3.3.3. Strengthening exercises

There are different forms of strengthening exercises that can be done by diabetic patients. Resistance exercises are commonly applied in physical rehabilitation programs to improve muscular strength, power and endurance of diabetic's patients. Many newly recognized type 2 diabetics may not have exercised in years. Therefore, there should be an awareness rising program together with health promotion and disease prevention campaigns about the clinical advantages of exercises with weights or other forms of mechanical resistance [46]. Then it will be imperative if they check in with their doctor first. After asking if there are any contraindicated moves they should avoid, they can start learning the right way to do each strengthening exercise. However, strengthening exercises have different requirements depending upon the treatment goals or function [28, 47]. The strengthening exercise programs need to be personalized to each patient's chief complaint, functional problems and goals. The workout variables such as speed, the intensity, the frequency and the type of muscle contraction used or the amount of muscles recruited in each contraction all effect the outcome of the program. Physiotherapists are experts who can guide and supervise patients with DPN. In addition to muscle strength, which can involve power, endurance and speed of contraction, the timing and balance of muscle contractions is very important. There are many different benefits of strengthening exercises for people with diabetes. Some of the benefits of working out a strengthening exercise are:


In addition, the American College of Sports Medicine recommends that people with type 2 diabetes should start practicing a strength training program to reduce the risk of further injury, to improve muscle strength, to improve the quality and range of movement and overall quality of functional mobility [35].

Strengthening exercise programs will include a variety of exercises designed to target specific groups or individual muscles. These exercises will begin easier and progress as strength is developed. Some of the exercises may involve the following:


#### 3.3.4. Muscle tone and joint flexibility exercises

Muscle tone and joint flexibility exercises are also called stretching exercises. There are two main types of stretching exercises: therapeutic stretching and self-stretching. While the first is indicated for therapeutic purposes, the second is used in bodybuilding, athletic training, dance and certain ritual exercises. The therapeutic stretching can be implemented on the desired muscle groups either by the therapist or by the patient himself. It is believed that stretching stimulates the body-mind complex to resolve injury, stress and pain. Gradual therapeutic stretching helps to keep the joints flexible and reduce the chances of injury during other activities. Thus gentle stretching for 5–10 minutes helps our body warm up and get ready for aerobic activities such as walking or swimming. Diabetes patients and prediabetes can do the following flexibility exercises of major muscle groups of both upper and lower limbs bilaterally. These exercises can be done either individually or in groups.

They are recommended to have a carbohydrate snack such as a glass of orange juice or milk at every exercise session. Exercising in a comfortable temperature is worthwhile. Never exercise

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For type 1 (insulin-dependent) patients, it is not allowed to exercise during the peak times of insulin. Before a physiotherapist asks a patient to do exercise, he should coordinate with the referring physician or nurse in charge for the patient regarding the stability of the patient and

Type 2 diabetics are advised to have an average of 30 minutes of exercise duration per session.

Menstruating women should have to boost insulin during menses, especially if they are not active. It is not reasonable to inject insulin close to the muscles to be exercised within 1 hour of exercise. Patients ought to eat 2 hours before they go for exercise. If they plan to exercise after meal, they should have to wait 1 hour prior to start. They should always bring their own portable blood glucose monitor. They should keep an eye on their glucose levels before and after exercise.

It is also important to drink adequate amount of fluid before exercise. If blood glucose level is between 70 and 100 mg/dl, the physical therapist can be allowed to provide carbohydrate

Make sure exercise does not contribute an unnecessary stress to the patient. Stress increases insulin requirements. A gradual progression from aerobic and resistance exercises is the key. Avoid exercising late at night. Thus, exercising five times a week as maintenance is preferred. Any known DM patient must not exercise alone as much as possible so as to call someone to

Majority of diabetes mellitus patients have physical impairments, activity limitations and associated complications. Physical therapy has an important role to improve physical function, activities of daily living and quality of life of diabetic patients. Persons who are at risk of developing diabetes mellitus should also be involved in appropriate levels of daily physical

It is recommended that people with DM ought to have a regular aerobic exercise and strength training to reassure positive adaptations in the control of blood glucose concentration, insulin action, muscular strength and exercise tolerance. Blood glucose levels should be monitored before and after exercise to prevent hypoglycemia. A medical screening and evaluation is essential to distinguish diabetes-related complications affecting cardiovascular function, which

activity based on personal preference and anticipated physical limitations.

Always wear proper footwear and exercise in a safe environment.

snack and then reassess the glucose level after 15 minutes.

in extreme temperatures.

the type of insulin administered.

help in unexpected situations.

5. Summary and conclusion

may be aggravated by an exercise program.

