Exercise Prescription

The type, duration, and intensity of exercise as therapy for diabetes is often decided by patient preference and common sense based on the patient's age and abilities and the previous considerations. As noted with walking, modest but periodic low-intensity efforts such as stationary cycling, arm conditioning with light weights, and dancing for 30 to 45 minutes with brief rest period, as often as daily, but at least three times per week, will achieve measurable improvement in HbA1c and lipid levels, indicative of the overall physiologic benefit.

For patients under age 40, the maximum heart rate (HR) is calculated simply by subtracting the patient's age from 220; for a 35-year-old patient, maximum HR would be 220 - 35, or 185 beats/min. Within a 30-minute exercise regimen, after a 5-minute warm-up, there should be 20 minutes of exercise in the pulse range of 111 to 124 beats/min (60%-67% of 185), followed by another 5 minutes of a cool-down phase. With more conditioning, the patient should aim to exercise in the range of 75% to 85% (139-157 beats/min). For patients over 40, the formula for maximum HR is 208 - (0.7 x age); for a 45-year-old patient, 208 -(0.7 x 45) = 208 - 32 = 176 beats/min, with the calculated HR guideposts of 106 (60%), 118 (67%), 132 (75%), and 150 (85%) beats/min.

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