Getting started with an exercise program can be difficult for people with diabetes who may be sedentary or have concerns about hypoglycemia or just don’t know where to turn to in order to get help. Exercise physiologist and certified diabetes educator, Richard Peng, has written a new book aimed at these considerations and provides some strategies for people looking to begin exercise and have either type of diabetes.

By: John Parkinson, Clinical Content Coordinator,

The new year marks a time when many people consider going on diets and exercising. The problem is many of these people end up giving up after just a couple of weeks. How can people get over the initial challenges and hurdles and keep at an exercise program?

Richard Peng MS, ACSM-RCEP, CDE has written a book, Exercise Manual: An Exercise Guide for Adult with Diabetes! to help people begin an exercise program and help them stick to it.  

The book is a comprehensive, concise book that provides an overview of elements of exercise as it relates to diabetes and also provides diagrams for readers to see how to properly do the exercise as well as provide an overview of medications, and a manual in the back to keep track of the regimen.

Peng (pictured, below left) is a clinical exercise physiologist and certified diabetes educator at HealthCare Partners Medical Group in Los Angeles, Calif. He sees a variety of patients including those with diabetes, COPD, asthma, and heart disease. He is responsible for doing stress tests and counseling patients on their disease states, and developing and overseeing exercise regimens for his patients.  

Peng is also a board member of the California Coordinating Body of the American Association of Diabetes Educators (AADE) and a newly-developed, not-for-profit Dance Out Diabetes program. Peng won AADE’s 2012 Rising Star Award after being nominated from his home state. He will also be presenting at the national conference in Philadelphia in August.

Peng is also actively involved with the Clinical Exercise Physiology Association and a member of the American College of Sports Medicine (ACSM). spoke to Peng about how the book can help people begin an exercise program; how to address the potential issue of hypoglycemia; and how to stay on track with an exercise plan. What made you decide to write this book?

Peng: Prior to writing the book, I wasn’t finding much information on exercise for people with diabetes, and I didn’t see any resources for these people in helping them develop a safe exercise program while managing their blood glucose. I didn’t come across anything that was concise enough to refer my patients or fellow diabetes educators when talking to their patients about exercise.

Therefore, I wanted to write a book my patients could refer to when treating hyper- and hypoglycemia and safely begin an exercise program. I want them to be able to pick up this book and get enough information that they can rely on to get them started as well as refer back to as they continue to exercise and improve in their blood glucose management. This book is an easy-to-understand yet comprehensive guide. Are your intended audiences both fellow medical providers and also people with diabetes?

Peng: My primary audience is people with diabetes. I also encourage diabetes educators and other medical providers to refer to the book when talking to their patients. How do you envision people using your book?

Peng: It is targeted for beginners who are just starting out and wanting to exercise. A good example might be someone who has just been diagnosed with diabetes and the person’s medical provider recommends the patient start exercising. That person can use the book to learn what he or she needs to start safely. For those who are starting a new program, what considerations and advice do you give?

Peng: People with diabetes want to first consult with their medical provider so that they are cleared to exercise. While there are many benefits to exercise, certain exercises can do harm or even worsen peoples’ disease states.

I also advise they talk to a qualified exercise expert. Whether it is a ACSM Registered Clinical Exercise Physiologist, ACSM Certified Exercise Specialist or physical therapist, the person needs to have a clinical healthcare background to understand peoples’ medical conditions and how to approach exercise with the patients’ conditions in mind. How do you approach the topic of hypoglycemia with patients? What advice do you give to people to avoid it?

Peng: When I talk to patients about hypoglycemia, I want them to know what the signs and symptoms are as well as which of those signs and symptoms pertain to them. Especially with recently diagnosed patients and/or new to exercise, I would include glucose range and recommend them starting out with a 120 mg/dl glucose reading or at a range according to their blood glucose record. I advise my patients to always have a quick acting carbohydrate source on them, including when they exercise. As it is the start of a new year and it is time for resolutions what advice do you give to those who want to stick by their exercise resolutions?

The two main items for people to stick to their resolutions are:  to have a specific realistic plan and focus initially on following their routine or schedule that works for them. 

Let’s say you have someone who wants to start an exercise program and they want to walk every other day for 15-30 minutes. Regardless if it`s a light exercise, once the mind and body have adapted to the routine, they are more likely to be able to stick to the program—and adding onto the workload will not require much effort. 

For obese persons, I usually recommend starting out with light weight or resistance exercises sitting on a chair. If people don’t have a realistic plan, after several attempts at exercise, they will soon feel like it’s a waste of time, and likely quit. For example, people cannot expect to join a health club and think they will suddenly transform themselves just because they joined. Is there any fundamental difference in how type 1s and type 2s when it comes to approaching exercise?

The biggest difference between the two is insulin supply. For the type 1s, they want to reduce the dosage so that they still have some insulin to enable glucose to enter some of the cells.

For type 2s who are not on insulin or oral medicines that increase insulin release, they usually just need to monitor their blood glucose before and after exercise. For those who are insulin-dependent, will they start to notice in a quick period of time that their insulin requirements will change?

Peng: Yes. People on insulin or oral medicine that stimulate insulin release usually realize they need to adjust their insulin or medicine dosage prior to each exercise session to prevent hypoglycemia.  During exercise, the working muscles have the ability to pull in the circulating glucose without requiring insulin.
So for people with diabetes who begin an exercise program, they need to be cognizant of their glucose level. How long into exercising should a person check their glucose again?

Peng: It depends on how long they are exercising. Generally speaking, if they are exercising for a half hour, they need to check their blood glucose before and after they exercise. If they are doing exercise for longer than half an hour, I suggest they check their blood glucose about every 20-30 minutes or if they start to experience any symptoms of hypoglycemia. Does this apply more to cardiovascular exercise as opposed to doing something like weight training?

Peng: Yes, it’s really for cardiovascular exercise because this type of exercise relies on circulating glucose and glycogen. With weight training, your muscles won’t use as much glucose and they rely mostly on glycogen for energy.  However, after the workout, your body will continue to pull glucose into the muscle cells to replenish their depleted glycogen. Understanding there is variability in results, when can people who are exercising start to notice some changes in how they feel and to their bodies?

Peng: For people who are focusing on lose weight, they might not see dramatic results if they include weight training as part of their routine, because muscle is denser than fat.  So if they gain some of the former and lose some of the latter it may not show on the scale. However, they may see their clothes are looser, they have more energy, they sleep better at night, and are in a better mood.

Within the first week or two of doing cardiovascular exercise, people will start to notice a difference in how they feel. They will notice a difference in their glucose before, and after they exercise, the results will be immediate—so it`s an instant reward for their action. The glucose gets even better, if they stick to their exercise. What is the overall message to those who might want to pick up the book?

Peng: This book is a concise manual which will provide everything you need to know if you have diabetes and are looking to begin an exercise program.  I gave my mom a copy of the book over the holidays. Even though I didn’t get a chance to go over it with her due to my hectic holiday schedule, my mom, who doesn’t read English very well, was able to implement the exercises in the book into her own regimen. And I was proud of her for doing so!

For anyone interested in finding out more or buying the book, you can go here to the publisher`s site or find the book on Amazon here.