 Hello guys, this is Dr. Ahmet Ergin from SugarMDs and today we are going to talk about how to work out for diabetes, the best workouts for diabetics. Okay, like we are going to now summarize what we are going to talk about today, and I'm going to try to go by the order. So if you do not want to listen to one part, you can jump to the other part easily if you want to, but I would recommend to listen to this entire lecture that will benefit you maximally. If you have diabetes and you want to work out to help your diabetes, you have to know these things before you jump into any exercise. I do that mistake sometimes, I go into things without really looking into those things in detail, and then I end up regretting it, and as a diabetic patient I don't want you to have the same mistakes. So we are going to talk about number one, why and how to work out for diabetes. So we are going to talk about why and how to work out for diabetes. So how does really working out help? How do you transition from a sedentary lifestyle to an active lifestyle with daily maybe workouts? So do you really need a medical evaluation before you start working out? What is a structured exercise program, and what are the types of exercises that any diabetic can do? And what are the safety precautions, and we are going to talk about the intensity of exercise that is needed for diabetics. We're going to talk about the duration of the workouts, and we're going to talk about the frequency of these workouts. So what are the optimal frequency intensity and duration, very important? Again, we're going to touch base all this, it's going to be a comprehensive video, so let's jump in. So basically, if you have diabetes or not, if you have physical activity in your life, if you exercise or workout regularly, then you are actually preventing to become a type 2 diabetic. So you may be eating carbs because you're on diabetic, or you may be diabetic and eating carbs. Eating carbs is nothing wrong with it, as long as you can control your blood sugars reasonably. And of course I'm talking about healthy carbs here, but the exercise is the ultimate best thing you can do for yourself. If you cannot exercise at all, then you have to really, really cut your carbohydrates because then that's going to spike your blood sugar significantly. So no matter what age you are, no matter what your physical abilities are, we can find you a way to exercise so you can actually improve your life, improve your diabetes. So when you exercise, what happens is your body burns glucose. The glucose is typically stored in your muscles, in your liver. As a result, you have to burn these glucose that is stored. If you do not burn the glucose, then that's going to turn into fat. So and if you keep eating carbohydrates and you're not really burning them, then you're going to gain weight. So of course, if you're eating fat and you're not burning that fat, that's also going to cause so. So even if you're in a keto type of diet, if you're not exercising at all and you're eating a lot of fat, that can also cause weight gain too. It's all about how much calories you're getting in and how much calories you're burning out. So also when you are working out, you're actually using your muscles and your muscles get larger and bigger and better and your metabolism gets better. So your body becomes more efficient utilizing the energy and if you're not fit and you're not exercising at all, your body becomes very efficient in turning everything into fat. So that is how you teach your body how to really utilize the energy resources. So again, the diabetes will be prevented with exercise and will be significantly improved with the workouts of many different ways. And we will talk about right now about how to transition from a sedentary life to a workout life, right? The biggest challenge is a lot of people are so scared because they do not exercise at all. Most Americans, I know which country you live while watching this video, but in America, we do not exercise much at all. So the problem with that is that you become more and more sedentary and it's harder to transition to workout. It becomes a big challenge and your body becomes tired. So a lot of times, people, patients will come and tell me that they're so tired to exercise. Well, because they don't exercise, that's why they're tired. So it's like a vicious cycle that people cannot get out. But it is very important for you to start slowly and build up and you can do that by just listening to your body. If you're huffing and puffing and you're like having palpitations and excessive chest pain and shortness of breath, stop. Don't force it too hard. So you have to know your limitations, think about what you have done last time and how long ago it was. Work with your exercise therapist or your doctor to find a starting point and then gradually increase it. You can put small goals. You don't have to be too passionate about it. As long as you increase your goals in time, before you know it, you can be a marathon runner. Even if you have not been, even if you haven't run for like months and months or years and years. If you start walking and then fast walking, brisk walking and jogging and then running, you can