Q: I have problems with my feet because of diabetes: I have Charcot neuropathy and surgical implants in one foot and two toes amputated on the other. My balance is now very problematic and I am afraid I will get too weak to remain independent if I do not exercise. What are the best exercises to do? — Anonymous, Nyack, N.Y.
A: Exercise is a crucial component to controlling diabetes because it builds muscle and controls weight, both of which help to 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 orthopedic surgeon before proceeding with any exercise program.
We consulted with registered dietitian Bonnie Jortberg, a diabetes educator and senior instructor in the department of family medicine at the University of Colorado Denver School of Medicine: “It sounds like you could participate in 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 said.
Building muscle, improving the cardiovascular system, and working on regaining balance (and, therefore, confidence) are the three areas to be focused on right away.
Tools: Start with 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 your 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 to improve balance.
Lifting weights builds muscle. In the process of building muscle, the bones are also positively affected. Basic exercises performed with resistance bands and/or dumbbells while sitting on a ball include 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 a DVD that teaches the proper use of the equipment, as well as suggestions for other exercises.
Cardiovascular exercise can also be accomplished on a ball simply by allowing yourself to “butt bounce” on it while seated. Swimming or water aerobics are great for aerobic improvement, as well.
Once you feel ready to do more walking, learn how to use walking poles. These can greatly enhance bilateral stability and balance and, because they engage the muscles of the upper body, the benefit to improved overall strength — and confidence — is enhanced.
Linda J. Buch is a certified fitness trainer in Denver; linda@ljbalance.com.
Where to get the equipment
Order a stability ball from Ball Dynamics, , or 1-800-752-2255.
Dumbbells (or one of the new compact hand-weight systems) and resistance bands can be purchased at any sporting goods store.
Walking poles can be purchased at REI ().
Instructional DVDs and Books:
Walking poles: DVD, PolesFor
“The Resistance Band Workout Book,” Ed McNeely, Burford Books, 2006, $16.95
“Strength Training for Beginners,” Joan Bassey, Ph.D. and Susan Dinan, HarperCollins, 2003, $21.95
“Weights on the Ball Workout,” Steve Stiefel, Ulysses Press, 2004, $14.95
Linda J. Buch
