Sanjay Kalra ( Department of Endocrinology, Bharti Hospital & BRIDE, Karnal, India. )
Hitesh Punyani ( Department of Diabetology, Chaitanya Cardio Diabetes Centre, New Delhi, )
Nitin Kapoor ( Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) -632004, India, and Non Communicable Disease Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. )
While guidelines recommend 30 to 60 minutes of physical activity daily, in order to manage diabetes or lose weight, it is difficult to motivate patients to do so. A wide variety of factors, ranging from biomedical (metabolic and musculoskeletal) to psychological and social, contribute to this. This communication describes socially accepted indigenous forms of physical activity, exercise and sports, which are easy to initiate and sustain. This information empowers physicians and other health care professionals to encourage lifestyle modification in a person-centred, community-oriented manner.
Keywords: Exercise, Lifestyle modification, Obesity, Physical activity, Sports, Type 1 diabetes, Type 2 diabetes.
Diabetes is becoming more and more frequent in South Asia, as in other parts of the world.1 The first line therapy of diabetes is lifestyle modification, which includes structured physical activity. At least 30 minutes of exercise daily is recommended in order to manage obesity, and this requirement doubles if one wishes to lose weight. While this fact is known to most practitioners, few are able to motivate their patients to exercise regularly.
Multiple factors play a role in preventing persons living with diabetes from exercising. These include biomedical factors such as poor physical conditioning, poor cardiorespiratory reserve, joint and bone dysfunction, sarcopenia, and mechanical obstruction due to obesity.2 Psychological factors include lack of will power, perceived lack of ability to exercise, and perceived lack of benefits of exercise. Social factors play an important role, especially in the South Asian context. South Asian society offers little encouragement or incentive to exercise, and there are few opportunities for physical activity or sports in a safe manner. Especially for girls and women. The entire socio-environmental milieu is such that it becomes challenging for the person living with diabetes to begin, and then maintain, a proper exercise regimen.
Motivation strategies to combat obesity have been discussed earlier in this journal.3 The same approach can be used in persons living with obesity. Remember to follow a hierarchy (begin with flexibility and balance exercises, followed by aerobics, and lastly resistance exercises) in an exercise-naïve individual.2
At times however, these tactics are insufficient. The astute physician should be able to tap into the psychosocial strength and resilience of the individual, and utilize these for motivation4 (Table-1). This requires in depth knowledge of the psychological as well as sociocultural background of the person. The role of a good diabetes educator and the importance of enrolling patients into a peer support programme is of paramount importance in helping a patient to initiate and start exercise.
We suggest some methods of indigenous and socially acceptable exercises, which can be advised to persons living with diabetes (Table-2). Do remember to advise these to the entire family, as they will work in both prevention and management of the syndrome. Our suggestions incorporate socially appropriate interventions, while using religion or family bonding as a motivational tool. Each individual will have his or her own unique motivational factors, and it is up to the physician to assess, explore, identify and utilize these factors to operationalise exercise regimens.
We highlight the special care needed for persons living with diabetes to initiate, incorporate and indefinitely maintain exercise regimens. We suggest indigenous forms of physical activity which can be suggested in a South Asian context, and hope that this will encourage physicians to begin exercise prescription.
1. Glovaci D, Fan W, Wong ND. Epidemiology of diabetes mellitus and cardiovascular disease. Curr. Cardiol. Rep.. 2019; 21:1-8.
2. Kalra S, Mandlekar A, Kapoor N. Exercise therapy for the exercise naïve: The first step in obesity management. J Pak Med Assoc 2021; 71:2828-30.
3. Kalra S, Arora S, Kapoor N. The motivation-opportunity-capability model of behavioural therapy-the vital component of effective patient centric obesity management. J Pak Med Assoc 2021; 71:1900-1.
4. Unnikrishnan AG, Kalra S, Garg MK. Preventing obesity in India: Weighing the options. Ind J Endocr Metab 2012; 16:4-6.