Exercise Harder, But Not Too Hard

Patient Expert

sheri margaret powers.jpg

Sheri Colberg-Ochs, Left, Receives Outstanding Educator Award

Hard exercise, such as high-intensity interval training, provides metabolic, heart disease, and fitness benefits. But a leading expert on diabetes fitness says that it’s too difficult for almost all people with diabetes.

Dr. Sheri Colberg-Ochs notes that high-intensity interval training is the current fitness craze. "Its health efficacy is not in question," she says. But, "there is no evidence supporting HIIT as a viable public health strategy."

Is HIIT feasible?

Maximum high-intensity interval training, or HIIT, means short bursts of all-out effort separated by recovery periods. When you go all-out, you are using 90 to 100 percent of the maximum volume of oxygen that you can; technically this is 90 to 100 percent of your VO2max. This means really intense short sprints of about 10 seconds or longer ones of 20 to 30 seconds. Sub-maximum HIIT can be repeated sequences of less than 45 seconds or longer ones of 2 to 4 minutes of rather high, but not maximum, intensity.

Advantages of HIIT

HIIT doesn’t require expensive and specialized equipment or facilities, and can be done in relatively short periods of time.

Still, people who actually do HIIT tend to be younger, already active, or athletic, with few or no health issues, Dr. Colberg-Ochs says. Few people with diabetes fit this profile.

For most people, "HIIT may be perceived as unpleasant at a subconscious level, if not at a conscious one," she says. It requires lots of planning, self-regulation, and considerable psychological effort. She says that the cons of HIIT far outweigh its pros for a large majority and that very few of the people who need to exercise the most will do it.

Why people drop out

Many people who start to do HIIT drop out in first six months or less for several reasons:

  1. The initial exercise intensity is too hard;

  2. They get injured;

  3. It’s not enjoyable; and

  4. If they start out from being sedentary, what pleasure they experience decreases after doing more than three to four intervals.

Consequently, Dr. Colberg-Ochs proposes that people with diabetes do higher -- but not high-intensity -- exercise. She recommends climbing stairs and incline walking on a treadmill.

I mentioned to her that "years ago one doctor suggested to me that I go up the one flight of stairs to my apartment as fast as I could, and I’ve done that ever since then."

I also said that I get a lot of my exercise by hiking in the Colorado mountains where I live. But, she replied, "Hiking is good, but not everyone lives somewhere that it is possible."

The easiest exercise

Still, everyone can do the easiest exercise, which Dr. Colberg-Ochs recommends along with her main message to exercise harder. Citing “Breaks in Sedentary Time,” she says to “make frequent transitions from sitting to standing.”

I couldn’t agree more, and taking regular breaks from my desk has become a part of my practice. Sitting for more than half an hour at a stretch is particularly hazardous for the health of anyone who has diabetes or prediabetes, as I wrote here. It’s easy to be so wrapped up in what you are doing that you can lose track of time. So one of my tricks is to set a timer to ring whenever I sit for 30 minutes. You earned that break.

Dr. Colberg-Ochs spoke at this year’s annual convention of the American Diabetes Association in New Orleans. She was diagnosed with Type 1 Diabetes almost 50 years ago, when she was 4.

Recently retired from Old Dominion University in Norfolk, Virginia, where she was a professor of exercise science, Dr. Colberg-Ochs is best known for her book Diabetic Athlete's Handbook. She accepted the 2016 Outstanding Educator in Diabetes award from the ADA’s Margaret Powers during this year’s convention.

See more helpful articles:

Interval Training Cuts Diabetes Blood Sugar

3 Reasons Why Some People with Diabetes Need to Run or Jog a BIT

Standing Up Is the Easiest Exercise


David Mendosa is a journalist who learned in 1994 that he has Type 2 diabetes, which he now writes about exclusively. He has written thousands of diabetes articles, two books about it, created one of the first diabetes websites, and publishes the monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, current A1C level of 5.5, and BMI of 19.8 keeps his diabetes in remission without any drugs.

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