Diabetes is a metabolic disorder characterized by hyperglycemia (high glucose levels) and glycosuria and occurs because of relative deficiency or diminished effectiveness of insulin – a hormone secreted by Pancrease, which regulates, the carbohydrate metabolism. Diabetes the future epidemic, having three hundred million patients at present throughout the world creating measure challenge towards human resource and toward medical science. W.H.O. has projected that the global prevalence of type II DM will double from 135 million to 300 million in developing countries by the end of the year. In developing countries the incidence of occurrence is greater, with India leading with 58 million potential patients. Diabetes usually manifests itself in adult life. Type II DM forms 95% of all Diabetes cases. Diabetes is also the major cause of blindness in the age group of 30-60, and each year more than 30,000 people lose their sight. It has veritable tendency to develop ketoacidosis, ocular complication, diabetic cataract, diabetic retinopathy, nephropathy, neuropathy, skin and muscle membrane complication.
Modern civilization and its life style are the prime causes of this disease. Excessively starchy diets, the manner in which we eat and drink, our intake of tinned or preserved food, the preservatives used in such food and beverages, the mental stress and strain to which a man is exposed today all these contribute to the occurrence of diabetes mellitus The comforts of life that modern science and technology have provided to human being have become a curse in disguise. Man has conquered the heat and cold by air-conditioning and distance by speedy vehicles and easy communication. It appears as if he has nothing to do except to think and a part of this thinking process has also been shared by modern electronic devices like computer. This absolute and unnatural rest to the body, a gift of modern civilization has made man prone to several diseases including diabetes.
A few who are conscious of this situation try to remedy it by some form of physical exercise at home. It nevertheless insufficient in comparison to what the body really needs. If the man has to overcome diseases, he has no other way but to go nearer to the nature.
The treatment of diabetes include in three phases
1. Diet control.
A lot of medicines are available in allopathic in every corner of the world. But a number of cases are coming to picture although a number of medicaments are available. So physician should give more stress on diet and exercise.
The practice of Yoga particularly Pranayam is very useful in diabetes mellitus It has shown that B.S.L. dropped appreciably after Pranayam. The yoga asanas which have been useful in control of diabetes can be practiced as follows.
15 minutes to 30 minutes as required.
Pranayam – 5 minutes
Dhyan, Dharana, Samadhi – 10 minutes.
Asanas Like Surya Namaskar, Uttan Padmasan, Bhujangasana, Shalabhasana, Paschimoottasana, Ardhachakrasana, Masyendrasana, Supta vajrasana, Shaavasana, Halasana, Mayurasana, Siddhasana, Shirsasana.
Though regular exercise form an important component of therapy in patients with type II Diabetes, while incorporating an exercise programme in the treatment schedule, appropriate monitoring should be done to avoid complications.
Evaluation of patient before exercise
Evaluation of patient should be done according to the complications or conditions. Because screening of the patient is necessary to give proper advice about exercises.
Before embarking on a moderate to high intensity exercise programme an assessment of the cardiovascular risk status of the individual should be performed.
Any individual with any of the cardiovascular risk factors will need to undergo a graded exercise test.
For patients who have proliferate diabetic retinopathy, strenuous activity may precipitate vitreous haemorrhages or traction retinal detachment.
These individuals should avoid exercises which are straining and jarring.
Patients with overt nephropathy often have a reduced capacity for exercise high intensity of strenuous exercises should therefore be avoided.
Peripheral Nephropathy results in loss of protective sensation in the feet.
Significant peripheral neuropathy is an indication to limit weight-bearing exercises. Repetitive exercises in insensitive feet can lead to ulceration and fractures. Patients should wear proper footwear and monitor blisters and other potential damage to the feet before and after an exercise session.
Presence of autonomic neuropathy may limit and individuals exercise capacity and increase the risk of an adverse cardiovascular event during an exercise.
Hypotension and hypertensions are more likely to develop in exercising patients with autonomic neuropathy. These patients also have difficulties in thermoregulation and should be advised to avoid exercises in extremely hot or cold environments and to be careful about their hydration.
GENERAL PRINCIPLES FOR EXERCISE IN DIABETES
Screening should be done for vascular and neurological complication including silent ischemic heart disease.
