More than 29 million Americans have type 1 or type 2 diabetes, which means at some point in your career you will likely work with clients who suffer from this chronic disease. In recognition of National Diabetes Month, we spoke with ACE pro Jacqueline Sinke, who shares detailed information about her Diabetes Intervention and Prevention (DIP) Exercise Program. Designed for older adults diagnosed with diabetes type 2 and diagnosed pre-diabetes, Sinke shares valuable information you can use with your own clients.

What is the purpose of Diabetes Intervention and Prevention (DIP) ExerciseProgram?

The purpose of DIP is to help older adults better manage and control their blood sugar, delay and prevent both the progression of the disease and the development of diabetes-related medical complications (especially cardiovascular disease), and also improve functional fitness.

How often is the DIP Program offered and what is included?

DIP is offered twice a week for 10 to 12 weeks, depending on the length of each term. Included with DIP is a nutrition and self-glucose management class instructed by a Certified Diabetes Educator (CDE) and diabetes support group, each of which is offered once a month. Each participant receives his or her own individualized exercise program, which they complete in a group setting.

At what type of a location should this program be held?

A DIP program can be held at a fitness center or senior center. The equipment needed for the program includes free weights, medicine balls, balance balls, resistance tubing and bands, mats, stretching table, machine resistance training equipment, a variety of cardiovascular exercise machines, balance pads, disks, chairs and benches.

An ACE Certified Personal Trainer and an ACE Certified Advanced Health and Fitness Specialist assist me in delivering the program. The maximum number of participants is 15 and the group is comprised of both repeat and new participants.

What are the requirements for enrollment?

Individuals must provide the following items:

• Signed medical release
• Completed health and medical forms and a lifestyle questionnaire
• Copy of most recent blood test (A1c, lipid panel); most recent bone density scan T-scores, if available

What is included in the pre- and post-screening?

• Screening: height, weight, circumference measurements (waist, abdominal, hip), BMI, resting blood pressure taken at left and right arms, resting heart rate; Omron body composition may also be used
• Senior Fitness Test (SFT)

What is the target population for this program?

The audience we aim to reach is older adults, age 55 years old and over. Most participants are 70 to 87 years of age.

What are some additional medical conditions that are common among this group of people?

By the time participants enroll in our program, diabetes-related complications (DRCs)—both diagnosed and undiagnosed—have already developed. Some common diagnosed DRCs include: high blood pressure, obesity, hyperlipidemia, heart disease, post-cardiac rehab, hip and knee replacements, arthritis, osteoporosis, TIA or stroke, early stages of dementia, peripheral neuropathy, peripheral artery disease (PAD), kidney transplant, and cancer. The exercise program for each person is individualized to take into account any additional medical conditions. While blood sugar control and diabetes is essential for this population group, it is also vital to be able to maintain the functional living skills to remain independent. Therefore, improvements in functional fitness help to insure a good quality of life.

What is included in the first week of the program?

Day 1

During classroom orientation, we collect any remaining medical releases, questionnaires, blood test and bone density test results from the participants. We go over the program objectives and safety guidelines, which include taking blood sugar before and after exercise, which is especially important for participants who do not know how their bodies will respond to exercise and to make sure that they are within safe limits.

After the orientation participants go through the pre-screening measurements (listed above). If blood pressure or heart rate results fall outside acceptable limits for exercise, we ask the participant to sit quietly a little longer and then we re-test. If these readings remain the same, we ask that the individual to retest the next day. If there is no change, the individual must consult with his or her healthcare provider. Even though all participants must have a medical release for exercise, we have found that blood pressures are not often well controlled, too high or there is too much of a difference in blood pressure readings between the left and right arms.

Day 2

This day is set aside for the senior fitness test (SFT). Medical release forms and health and medical history forms are reviewed prior to this test to screen out any participants for whom this test may be contra indicative or need to be adapted.

Class participants warm up 10 minutes prior to this test and choose their first cardiovascular exercise (recumbent bike, treadmill, NuStep, recumbent elliptical). Settings are recorded on each individual’s workout card. The SFT test is done as a group; seniors partner up, while those with cognitive problems areassisted by an instructor. The lead administrator and an assistant monitor the test for accuracy.

