One of the most recent subspecialties emerging within the personal training arena is a certification in Corrective Exercise.  As our population ages, and as these individuals strive to remain active, we are seeing an uptick in gym members with artificial limbs, pronounced curvature of the spine, and even wheelchair-bound. Corrective Exercise trainers are equipped with the knowledge of how to safely and effectively work with such clients, improving their quality of life tremendously.

However, there are also a number of clients living with disorders that are not as readily apparent. These individuals are often hesitant to embark on an exercise program, being insecure about how their unseen situation might be adversely affected.  An awareness of these situations is a valuable tool for trainers, as these gym members’ lives can also be dramatically improved through prudent, regular exercise.

Diabetes is near the top of the list when enumerating and discussing unseen health concerns.  Many individuals have been living with and effectively managing their blood sugar levels for decades, while others may be newly diagnosed and just beginning to embark on what is at first a daunting process of regulation and nutrient timing. Doctors often suggest that their diabetic patients engage in exercise on a regular basis, so as fitness professionals we might choose to delve a bit deeper into the specific issues that need to be addressed when training a client with diabetes.

Diabetes can lead to the development of a variety of diseases, including heart disease, stroke, peripheral vascular disease, and neurological disorders. In many cases, the cause of death in individuals with diabetes is not the disorder itself but rather a secondary disease associated with the condition, most notably heart disease. While only 10% of diagnoses are classified as Type I, tending to appear in younger people, the American public is sadly looking at an overwhelming 90% of cases that fall into the Type II category. This is the kind of diabetes that is very often preventable or at least can be minimized to a potentially medication -reduced lifestyle.  Very often the key to facilitating such a process begins with a lifestyle change, and this is where a well-educated personal trainer can be very impactful.

Diabetes is a disorder wherein the pancreas, the insulin-producing organ in the body, is not functioning optimally. Insulin is made and stored in specialized cells within the pancreas, being released in response to various signals sensitive to the intake and digestion of food. In Type I diabetes, these specialized cells in the pancreas are destroyed, thereby interfering with the production of insulin in affected individuals. In Type II, the specialized cells are able to produce insulin; however, it is ineffective at helping blood sugar enter the tissues that require it to produce energy. This condition is known as insulin resistance.

Heredity plays a role in the development of both types of diabetes. Another cause may be a viral infection that destroys the pancreas. In contrast, race, age, and obesity are landmarks related to Type II diabetes. While one cannot alter one’s race, nor slow down the advancing years, obesity can be managed and overcome. Exercise is a powerful force in combating a weight problem, and knowledgeable trainers can be a valuable resource in guiding a diabetic client toward a more successful quality of life.

We already are familiar with all of the positive benefits of resistance training in improving overall health: lowering cholesterol and blood pressure, better heart health, and greater flexibility/endurance.  In addition, research has demonstrated that improvements in insulin sensitivity and blood glucose control are parameters to which a client may look forward after embarking upon a strength- training program.  Since many Type II diabetics tend to lead a relatively sedentary lifestyle, low-impact exercises such as walking or stationary cycling are excellent beginning recommendations, along with enough exercise to promote weight management.  An ultimate goal might be to gradually work up from 10-20 minutes 2x/week to 40 – 60 minutes per session, 5x/week, at a moderate intensity.   It becomes especially important for these new clients to increase only one factor at a time (days per week, length of sessions, or intensity).  Since lean muscle mass can also aid in weight management, the recommendation for resistance training from the American College of Sports Medicine is a minimum of 2x/ week, performing 8 – 12 repetitions per set of 8 – 10 exercises, and making an effort to target major muscle groups.

As with any serious condition, there are several aspects of exercise that must be taken into consideration when working with a diabetic client. The primary goal is always minimizing the risks involved while still enabling the individual to successfully exercise. If a client presents with a history of vascular problems or high blood pressure, it is wise to ask permission to consult the client’s physician before progressing. Once the medical green light has been given, begin by using lighter workloads for these individuals.

It is also important to keep in mind that diabetic individuals are also at risk of developing hypoglycemia (low blood glucose) during exercise. Prior to the first training session, clients will undoubtedly appreciate some nutritional suggestions to hold this at bay, such as eating 1-2 hours before exercise, coming to the gym with a snack for during the workout if necessary, and remaining well hydrated.  If either you or your client is unfamiliar with the best food choices to make before, during and after exercise, a consultation with a registered dietitian might be appropriate.

Most clients who have been living with diabetes for any length of time will know to monitor their blood glucose before exercising. An unusually high resting blood sugar level, greater than 250-300 mg/dl, is a red warning flag that perhaps you should not continue with the scheduled workout session. On the opposite end, being aware of the warning signs of hypoglycemia (dizziness, anxiety, shaking, and uneasiness) will help when observing exercise tolerance.  Keep a close eye on any obvious drop in blood pressure upon exertion. Knowing when to stop exercise and seek emergency care can be lifesaving for a diabetic client.

As with any client, adhering to general exercise guidelines is important for the diabetic, especially when obesity is a serious consideration.  Being mindful of a proper warm-up and cool-down as well as avoiding exercising in extreme cold or heat will be of great value to a client. In addition to properly fitting exercise shoes, diabetics should be reminded to wear cotton socks, and to be aware of any blisters, cuts, or irritations that may appear on the feet.

As mentioned above, there are several related health conditions that tend to be present in individuals with diabetes.  Prior to embarking upon a new exercise program, ask the client if he or she has been diagnosed with diabetes-related autonomic neuropathy, peripheral neuropathy, neuropathy or retinopathy.  These conditions will greatly alter the design of a workout, and due to the strict limitations associated with such considerations it is advisable to have the client speak with his or her physician for specific exercise guidelines/contraindications.

As many of us in the industry have observed through the years, fear can serve as a very powerful motivator. Unfortunately, diabetics have plenty to think about, and sadly, a significant number of health concerns that can conjure up high levels of fear. Sometimes the mere idea of becoming insulin-dependent and facing a lifetime of administering daily subcutaneous shots is enough to bring a client to the gym, knowing how impactful a structured exercise program can be in holding off this possible outcome. With the combination of a proper diet/weight control and oral prescription medications, exercise can often help prevent the need to ever add insulin to a patient’s regimen.

The fear doesn’t just stop with newly diagnosed diabetics, either. Those individuals who have been living with this illness for an extended length of time may be at serious risk for toe and leg amputations. If started early enough, an exercise regimen may thwart the need for such drastic measures.  Gentle but frequent reminders from a caring personal trainer can often succeed when words from a harried medical professional fail or fall upon deaf ears…..or scared ears!

Once word gets around that a qualified personal trainer can be a valuable asset in the management of diabetes and its accompanying health concerns, the medical industry just may be delighted to see a new era of healthier patients emerging from the gym, and requiring diminished levels of care on their part.  This is a great motivator for the fitness industry to become as educated and informed as possible on this diagnosis, thereby becoming an integrated member of a healthy solution for the millions of Americans living with diabetes.



About the Author

Cathleen Kronemer is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for more than two decades. Look for her on, and feel free to contact her here. She welcomes your feedback and your comments!

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