develop that. It just requires a lot of patience and discipline, but definitely that can be done. And of course, if you have been a very sedentary and you have been diabetic for a long time and you're above age 40-50, you may want to get checked medically to make sure that you actually do not have an underlying cardiovascular disease that can put you into a heart attack situation. Now we doctors, we look at the risk factors. We look at your symptoms and we decide to run some testing if we need to. So you can always ask your doctor if you are a patient that requires medical evaluation individually for you. Again, at SugarMDs at my practice, we do that all the time. The simplest thing you can do is an EKG or sometimes a stress test. And just simply discussing with the patients, see what their daily activities are, what are their symptoms, how many stairs they can climb without problems, how much blocks they can walk without problems. Those are the indicators of how overall a patient's health and fitness status is to begin with. So developing a structured exercise program is very important. And the most thing that most things that people know or dating they know can be actually wrong. And one thing that a lot of people ignore is the warmup. So anytime you try to do an exercise, I always recommend patients to start stretching. So start stretching if you're going to lift something, if you're going to do resistance exercise. And if you're doing a cardio exercise, what we recommend is to warming up for three to five minutes, which means starting slowly and gradually building speed to whatever your comfortable speed is. So your heart rate will slowly go up and that's also going to prevent the fatigue. Remember the first five, 10 minutes of cardiac exercise or aerobic exercise or workout is the first five, 10 minutes is the most miserable time for most people because they generally hit it hard, they start very fast, they think they can go 100 miles an hour from the first minute. That's not the way to go. That's going to hurt you. That's going to hurt your muscles. That's going to cause a lot of aches and pains. Now of course, at the conditioning phase, you bring your heart rates to a comfortable heart rate that we will talk about. And then you slow down the last three to five minutes that will prevent the accumulation of lactic acid that will prevent the post-exercise fatigue. So that's very important that you slow down and gradually bring your heart rate down and then stop the exercise or your workout. That's in our previous video. There are some safety precautions every diabetic should know. So basically you should check your blood sugar before, during and after. If you have a CGM that's great. Remember to warm up and cool down. Remember stretching and remember that your blood sugar can go down even after 24 hours after your workout. And then consult a physician if you are very sedentary and if you're not physically active at all to see if you need to be checked out for certain cardiovascular problems. Now the next thing we are going to talk about is the intensity and frequency and all that good stuff. You know common questions like how many times should I exercise? How long should I work out? And how do I know how much intensity that I'm in and so forth. And let's talk about that right now. So how do you know how intense you're exercising? So basically there is something you can do. This is especially true for relatively younger individuals whose you know my maximal heart rate could be near 200. But typically I would say on a scale of 6 to 20 the moderate intensity exercise is around 12 to 16. Okay so if you're at the 18 or 20 that's really how do you know really that you're really doing intense or moderate intensity exercise? So you multiply the intensity of exercise. Let's say you want to do moderate intensity that's 12 to 16 out of a 6 to 20 scale. So in this case let's say you want to do 12 for 13 multiply by 10 that's 120 or 130 that's your heart rate. So if your heart rate is 120, 130, 140 that's the zone where we call it moderate intensity exercise. That is the best zone for most diabetics and the reason for that is the higher the intensity the more difficult it is and most patients with diabetes it is just hard for them to do that. For athletes great yeah they do that all the time but if you're a regular person you know it's not a normal person with diabetes we do not recommend doing really very intense exercise. They can cause injuries problems and so forth but if you can do that intensity keeping your heart rate at 120 to 140 range if you're older I would say 120 to 125 if you're on the younger age like less than 50 maybe try to shoot for 130, 135 provided that you're not getting chest pains or excessive shortness of breath and so forth. Now another way you can actually tell how intense you're actually working out if you are not able to talk to someone at all that you're breathing so heavy that's really intense right so you can tell that's intense but if you are able to make short sentences to someone oh hey hey how are you I'm okay how are you doing that's like that's not too bad right so you can still talk but but you're they can tell that you're actually busy