Exercise Program for Obesity and Chronic Diseases: Scientific Weight Loss and Safety Monitoring for Patients with Diabetes and Coronary Heart Disease
Before obese patients with diabetes undergo exercise for weight loss, a medical history investigation, physical examination, and medical tests should be conducted, including: height, weight, BMI, body fat percentage, waist circumference, hip circumference, blood glucose, urine ketones, blood lipids, urine microalbumin, blood urea nitrogen, carbon dioxide combining power, fundus examination, and lifestyle information. An exercise stress test should also be performed to determine the presence of cardiovascular disease and contraindications to exercise, thereby determining the appropriate exercise intensity and method for individual weight loss.
The choice of exercise program should be based on the patient's age, physical condition, exercise habits, social and economic circumstances, and the presence or absence of diabetic complications. The exercise method does not need to be singular; various forms can be alternated. Examples include walking, brisk walking, flat-ground cycling, Tai Chi, aerobics, and fun ball sports. Excessive strength training is not recommended. The determination of exercise intensity should consider both safety and effectiveness. Obese patients with diabetes should engage in at least 30 minutes of moderate-to-low intensity aerobic exercise daily, which has a significant effect on reducing body fat, blood sugar, and urine sugar.
For obese patients with diabetes, exercise is generally best performed 90 minutes after a meal, as this has the best blood sugar-lowering effect. Avoid exercising immediately after insulin injection to prevent hypoglycemia. The duration of exercise should be adjusted according to individual physical condition, gradually increasing the duration, but care should be taken to avoid damage to joints and muscles from excessive exercise. Before exercising, perform 10-20 minutes of warm-up activities, depending on the ambient temperature, until you break a light sweat. After exercising, perform at least 15 minutes of cool-down activities.
Increase exercise intensity gradually, starting with low intensity and gradually increasing until the intensity prescribed in the exercise prescription is reached. Regularly monitor blood glucose and urine glucose levels, and pay attention to changes in symptoms, continuously adjusting the exercise plan accordingly. Wear soft-soled, flexible athletic shoes that fit well, neither too tight nor too loose. Wear loose, warm clothing to prevent skin damage and diabetic foot. Carry candy or sugary drinks with you during exercise to prevent hypoglycemia.
Contraindications for exercise in diabetic patients include: poorly controlled blood glucose (postprandial blood glucose above 13.9 mmol/L); diabetic ketoacidosis, hypoglycemia, and significant hyperglycemia; diabetic retinopathy; diabetic infection; uncontrolled severe diabetes and severe hypertension, and unstable angina.
Coronary atherosclerotic heart disease, or coronary heart disease for short, refers to heart disease caused by the formation of atherosclerotic plaques in the coronary arteries, leading to narrowing, blockage, and insufficient blood supply, resulting in myocardial ischemia and hypoxia. It is one of the most common chronic cardiovascular diseases, seriously affecting human health and lifespan. In recent years, the incidence and mortality rates of coronary heart disease in my country have been on the rise, becoming a major cause of death.
Traditional treatment for coronary heart disease primarily relies on medication, and exercise is not recommended. However, recent studies have shown that in addition to conventional drug therapy, exercise as an adjunct therapy can not only leverage the advantages of medication but also regulate various beneficial physiological functions through appropriate exercise, improving blood lipids and cardiac function, enhancing immunity and myocardial blood perfusion, and accelerating the formation of coronary collateral circulation, thereby achieving the goal of effectively treating coronary heart disease. When coronary heart disease patients engage in exercise for weight loss, safety is the primary consideration.
Because patients are prone to myocardial ischemia and hypoxia during exercise of a certain intensity, it is crucial to carefully control the intensity of exercise within a limited range. Prolonged, low-to-moderate intensity aerobic exercise can help burn and utilize body fat. Appropriate exercise can increase myocardial oxygen consumption, increase myocardial oxygen supply, improve myocardial blood circulation, and, by improving cardiac function in obese patients, reverse and control the progression of coronary heart disease.
Moderate-intensity aerobic exercise can lower blood lipids, stabilizing the body's lipid metabolism and thus alleviating or regressing potential atherosclerosis. Through regular exercise, patients experience weight loss, stable blood pressure, and a lower resting heart rate, thereby reducing the individual's cardiac workload and oxygen consumption. Simultaneously, exercise can improve systemic circulation in patients with coronary heart disease, enhance immunity, significantly reduce the incidence of infectious diseases, and stabilize patients' emotions, which is also beneficial for the treatment of coronary heart disease.
Low-load strength training can also be an option for obese patients with coronary heart disease. During strength training, the heart rate rises more slowly, thus relatively prolonging the diastolic phase. This allows sufficient time for blood flow to nourish the myocardium through the coronary arteries. At the same time, strength training increases diastolic blood pressure, which is beneficial for coronary artery filling and ensuring adequate blood supply to the myocardium. The improved myocardial contractility also contributes to increased stroke volume, allowing patients to achieve higher cardiac output at a lower heart rate.
However, because strength training carries a greater risk of causing myocardial ischemia than aerobic exercise alone, the testing of strength indicators and the design of exercise intensity must be approached with extreme caution. Patients with coronary heart disease should ideally have a designated medical supervisor supervise their low-load strength training to prevent injuries. Regardless of whether it's aerobic or strength training, target heart rate can serve as an objective indicator of the body's ability to withstand load intensity. Obese patients with coronary heart disease should have their target heart rate range set lower than that of healthy individuals when designing exercise intensity.