Considering which activities you should do

Any activity that you do continuously for two minutes or more is primarily cardio training, although some are a mixture of aerobic and more intense anaerobic activities when they involve a lot of stop-and-start movements (like tennis and basketball). Some examples of mostly aerobic activities include walking, jogging or running, cycling, rowing, swimming, arm biking, aerobic exercise classes, aerobic machines such as the elliptical trainer, recumbent or cross-trainer bike, conditioning machines, circuit training, and dancing.

Doing any type of aerobic activity has the potential to get you more fit. The key is to pick activities that you can do safely to improve your endurance. Try to include a wide range of activities to increase your overall fitness. As you become more successful and confident at being active, you can add in or substitute other types of activities to expand your exercise options.

Looking at amount, intensity, and duration

To follow the latest guidelines (including those in Chapter 9), all healthy adults who are 18 to 65 years old should do at least 150 minutes of moderate cardio training or 75 minutes of vigorous exercise per week (or a combination of both). This recommendation also applies to all adults with type 1 or type 2 diabetes.

Because most people with type 2 diabetes have a low aerobic capacity, doing 150 minutes of moderate (or harder) cardio training each week is particularly beneficial. If this scenario describes you, focus on getting in enough exercise to get fit, with the added benefit of possibly burning some extra calories to help you lose weight or keep your weight down.

If you’ve been mostly sedentary, start with mild or moderate exercise. Then progress slowly to higher intensities or longer durations to avoid getting injured, losing your motivation to exercise, or having any possible problems with your heart or blood vessels.

Remembering to warm up and cool down

Easing your way into and out of the more demanding part of your workout is important. The best way to do that is to spend at least three to five minutes doing an activity at a lower intensity before ramping it up to your desired one. Do an easier activity for another three to five minutes when you’re getting ready to stop to cool down. Remember that your body clears out any lactic acid that has built up more effectively during an active cool-down compared to just resting. After cooling down can also be a good time to do some stretching since all your joints are more nimble then and it’s easier to flex your joints through their full range of motion.

Determining whether to see a doctor first

Brisk walking and other mild and moderate activities are generally safe to start on your own. But if you want to do vigorous activities and you have been sedentary, it’s recommended that you see your health care provider first just to be on the safe side.

If you haven’t had your annual checkup this year, getting one prior to starting harder exercise than you’re currently doing may be a good idea. At the same time, your doctor can check for any possible health issues that make being active less safe or less effective and help you manage those. The goal is to be as active as you can possibly be without getting injured or demotivated.

Walking correctly to avoid injury

To lower your chances of developing an overuse injury from regular fitness walking, you need to adopt the proper form. Really, it’s all about lining up your body parts, standing tall, and not taking strides that are too long.

Here are some tips to walk correctly for fitness:

• Try to stand up straight, keeping your shoulders pulled back. Align your head and your neck with your spine, and tighten your abdominal muscles (or at least keep them pulled in).
• Walk heel-to-toe. Use your behind foot to push off your toes, and land on the heel of your forward foot, rolling onto your toes last.
• To use your whole foot, try to let your ankle flex and move freely from back to front during each stride.
• Don’t over-stride. If you want to walk faster, simply take more steps per minute rather than longer strides.
• To get the most help from your arms, bend both your elbows at about a right angle and use them to propel you forward by swinging them next to your sides. Swing them from your shoulders, but don’t overswing them.
• Keep your hands somewhat loose at the ends of your arms. Clenching them feels like more work and doesn’t help you walk faster.
• Don’t lean forward or backward on hills. People tend to lean forward going uphill and back going downhill, which can strain the back. Keep your posture erect and use your toes (push off them more going uphill) and knees (relax them more on the downhill portions) on hills.
• Stretch regularly, particularly your lower legs. Also do some strength training with your legs to get them stronger.

Planning out your walking routine

Walking indoors on a treadmill is fine, but studies have shown that exercising outdoors has additional emotional benefits for everyone. So if you can walk outside, try to do it at least sometimes. (Always have an indoor backup plan for when the weather isn’t conducive, though.)

