Exercises for type 2 diabetes patients.(EXERCISE RX)

Type 2 diabetes is becoming increasingly common in the United States across all ages and ethnicities. This kind of diabetes, which is not dependent on insulin, can be controlled in many people by better attention to exercise and weight management.

Weight control is important for patients with type 2 diabetes, and walking is a safe exercise for most of them.

However, diabetes can predispose patients to aches and pains that can limit their mobility and discourage them from physical activity. In addition to promoting problems such as high blood pressure, type 2 diabetes can affect the nervous system. Patients may have problems with walking and develop an ungainly gait.

Patients with type 2 diabetes should begin gait exercises as soon as they notice a problem with walking. I recommend that the patient mark the positions of several normal steps on the floor and walk back and forth, stepping on the marks, to improve an awkward, broad-based gait.

An awkward gait can lead to tightness in calves, hamstrings, and hip flexors.

Conversely, any preexisting tightness in those muscles can contribute to the development of gait problems. Strong and supple hip flexor muscles and adductor muscles are especially helpful for a smooth gait.

In this month's column, I'll describe several exercises that patients with type 2 diabetes should do both before and after walking. (See illustrations and instructions for patients below.) Proper footwear will make patients more comfortable, and I recommend athletic socks, preferably those made with moisture-wicking materials, and sneakers with laces that can be easily adjusted as the feet swell.