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  Reprinted from Mature Fitness (formerly published as the Senior Fitness Bulletin) by
 permission of the American Senior Fitness Association (800) 243-1478,


Programming for Special Conditions

By Karl Knopf, Ed.D.



Karl Knopf, an SFA National Advisory Board member, is professor of Adapted Physical Education at Foothill College, Los Altos, California. He is the author of "Fitness After Fifty" and the director of Fitness Educators of Older Adults (FEOAA), a professional organization that conducts workshops approved for SFA continuing education credit. SFA members receive discount rates on FEOAA services. For more information, contact Dr. Knopf at 759 Chopin Dr., Suite 1, Sunnyvale CA 94087 (408/450_1224). Website: .


Studies suggest that exercise can positively influence the course of diabetes. The United States Center for Disease Control estimates that one out of every 17 Americans has diabetes. Diabetic populations develop cardiovascular disease at an earlier age and with a greater severity than do people who do not have diabetes. It has long been recognized that diabetes accelerates the arteriosclerotic process and is considered an independent risk factor for heart disease __ right along with obesity and high blood pressure. Diabetes not only can contribute to heart disease but can also contribute to blindness and the loss of limbs due to poor circulation. ( I spent many years working with visually impaired people who had lost their vision secondary to diabetes, and as a young therapy intern I had to observe an amputation of a leg secondary to diabetes. The bottom line is that diabetes is not a simple and common condition to be dismissed as just a blood sugar imbalance.)

There are two distinct forms of diabetes: type 1 or insulin-dependent diabetes mellitus and type 2 non-insulin-dependent diabetes mellitus. For those of us who work with the older adult population it is important to be informed about type 2 diabetes since about 90 percent of the diabetic population has this form of the disease. Whereas type 1 is characterized by an absolute insulin deficiency caused by an auto immune destruction of the insulin-producing beta cells of the pancreas, type 2 is characterized by a relative insulin deficiency.

Many experts in this field believe that proper lifestyle changes can and will positively influence the course of this disease. Many doctors suggest that the first course of treatment for a person with adult onset diabetes is to get more active and lose weight.

The Role of Exercise and its Benefits

The interplay between exercise and diabetes is a critical one. This is because of the way in which exercise influences metabolism. Exercise contributes to glucose control, weight control, and stress management.

In short, exercise helps! It has been seen to:

1. Improve glucose uptake and help control glucose levels.

2. Promote weight control. Reduction of excess body fat has been shown to decrease insulin resistance.

3. Help regulate stress level. Or, said another way, exercise de-stresses the body. DIS-stress (bad stress) can disrupt the diabetic's ability to maintain the delicate balance of hormones, ketones, free fatty acids, and urine output.

General Cautions

1. Avoid stressful activities to the feet.

2. Avoid exercise when blood sugar levels are greater 250 mg/dl. (Consult patient's physician for specific guidelines.)

3. Avoid exercise if blood pressure is elevated above 160 systolic/100 diastolic. (Consult physician for specific recommendations.)

4. Avoid exercising in extreme weather conditions.

5. Avoid heavy training with clients who have retinopathy, a disorder of the retina resulting in impairment or loss of vision. (Retinopathy is usually due to damage to the blood vessels of the retina, occurring, for example, as a complication of diabetes or high blood pressure.)


1. Aerobic exercise should be done most days of the week at a comfortable pace as tolerated (50 to 70% maximum VO2 for 20_40 minutes).

2. Monitor blood sugar levels and blood pressure.

3. Clients who experience hypoglycemic reactions should have quick sugar on hand.

4. Never exercise on an empty stomach and have plenty of fluids available.

5. Always warm up and cool down.

6. Always stay alert to the potential for hypoglycemia and diabetic coma.


1. Have clients obtain medical clearance and a stress ECG (electrocardiogram).

2. Make sure that your clients are aware of the effects that their medication will have on exercise.

3. Remind your clients to be mindful of foot hygiene and to carefully monitor the healing process with regard to cuts.

4. Encourage clients to adopt exercise and activity as a way of life.

5. Make exercise fun!


Lasko & Knopf. (1994). Adapted physical education for adults with disabilities. Dubuque, IA: Bowers Publishing.

FEOAA. (1998). Adults with chronic conditions (an FEOAA Training Manual).

American Diabetes Association. Alexandria, VA. Telephone: 703_549_1500.

Center for Disease Control. Atlanta, GA. Telephone: 770_488_5015.

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