Choose to do your outdoor walking either for a certain amount of time or a given distance. Having a planned route helps you mentally deal with how far you’ve gone and how far you have left to go to finish.

When walking outdoors, always carry a mobile phone with you in case of emergency, along with supplies to treat a blood glucose low just in case.

For your planned walks, also make sure you’re wearing proper shoes and socks if you’re going to walk more than ten minutes. Athletic shoes are best because they’re made to help cushion your lower leg joints and your feet and make you more stable on your feet. Having the right shoes also helps prevent overuse injuries. Make sure to change to a new pair before the old ones completely wear out and lose their cushioning ability. Chapter 8 has more info on choosing your footwear and other exercise garb.

You don’t have to necessarily plan for unstructured walking, especially if you take steps all day to reach your target. Just keep in mind various ways to add in extra spontaneous physical activity (which I discuss in Chapter 9), and you’ll end up taking more daily steps.

Examining outdoor jogging versus indoor treadmills

Running on hard surfaces like concrete and asphalt can take a toll on your joints. Those surfaces aren’t designed to absorb the impact of your stride, and the force each step causes is a little different from the last due to unlevel surfaces and other changes in the terrain. Outdoor running can also come with wind resistance that makes you work harder when running into it and less hard when it’s pushing you from behind.

On the other hand, most treadmills are built with padding beneath the moving belt that softens your landing, reducing the stress on your leg joints and feet. This feature is especially good if you have knee, leg, or foot pain or are recovering from an injury.

Treadmills tend to give you a less challenging workout if you don’t vary the settings — which you can do whether you choose to jog, run, or just walk. Use incline settings to simulate going up hills. Doing so helps you use up more calories and get fit faster. You can still get overuse injuries from running on the smooth surface of a treadmill belt, though.

Alternating between indoor and outdoor running gives you the potential benefits of both types of workouts.

Perfecting your technique

Perfect running form apparently varies from person to person, but everyone should avoid certain form errors. One is hitting the ground with the back of your heel first. Some experts suggest that you should learn to run in shoes like you’d run barefoot, meaning that you land more on the front part of your heel or midfoot before rolling forward to your toes. Just thinking about how you’re landing on your feet with each stride can help you develop better form.

Running barefoot isn’t advised for most people with diabetes. For better form, simply try to run in athletic shoes like you’d do if you were running barefoot.

Every runner can improve his or her running or jogging technique. Try these additional suggestions to improve your stride and avoid injuries:

• Train by varying workouts on different days: shorter distances, interval runs, tempo (near-race pace) runs, and longer-distance training runs.
• Correct common muscle imbalances like tight hip flexors (muscles that lift the thigh up) caused by too much sitting.
• Use flexibility and muscle-strengthening exercises to improve hip joint mobility, and stretch out your calves to limber up your ankles. (Chapters 11 and 13 offer some suggestions for resistance and flexibility activities, respectively.)

Keeping your joints and feet healthy with footwear

Regardless of which types of surfaces you’re running on, you should buy running shoes that provide the right kind of cushioning and stability for your foot type at a specialty store to keep this activity from ravaging your joints. Replace your shoes every 400 to 600 miles — or sooner if they’ve worn down a lot in fewer miles than that. Having uneven bottoms and less cushioning in your shoes sets your joints up for more wear and tear. Once again, get some help with selecting the right shoe for your feet.

If you have some loss of sensation in your feet due to nerve damage and still want to jog or run, wearing the right shoes and socks is critical to preventing injuries to your feet that can progress into something even more serious. (Flip to Chapter 8 for more on sock choices.) Also, check your feet daily for redness, blisters, calluses, and other signs of irritation and treat them sooner rather than later. It may be better to pick a less impactful exercise, though, for the long-term health of your feet.

Speeding through a workout plan

You can benefit from alternating easier and harder days and varying the type of training you’re doing. Back in the early days, long, slow distance was all the rage, but now the running experts recommend doing faster intervals or even sprint training some days, which helps increase fitness more. (For details on working with intervals, check out the later section “Including Some Interval Training.”)

