activity
for patients with diabetes
A noncommunicable disease education manual for primary health care professionals and patients
Physical
activity
for patients with diabetes
A noncommunicable disease education manual for primary health care professionals and patients
The Noncommunicable Disease Education Manual for Primary Health Care Professionals and Patients results from the contributions and hard work of many
people. Its development was led by Dr Hai-Rim Shin, Coordinator, and Dr Warrick Junsuk Kim, Medical Officer, of the Noncommunicable Diseases and Health
Promotion unit at the WHO Regional Office for the Western Pacific (WHO/WPRO/NCD) in Manila, Philippines.
WHO graciously acknowledges the intellectual contributions of Dr Jung-jin Cho, Co-director, Community-based Primary Care Project Committee and Professor,
Department of Family Medicine, Hallym University Sacred Heart Dongtan Hospital, Republic of Korea; Dr Hyejin Lee, Volunteer, WHO/WPRO/NCD (currently PhD
candidate, Department of Family Medicine, Seoul National University, Republic of Korea); Ms Saki Narita, Volunteer, WHO/WPRO/NCD (currently PhD candidate,
Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan); and Mr Byung Ki Kwon, Technical Officer, WHO/WPRO/NCD
(currently Director, Division of Health Promotion, Ministry of Health and Welfare, Republic of Korea).
Many thanks to Dr Albert Domingo, Dr Sonia McCarthy, Ms Marie Clem Carlos, Dr Katrin Engelhardt, Mr Kelvin Khow Chuan Heng and Dr Roberto Andres Ruiz
from the WHO Regional Office for the Western Pacific and Dr Ma. Charina Benedicto, Physician-in-Charge, Bagong Barangay Health Center & Lying-in Clinic,
Pandacan, Manila, Philippines for reviewing the draft publication.
Financial support for this publication was received from the Korea Centers for Disease Control and Prevention, Republic of Korea.
This is a translation of a manual published by the Ministry of Health and Welfare and Community-based Primary Care Project Committee in the Republic of Korea.
Some of the content has been adapted, with permission, to align with current WHO recommendations and policies. However, the views expressed in the manual
do not necessarily reflect the policies of the World Health Organization. The source publication was developed under the leadership of Dr Jung-jin Cho (also
mentioned above); Mr Hyunjun Kim, Co-director, Community-based Primary Care Project Committee and Director General, Bureau of Health Policy, Ministry of
Health and Welfare, Republic of Korea; and Dr Sunghoon Jung, Deputy Director, Division of Health Policy, Ministry of Health and Welfare, Republic of Korea.
Photo credits
WHO: pages 7, 8, 27-28
Shutterstock: pages 5, 6, 19, 20, 25-26, 29-30
This will be used in the form of a flip chart for health professionals to educate their patients with either
hypertension or diabetes.
140
mmHg
90
mmHg
*Age more than 80: blood pressure to be controlled below 150/90 mmHg
11 FOR PATIENTS
understanding. A small image of the For patients side is included so that the
evaluating your current health status and risk 140/90 mmHg for hypertension combined with
factors. cerebrovascular disease and atherosclerosis.
Systolic blood Diastolic blood For those under age 80 maintain below 140/90
pressure pressure
140
mmHg
90
mmHg
*Age more than 80: blood pressure to be controlled below 150/90 mmHg
REFERENCE:
James, Paul A., et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
JAMA, 2014, 311.5: 507-520.
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This publication is intended to serve as a template to be adapted to national context. Images and graphs
that have been watermarked should be replaced with images or graphs that represent the national
situation. If assistance is required, or if you have any questions related to the publication, please contact
the Noncommunicable Diseases and Health Promotion unit at WHO Regional Office for the Western Pacific
(wproncd@who.int).
Table of contents
Module 5
Physical activity for patients with diabetes
Why exercise?
Helps to maintain healthy body weight
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Physical activity for patients with diabetes
Why exercise?
Helps to maintain healthy body weight
Decreases risk factors
- reduces blood pressure
- reduces blood cholesterol levels
- enables better blood sugar level control
Prevents complications
- prevents atherosclerosis
- prevents angina, myocardial infarction
and stroke
Improves quality of life and relieves stress
REFERENCE:
Anish, Eric J., Chris A. Klenck. American College of Sports Medicines Primary Care Sports Medicine 2nd Edition. 2007.
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Physical activity for patients with diabetes
Dizziness
Uncontrolled hypertension
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Physical activity for patients with diabetes
REFERENCE:
Canada - Physical activity readiness questionnaire. 1st ed. 2016 (http://icord.org/wp-content/uploads/2015/08/PARmed-X.pdf, accessed 28 September 2016).
4 FOR PHYSICIANS
Physical activity for patients with diabetes
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Physical activity for patients with diabetes
REFERENCE:
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015.
