Getting “fit” according to the latest guidelines

How much activity and what types of exercises do you need to reach an acceptable level of fitness? According to updated physical activity guidelines released by the U.S. government in 2008, all healthy adults ages 18 to 65 years need to do moderate-intensity aerobic physical activity (for example, brisk walking or bicycling on level terrain) for at least 150 minutes a week or vigorous-intensity aerobic activity (like running or uphill bicycling) for at least 75 minutes weekly. The American College of Sports Medicine (ACSM) has issued similar recommendations for adults of that age range.

In addition, the federal guidelines and ACSM strongly recommend that all adults do some type of resistance or weight training at least two days each week. You should do these planned physical activities in addition to your usual activities of daily living, such as basic self-care, casual walking, grocery shopping, gardening, housework, and taking out the trash.

Goals are the same for all individuals with the exception of modified guidelines for those 65 years and older or people between 50 and 64 years of age who have chronic conditions or physical functional limitations that affect their ability to move or their physical fitness. If you have a physical impairment, such as arthritic joints, that makes it harder for you to be active, you may need to modify your goals a bit to be as active as you can be under the circumstances.

Maintaining your physical functionality is an important benefit of exercise and even more important as you age. Keeping some level of fitness makes it easier for you to keep doing your everyday activities, such as carrying groceries, cleaning the house, taking out the trash, or just taking care of yourself. Keeping fit to live long, well, and independently should be your goal, not just staying alive a long time without good health and the ability to do (most of) what you want to do.

For older people or those with limitations, engaging in resistance training is especially important to prevent loss of muscle and bone mass. Working on flexibility and doing exercises can improve balance and lower the risk of falling.

Standing up more

Most people’s calorie use during the day comes more from daily movement than from a formal exercise plan. Just standing up for two hours a day rather than sitting can expend upward of 350 calories daily and may be the difference between remaining lean and gaining excess body weight.

Homing in on your favorite workouts

One thing people forget to consider when designing a fitness program is enjoyment. Do you think the people you see grunting and groaning during agonizing workouts are truly enjoying themselves? Due to human nature, if the activities you pick are simply not fun for you, you’re likely to stop doing them at some point.

Choosing an activity that’s a workout

Another thing to keep in mind is that you have to work out at a certain intensity to gain fitness. That means your activity usually has to be moderate or vigorous to really boost your fit factor.

However, what you need to pick to boost your fitness depends largely on your starting fitness level. A brisk walk may be moderate or easy for someone who is adapted to doing harder workouts, while people who are sedentary and just starting out may not need an activity any harder than walking to gain greater fitness and endurance.

Tricking yourself into finishing

Even when you start on a new exercise program with the best intentions, slipping up on doing it becomes easy as time goes on. On those days when you simply lack the motivation to exercise, make a deal with yourself: You’ll start your workout with the goal of doing at least half of it, and when you get to the halfway point, you can choose to stop or continue. Amazingly, you may find that most of the time when you reach that first goal, you’re feeling more physically energized and mentally ready to complete the whole workout.

If you just can’t finish your workout on any given day, see if you can do five more minutes before calling it a day.

You can also set smaller goals at the beginning (for example, doing the first five to ten minutes of your workout at an easier pace than normal) and end up finishing more than you thought you could or would. Often, you can get rid of that sluggish, lethargic feeling that comes from being inactive and from having higher levels of insulin resistance. Just get moving on any given day and see how much better you’ll feel.

Dressing right

What you choose to wear when you’re physically active is important, but it’s not more important than getting moving itself. If you can buy clothes you feel good exercising in, then by all means do that. If not, just pick some loose-fitting clothes that allow for maximal movement of your joints in all directions and that let air movement help keep you cooler. (Leggings are comfortable, but they can make you feel hot because of their tight fit.)

Avoid wearing pure cotton socks because they tend to get wet and stay wet, which may promote damage to your feet. Wear polyester, cotton-polyester blends, or specialized athletic socks to prevent the formation of blisters and keep your feet dry during exercise.

Also keep in mind that darker clothes can absorb more heat from any direct sunlight while you’re exercising outdoors. Dress in white or light-colored clothing, if possible, to keep from getting as hot from the sun.

Choosing the right footwear

Wearing appropriate shoes is critical to preventing problems with your feet and legs. The best choices vary with the activity; walkers and runners generally need some cushioning, while tennis players require footwear with greater stability for side-to-side movements. For most physical activities, you benefit by picking your shoes based on whether you rotate on your feet toward the arch of your foot or the outside edge.

To determine how you step, look at the wear pattern on the bottom of your shoes.