working out so they're not going to bother you too much so that's like a moderate intensity so you can look at your heart rate you can look at you know what you can do when you're exercising and then and then the really mild intensity is let's say you're jogging you're just walking around here you can have a conversation easily you don't look like you're in distress or anything then that's that's mild really now the duration depends on the intensity of exercise so we recommend around 150 minutes of moderate intensity exercise so that can be like 30 minutes for five days so if the intensity goes up if you're like doing really athletic stuff then up just 60 minutes in a week is okay but most of the time as I said most people cannot do that so we say at least 120 minutes the preferably 150 minutes a week and we prefer at least three days so if you want to do like a like a long workouts and you want to do let's say 60 minute exercises 50 60 minutes but you can only work out for three days a week you can do that or you can be someone who just want to do short exercises like 10 15 minutes two times a day and that's like 30 minutes a day and five days a week you can do that as well so as long as you are making that 150 minutes a week of short bounce or long stretches they're all okay so it doesn't have to be one certain way so whatever your lifestyle is whatever you can do if you're too busy with kids and family just see you can do 10 15 minutes something and you'll get your heart rate up and that's fine if you can get away from your family and friends and you can get away for an hour just take your time and do whatever you can that's going to add up so 150 minutes moderate intensity heart rate around 120 to 140 provided that you don't have significant medical problems or you can you can you can do it in a at a reasonable comfort level again the frequency depends on the the duration and intensity so you're looking for 150 minutes of total time you're looking for moderate intensity exercise which we talked about what the moderate intensity feels like or in your heart rate how you feel with the moderate intensity exercise and the frequency totally depends on your schedule so as long as you are making the 150 minutes a week i don't care how you do it just do it okay now we are going to talk about the the cardiac the the arabic exercise so as we discussed starting the exercise with a low intensity and then building it up is very important so warm up is very important so i'm assuming that you stretched the stretching part i skipped but i'm going to start with uh just just warming up period so you don't want to just jump that intensity or resistance to too high and just start getting like really really passionate about this the first minute don't do that cut back down and just you know just start taking it easy or whether i typically do i increase the resistance to uh you know maybe one at a time every minute so i start with like resistance two maybe and then go to resistance three by third minute and then four maybe four minutes and then five in the fifth minute now i also want you to pay attention right now i can talk to you yes you can tell i'm exercising but i am able to talk to you and i do not have to cut my sentences into short but now let's assume that i have done three to five minutes of um the warming up uh assuming you know just trying to shorten the video but i'm going to like increase my intensity to more like a moderate intensity in the moderate intensity i'm going to increase my intensity right now in the moderate intensity you may not be able to make uh the full sentences as you can see now i feel like i have to breathe as i talk instead of making the full sentence at a time so i feel like i have to breathe more often and i think you can do if you have a reasonable uh heart rate monitor basically you can monitor your heart rate as we said you know your heart rate or divided by i would say 10 so if your heart rate is 130 you divide it by 10 your intensity is 13 so as you discussed 12 to 16 it's like a moderate intensity exercise and that's where you want to be in the condition stage where this is the bulk of your exercise the first three to five minutes is warming up the last three to five minutes is cooling down and then the uh the majority in the between is your conditioning part now i'm going to jump on and get a heart rate now i'm going to show you my heart rate right now and most of you are okay as you can see now i am at moderate intensity as you can see i can not really make full sentences but i can still talk to you why this is not really a high intensity exercise because i can still talk right so and when i look at my heart rate as you can see my heart rate is around 130 140 range and i can still talk so i think that's 145 so this is a good range that i can actually keep my heart rate up like this for another 20 minutes and then i'll start cooling down in the last five minutes so this is if we have been really actually uh you don't have to necessarily put all those whole sorts of looks if you don't rely on the heart rate monitors on the machines you can use definitely that and they'll help you a lot now let's talk about how the really intense exercise