To boost your running fitness or safely train for specific events, follow these training tips:

• Before you start your workouts, always warm up with a slow jog or brisk walk to get the blood flowing in your muscles and your joints more limber.
• For most people, training 8 to 30 miles is a good range; more than 30 miles may raise your chances for getting overuse injuries.
• To keep from getting injured or sick from overtraining, never increase your mileage by more than 10 to 20 percent in a single week.
• If anything hurts in your feet, shins, knees, hips, or back, take some time off from running and substitute another activity (like aquatic activities).
• Train harder or do faster intervals one day a week to boost your fitness level or prepare for a running event.
• Add in another day where you train slower but longer.
• Include at least one day a week of rest — or, barring that, one day when you substitute other physical activities in place of your usual ones.

If running or jogging are activities you enjoy and you’re motivated to do a 5-kilometer (5K), 10-kilometer (10K), or longer running race, make sure you train appropriately to avoid injuries. You can search online for many recommended workouts — such as the Couch to 5K ones — and follow their training suggestions. You should take at least two months of consistent training to be ready for even a 5K event. Plan ahead and leave plenty of time to train right for your event. For additional considerations for longer events, race to the next section.

Gearing up for a longer event

If you’re training for a prolonged event like a half or full marathon, include some longer workouts to enhance your endurance capacity. They don’t all have to be long, though. In fact, most people only do one long training run a week that’s not even the full length of their upcoming event. Increasing your exercise beyond 60 minutes doesn’t increase your endurance gains enough in most cases to justify risking an overuse or other joint injury from training longer most days of the week.

If you don’t have time to fit in longer training, you can benefit by pushing yourself a little bit harder for less time, such as adding in some faster intervals.

Investigating more ways to do interval training

The options for integrating interval training into your workouts are endless, and the benefits to your health are almost limitless, assuming you respect your health limitations and don’t start on this type of training before you’re physically (and mentally) ready to take it on.

You can add moderate intervals into easier activities, but high-intensity intervals aren’t an appropriate starting point if you’re unfit, sedentary, or obese.

The effects of interval training have been studied in some people with type 2 diabetes. In one study, active adults with type 2 diabetes who were already walking over 10,000 steps a day began pick up the pace (PUP) training, which involved some faster-paced walking during a normal workout. They measured their usual walking speed (in steps taken per minute using a pedometer) and then began walking for 30 minutes, three times a week, at a pace that was only 10 percent higher than normal. That means if their usual pace was 90 steps per minute, they upped it to about 100. Twelve weeks of PUP training for 90 minutes a week improved how well their insulin worked and increased their fitness level without requiring them to take any extra steps.

Another way to do intervals is just to vary the way you’re doing an activity. With walking, you may alternately take longer and then shorter strides for short periods of time. This method may not be as effective in terms of aerobic fitness as doing harder training, but it may encourage you to use a wider range of motion, which can help enhance the flexibility of your joints. Adding in arm movement, such as pumping your arms in an exaggerated manner while walking, can also benefit both fitness and your upper-body flexibility.

Hitting on whether high-intensity intervals are for you

Another training fad is doing high-intensity interval training (HIIT) or the related form sprint interval training (SIT). Though popular, high-intensity interval training is an inappropriate and potentially dangerous activity to start with if you’re sedentary, especially if you’re overweight or obese. After you’ve been doing other training for a reasonable amount of time (at least three to four months), or if you’re a younger, more fit person, such training may be an appropriate choice, however.

Recent research has shown that HIIT can improve blood glucose control and cardiovascular health in individuals with type 2 diabetes, assuming they safely implement it and use it as an adjunct to more traditional exercise approaches. Although some researchers have shown this type of training to be safe for the exact people studied, more research is needed to determine its safety in all individuals with diabetes, particularly anyone who has more health complications. For example, although some individuals with type 2 diabetes and nerve damage have safely undertaken HIIT, these results can’t be generalized to everyone with diabetes.

