Can you advise on an exer­cise pro­gramme for a dia­betic man aged 59? He is over­weight (20^st) and suf­fers from spon­dylitis in his neck and arth­ritis in his lower back. He can walk quite well but gets breath­less eas­ily. He would like to feel fit­ter but is unsure where to start.

Diabetics are much more likely than aver­age to be over­weight and at risk of heart dis­ease and stroke. So reg­u­lar exer­cise needs to become a life-​long habit and the sooner you start, the bet­ter.

Not only will exer­cise help you to lose weight, it will also help keep some of the more unpleas­ant com­plic­a­tions of dia­betes at bay, includ­ing high blood pres­sure, furred-​up arter­ies and fluc­tu­ations in your blood sugar levels which over time can cause ser­i­ous dam­age to your body.

All extra activ­ity will help, but I sug­gest you take a ser­i­ous and meth­od­ical approach to get­ting your weight down and keep­ing more fit and act­ive. You must get clear­ance from your GP or dia­betes sup­port team to start an exer­cise pro­gramme; then seek a qual­i­fied instructor at your local gym or through a GP exer­cise refer­ral scheme, to get you star­ted safely. At the same time, talk to your dieti­cian about a diet /​good eat­ing régime, so that you are attack­ing your weight prob­lem from both angles (fewer cal­or­ies, more activ­ity).

Because of the ser­i­ous nature of dia­betes, pay spe­cial atten­tion to the fol­low­ing:

• reg­u­lar blood sugar mon­it­or­ing is essen­tial, before and for up to two days after each exer­cise ses­sion
• have your feet checked reg­u­larly, make sure shoes and socks are com­fort­able, and deal with blisters or other foot prob­lems without delay
• even though you may be “diet­ing”, you will need to add a little extra car­bo­hydrate at cer­tain times so your body can cope with the demands of exer­cise. Your instructor or dia­betes care team can advise on the tim­ing and which snacks are best
• cer­tain times of day will be bet­ter or worse for exer­cise, depend­ing on your med­ic­a­tions and blood sugar levels
• you may need to change your insulin injec­tion site – again, your care team can advise.

Begin your pro­gramme gently and don’t expect instant mir­acles. With your neck and back prob­lems, your best activ­it­ies may be cyc­ling in the gym and/​or swim­ming (or walk­ing in the water) to start with, but try gradu­ally to add in some brisk walk­ing. Build up to 40 minutes of daily ses­sions such as these.

Don’t be too alarmed about breath­less­ness. As your heart and lungs get stronger, your breath­ing will improve – it is very nor­mal for unfit people to be breath­less when you start exer­cising. If you stick at it, you will cer­tainly feel the bene­fits within a couple of months.

Working with weights (not too heavy at first – get expert super­vi­sion) in the gym is another good way of burn­ing fat, as well as mak­ing you feel and look bet­ter! For excel­lent advice on exer­cise and diet, visit Diabetes UK.