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APTA Guidelines for Diabetics
APTA diabetic precautions to exercise
• Nephropathy
o SBP should not rise above 180 mm/hg
o Avoid weight lifting, breath holding or high-intensity aerobic exercise
• Retinopathy
o Avoid head jarring activities
o Avoid valsalva
o Avoid position with the head below the waist
o SBP should not rise above 20-30 mm/Hg above RBP
• Autonomic Neuropathy
o Monitor blood glucose signs more closely.
o Monitor for signs and symptoms of silent ischemia (dyspnea, diaphoresis,
orthostatic hypotension
• Be aware of A1C values-generally below 7% is considered good control
• Fast acting carbohydrate must be carried at all times.
• Carbohydrate should be ingested if glucose levels are <70 mg/dl
• Vigorous exercise above 80% of Karvonen can cause hyperglycemia after
exercise.
• Fluid ingestion should occur before, during and after exercise.
• Proper foot wear/vigilant foot inspection should be performed.
• Exercise should be avoided prior to going to bed
• Rotate insulin injection sites away from active muscles.
• ID must be carried at all times
Relative contraindications requiring close monitoring
• Age >40, w/ or w/o CVD risk factors other than DM
• Age > 30 yrs and any one or more of the following:
o Type 2 DM of > 10 yrs
o Cigarette smoking
o Dyslipidemia
o Proliferative or preproliferative retinopathy
o Nephropathy, including microalbuminuria
• Any of the following, regardless of age:
o Known or suspected CAD, CVD, and/or PVD
o Autonomic neuropathy
o Advanced nephropathy with renal failure
Absolute contraindications to exercise
• Ingesting alcohol 3 hours prior to exercise
• Hypoglycemia < 70 mg/dl. Symptoms include:
o Shakiness
o Dizziness
o Sweating
o Hunger
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