Diabetic patients should be familiar with their individual
blood glucose patterns and should be taught to recog-
nize symptoms of hypoglycemia and hyperglycemia.
•Exercise is safe when diabetes is under good control
(serum glucose of 90–140 mg/dL). Diabetic patients
should eat approximately 1–3 h before exercise. The
content of the meal should be tailored in accordance
with estimated intensity, duration, and energy expen-
diture of the exercise session.
•Type I diabetic patients should administer insulin in
the abdomen (away from exercising muscle groups
that delay absorption) 1 h prior to exercise. If the pre-
activity serum glucose is less than 100 mg/dL, a sup-
plemental snack should be consumed before exercise.
If the serum glucose is greater than 250 mg/dL or the
urine is positive for ketones, the exercise session
should be postponed.
- During exercise, supplemental snacks should be con-
sumed during particularly strenuous or lengthy exer-
cise. All patients should be advised to consume
adequate fluids during their exercise session. - After exercise, patients should monitor serum glucose
levels and be alert for signs and symptoms of either
hypoglycemia or hyperglycemia.
CORONARY ARTERY DISEASE
- An individualized exercise prescription is an impor-
tant secondary preventive tool for patients with docu-
mented coronary artery disease. All-cause mortality is
reduced in patients suffering a myocardial infarction
who participate in a program of cardiac rehabilitation
(Franklin BA, 2000). - The level of supervision for patients with known coro-
nary artery disease should be based on the patient’s
clinical status, vocational demands, and personal goals. - The American Heart Association has published specific
guidelines regarding staffing, supervision, and progres-
sion of cardiac rehabilitation programs for patients with
known coronary artery disease (Balady et al, 2000).
PREGNANCY
•Physical activity is safe for pregnant patients and should
be routinely encouraged. Pregnant women should accu-
mulate 30–60 min of moderate physical activity at least
three times per week (American College of Obstetricians
and Gynecologists, 1994). Vigorous sustained exercise
should be avoided during pregnancy.
- As pregnancy progresses, a pregnant woman’s center
of gravity changes, and she should be counseled to
avoid activities with a high risk of falling.- Pregnant women should avoid saunas, hot tubs, or
prolonged exercise that consistently elevates core
body temperature. - Pregnant women should be encouraged to consume
adequate amounts of fluid during exercise.
Pregnancy-induced hypertension, preterm, or prema-
ture rupture of membranes, preterm labor, persistent,
or unexplained vaginal bleeding or intrauterine
growth restriction are all contraindications to exercise
during pregnancy (American College of Obstetricians
and Gynecologists, 1994).
- Pregnant women should avoid saunas, hot tubs, or
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