Exercisers who are pronators — that is, they overpronate, or rotate their feet too far to the inside — or have flat feet or are overweight wear out the insides of their soles first. If you have this problem, motion-control shoes may help. Overpronation can place extra stress on your knees, hips, and ankles and cause injuries if your shoes don’t compensate for it. Conversely, supinators usually have high arches and more rigid feet and wear out the soles of their shoes on the outside edge. If you’re a supinator, you’ll generally do better in highly cushioned shoes with plenty of flexibility to encourage foot motion. If you have normal arches, aim for shoes with moderate control, such as a two-density midsole.

If you’re unsure which type of arches you have, get your feet wet and make a footprint on the ground to see how much of the arch region of your foot shows. Based on that, any sporting goods or specialty running shop should be able to guide you in your selection of a particular brand or style of workout shoes that work best for your feet.

If you have any loss of sensation in your feet (from peripheral nerve damage due to diabetes), picking appropriate shoes for activities is even more critical. For this condition, athletic shoes with silica gel or air midsoles work better to cushion your feet. An ill-fitting shoe can rub your feet and contribute to irritation, calluses, and even ulcers, which you need to avoid and treat quickly to prevent the possibility of gangrene and amputation. Many athletic stores have employees trained to help you choose appropriate footwear. You can also talk with your podiatrist or diabetes healthcare team about the best shoes to wear on your unique feet for keeping fit.

You (or someone else) must check your feet daily for signs of trauma (redness or irritation) and aggressively treat any irregularities you find to prevent worsening of the problem. Place a mirror on the floor and hold one foot over it at a time to see the bottom if you can’t check your feet easily otherwise.

Getting the equipment you need

The equipment or gear you may need to work out varies by the activity. Specialists for every type of sport exist, so check with some of them if you need to buy special stuff to do your activity right. For example, getting a soft mat on which to do yoga, stretching, or floor exercises can help prevent irritation to your hips, back, and other joints. You can find out more about your equipment needs for specific activities in the discussions about those activities in the chapters to come.

Starting (or jump-starting) your motivational engine

Most people with diabetes aren’t active at recommended levels, and many lack access to behavior change programs to help them get started. To motivate or remotivate yourself, try some of these suggestions:

• Fit exercise in whenever you can, even if it’s for ten minutes at a time.
• Schedule exercise time into your daily life (and keep to your schedule).
• Avoid getting injured by starting out at an appropriate exercise level (not too long or hard) and progressing slowly.
• Include balance exercises to avoid falls and stretching to prevent injuries. (See Chapters 12 and 13, respectively, for more on these exercises.)
• Pick activities you enjoy doing (like dancing) and do those to stay more engaged and motivated to be active.
• With all the potential health benefits from being active with diabetes, use the promise of better health as part of your motivation.
• Keep your body in motion all day long in any way possible.

Tracking your progress

Sometimes the biggest obstacle to staying motivated is the feeling that your exercising isn’t getting you anywhere. That’s where keeping track of stats like your daily step counts can be a valuable tool; the actual numbers may paint a much more positive picture than the one in your head. The following sections give you a few options for monitoring how many steps or step equivalents you take each day.

Using mobile technology to get fit

In today’s mobile technology world, you have a lot of choices for tracking your daily activity and monitoring it online and on the go. It may motivate you to stay on top of your diabetes management as well.

In one study, using a diabetes-related smartphone application (Glucose Buddy) combined with weekly text-message support from a provider vastly improved blood glucose management in some adults with type 1 diabetes. Many people with type 2 diabetes don’t have access to programs to help them make lifestyle changes, but using technology tools, mobile applications, social media (like Facebook), and video games (Wii Fit) are proven tools for behavior change that work.

Often taking advantage of built-in accelerometers and GPS data, many exercise and fitness apps can monitor and measure factors like calories expended, miles covered, heart rate, and more. Others are simply programs that help guide you doing exercise programs (for example, resistance training or CrossFit workouts). Others are focused more on diet and weight loss.

Hundreds of mobile apps for smartphones and other devices, as well as online websites, can work for you. Here are just a few of the more popular ones:

• MyFitnessPal: Very popular free calorie counter that allows you to track your diet as well as your daily exercise.
• Endomondo Sports Tracker: Traditionally used by runners, it has been acquired by Under Armour, which also picked up MyFitnessPal under its umbrella to go with this tracker.
• DigiFit iCardio: Works with a heart rate monitor purchased separately.
• Fitbit: Tracker that works with Fitbit devices and many smartphones.
• Polar Beat: Polar makes heart rate monitors (watches and sensors)

This list of apps is by no means all inclusive. For example, the “Zombies, Run!” app is an audio adventure and game rolled into a running workout. You listen to a story about zombies and keep running to complete missions as they come up in the story — silly, yes, but engaging, especially if you aren’t motivated by seeing all the data from your activities. An alternate is “The Walk,” which also uses audio storytelling to add some adventure to your walking workouts. As you walk, you hear a story and are tasked with completing different missions, which may be all the motivation you need to stay active.