Exercise must be done regularly and aerobic type of exercise is the best form of exercise. Plain brisk walking is the simplest and safest of all exercises.
- All the aerobic (isometric) exercise like badminton, tennis and basket ball improve the cardio-respiratory functions and utilize a large portion of muscles mass. On the other hand isometric exercise like weight lifting, sustained handgrip are to be avoided in diabetes as they increases the arterial pressure and precipitate angina.
- The duration of exercise should be 30-60 minutes and any exercise should have a warming up and cooling down period of 5-10 minutes. Frequency of exercise is 5 days a week.
- The ideal time for exercise is on an empty stomach in the morning or evening.
- Most diabetics may need to reduce the dose of insulin and oral drugs during regular exercise.
- The drug that a patient is receiving should be ascertained and their possible interaction with exercise should be assessed.
- Exercise in elderly diabetes cases are very much essential for better results but many of the elderly patients tend to avoid physical exercise.
There is a progressive decline in insulin sensitivity, muscles mass, strength and loss of mineral from the bones with increasing age. Regular physical exercise can prevent and reverse their changes. With exercise a better quality of life is attained with reducing in the burden of chronic vascular disease.
Arthritic patients – It is better for them to do upper body exercise.
Pregnant ladies – Better to recommend walking and not to recommend upper body exercise.
Benefits of exercise
- Improvement in insulin sensitivity
- o Reduction of hypertension
- Reduction in weight
- Improvement in lipid profile reduces serum tryglycendes and increases particularly HDL-2 cholesterol.
- Improvement in cardio vascular function.
- Improvement in quality of life.
Some specific methods of Asanas useful for Diabetic patients
Surya Namaskar is effective in loosening, massaging and toning of the joint muscles and internal organs of the body. This set of asana was not regarded as a part of Hatha Yog. It activates the production of the vital energy or life force in the body. It generates heat and aids in the purification of the physical body. Salutations to the sun balance the solar energy and bring about a state of harmony at both mental and physical levels.
The practice consists of 12 postures.
1. Pranamasana (prayer pose)
2. Hasta Utthanasana (Raised arms pose)
3. Padahastasana (hand to foot pose)
4. Ashwa sanchalanasana (equestrion pose)
5. Parvatasana (Mountain pose)
6. Asthanga namaskar (salute with eight parts)
7. Bhujangasana (colbera pose)
8. Parvatasasana (Mountain pose)
9. Ashwa sanchalasana (equestrian pose)
10. Padahastasana (head to foot pose)
1 1. Hasta Utthanasana (Raised arms pose)
12. Pranamasana (prayer pose) Contraindication
Not to be practiced by people with high blood pressure, coronary artery disease, hernia, instestinal tuberculosis. Those with back pain should do it under guidance. Women should not practice it during menstruation.
It stimulates and balances all the body system, it prevents degeneration of the pineal gland and hypothalamus makes rhythmic breath possible and supplies oxygenated blood to the brain.
Bhujangasana (Serpent pose)
Lie down straight on the face, stretch out the legs and feet as far as possible keeping them close together, place the palms on the ground close beside your chest but not for any support now raise up the head slowly then bending the spine and neck so as to look up to the sky, the feet and the umbilicus must remain on the ground. The hands will not be used as a support, though a little strain on them may take place at the beginning but this reduces much of the benefit of the exercise meant for the nerves and muscles around the spinal column.
It tones up the nerves and muscles of the heart together with those of the abdomen and back. The air cells of the lungs are toned up by this asana. Besides it is a great aid to curing female diseases like leucorrhoea, menstrual difficulties etc.
Lie down straight on the face and rest the chin on the ground, place the hands with clenched fists along the thighs, now raise up any one leg as far as possible while keeping it perfectly straight, stay for a few second at this position and lower the leg down. Do the same with the other leg, repeat this process 3-4 times with each leg at the third stage, raise up both legs together and that at least 7-8 inches above the ground on the support of the clenched hands stay at that position for a few seconds and repeat this sequence initially for 2-3 times only, and 5 to 7 times only after attaining perfection.
It is meant for the proper exercise to the lower half. During its practice profuse blood circulates along the flexor and extension muscles and its accurate practice results in diminution of surplus fat accumulated on the hip and buttocks.