6 FOR PHYSICIANS
Physical activity for patients with diabetes
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Physical activity for patients with diabetes
REFERENCES:
Diabetes basic physical activity course. Centers for Disease Control and Prevention, Republic of Korea. 2016. (http://www.kncd.org/down/sub09/01/9_1_2_5.pdf, accessed 28 September 2016).
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015\.
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Physical activity for patients with diabetes
Walking Cycling
Do not lift Should be light
weights that enough to lift at
Swimming are too heavy least eight times
comfortably
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Physical activity for patients with diabetes
REFERENCES:
Cornelissen, Vronique A., et al. Impact of resistance training on blood pressure and other cardiovascular risk factors a meta-analysis of randomized, controlled trials. Hypertension, 2011,
58.5: 950-958.
Physical Activity Guidelines Advisory Committee, et al. Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services, 2008: A1-H14.
Mancia, Giuseppe, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension
(ESH) and of the European Society of Cardiology (ESC). Blood pressure, 2013, 22.4: 193-278.
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Physical activity for patients with diabetes
AGES:
INSERT IMts in your country
spor
Common leisure
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Physical activity for patients with diabetes
REFERENCES:
Ainsworth, Barbara E., et al. 2011 Compendium of physical activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011, 43.8: 1575-1581.
Mancia, Giuseppe, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension
(ESH) and of the European Society of Cardiology (ESC). Blood Pressure, 2013, 22.4: 193-278.
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Physical activity for patients with diabetes
At least 75 minutes/week
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Physical activity for patients with diabetes
REFERENCE:
Ainsworth, Barbara E., et al. 2011 Compendium of physical activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011, 43.8: 1575-1581.
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Physical activity for patients with diabetes
Weight-bearing
physical activity
Enhances body flexibility
- reduces injury risk
Increases basal metabolic rate
- helps control weight
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Physical activity for patients with diabetes
Weight-bearing
physical activity
Enhances body flexibility
- reduces injury risk
Increases basal metabolic rate
- helps control weight
REFERENCE:
World Health Organization. Global recommendations on physical activity for health. 2010.
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Physical activity for patients with diabetes
Types of muscle-strengthening
exercises
Lifting objects
Resistance bands
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Physical activity for patients with diabetes
REFERENCES:
ACSM Brochures. American College of Sports Medicine. 2016. (http://www.acsm.org/public-information/brochures, accessed 28 September 2016)
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015.
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
REFERENCE:
World Health Organization. Global recommendations on physical activity for health. 2010.
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
REFERENCE:
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015.
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Physical activity for patients with diabetes
Conditions Actions
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Physical activity for patients with diabetes
REFERENCE:
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015.
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Physical activity for patients with diabetes
Include stretches
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Physical activity for patients with diabetes
REFERENCES:
Physical activity advanced course. Centers for Disease Control and Prevention, Republic of Korea. 2016.(http://www.kncd.org/down/sub09/01/9_1_1_6.pdf, accessed 28 September 2016).
World Health Organization. Global recommendations on physical activity for health. 2010.
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Physical activity for patients with diabetes
Absolute contraindications
Heart disease: pathologic arrhythmia
Relative contraindications
Other heart disease
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
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Physical activity for patients with diabetes
REFERENCES:
Physical activity basic course. Centers for Disease Control and Prevention, Republic of Korea. 2016.(http://www.kncd.org/down/sub09/01/9_1_1_5.pdf, accessed 28 September 2016).
Weber, Michael A., et al. Clinical practice guidelines for the management of hypertension in the community. The Journal of Clinical Hypertension, 2014, 16.1: 14-26.
National Institutes of Health, and National Heart, Lung, and Blood Institute (United States). Your guide to lowering blood pressure. NIH publication, 2003, 03-5232.
Chobanian, Aram V., et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension, 2003, 42.6: 1206-1252.
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Physical activity for patients with diabetes
Take-home message
Physical activity
Chest pain
Dizziness
Fatigue
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Physical activity for patients with diabetes
Take-home message
Physical activity
Patient education
Regular physical activity is important to
maintain health and prevent cardiovascular
complications.
However, be cautious of starting new exercises
that are beyond your current fitness level.
If you have diabetes, drink ample fluids, always
carry light snacks in case of hypoglycaemic
attacks, and examine your feet for injuries after Check your physical fitness and limitations.
exercising. Drink sufficient fluids.
In case of chest pain, dizziness, or severe Carry light snacks or candies in case of
fatigue during exercise, stop immediately and hypoglycaemia.
consult your doctor. Examine your feet after exercising
- look for injuries: early treatment is important.
Chest pain
Dizziness
Fatigue
REFERENCES:
World Health Organization. Global recommendations on physical activity for health. 2010.
American Diabetes Association. Standards of medical care in diabetes2015. Diabetes Care, 2015.
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