage my patients to do some strength training, two to three times a week, if they're able to.

Both aspects, cardio and strength training, are so important, and yes, people can do either or, but they're really going to get the biggest benefit doing both. So just to recap, I say let's do 150 minutes a week, and that is usually broken down to 20 to 30 minutes a day most days of the week, and then strength training twice a week for the biggest benefit.

Host: Sarah, can this be done at home, or do you advise people living with diabetes to do it somewhere monitored or where there's people around?

Sarah Deets, LIMHP: I think that just depends on the person and what other issues they might be having. For example, I might have a patient who says, I don't feel correctly balanced when I walk, so I don't want to walk by myself. So in that situation, I would recommend, either them joining a gym or having a walking buddy, but somebody that can be there, to not only give them that emotional support and accountability, but also the physical support if, they would feel unbalanced.

Most of my patients, I do give a exercise prescription so that they can do it at home. And so I will give them strength training things that they can do with a resistance band or a dumbbell at home. And I also say, you know, if you don't have anything at home, you can use things that you have around the house, like a soup can, or a suitcase, or a backpack, or anything that might give you a little resistance with strength training.

With regards to cardio or aerobic exercise, again they can walk, they can do whatever they want to do, as long as they feel safe at home doing that. If they want to join a fitness facility, I do encourage people to join some place that has a certified personal trainer or someone that can be there to assist if they do have questions or they need help.

Host: That's great advice. And as we get ready to wrap up here, your best advice, Sarah, cause you're a really great guest and so much knowledge that you have for people that have diabetes and that really want to get control and manage it. Give your best advice to the listeners of what you think are some of the most important aspects of managing diabetes and including exercise into their lifestyle so that it's like brushing their teeth. It's just a part of their day.

Sarah Deets, LIMHP: My best advice, would probably just be to start. And I know I'm repeating myself, but we talk a lot about just starting will increase those benefits dramatically. You're going to deal with probably less blood pressure medication, lower A1C, better strength, better balance. Better, triglycerides, all those benefits, but it also is going to help with your mental health.

With exercise, we know that it increases your adrenaline and those happy chemicals and you're going to feel better about things. So it's so important just to start and say, okay, today I'm going to start and you might use, specific goals saying I'm going to do it two to three times a week.

This is what I'm going to do. But it's just so important to start. The other suggestion I would always make is, to think about maybe a reward system, and that just might be, you know, my goal is to do three times this week, and if I do that, then I'm going to reward myself with a day at the spa or something that is not food related, because we want to get off the idea that food is a reward.

It's, we eat to live, not live to eat, and so we need those rewards to motivate us and keep us going. So have an idea of what's going to motivate you to get to those goals and to accomplish those goals.

Host: Very Informative episode, Sarah. Thank you so much for joining us. And Bryan offers several physician clinics that provide comprehensive diabetes care for patients. At these clinics, patients receive coordinated care important to diabetes management that includes their provider, as well as certified diabetes educators, registered dietitians, social workers, care navigators, and pharmacists.

To learn more, please visit bryanhealth.org/diabetes. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.