Pashchimottanasana Lower body stretch pose
Sit down erect with legs stretched in front heels attached to each other and the toes upturned, clutch at the big toes with the respective hands. Now breathe out slowly and bend down the trunk so as to place the forehead on the knees, the knees must be placed firmly on the ground all the while, though initially this may seem difficult. But do not hurry to be perfect in a day or two because yoga bans hurry from all its methods and favors the slow but steady devotees only.
This Asana invigorates the muscles and nerves of the front side of the spine as also those of the hands, legs and of the anal region. It reduces the fat around the waist and in the body nerves lethargy and weakness and makes the body strong enduring and quite active.
Lie down flat on the back with legs close to each other, then fold the legs up to the knees keeping the feet on the ground, now raise the head, with inverted palms over the head, twist the head inwards as far as possible, now draw in the legs attempting to complete the wheel, keeping the knees straight on the ground. Initially the body in this posture will look like a semicircular and by steady practice it will gradually form very nearly a complete circle.
It gives a proportionate development of chest of the body, reduces surplus fat and helps proportional development of the body.
Take the right leg over the left thigh to place it on the ground on the side of the hip. Place the left heel on the urethra. Now take the left hand by the right side of the right knee so as to catch at the bit toe of the right foot, the right hand should be pushed behind the back, so as to touch the juncture of the thigh and the abdomen, next turn the head and shoulder as far as possible to the right side to look over the side of the back. Stay at this position only from 5 to 15 seconds and relax. Now the Asana has to be practiced in reverse order.
Kneel down and sit upon the heels, place your palms just a cubit a far from the knees keeping the wrists close to each other, the palms will remain inverted with fingers towards the knees, next rest the body on the hands keeping the elbows on the region on the umbilicus, now try to raise lower half of the body as far above ground level as possible, the head and legs remaining straight with gradual success, the feet will rise above 8 inches above the point of the umbilicus, thus showing the body like a peacock.
It keeps the digestion normal and invigorates the nerves and muscles of the abdomen and pelvic regions.
Shavasana (Relaxation pose)
Lie flat on back keeping the legs and hands straight and place the hands beside the body. Now gradually relax the control over the nerves and muscles of the legs first, the hands, the trunk, one by one as if you have no control over them. Now keep the body free from all thoughts and ideas as in case of deep slumber.
Its practice quickly relieves the body of all strain as already said and prepares it for fresh tasks. It can be utilized as a substitute for sleep and as such, a few minutes practice of shavasana maintains the equilibrium of health.
Halasana (Plough pose)
Lie flat on back placing the hands straight besides the body, gradually raise the legs, stay up to 30° and pause for a second or two then up to 60° and pause as above now slowly lower the legs over the head and rest the toes about there, stay at this posture for about 10 seconds and then return to the original flat position.
The muscles of the pelvic region, the abdomen and of the heart in addition to those connected with the spine are contracted and relaxed as a result, these get invigorated, excess fat is reduced, the liver and spleen get corrected and the heart becomes quite strong.
Fall on your knees, place both of your palms interlocked on the ground. Now place your head on the interlocked palms, while the elbows will rest on the ground, now on the support of the head and the two elbows try to uplift your toes a little above the ground and stretch your body straight with head down and legs up for a few seconds.
During the practice of this asana all the blood from the different parts of the body rushes to the head. As a result the functions of the whole body system remain intact and the body keeps in perfect health.
Exercise is very common but it is a very difficult to a patient because it is an extra task to the patient especially to the Diabetic. In diabetes it is well known that diet is the first line of management, next exercise and at last medicines are given. But people are not getting perfect counseling to do perfect exercises or asanas with perfect time limits. As it is well established that medicines cannot cure the diabetes fully, it can only control it. People should adopt the non-harmful management of the disease. So every diabetic patient should do some exercise by getting proper guidance from a proper physician. So that they can get some relief from the disease without complications. Exercise can be divided into three basic types, stretching/ aerobic, yoga & strengthening. Each type of activity meets different needs and treatment goals. So every patient should discuss his or her plan with health care professional to determine how to do perfect exercise safely and get the most out of it.