Note, too, that HIIT isn’t necessarily as efficient as it may sound. Some studies have had people do ten 60-second intervals as near maximal as possible, with one-minute active rest periods in between. That only adds up to 10 minutes of near-maximal exercise, but it takes nearly 25 minutes to complete when you add in a warm-up, cool-down, and rest periods, so it’s not much of a time-saver. Plus, people report that intense intervals lasting 60 seconds or less are more enjoyable than ones lasting longer.

HIIT also has the potential to aggravate joints and result in overuse injuries, particularly if you’re not used to being active.

Exploring elliptical machines

Elliptical trainers have some advantages over treadmills. Because your feet are in constant contact with the foot pedal of an elliptical machine, using one is less stressful on your knees, hips, and back than walking or running on a treadmill. This benefit is particularly advantageous if you’ve had to stop running due to joint issues; many people who can’t run anymore have no problem “running” on elliptical machines. It’s also a full body exercise like walking or jogging on a treadmill if you use an elliptical that has arm levers while doing your leg movements.

Even though elliptical training is kinder and gentler to your leg joints, it still allows you to do a weight-bearing exercise that promotes bone health.

Another benefit of elliptical striders is that you can easily choose an interval profile to follow for your workout, which can automatically take you through short periods of higher work, followed by easier segments. Most treadmills simply allow you to change your speed and the incline on them manually. Ellipticals also let you choose which parts of your lower body to focus on working harder by changing the incline of the foot pedals to get a workout for your calves all the way up to your glutes (butt muscles).

Surveying stair-steppers and other cross-trainers

Stair-stepping machines came on the scene before most elliptical ones (see the preceding section). Their workouts can be intense for many people, though, and aren’t the best place to start out if you’re sedentary. They also can irritate your knee and hip joints if walking up stairs usually bothers you.

In recent years, some hybrid cross-trainers have combined the forward movement of ellipticals with a stair-stepping motion. You can now find cross-training machines that allow you to mimic jogging, walking, running, and climbing a staircase at multiple levels of resistance and intensity. Most also have arm levers that let you get an upper and lower body workout at the same time. Many also have various profiles you can choose to add in harder intervals of some sort. All have the same benefits of reducing lower body joint stress, which is very helpful if you already have joint issues or are carrying a lot of extra body weight.

Cycling indoors as an alternative

If you have an underused stationary bike, it’s time to clean it off and put it to good use. Otherwise, you may want to consider investing in a newer model or using one at a fitness facility. You can choose between traditional ones and others that have recumbent seats (that have a back and allow you to sit normally), which are more comfortable for many people with low-back pain or other issues. The newer stationary ones also have hill and interval profiles that you can choose to increase fitness faster.

Overall, if you’re less stable biking outdoors than you used to be, using a stationary cycle can take away any concerns you may have related to falling over on your bike or crashing while riding. Indoor cycling is also recommended if you have impaired vision. It’s an activity that doesn’t make you bear your weight, which may work better if you have some mobility issues or have arthritis in some of your lower leg joints.

You can always fit in an indoor cycling workout, regardless of the weather or time of day. Watching TV, talking with someone or on the phone, or reading while you’re cycling also make the time pass quickly.

Rowing to get fitter

One of the best things about using a rowing machine is that you can do a full-body exercise that doesn’t make you carry your own body weight (unlike treadmills, elliptical machines, and other cross-trainers). Cycling only works the lower body muscles. Rowing is low-impact (putting little pressure on joints) and works your legs, hips, and buttocks in the lower body and your back, shoulders, and arms in your upper body. You can adjust most rowing machines to create a harder resistance to pull against, and you can vary your workout by changing the rate at which you pull.

Good form is important when you row. When you’re rowing with good form, about 60 percent of your power comes from pushing back with your legs, 20 percent from keeping your abdominals tight, and 20 percent from pulling with your arms. Try to keep your back straight throughout the rowing movement. Push back with your legs first, and then pivot backward at your hips so your shoulders pass and are slightly behind your pelvis (a slight lay back). Finally, pull your arms into your chest with your hands returning about where you’d put them for a bench press or near the bottom of your rib cage. When your hands are pulled into your chest, reverse the order and repeat.

