As I was beginning my discussion on exercise guidelines one morning, I mentioned that walking was an excellent exercise. As I continued discussing the benefits of walking I noticed that a patient started shaking her head as if to say no and had a peculiar grin on her face. I looked at her and asked why are you shaking your head?
She responded, "Can't do it?"
"Can't do what?" I asked.
"Can't walk," she replied.
"Ok, how come?" I asked.
"It hurts my legs too bad. If I try to walk, I have to stop and quit after five minutes cause my legs hurt so bad," she answered.
"You might want to try walking somewhere like a mall where once your legs start hurting you can sit down and rest until they start to feel better. Then you can get up and walk a little bit more until they begin to hurt again. When that happens sit down and rest some more," I suggested.
Again, the patient starts shaking her head as if to say no and the smile appears. "Can't do it," she says.
"You don't think that might work?" I asked.
"There are too many smells in the mall and it bothers my asthma."
"Well it doesn't have to be a mall, any place where you have the opportunity to stop and rest periodically will do. How about swimming or water exercise, those are both good, particularly swimming?"
Again the patient starts shaking her head. "I can't do that either, I don't have a pool."
"Do you have access to a public pool?" I asked.
She shook her head no, while smiling.
"Okay," I said, "How about riding a stationary bike, that works for a lot of people and is a great exercise?"
Yet again she smiled and shook her head. At this point one thing was certain, that the patient could shake her head very well from side to side. If no other exercise worked I knew I could fall back on that one. "Why can't you ride a stationary bike?" I asked.
"I have hemorrhoids and it's just too painful," she stated.
I began to get the feeling this was all a game to her. It looked as though she was going to come up with an excuse to avoid doing anything I recommended. It wasn't funny, not to me anyway. It was actually sad. By now every time I suggested something the rest of the class looked at this lady to see if she was going to shake her head.
The patient, I believe, had pretty much convinced herself that she could not do any exercise due to her bad legs, asthma, hemorrhoids, etc. I think the patient thought she had some legitimate excuses not to exercise and whatever the consequences that resulted could not be helped. I couldn't let the patient leave class that day with that attitude. I had to at least try and change the way she felt about her ability to get some exercise.
After pausing a moment, trying to figure out how I could be the most effective, I walked over to the table where the patient was sitting and explained politely but firmly, "You have just got to move. You have got to figure out a way to move more than you have been. The more you move, the better your diabetes is likely to be. Granted it may be more difficult for you to become active, and you may have more obstacles to overcome than some other people you know, but remaining sedentary is not an option. That is, not if you want to improve your diabetes control and reduce your risks of developing complications in the future."
Orthopedic, cardiovascular or other limitations do not usually preclude exercise; it simply means they have to be more creative to figure out what they can do. In most cases, exercise is still possible, is strongly encouraged and is extremely beneficial.
Milt Bedingfield is an exercise physiologist and certified diabetes educator living in Tampa, Florida.
Milt has been teaching people about diabetes for the last 18 years. Milt also is the author of the book: Prescription For Type 2 diabetes: Exercise. His web site's address is: http://TheExerciseDiabetesLink.com
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