The SA Journal Diabetes & Vascular Disease Vol 16 No 1 (July 2019)

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VOLUME 16 NUMBER 1 • JULY 2019 43
SA JOURNAL OF DIABETES & VASCULAR DISEASE CLINICAL COMMENTARY
adversely influencing the patient’s proprioception. Proprioception
is a person’s awareness of their body position. Should a patient be
diagnosed with this condition, proprioceptive exercises will help to
rehabilitate the deafferentated nerves over a long period of time.20
Proprioceptive exercise enhances the ability of patients to perform
daily activities and reduces their risk of falling.20,21 Many protocols
also include biomechanical gait analyses aimed at identifying
deviant walking patterns.1,19
Exercise rehabilitation prescription
All diabetic exercise rehabilitation and/or sports performance
programmes should include the following components: warm-up,
stretching, aerobic, strengthening, proprioception, and functional
exercises and activities, as well as a gentle cool-down.1,19 While
the ACSM prescribes a generic rehabilitation programme for
diabetic patients, with specific goals (Table 1),1,19,21 the types of
exercise prescribed to a patient will vary depending on the patient’s
cardiorespiratory, muscular and flexibility conditioning and their
desired outcomes (improved quality of life, enhanced health and
fitness or competitive sports performance). The primary objectives
of non-insulin-dependent diabetics would be to decrease body
fat percentage, prevent obesity and lower hypertension. Insulin-
dependent diabetics should strive to incorporate exercise to
reduce their hyperglycaemia, which will allow them to lower the
exogenous insulin intake. Table 1 is an overview of the ACSM’s
diabetes rehabilitative programme.1
Despite the fact that the prescription of stretching and muscle-
strengthening exercises depends on the patient’s capability, these
exercises should nevertheless pertain to all major muscle groups. It is
furthermore important that when diabetic patients start an exercise
rehabilitation programme, they exercise at conversational heart
rate zone: they should be able to exercise but simultaneously be
comfortable talking to their biokineticist and/or training partner.12
Conclusion
Regular exercise is an essential component of a diabetic patient’s
lifestyle-management strategy. However there are several exercise-
induced metabolic complications that warrant recognition and it
would therefore be prudent for all diabetic patients to consult a
biokineticist or physiotherapist prior to commencing an exercise
rehabilitation programme. It is furthermore clear that post-exercise
exogenous insulin supplementation and meals must be adjusted
to appropriately maintain sound energy metabolic homeostasis.
References
1. Durstine JL, Moore GE, Painter PL, Roberts SO. ACSM’s Exercise Management for
Persons with Chronic Diseases and Disabilities. Human Kinetics, 2009.
2. Pheiffer C, van Wyk V, Joubert JD, Levitt N, Nglazi MD, Bradshaw D. The
prevalence of type 2 diabetes in South Africa: A systematic review protocol. Br
Med J Open, 2018; 8: e021029, http://doi.10.1136/bmjopen-2017-021029.
3. Hunter-Adams J, Yongsi, BN, Dzasi K, Parnell S, Bouford JI, Pieterse E, Oni T. How
to address non-communicable diseases in urban Africa. Lancet 2017; http://doi.
org/10.1016/S2213-8587(17)30220-6.
4. SAHR South African Health Review 2016/17, Available at: .
za/publications/South%20African%20Health%20Reviews/HST%20SAHR%20
2017%20Web%20Version.pdf.
5. GBD (Global Burden of Disease) 2015. Global Burden of Disease Report 2015.
Available at: .
6. WHO (World Health Organization). Global Action Plan for the Prevention and
Control of Non-communicable Diseases: 2013-2020. Geneva, Switzerland; WHO
Press: 2013. Available at:
publications/global-actionplan-ncds-eng.pdf.
7. Mickelsfield L, Lambert EV, Hume DJ, Chantler S, Pienaar PR, Dickie K, et al. Socio-
cultural, environmental and behavioural determinants of obesity in black South
African women. Cardiovasc J Afr 2013; 24(9): 369–375.
8. GHE (Global Health Estimate) 2016: Estimates deaths by cause, age and sex.
World Health Organization. Geneva, Switzerland. Available at: .
int/healthinfo/global_burden_disease/en/.
9. Ehrman J, Gordon P, Visich P, Keteyian S. Clinical Exercise Physiology (3rd edn).
Human Kinetics, 2013.
10. Adams P. The impact of brief high-intensity exercise on blood glucose levels.
Diabetes, Metab Syndr Obesity: Targets Ther 2013; 6: 113–122.
11. Shadar J, Harndy O. Medication and exercise interactions: Considering and
managing hypoglycaemia risk. Diabetes Spect 22015; 8(1): 64–67.
12. McArdle WD, Katch FI, Katch VL. Exercise Physiology: Nutrition, Energy and
Human Performance (7th edn). Lippincott Williams & Wilkins, 2012.
13. Melzer K. Carbohydrates and fat utilization during rest and physical activity. Eur
e-J Clin Nutr Metab 2011; 6: e45–e52.
14. Jensen J, Rustad PI, Kolnes AJ, Lai YC. The role of skeletal muscle glycogen
breakdown for regulation of insulin sensitivity by exercise. Frontiers Physiol 2011;
http://doi:10.3389/fphys.2011.00112.
15. Du Toit E. Diabetes and exercise. S Afr J Diabetes Vasc Dis 2009; 6(1): 8–12.
16. Frontera WR, Slovik DM, Dawson DM. Exercise in Rehabilitation Medicine (2nd
edn). Human Kinetics, 2006.
17. Trefts E, Williams AS, Wasserman DH. Exercise and the regulation of hepatic
metabolism. Prog Mol Biol Transl Sci 2015; 135: 203–225. http://doi:10.1016/
bs.pmbts.2015.07.010.
18. HPCSA (Health Professions Council of South Africa), Act 56 of 1974. Regulations
defining the scope of practise for the profession of Physiotherapy, Podiatry and
Biokinetics. Available at
19. Riebe D. American College of Sports Medicine Guidelines for Exercise Testing and
Prescription (10th edn). Human Kinetics, 2018.
20. Prentice WE. Rehabilitation Techniques for Sports Medicine and Athletic Training
(5th edn). Champaign, IL: Human Kinetics, 2011.
21. Chetty T. Exercise as treatment for diabetes: A practical guide to exercising. S Afr
J Diabetes Vasc Dis 2009; 6(1): 33–39
ZARTAN 50, 100 mg. Each tablet contains 50, 100 mg losartan potassium respectively. S3 A41/7.1.3/0287,
0289. NAM NS2 08/7.1.3/0067, 0086. For full prescribing information, refer to the professional information
approved by SAHPRA, 10 August 2007. ZARTAN CO 50/12,5, 100/25. Each tablet contains 50, 100 mg
losartan potassium respectively and 12,5, 25 mg hydrochlorothiazide respectively. S3 A42/7.1.3/1068, 1069.
NAM NS2 12/7.1.3/0070, 0071. For full prescribing information, refer to the professional information approved
by SAHPRA, 17 February 2017. ZNCH514/04/2019.
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