Quite a few apps exist that focus on ways to monitor blood glucose and diabetes management as well as fitness and diet, such as One Drop. Look for them online.

Finding out what your barriers are

Take this CDC quiz to see which areas you need to focus on to get yourself moving in the right direction. You can also access the quiz online at www.cdc.gov/diabetes/ndep/pdfs/8-road-to-health-barriers-quiz-508.pdf.

The quiz lists common reasons people give to describe why they don’t get as much physical activity as they think they should. Read each statement and indicate how likely you are to say each of them (very likely = completely agree; very unlikely = completely disagree).

Using the following scale, give yourself the score that corresponds with your answer for each statement. Write your number down next to each question to use for final scoring at the end.

1. My day is so busy now; I just don’t think I can make the time to include physical activity in my regular schedule.
2. None of my family members or friends likes to do anything active, so I don’t have a chance to exercise.
3. I’m just too tired after work to get any exercise.
4. I’ve been thinking about getting more exercise, but I just can’t seem to get started.
5. I’m getting older, so exercise can be risky.
6. I don’t get enough exercise because I’ve never learned the skills for any sport.
7. I don’t have access to jogging trails, swimming pools, bike paths, and so on.
8. Physical activity takes too much time away from other commitments, such as work, family, and so on.
9. I’m embarrassed about how I will look when I exercise with others.
10. I don’t get enough sleep as it is. I just couldn’t get up early or stay up late to get some exercise.
11. It’s easier for me to find excuses not to exercise than to go out to do something.
12. I know of too many people who have hurt themselves by overdoing it with exercise.
13. I really can’t see learning a new sport at my age.
14. It’s just too expensive. You have to take a class, join a club, or buy the right equipment.
15. My free times during the day are too short to include exercise.
16. My usual social activities with family or friends don’t include physical activity.
17. I’m too tired during the week, and I need the weekend to catch up on my rest.
18. I want to get more exercise, but I just can’t seem to make myself stick to anything.
19. I’m afraid I may injure myself or have a heart attack.
20. I’m not good enough at any physical activity to make it fun.
21. If we had exercise facilities and showers at work, then I would be more likely to exercise.

To score your quiz,

• Enter the number you rated for each question in the corresponding blank (so the number for statement 1 goes on the line marked 1, statement 2 on line 2, and so on).
• Add the three scores on each line. A score of 5 or above in any category shows it’s an important barrier for you.

Getting past your unique barriers

Barriers — perceived or real — greatly reduce the chances that you’ll participate in regular exercise. A great number of potential hurdles exist, but they largely come in three main flavors: physical, environmental, and emotional. In the following sections, I explain how these groupings relate to the categories in the preceding section and give you some tips for working around them.

Most American adults with type 2 diabetes or prediabetes don’t exercise regularly, even less so than the rest of the adult population. People with type 1 diabetes also exercise less often than others, likely because managing their blood glucose can be a daunting task with activity. You may need additional strategies, such as the ones I discuss in Part 2, to get fit with diabetes.

Setting some SMART goals

You need to build confidence in your ability to exercise with diabetes and set exercise goals that won’t sabotage you from the start. Particularly when you have diabetes, specifically planning your exercise and tracking goals to see your progress is helpful.

Set some appropriate physical activity goals that are SMART, meaning that they’re specific, measurable, attainable, realistic, and time-frame specific:

• Specific: Set goals that are as precise as possible related to exercise frequency, duration, intensity, and type of activity.
• Measurable: Choose goals you can quantify so you can accurately track, measure, and identify progress.
• Attainable: Set goals that are challenging, but reachable, to increase your confidence and your likelihood of setting even more challenging future goals.
• Realistic: Even goals that are attainable may not be helpful if they’re for something you aren’t likely to complete, so develop goals that are relevant to your current situation and that you can realistically accomplish in the time frame you choose as a goal.
• Time-frame specific: Putting a deadline on your goal helps keep you working toward it. Set short-term goals that provide more immediate feedback on your progress, such as one week.

You benefit most from setting realistic and practical goals for getting and staying fit. Goals that are too vague, too ambitious, or too distant don’t give you enough self-motivation to maintain your interest over the long haul.

Table 8-2 illustrates some less effective goals with SMART versions of those goals.

Create a plan for yourself for this week that includes what you plan to do (using SMART goal statements), potential barriers, an action plan for overcoming your unique barriers, and a later evaluation of what worked and what didn’t work. When you get the hang of setting and using SMART goals, you’ll never go back to using vague ones.

No pain, no gain

The pain part of exercise results from the build-up of acids in active muscles (like lactic acid), and acids drop the pH of your muscles and sensitize pain receptors. Usually, it’s just a sign that you’re working hard or that your muscle is fatiguing.

However, you can certainly have gains in your strength and endurance without pushing yourself to the point of having a lot of pain in the process. The more fit you become, the more easily your body can clear out those excess acids produced by physical activity.