will look like by going intense here okay now getting pretty close to intense and i think my heart rate is around 160 170 range and i don't want you to do that i think if you're athletic you can but you start coming down of course it's better to do moderate intensity and then start calming down they're lost three to five minutes okay again for a lot of diabetics to have physical limitations all the individuals i will show you now what exactly you should be doing if you're not able to run treadmill optical a lot of people have joint problems they have physical limitations that they just cannot do things just just because we tell them to do they're just not able to do it a lot of people have hip problems they can't really move their certain body parts and extremities okay guys so for those who are not physically very capable if you're not able to stand or walk i'm going to show you a few exercises that you can do at home so basically i'm calling this a sitting march so you're going to just march with your legs up so yeah that doesn't really uh look like it's very uh the effort intensive but if you keep doing this there's actually going to uh start uh you know uh you're gonna start feeling this so keep doing that it's just a matter of time and you can just entertain yourself with some music or something like that or you can get some rhythm or whatever you want to do uh just you know just keep doing that that's going to be a great exercise the next thing you can do or you can use your arms if you're not use your legs at all and what you can do is you can make a fist and bring it up and down up and down so you can do that one up one down one up one down if you want to use a little bit of a weight in your arms uh not too heavy because you want to make this a cardio exercise so you want to make sure that you can keep this up for at least you know 15 20 minutes so your heart rate can go up a little bit and uh the touching that I want to show you is um basically going back uh behind that chair and if you have a balance problem as much as you're not able to stand well uh what you can do is um lift your leg up and hold it there for a while and uh for maybe five minutes that's going to strengthen your leg muscle on the other side and you can do that for the other leg as well and repeat this procedure as often as you can all right so um the next thing that I want to show you um is basically like almost like a preacher curl you can basically do this uh and repeatedly and again you can have two pounds three pounds five pounds uh if you want to use weights but you don't have to use weights especially if you're not strong to begin with and you just need to do that again repeatedly as many times as you can try to do at least 50 to 20 minutes and if you get tired or bored you can just stop doing that and then resume that maybe in the next hours again uh these exercises look small and unimportant but actually it is it is doing something some sort of physical activity is better than nothing so as a result I would suggest strongly suggest that you perform the exercises if you do the uh the march if you do the curls and if you do the fist these are the things that can actually help you uh stay a little bit more active and yes these are going to take a little bit longer time than a moderate intensity exercise so you may try to do that maybe at least 45 minutes a day uh then you will hopefully see an noticeable result in your blood sugar levels now I get a lot of questions what type of exercise should I do should I do a cardio workout should I do uh resistance training or workout my answer to that is both because you have benefit from both so when you have a better and bigger muscles basically you are able to utilize more glucose when you exercise so in a shorter amount of time you can burn more calories your metabolism is typically higher so as a result gaining weight potential is much lower as well also being strong overall helps your balance and stability as a lot of patients with diabetes tend to have balance problems and that also is an important factor to prevent injuries so the cardiac exercise is also very important and that has to be mixed with the resistance training although you have to be careful especially if you have diabetic retinopathy diabetic eye disease like sometimes bleeding vessels at the back of the eye can be a problem if you are trying to lift too heavy again as we discussed you start slow you try to lift in carefully and make sure you get your eyes checked before you start any sort of heavy lifting and do not go try to lift the heaviest thing start slowly see what you can do with an eighth repetition do not increase your your weight unless you can comfortably do a weight eight to ten times at a time for three times so that's like a rule of thumb and that will also prevent injury again start stretching start warming up start lifting light and then gradually build up again if you're in florida or new york we are definitely available just call us give us a thumbs up for this video and we are going to bring up more and more videos please support us subscribe share these videos so that everybody can benefit from it so again we'll see you in the next video a wonderful day