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VOLUME 16 NUMBER 1 • JULY 2019
CLINICAL COMMENTARY
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Table 1.
Exercise rehabilitation prescription for diabetic patients
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Exercise components
Types of exercise
Objectives
Intensity/frequency/duration
Aerobic:
Large muscle group activities
Walking, jogging, running, swimming,
simulated stair climbing, cycling
Increase aerobic capacity
(cardiorespiratory fitness)
Reduce co-morbidity
cardiometabolic risk factors (obesity,
cardiac artery diseases)
Intensity:
50–90% heart rate maximum
50–85% VO
2max
Monitor Borg RPE scale
Frequency: 4–7 days/week
Duration: 20–60 min/session
Strength:
All major muscle groups (shoulders,
biceps, triceps, forearms, chest, back,
lumbopelvic hip complex, quadriceps,
hamstrings, adductors, abductors,
calves
Free weight exercises
Calisthenics
Resistance gym machines
Isokinetic machines
Increase muscle strength
Increase muscle endurance
Enhance sports performance among
elite diabetic athletes
Rehabilitation:
Low resistance/weight, high repetition
for patients
Sport performance:
Athlete-designed strengthening
programme
Anaerobic:
Only for diabetic athletes with good
energy metabolism control
High-intensity interval
Increase anaerobic capacity
High-intensity interval training (e.g.
track running interval training or
pyramid swimming interval training)
Flexibility
Static, proprioception neuromuscular
facilitation, dynamic stretching
Increase muscle extensibility
Increase joint range of motion
(passive and active)
Minimum of 2 sessions per week
Neuromuscular/
Proprioception
Biodex balance system
Romberg stance
Improve balance
Improve proprioception
Improve neuromuscular
co-ordination
Minimum of 2 sessions per week
Functional activities
Daily living activities
Sport-specific activities for athletes
Dependent on patient lifestyle and
activities
Minimum of 2 sessions per week
How to calculate heart rate maximum using Karvonen formula
Target heart rate = (maximum heart rate − resting heart rate) × % intensity) + resting heart rate
Maximum heart rate = 220 − age of patient
Resting heart rate is resting pulse rate.
VO
2max
is the maximal oxygen consumption to be determined by the sub-maximal cardiorespiratory treadmill or cycle test
50 to 90% heart rate maximum corresponds to 50 to 85% VO
2max
.
Borg rate of perceived exertion (RPE) scale
This is a self-evaluation of the patient’s exercise intensity effort. The scale ranges from 6−20, with a rating of 10 being equal to a heart rate of 100 bpm.
patients should have regular contact with a biokineticist and/
or a physiotherapist as part of their multi-disciplinary diabetes-
management team. All diabetic patients should obtain medical
clearance from their endocrinologist before starting an exercise
rehabilitation programme. The diabetes multi-disciplinary medical
team should include an endocrinologist, medical nurse, dietician,
pharmacist, biokineticist and an exercise scientist for athletes.
Clinical exercise testing
All diabetic patients should undergo a clinical test protocol as
recommended by the American College of Sports Medicine
(ACSM).
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The testing protocol entails a sub-maximal aerobic cycle
or treadmill test with an electrocardiogram (ECG). The sub-maximal
aerobic test is used to evaluate the patient’s cardiorespiratory
endurance (VO
2max
), while the ECG is used to identify cardiac
dysrhythmias, especially among patients with cardiac pathologies.
The strength of the patient can be tested isokinetically and/
or isotonically. The joint range of motion (flexibility) should be
measured through the use of a goniometer and proprioception can
be evaluated either through the use of an electronic balance system
or through a Romberg stance test.
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Peripheral neuropathy is a neurological condition, which results
from injury to the nerves (deafferentation) that relay messages to
and from the brain to the spinal cord and to other parts of the
body. Peripheral neuropathy can be caused by diabetes mellitus,