Development of Exercise and Physical Activity Plan

All forms for each participant are collected, these include:

1. Medical release
2. Health medical history
3. Blood test results (HbA1c, lipid profile)
4. Bone density scan T scores
5. Pre-screening measurements
6. Senior fitness test ( use the Human Kinetics SFT online software)

I review and analyze each participant’s information and prepare a physical activity plan and exercise program, which also are reviewed by the assisting trainers.

A health fitness appraisal is prepared to provide feedback on the following measurements: healthy body weight range, circumference measurement, BMI, body composition, body fat percentage and pounds and lean body mass percentage and pounds, resting blood pressure and heart rate, A1c, CHOL, HDL, LDL, triglycerides, fasting blood glucose, T-scores if available, and senior fitness test results. The activity plan also includes independent or at-home exercise recommendations, dates of the nutrition classes and diabetes support group meetings.

What is included in the second week of the program?

When participants return to class they each receive a copy of their personal health fitness appraisal, exercise/activity plan and exercise program. In addition, each person receives a tracking form to record weekly resting blood pressure and heart rate readings, body weight, blood sugar prior to exercise and after exercise (usually done by participants new to exercise).

Order of Each Session

Once a week, we check and record resting blood pressure and heart rate, and body weight for each participant.

Next, participants warm up for 10 to 15 minutes before performing balance exercises, resistance-training exercise and stretching. We want every participant to feel successful. Doing too many exercises can be overwhelming and frustrating and increases the likelihood an individual will drop out of the program. Participants perform one or two sets of each exercise during the learning period. Resistance is kept low until participant is able to demonstrate correct form and there is no pain or discomfort while performing the movement. Most participants perform one set of 10 to 15 repetitions due to time limitations.

What are some additional things to consider when working with diabetic clients?

It is important to prepare for unexpected events:

• Low blood sugar events most commonly happen in the beginning of the program or after about four weeks when a new participant is able to increase exercise intensity, has been able to increase muscle strength and has increased blood sugar uptake. If this occurs, the participant is monitored, stops exercising, consumes glucose tablet or snack, checks blood sugar, rests and rechecks blood sugar reading. He or she can resume exercise when blood sugar is 100 or higher.
• Participants sometimes don’t feel well due to irregular heart beat, or atrial fibrillation. When this occurs, we follow doctor’s guidelines and the participant generally stops exercising. We continue to monitor the individual, who will go home after he or she feels better or when a family member arrives. The individual is advised to contact his or her physician.
• Claudication is a symptom of peripheral vascular disease (PVD) that often becomes apparent after a repeat participant returns to exercise after a summer break. The individual may be unable to walk on the treadmill longer than just a few minutes before intense leg pain forces him or her to stop exercising. PVD is common in individuals with diabetes and this individual should be referred to his or her healthcare provider.
• Changes in balance and/or mobility occur for various reasons, including dehydration, low blood pressure or orthostatic hypotension. Again, the individual should be advised to consult with his or her healthcare provider.
• Blood pressure readings that are too high often result from a participant forgetting to take his or her medication. When this occurs, the individual cannot exercise that day and is sent home with recommendation to retest blood pressure regularly. If the problem persists, her or she should contact a healthcare provider.

What positive results have you noticed among your DIP program participants?

Our participants have experienced the following results:

• Improved functional fitness (based on SFT test results), more energy, ease in accomplishing activities of daily living
• Reduced HbA1c and reduction in medication
• Reduction in total weight
• Feeling better, less pain
• Better balance and mobility
• Improved lipid profile

Final Thoughts

I have instructed this program since 2007. Several participants continue to take the program term after term and year after year because it not only helps them to better manage their blood sugar, they are also able to maintain functional health and stay independent.

Make a difference in the fight against Diabetes. Check out our Diabetes Prevention Coaching online course and equip yourself with evidence-based disease-prevention strategies you can use with clients coping with, or at risk, for diabetes.