Aerobic training programs in diabetes should consist of moderate to low impact (to guard against injury to feet and lower legs), and should be built up to regarding both intensity and time. Starting with walking is one of the most beneficial forms of exercise in diabetes, and for those with lower extremity problems, using arm crank exercises or other non-impact aerobic machines is also beneficial.

Progressive resistance programs for diabetic persons should consist of moderate weights to improve muscle tone and posture, and improve their blood sugar control. Because these patients may have had diabetes for a long time, it is important for them to have visited their doctor, and have had a medical exam before participating in any regular program. Physicians are responsible for administering the initial medical screen and stress test. They should also be involved in follow up routine exams to monitor patient progress in their diabetes management. If the patient has any questions about an exercise program, the doctor should be familiar with personnel who are trained in the area, and are willing and capable of working with their patient in prescribing exercise.

Recommendations
The following table highlights information for exercise and diabetes.
General recommendations

1. Carry a home glucose monitor and use it before and after each aerobics class. Record blood sugar values.

2. Carry some available short acting glucose solution and know when to use it. (apples, orange juice boxes, hard candy are excellent examples).

3. Have identification handy in case of an emergency. Instructors should know that if a member becomes dizzy, faint-like, or drunk-like, then some glucose feeding may be necessary. Life Savers, or a sugar drink (orange juice) should be administered without reservation within seconds of the beginning of these symptoms. Call for medical assistance. The best assurance against insulin shock (hypoglycemia), is to test blood sugar levels before EACH session.

1. Glucose <100 or >300 mg/dl means NO exercise until food or insulin is administered.

2. Diabetic complications usually mean that exercise is not medically advised. If a new member has a diagnosis of any complication, check with their physician before starting any program.

3. Outward signs of blisters on hands or feet, cardiac problems, high lipid levels.

4. Excessive amounts of weights lifted (>50% of estimated maximal voluntary contraction) for persons with overt complications, or physician recommendation.

5. Performing Valsalva Maneuver while training