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Just 15 to 20 minutes of cardiovascular exercise 3 or 4 days a week done the right way can help prevent heart disease, but diabetics need to get an EKG and get blood sugar levels in control first.

What Diabetics Need to Do Before They Start Cardiovascular Training

Cardiovascular exercise focuses on increasing circulation. It has become associated with what has come to be termed aerobic exercise. A slow walk in the woods, a nice long swim at a gentle pace, or maybe a few minutes on an exercise bike that require just a little harder breathing than normal have come to be known as both "aerobic" and "cardiovascular" exercise.
The kind of cardiovascular exercise that does diabetics good, however, isn't a slow walk in the woods or a nice gentle swim or a few minutes on an exercise bike. The kind of cardiovascular exercise that helps diabetics lower their blood sugar levels and lower their long-term risk of heart and vascular disease requires huffing and puffing and getting out of breath. This kind of exercise is anaerobic, not aerobic.

When we work out so hard that our lungs cannot keep up with the demand of oxygen from our muscles, the muscles start making energy without oxygen. This process is called anaerobic respiration. It uses 34 times as much sugar to make the same amount of energy as aerobic exercise. Since the end product of using sugar for fuel without oxygen is lactic acid and lactic acid causes a burning sensation in the muscles, any diabetic will know when he or she is working out hard enough that exercise has become anaerobic. Just a minute or so under these conditions will make a measurable difference in blood sugar control for 24 hours or so—when the exercise can be done all over again.

Diabetics can do anaerobic exercise by sprinting on a track, swimming in cold water at a maximum pace, or maybe by taking up freestyle rock climbing. But because most diabetics also have other health conditions, it's usually a better idea to get maximal exercise in a gym by pedaling fast on a stationary bike or working out extra hard on a stair master or elliptical trainer—with other people nearby for the rare possibility that something will go wrong.

How can you tell if your exercise is really in the anaerobic range? The easiest way to do this is to use an exercise machine that measures your pulse. You are exercising in the anaerobic range when your pulse is about 70% of your maximum beats per minute, estimated by using the formula 220-minus your age. If you are 60 years old, for example, your predicted maximum pulse rate is 160 and you should aim to work out hard enough to keep your pulse at 70% of 160 or 112. If you are 16 years old, your predicted maximum pulse is 204 and you should aim to work out hard to enough to keep your pulse at 70% of 204 or 143.

About 15 minutes at your target heart rate burns some carbs and calories and helps keep your heart and blood vessels in good shape. If you can't exercise as fast as the formula says you should, don't worry. You can gradually get in better shape by doing a warm up for 3 to 5 minutes and then exercising all out for just 20 seconds at a time—then falling back to your regular pace for the rest of your workout. But there are two things you should do before you start working on your cardiovascular fitness.

Every diabetic needs to have had an EKG. This simple, inexpensive test can help your doctor find hidden heart damage that might be catastrophically evident when you started your exercise routine.

And every diabetic needs to get blood sugar levels down at least to the 170 mg/dl (9.4 mmol/L) range before starting to work out. The stress of working out causes the liver to release sugar, and working out when your blood sugar levels are already high may actually raise your blood sugars rather than lowering them.

Working out hard for 15 or 20 minutes 3 or 4 times a week is all diabetics need to do for cardiovascular fitness. But that doesn't mean they can't do lighter "aerobic" exercise just for fun. Only hard exercise helps keep diabetes in control, but any kind of exercise can enhance quality of life.