Feeling too much pain during an activity may be a signal that you’re likely to get injured. Back off to keep yourself injury free.

Exercise makes you tired

Although you may feel somewhat tired during a workout, when you’re done you usually feel more invigorated for a while afterward. Doing regular physical activity is guaranteed to raise your overall energy levels. If you’re having trouble concentrating at work or the stress of your day is getting you down, the best remedy is a short walk or other physical activity to raise your energy levels, clear your mind, and decrease your stress.

Doing regular physical activity also helps you sleep better at night, leaving you more refreshed and energetic during the day.

To lose fat, you have to be in a fat-burning range

Exactly what is “fat-burning” range? First, you must understand what fuels your body uses during rest and exercise. Typically, 60 percent of your energy needs are supplied by fat (stored or eaten) during rest, with the other 40 percent coming from carbohydrates.

As soon as you start to do any type of physical activity, though, carbohydrates go up to a much higher percentage of your total energy supply. Even during brisk walking, you use very little fat and mostly carbohydrates. During more vigorous exercise, your body gets almost all energy from carbohydrates. You use plenty of fat during recovery from exercise, though.

Try to expend as many calories during exercise as possible without worrying about being in a fat-burning range. This range really isn’t relevant.

If you don’t use your muscles, they turn into fat

It’s physically impossible for inactive muscles to turn into fat. When you work your muscles out regularly, they can increase in size or simply look more toned; if you stop using them, the muscle fibers will atrophy and disappear — like what happens with aging if you don’t fight against it. Then if you don’t start eating less, you’ll gain weight as fat that then can be stored under your skin.

Lose weight first, because weight training will bulk you up

Women are often especially worried about bulking up and getting bigger arms or legs. However, if you’re losing fat all over (including from under your skin) while you’re gaining muscle mass, you’ll stay about the same size. If you gain muscle without losing fat, you may look slightly bigger, or simply more toned. Either way, it’s not a big deal because most people don’t gain enough muscle from weight training to ever look bulked up.

Lifting weights more slowly builds larger muscles

If you try lifting weights more slowly, you’ll certainly feel the pain, but it absolutely doesn’t mean that your muscle size gains will be more. On the contrary, lifting weights slowly when you can lift them more quickly will build more muscular endurance, while lifting the heaviest weight as quickly as possible will recruit extra muscle fibers and cause you to build bigger muscles.

If you’re lifting a weight slowly but could lift it more quickly, you either need to pick up the pace or try a heavier weight.

Working on your abs will make your belly flat

As much as you want to pick and choose where you lose your fat, spot reducing just isn’t possible. Doing hundreds of crunches won’t make you lose stomach fat any faster than you lose it from anywhere else.

If you want a flat belly, you can work on toning up your abdominal region, but focus more on simply burning off excess calories. Doing harder workouts also builds more muscle, and having more muscle increases your daily caloric needs. One side benefit of including abdominal exercises is that having toned abs makes pulling in your stomach easier, so your belly can look flatter even if you can’t spot reduce.

You can’t exercise too much

As with anything, excessive exercise has a limited benefit. When you do more than 60 to 90 minutes of aerobic exercise daily, you’re much more likely to develop overuse injuries such as stress fractures, tendinitis, bursitis, and other joint issues. You don’t want to get injured, because then you’ll have trouble working out. You’re better off doing slightly more intense exercise for less time, which you can do with any type of interval training to gain the same benefits (or even more) from your workout.

To gain muscle, eat more protein

It’s true that you have to eat some protein to gain protein in your body. (Muscles are made of amino acids, the building blocks of protein.) And, yes, physically active people do need more protein than sedentary ones, but not that much more. No athlete needs more than 1.6 to 1.7 grams of protein per kilogram of body weight (about 0.75 grams per pound), or just twice that of a sedentary person.

Does that mean you need to take protein supplements or up the protein in your diet? Probably not. Most Americans already eat well over their recommended amount of protein per day just by eating normally, mostly from meat, poultry, fish, and other animal sources like dairy and eggs. Having a glass of milk or some yogurt after a workout may be an easy way to take in a good combination of carbohydrate and protein to help your muscles rebuild. Some athletes have actually touted chocolate milk as the ultimate recovery drink following workouts.

If you want to take in extra protein naturally, try eating more egg whites or drinking milk of some type post-exercise.

If you’re not sweating, you’re not working out hard enough

Everyone equates sweating with working hard, but that simply isn’t always the case. People’s sweating rates vary. Being physically trained improves your ability to sweat more and to start sweating sooner, but men always tend to sweat more than women.

Sweating is related to not only exercise intensity but also the environment you’re in. If it’s hot and humid, you’re going to sweat more, even if you’re not working out that hard. You also sweat less if you start out dehydrated or lose too much fluid while you’re working out.