Walking toward glycemic control.(Guest Editorial)

We are all frustrated at times in our efforts to improve glycemic control in our diabetic patients. We tend to focus on nutrition and medications, over-looking exercise. Sure, we tell patients that they need to lose weight and start exercising, but we rarely offer them specific advice about an exercise program.

The benefits of exercise are well documented for diabetic patients, especially in conjunction with medications and nutrition counseling. Although all types of exercise should be discussed with diabetic patients, most research has been conducted with respect to aerobic exercise. In a study published in early 2003, mortality for all causes was reduced in diabetics who walked at least 2 hours per week (Arch. Intern. Med. 163[12]:1440-47, 2003).

As part of the Nurses' Health Study, participants were asked about levels of aerobic activity such as walking as well as vigorous activities such as jogging, bicycling, or swimming. Higher levels of aerobic exercise were associated with a substantial reduction in the risk of developing type 2 diabetes (JAMA 282[15]:1433-39, 1999).

Other studies have documented improved glycemic control as a result of following a simple program of walking several miles per week. The American Diabetes Association (www.diabetes.org) recently launched the "Small Steps, Big Rewards" program that emphasizes the importance of aerobic exercise and walking.

How do we encourage diabetic patients to start walking more? What advice can we give them regarding how long, how far, and how intensely to exercise? One of the simplest ideas you might consider suggesting is the use of a step counter or pedometer.

Pedometers can measure the number of steps taken, calories burned, and miles walked and generally cost less than $10.

The current recommendation is for patients to walk 10,000 steps per day; this translates to about 5 miles. This number is based on ...