How Much Exercise to Help Manage T1D and Optimize One’s Immune System?

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Woman doing home fitness exercises with her dog.

Most people with type 1 diabetes (T1D) know they should exercise to help manage their blood glucose levels and improve their overall health.

But if you need another reason, numerous studies show that regular exercise may help your immune system better fight off viruses and bacteria.

In fact, a recent, in-depth review of previously-published medical research indicates that regular exercise may reduce the risk of acute respiratory distress syndrome (ARDS), a major component of severe illness—sometimes even death—associated with the coronavirus disease (COVID-19).

What may surprise most people is just how little daily exercise—paired with day-to-day general activity—one needs to reap the benefits.

“For cardiovascular benefits, 20 minutes to an hour a day is reasonable,” said Gary Scheiner, an award-winning Certified Diabetes Educator (CDE) and Masters-level Exercise Physiologist who was diagnosed with T1D in 1985. “For cardiovascular benefits, we look for at least 20 minutes of  continuous, moderately-challenging activity. But I like to throw some resistance training—some strength training—in there as well as it’s also very beneficial.”

Scheiner, the author of six books and numerous scholarly and consumer news media articles about managing diabetes, is owner and clinical director of the Philadelphia-based Integrated Diabetes Services, LLC, an organization that helps people navigate the complexities of living with and managing insulin-dependent diabetes.

Does it really have to be every day?

That should be your goal, according to Scheiner.

“Daily activity is really best for most people with type 1 diabetes. And that goes for managing glucose levels as well as all the other associate benefits that come with it,” he said.

“Now, it’s  particularly evident with blood sugar management that people who exercise just a few days a week sort of see a waxing and waning of their body’s insulin sensitivity and blood sugar levels can actually become more challenging to control,” Scheiner added. “People who are getting some physical activity on a daily basis have much more consistency. There’s a lot to be said for having routines when you have diabetes. And having a routine of getting that physical activity daily is a very good one.”

Scheiner is living proof that daily physical activity is best.

“I’ve had type 1 for 35 years. I work out just about every day. I usually manage to get it in 6 days a week, but there’s always a day when something gets in the way,” said the father of four. “But I find the day I don’t exercise, I’m really dragging the day after.”

Does this mean I have to torture myself until I’m dripping with sweat?

Believe it or not, exercising at least 20 minutes to an hour a day doesn’t mean you need to wear yourself out to the point of exhaustion.

“Intensity is really in the eye of the beholder—what’s intense for me would kill some other people and would be nothing to other people. So it’s really dependent on the individual’s ability,” Scheiner said.

So how do you know if you’re working out at your just right intensity? It could be as  simple as the difference between talking and singing.

“I find a good way to gauge the intensity level is what we call a ‘talk method,’” Scheiner said.  “You should be able to speak in short sentences without too much difficultly. If you’re struggling to speak in short sentences, you’re probably working too hard. But if you’re able to sing, you’re not working hard enough. It doesn’t mean “sing well”—but even sing at all. If you can sing while you’re exercising, you probably need to pick up the pace. You’re probably not challenging yourself enough.”

What if I haven’t been exercising and want to start?  

If you have T1D and little to no complications with well-managed blood glucose levels, you have no reason to delay.

“You don’t have to jump in and do seven days a week,” Scheiner said. “You can start out doing a couple of days a week. Ultimately try to build up to something that’s more daily.”

Before you start, consult  JDRF’s new exercise and T1D guidelines. Different types of exercise can affect your blood glucose levels in different ways and may change your pre-workout and post-workout routines.

However, Scheiner advised that some people with T1D should use caution before ramping up their daily physical activity.

“Somebody who has unstable heart disease, they have to be pretty careful,” Scheiner said. “Somebody who has existing, proliferative retinopathy—there are certain things they just shouldn’t do.”

“It’s always a good idea for people who have had diabetes for many years to take an exercise stress test before they start,” Scheiner said. “Just to make sure there are no underlying problems. Once you pass something like that, there’s no reason to limit what you do.”

Typically, exercise stress tests are prescribed by physicians and conducted at a hospital or outpatient care clinic. Cardiac rehab patients often take these tests, but other people do, too. Usually a stress test involves walking and running on a treadmill at different intensities while a health care professional monitors your heart rhythm.

Bottom line: if you are someone who has T1D and blood glucose levels that are not well-managed or another serious underlying medical condition, consult with your physicians before you undertake any kind of new exercise regimen.

Can I break up my daily exercise into smaller chunks of time through out the day?

“To really see improvements in your cardiovascular system, you can’t do really small chunks,” Scheiner said. “It’s got to be a little bit longer. Again you’ve got to do at least those 20 minutes at a time.”

In addition, be sure you don’t fall into the trap of being what Scheiner calls becoming “actively lazy”: you exercise each day, but then do little else.

“The danger we run into with guidelines like those is that people will get those 20 to 60 minutes of activity, but then they sit and don’t move the entire rest of the day and that’s very unhealthy,” Scheiner said. “Sitting for very long stretches of time is just no good for anybody.”

Fortunately, to avoid becoming “actively lazy,” all you have to do is move.

“Find ways to be active other than scheduled things. Do you own yard work. Do your own housework. Find projects around the house or yard that involve some physical activity,” Scheiner said. “Gardening is great. Do your own landscaping, repair projects and painting. Those are things you can do to improve the quality of your home, your room, your environment and you’re burning energy while you do it. Take the stairs instead of escalators and elevators. Little things like that that we just don’t do enough of these days.”

I would exercise, but the gym is closed and I don’t have equipment

“It’s not that hard to get in a cardio workout from home, “Scheiner said. “You can do lots of different cardio exercises, including exercise videos but you can also simply put on music and dance or even jump rope—both of which can be really good for kids, too.”

“But strength training is tough because you’re used to using weights at the gym or strength training machines such as a leg press—most people don’t have those at home,” he added. “I just created my own weight set in the basement using rocks, boulders and bricks I found around the garage and my yard. I call it my ‘Neanderthal weight room,’” Scheiner joked.

Other at-home weight training hacks include using bottles of water, or bags of rice or even pet food—so long as they are secure and are a weight that you can safely lift while challenging yourself.

“Most people have all these loose change jars sitting around the house—we have one that weighs about 45 pounds. You can build your own weight set with things like that,” Scheiner offered.

Don’t forget, it’s also good for your mind

“The psychological benefits of exercise cannot be overstated,” Scheiner said. “Especially now when people are kind of confined and there are all of these health threats.”

“Anything we can do to make ourselves feel better mentally is just as important as the physical part. Exercise is a great way to relieve stress and feel good about ourselves. When you build a routine of diabetes self-care, part of that should be daily exercise.”

Facebook Live with Gary Scheiner, MS, CDE

We're live with Gary Scheiner, MS, CDE who's speaking about his experiences during the COVID-19 pandemic both as a CDE and a person living with type 1 diabetes (T1D).Don't forget to leave your questions for Gary in the comments!

Posted by JDRF on Friday, May 8, 2020
Watch Gary Scheiner’s JDRF Facebook Live event from Friday, May 8. He answers questions about exercise and T1D, and how living with T1D inspired his career.

By Maggie Barrett