Importance of Physical Activity

While physical activity is an integral factor in maintaining healthy blood glucose levels, it also improves mental well-being and provides some structure to your days indoors during the COVID-19 pandemic. For children and youth, at least 60 minutes of physical activity per day is recommended. For adults, the goal is to get at least 150 minutes per week¹. Some of the exercises presented on this site may be new and unfamiliar. As such, it is important to start light and gradually increase the level of exercise intensity and frequency.

It is important to ensure that if these activities are done indoors that the space used is safe, and is big enough to allow for these activities to take place. It is also important to stay well-hydrated and check the glucose levels regularly while being active.

If there are recommendations from the diabetes team around insulin dose adjustment and carbohydrate intake, follow the team’s advice. Below, we offer some suggestions and examples on how to engage in activities.

Table of Contents

1. Glucose Monitoring During Exercise
2. Children Under 16 
3. Ages 16+: A. Exercises Without Home Gym, B. Exercises With Home Gym 
4. Additional Information and References

Keywords: Staying active, physical activity, work out, fitness, exercise

1. Glucose Monitoring During Exercise¹³

Adjusting insulin and food intake with exercise are important. Blood glucose levels will vary with exercise and this variation depends on age, kids size, type of exercise, duration, familiarity with the exercise, and intensity.

By recording the exercise details, blood glucose levels before, during, and after activity and the food that is eaten, trends can be spotted and this can help the development of management strategies with the support of the diabetes healthcare team to achieve normal glucose level. 

General Tips:

• Normally, moderate exercise (e.g. walking) results in a slow drop in blood glucose levels
• Intense exercise may result in a temporary rise in blood glucose levels especially during competitions or if the insulin dose is lowered excessively pre-exercise
• Hypoglycemia may occur if there was an insufficient intake of carbohydrates pre-exercise or the insulin dose was not adjusted as needed

After exercise:

After exercise, it is important to monitor the glucose levels to avoid hypoglycemia. During this post-activity period, adrenaline levels fall and muscles and liver take up more glucose to replenish their supplies of carbohydrates that were used during the activity.

Strenuous activities in the late afternoon or evening can lead to overnight hypoglycemia. Discuss with your exercise plan with the healthcare team for the best plan of action.

Guidelines to lower risk of night time hypoglycemia after evening exercise:

• Monitor glucose levels overnight (midnight, 3 am) using a blood glucose meter or continuous glucose monitor (CGM) as needed
• Eat a carbohydrate-containing bedtime snack or reduce evening insulin if needed. 

Children and Adolescents With Diabetes Can Exercise Safely: A Video by JDRF

2. Children Under 16

The ideas below, adapted from the World Health Organization, offer some fun ways to keep children physically active¹:

Infants under 1 year old: spread out tummy-time floor-based play throughout the day (Tummy Time Tips)

Children under 5 years old: invent new games with your child that require running, skipping, jumping, dancing, catching, kicking, and/or balance (e.g. Exercise Circuit, Dance, Yoga I, Yoga II)

Children ages 5-16 years old: join online activity classes, learn a new exercise-based skill, set up playground games and/or workout exercises (Exercise Circuit for Kids I, Exercise Circuit for Kids II, Exercise Circuit for Adolescents , Living Room Workout, Family Cardio Workout). 

Example Exercise (Ages 5-16 years old): Olympic Hot Spot Challenge 

To play, clear some space to set up “hot spot” stations with different 45-60 second activities. Children can run through the challenge a few times depending on the number of stations, in order to get the minimum recommended 60 minutes of physical activity per day.

Station Ideas: 

• Pushups (against the wall, on their knees or full pushups for older children and teens) 
• Situps
• Jump rope 
• Step-ups (either with a “step” or up and down the stairs)
• Circle jumps (small rings or hula hoops or tape marks)
• Jumping jacks
• Squats
• Balance on one leg
• Ball toss (with a partner)

To Increase Difficulty: 

• Increase time at each hot spot: so 30, 45, 60 seconds
• Increase the number of times you do the complete hot spot circuit, so 2, 3, 4 or 5 times
• Mix-up the hot spots or doing them in a different order
• Creating new hot spot activities of your own
• Adding new hot spot props like soup can weights

The Olympic Hot Spot Challenge was adapted from Care.com². 

3. Ages 16+

A. Exercises Without Gym Equipment

Create your own home-circuit using the exercises below³. 

• Push-ups
• Planks
• Bodyweight Squats
• Lunges
• High knees
• Jog in place
• Jump rope
• Jumping jacks
• Vertical jump
• Stair climbing

Example Exercise Plan 

Try to perform each step three to four times, with a 60 second rest in between⁴. 

1. “Bodyweight Squat: 40 seconds and 30 second rest 

Stand with your feet hip-to-shoulder width apart. Create tension through your torso by bracing your core. Descend into your squat until your hips are below your knees. To return to your starting position, drive through your feet, maintaining an upright torso position, exhaling on the way up.

2. Vertical Jump: 6 reps

Start with your torso at 45 degrees, feet shoulder width apart and with your arms behind you. Explode off the ground by extending through your legs and hips, using your arms to assist you. Reaching as high as you can, then snapping your arms back down to your start position with an exhale. 

