Hosted by Ray Shields, MD

The IHS recommendations for physical activity and exercise in this document do not diverge from those of the ADA.  The ADA uses the terms "physical activity" and "exercise" interchangeably in the ADA Standards of Medical Care In Diabetes – 2006.  However, the term "aerobic exercise" better describes the type of physical activity emphasized in their recommendations.

Given the often-earlier onset of diabetes and the increased rate of complications in AI/AN populations, the initial medical examination should carefully screen for the presence of macrovascular and microvascular disorders that may worsen as a result of an exercise program.  The provider is responsible for:

·      Giving medical clearance.

·      Providing an exercise prescription based on the medical evaluation.

·      Ensuring the patient has the resources and ability to evaluate his or her glycemic response to an exercise session (i.e., SMBG).  This may require referral to a diabetes educator.

·      Ensuring the patient can identify and treat hypoglycemic episodes.  This may require a referral for DSME or other resource.

·      Educating the patient about proper footwear and care, especially when prescribing weight-bearing activities.  This responsibility may be referred to another member of the diabetes team.

Referral to resources for supervision by fitness specialist and for coaching is highly recommended.  Many IHS/Tribal/Urban programs have invested Special Diabetes Program for Indians grant funds in physical activity services, professionals, and equipment. This has increased patients' access to knowledgeable exercise specialists who can assist in problem solving and provide ongoing support.  An individualized exercise program minimizes the risk and maximizes the benefits of exercise by:

·      Considering the appropriate type of activity based on interest and indications/contraindications due to complications of diabetes.

·      Prescribing specific guidelines for intensity, duration and frequency of exercise.

·      Teaching proper methods and technique for performing resistance exercise, a new recommendation by the ADA.

Any increase in physical activity – from daily living, occupational pursuits, structured aerobic exercise or resistance exercise – will add to the overall caloric expenditure that could contribute to weight loss and may have other beneficial effects. The American Heart Association has identified physical inactivity as a major modifiable risk for chronic heart disease. Therefore, providers should encourage any increase in physical activity.