Cross-country skiing indoors

Cross-country skiing is well-known as one of the best exercises for increasing your endurance and overall fitness. If you’re looking for a full-body workout that is weight-bearing, then using a cross-country skiing machine may be for you. It fully engages both your legs and your arms during the skiing movement, and you don’t have to worry about snow sticking to the bottom of your skis and slowing you down. The coordination you need between the movement of your arms and your legs can be tricky to work out at first, but soon you’ll be skiing like a pro on one of these machines.

Swimming your way to better health

Swimming is good for you for so many reasons, and it’s a full-body exercise. If you’re carrying a lot of extra weight, have mobility issues, or want to exercise off your feet for any reason, swimming or other aquatic exercise in a pool is a great choice. Most aquatic classes offer a blend of cardio, resistance, and flexibility training given how your body moves through water.

Water supports up to 90 percent of your weight, making it an appropriate activity during recovery from most injuries as well.

One of the biggest issues people have with working out in a pool is that they have to wear a bathing suit in public (unless they have their own in their backyard). The good news is that after you’re in the water, most of your body is largely hidden by the water and not that visible to others either in the pool or out.

Another barrier to doing aquatic activities is finding a pool to use, especially year-round. Even if you have your own backyard pool, you may only have access to it during the warmer seasons. Look around your area to find out about pools in local fitness clubs, community centers, senior centers, nearby schools, or other recreation centers. Most such places with pools likely also offer classes if you prefer aquatic exercises to swimming on your own.

Biking outdoors

Cycling outdoors gives you most of the same benefits you can get from using a stationary cycle indoors (see the earlier section “Cycling indoors as an alternative”). If you love being outdoors and feel stable enough to stay upright when riding a bike, outdoor cycling may be an ideal activity for you to do. Prices and types of bicycles (road, mountain, and triathlon) vary widely so talk with a reputable bike dealer prior to purchasing a bike to make sure you get the right one for you.

Seated march

If you like to march but without standing on your feet, this exercise is for you. Figure 10-1 shows you what to do.

1. Start by sitting upright and marching your feet in place, right foot and then left foot.
2. Swing your arms back and forth with your elbows bent while you march.
3. Continue marching for about one minute.

Seated foot drill

This activity is marching to a faster beat, so to speak. Feel free to hold on to the sides of your chair with your hands (as shown in Figure 10-2) while you keep up this faster pace.

1. Do the seated march exercise from the preceding section, picking up the pace by tapping your feet faster.
2. Continue sitting upright.
3. Keep tapping for 45 seconds.

Seated arm curls

This activity (Figure 10-3) rests your legs and gives your arms a workout. You’ll find you can easily do this anytime and anywhere.

1. Keeping your elbows at your sides, start with your fists beside your legs.
2. Move your fists in front of your body and up toward your shoulders.
3. Make sure your elbows stay firmly planted at your sides and bring your fists back down to your legs.
4. Repeat the arm curls for 30 seconds (about 30 arm curls).

Seated overhead punches

These overhead punches will not only give your shoulders a workout, but they’ll also let you vent your frustrations in a healthy way. Follow Figure 10-4 to get started.

1. Start with your fists in front of your shoulders.
2. Punch your right fist up overhead and bring it back down.
3. Punch your left fist up overhead and bring it down.
4. Alternate right-side and left-side punches for 45 seconds (about 20 times for each arm).

Standing march

Doing your marching standing will expend even more calories than doing it sitting. So try it (as shown in Figure 10-5) for 45 seconds either as the next step up from doing the seated march (Figure 10-1) or as an additional activity.

Standing raise the roof

Raising the roof (Figure 10-6) feels like more than double the workout of doing the standing march (shown in Figure 10-5), but it can be so good for raising your heart rate and your fitness level faster. Try it today and practice it as often as you can.

1. Marching in place, bend your elbows and push both your hands toward the ceiling.

   Your palms should be up while you straighten your elbows.

2. Bring your hands back to shoulder level and then push them back up toward the ceiling.
3. Repeat Steps 1 and 2 for about 45 seconds.