There is a reason why people in their 30s and 40s are suddenly becoming more health conscious and turning to an active lifestyle. Thanks to sedentary lifestyles and poor choices when it comes to food and exercise, many people are developing health conditions like heart disease, cholesterol, diabetes, obesity, etc. One of the biggest concerns for India is Type 2 diabetes. Type 2 diabetes is increasing at alarming proportions in India, says Dr Archana Juneja, a consultant endocrinologist at Kokilaben Dhirubhai Ambani Hospital in Mumbai.
Diabetes is one of the biggest causes of death accounting for 6.7 million deaths in 2021, according to the International Diabetes Federation (IDF). A Cambridge University study last year found that people with Type 2 diabetes have a higher risk of as many as 57 other health complications, including cancer, and heart, neurological and kidney ailments. The IDF Diabetes Atlas Tenth Edition published in 2021 counted 537 million adults living with diabetes and predicted that the total number of people living with diabetes would rise to 643 million by 2030 and 783 million by 2045. Moreover, three out of every four diabetics are from a middle or low income country, which is where India falls. “Approximately 100 million Indians are diabetic and the figures are rising rapidly. About 30-40 million people have prediabetes and it is estimated that every second or third of 10 Indians is a diabetic,” says Dr Juneja.
Though the numbers and reality are alarming, not all news is grim. It is possible to manage and even beat diabetes with lifestyle interventions such as exercise and an active lifestyle, say doctors citing peer reviewed evidence-based studies covering large sample sizes. “When people exercise their muscles use more glucose. This lowers the plasma glucose levels in the blood and thus maintains your blood sugar levels. Exercise is beneficial in all types of diabetes, including type I, type II, and gestational diabetes,” says Dr Sunil Kumar Mishra, senior director of endocrinology and diabetes, Medanta Hospital, Gurugram.
Apart from glucose control, exercise also makes one’s body more sensitive to insulin, the hormone that allows cells to use sugars from the blood for energy, and hence helps in diabetes management. “Furthermore, diabetes patients are at an increased risk for cardiovascular problems. Physical activity also reduces the risk of heart disease and nerve damage while helping boost immunity. Because diabetes affects the musculoskeletal system, diabetics face flexibility issues resulting in muscle stiffness. Exercise helps overcome this problem and maintain the integrity of muscles, limbs, spine, and joints, as well as give people a sense of wellbeing,” adds Dr Mishra.
Exercise, strength training in particular, plays a big role in this. Strength training increases the glucose receptors in the muscle fibres and this increases their glucose uptake and utilises the blood glucose more effectively, explains Dr Juneja. “Thus strength training can help to lower your blood glucose levels and improve blood circulation to different parts of the body. In addition, strength training improves cardiovascular health, posture, mood and overall fitness. Strength training can be done by using body weight exercises such as squats, planks, lunges, pushups, etc., or using equipment like dumbbells, Therabands or barbells,” adds Juneja. It also reduces falls and fractures, especially in elderly diabetics.
Exercise also helps lose weight, which is a boon for those who suffer from diabetes. It is proven that losing weight rapidly can reverse Type 2 diabetes. This was demonstrated 12 years ago in a study by Prof. Roy Taylor of Newcastle University. “We always encourage diabetics to maintain a healthy lifestyle that includes 30-40 minutes of regular exercise,” advises Dr. Mishra. Both medical and fitness experts agree that those with diabetes should exercise at least 150 minutes per week. Juneja recommends a mix of exercises of moderate intensity including cardio (brisk walking, cycling, jogging, swimming, badminton) with at least two days of strength training. They should also include two-three stretching and/or yoga sessions. “Each exercise regimen has its unique benefits. Cardio improves cardiovascular fitness, strength training improves muscle fitness and glucose control while yoga and stretching improve muscle tone and regulate the internal body mechanisms,” she adds.
Those with diabetes can lead a regular life and can also play competitive sports at the highest level. Take cricketer Wasim Akram and actor-television presenter Gaurav Kapoor, for example. While Akram continued playing cricket for Pakistan after his diabetes diagnosis, Kapoor is a picture of health and fitness and no one would ever know he has diabetes. One reason Akram and Kapoor can live healthy lives is exercise. Those with diabetes should follow FITT (Frequency, Intensity, Time, Type) principle, says Sandeep Sachdev, coach and co-founder of EasyHuman fitness studio and café in Mumbai. “Start with short bouts of activity five times a week. That takes care of frequency. For intensity, it’s important to base your training by monitoring your heart rate. Those starting out should maintain their heart rate at 60-75 per cent of their maximum heart rate. Gradually, take it up to a high of 85 per cent. How much time? Start with 10 minutes and build it up to 30 minutes a day and then to 45 minutes. Set and achieve small goals. That is motivating. So, it’s important to start small, smash those goals, and think big. As for what type of activity, a mix of cardiovascular exercises such as walking and using the cross-trainer, jogging… everything is fair game, just keep an eye on your heart rate. Also, weight training is very important, as these exercises would make your muscles use more glucose. Focus on high repetitions with lower weights and avoid heavy lifting or high intensity workouts till you are properly conditioned,” says Sachdev.
Also, before taking up any fitness or strength training routine, it is necessary for diabetics to get a cardiac and eye test so as to prevent any cardiac and eye issues which can happen because of added pressure on the upper body, warns Dr Juneja. Moreover, apart from exercise, all diabetics should also have a healthy balanced diet. “Minimise fasting and feasting and avoid processed and packaged foods. They should also try to get at least seven hours of sound sleep every night. They should be encouraged to indulge in their hobbies for stress reduction for at least 20-30 minutes daily,” adds Dr Juenja.
Workout routine for a week
Day 1 Walking or cross-trainer or cycling for 30 minutes
Day 2: Upper Body
Two sets of 10-15 repetitions with light weights
Dumbbell chest press
Bent-over row
Chest dumbbell fly
Overhead shoulder press
Lat pull-down
Lateral raise
Front raise
Take a break of 45-60 seconds between sets
Day 3 Walking or cross-trainer or cycling for 30 minutes
Day 4: Legs
Two sets of 10-15 repetitions
Wide Squats
Back Lunges
Narrow Squats
Leg Extension
Walking Lunges
Leg Curl
Mid Squats
Calf Raises
Take a break of 60-90 seconds between sets
All exercises except for Leg Extension and Leg Curl can be done as body weight exercises. Add weights after four weeks and start with light weights
Day 5 Yoga or stretching or core work for 30 minutes
Day 6: Walking or cross-trainer or cycling for 30 minutes
Day 7: Rest day
