Q:My son has diabetes and, as a result, many problems with his feet. He has had to have surgical implants, has Charcot neuropathy in the left foot, and has had three toes amputated on the right foot, including the great toe. He is getting weaker due to no exercise or muscle strengthening, and his balance is in jeopardy. What kinds of exercises can he do?
A: Exercise is a crucial component to controlling diabetes because it builds muscle and controls weight, both of which help lower blood sugar. Exercise is particularly effective when neuropathy (degeneration of the nervous system) starts affecting the extremities. This is because exercise improves the blood flow, which is crucial to the microvascular system in the feet, eyes, legs and kidneys — all areas of particular concern to diabetics.
Charcot neuropathy (defined as “a progressive deterioration of weight-bearing joints, usually in the foot or ankle”) and surgical implants will most likely require non- weight-bearing activities. But to be sure that the implants are not disturbed or jeopardized, you should check with an orthopoedic surgeon before proceeding with any exercise program.
Diabetes educator Bonnie Jortberg of the University of Colorado at Denver and Health Sciences Center suggests non-weight-bearing activities. “Diabetic neuropathy is a result of decreased blood flow to the extremities. Several studies have shown that regular physical activity can increase blood flow and prevent and even improve neuropathy,” Jortberg says.
Building muscle, improving the cardiovascular system, and working on regaining balance (and, therefore, confidence) are the three areas to be focused on right away. The tools suggested as a starting point are some resistance bands, a few sets of hand weights, and a stability ball with a support tray for the ball to sit on. The tray is helpful because it will keep the ball from rolling too much while the balance improves yet still allow for a full range of exercises to be properly executed.
Using a ball instead of a chair is suggested because sitting on an unstable surface will stimulate and strengthen the core muscles of the abdomen and back, which help improve balance.
Lifting weights builds muscle. In the process of building muscle, the bones are also positively affected. Basic exercises performed with resistance bands or dumbbells while sitting on a ball are presses for the chest and rows or pulls for the back, shoulder presses, triceps extensions and biceps curls. Standing up from a seated position and sitting back down on the ball are good for the legs and for balance.
Most of the stability balls come with either a poster or DVD that teaches the proper use of the equipment, as well as suggestions for other exercises.
The TRX Suspension Training System is another fine option because it uses body weight to supply the resistance. It can easily be rigged in the house by purchasing the over-the-door attachment.
Cardiovascular exercise can also be accomplished on a ball simply by allowing yourself to “butt bounce” on it while seated. Swimming and water aerobics are great for aerobic improvement, too.
Linda J. Buch is a certified fitness trainer in Denver; linda@ljbalance.com