3. Up-Down Push Ups: x 40 seconds and 30 second rest

Start in a plank position with your elbows under your shoulders and feet hip width apart. Replace your right elbow with your right palm, follow with your left until you are in a tall plank position with both hands under your shoulders. Complete the movement by coming back down to both elbows one at a time.

4. Animal Flow Front Step x 6 per side

Imagine sitting back into a child pose-like position, by walking your hands away from you, hips pushed back into your heels, with your knees 1” above the ground. Explode forward to replace your right hand with your right foot. Finish by bringing your palm up and eyes up. Return to your starting position by reversing the movement and then alternate sides.

5.  Alternating Lateral Lunges: 40 seconds and 30 second rest

Beginning with your feet together, take a large step to the side with your right foot. Keeping your torso upright, sit your hips back to load your right leg, while keeping your left leg straight. To return to your starting position by pushing off your right foot. Alternate sides.

6. Lateral Bound: 6 per side

Pushing off one leg at a time, aim to travel a large distance between each step. Imagine pushing side-to-side versus jumping over side to side like a speed skater. Absorb each bound with a bent knee, while maintaining an upright torso. Swing opposite arm to opposite leg for more power.”

Information derived from The Toronto Star⁴. Exercise images are property of Jennifer Lau ^{5,6,7,8,9.10,11}.

B. Exercises With Gym Equipment 

If you have access to some of the resources below, you can make your own fitness circuit, join an online class, or watch tutorial videos⁶. 

1. Treadmill: adjust the slope of the track to engage more muscles and increase energy expenditure (Visual Scenery)
2. Stationary Bicycle: two 15 minute sessions at a comfortable intensity  
3. Bodyweight Exercises: create a 30 minute fitness circuit with push-ups, sit-ups, deep-lunges, crunches and forward flexes (Bodyweight Workout)
4. Joint Mobility Stretching Exercises: try a yoga or pilates routine (Yoga Workout, Pilates Workout)
5. Stairs: make some safe space on your stairs and try climbing up and down them a few times to help engage your cardiovascular system

The above exercises are adapted from the International Diabetes Federation¹².

Example Exercise Plan

This exercise plan may be modified to suit the resources found in your home, and your current fitness level.

1. Two sets of 15 crunches
2. Two sets of 15 forward flexes 
3. Two sets of 10 rowing exercises using dumbbells and slight forward flexion 
4. Two sets of 8 push-ups 
5. Two sets of 8 sitting/standing hand-weight lifts
6. Three sets of 15 squats
7. Twenty minutes on the treadmill again, or however long you feel comfortable
8. Stretches and meditation

The above exercises are adapted from the International Diabetes Federation¹².

4. Additional Information and References

1. World Health Organization. Be Active during COVID-19. https://www.who.int/news-room/q-a-detail/be-active-during-covid-19
2. Care.com. Fun indoor exercises for school-aged kids (5-12 years old). https://www.care.com/c/stories/10371/fun-indoor-exercises-for-school-aged-kids/
3. Thomas Y. No gym, no problem: Try these simple at home workouts during COVID-19 pandemic. 2020. https://www.wbir.com/article/news/local/as-seen-on-tv/try-these-easy-at-home-workouts/51-576af112-2997-4a1d-b040-51afd31ccda9
4. Kwong E. Missing the gym amid COVID-19? Here’s a special at-home cardio workout for Star readers. 2020. https://www.thestar.com/life/health_wellness/2020/03/21/missing-the-gym-amid-covid-19-heres-a-special-at-home-cardio-workout-for-star-readers.html
5. GIPHY. Animated gif – https://media.giphy.com/media/ckT0RQB1Bqow3MHgs2/giphy.gif
6. GIPHY. Animated gif – https://media.giphy.com/media/ckT0RQB1Bqow3MHgs2/giphy.gif
7. GIPHY. Animated gif – https://media.giphy.com/media/ZArGw8DKQp6p6fos5M/giphy.gif
8. GIPHY. Animated gif – https://media.giphy.com/media/JmmJLtZb5FvRJtyLUh/giphy.gif
9. GIPHY. Animated gif –https://media.giphy.com/media/LpRxPiDYCYTZBzgFFG/giphy.gif
10. GIPHY. Animated gif –https://media.giphy.com/media/hSvb7XbXHQj22JftcO/giphy.gif
11. GIPHY. Animated gif –  https://media.giphy.com/media/h8aMhQJFKDO9VrlF3Z/giphy.gif
12. International diabetes federation. Home-Based exercise. https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/home-based-exercise.html
13. JDRF Canada. Exercise and Type 1 Diabetes. 2020. https://www.jdrf.ca/resources/learn/adults/exercise-and-type-1-diabetes/

Disclaimer: The information regarding COVID-19 is changing constantly as more data become available. The information provided in this website is not meant to replace diabetes healthcare team or public health agencies recommendations, and is intended for information purposes only. Please check with your healthcare providers for any deviations from your care plans.

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