What Exercise Should Be Performed Last

What Exercise Should Be Performed Last

  • Journal List
  • Korean J Fam Med
  • v.xl(three); 2019 May
  • PMC6536904

Korean J Fam Med.
2019 May; 40(iii): 135–142.

An Overview of Current Concrete Activeness Recommendations in Principal Care

Yun Jun Yang

Section of Family Medicine, Inje Academy Ilsan Paik Infirmary, Goyang, Korea

Received 2019 May 4; Revised 2019 May 14; Accepted 2019 May fourteen.


Primary care physicians should encourage their patients to engage in adequate physical action. Current recommendations for physical action in adults are as follows: at least 150–300 minutes per calendar week of moderate-intensity, 75–150 minutes per week of vigorous-intensity aerobic physical activeness, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should besides perform musculus-strengthening activities of moderate intensity or higher that involve all major muscle groups for 2 or more days per week. The elderly should perform additional balance training and autumn prevention exercises more than iii times a week. Children and adolescents should perform at least one hour of moderate-to-vigorous physical activity daily, which includes vigorous aerobic activeness at least 3 days per calendar week. As role of their 60 minutes or more of daily concrete activity, resistance training and bone strengthening exercise should be washed at to the lowest degree iii days per week. According to new bear witness, one bout of any exercises tin can be shorter than 10 minutes. Previously, physical activities were recommended for more than x minutes. For patients with diabetes, it is advisable to perform resistance practice or brusk-altitude running earlier aerobic exercise to prevent hypoglycemia. New show shows that dynamic resistance training is prophylactic and effective in patients with hypertension provided the load is non likewise heavy. Exercise reduces pain and improves quality of life and physical office in patients with osteoarthritis,. Therefore, the treatment guidelines for osteoarthritis have been changed recently from not recommending exercise to highly recommending it.


Practice, Guideline, Diabetes Mellitus, Hypertension, Osteoarthritis


Research about the furnishings of exercise and physical activeness on health began in the 1950s with cardiovascular disease. The positive effects of exercise has been verified in a variety of boosted enquiry areas including cancer, cerebrovascular disease, mental illness, and musculoskeletal disorders. Therefore, practise and concrete activity are an important topic in clinical practice, and ever increasing in the modern age where lifestyle-relate and chronic diseases have go more than of import than infectious and acute diseases.

It was suggested that practise should be vigorous to have a positive event on health, considering it was believed that all-encompassing exercise causes physiological changes such as comeback of cardiopulmonary endurance which is beneficial. However, many studies concluded that even without intensive practice, there were wellness benefits equally long as there was enough of physical activity. With that, moderate exercise was recommended to promote health later on the mid 1990s. Moderate exercise produces enough health benefits without a high risk of injury. Exercise corporeality is defined by the equation intensity×frequency×duration and equally it increases as does its positive impact on health, as long as it is not overdone.

It is also known that physical activity that can encompass standard daily activities are beneficial to health. In recent years, concrete activity, which is a broader term than exercise, tends to be defined by its impact on wellness.

This article summarizes the contempo advances in sports medicine and practice-related research.


Physical action reduces mortality, prevents various cancers, musculoskeletal and cerebrovascular diseases, improves metabolism, and is beneficial for mental wellness.

There is a great bargain of research showing that mortality declines when concrete activeness increases or torso fitness improves. The Shanghai women study showed that general daily physical activity, without intentional exercise, is too beneficial to health [1].

Physical activity decreases the incidence of colorectal cancer, breast cancer, float cancer, endometrial cancer, esophageal cancer, kidney cancer, lung cancer, and stomach cancer. Concrete activity also has a positive effect on rehabilitation of cancer patients.

Studies on the prevention and handling of cardiovascular diseases using practice have been ongoing for many years. Physical activity controls hypertension, diabetes, and dyslipidemia, thereby preventing cerebrovascular disease. It also improves obesity and insulin resistance, otherwise known as metabolic syndrome.

Positive furnishings of physical activity on the musculoskeletal system accept been demonstrated as they prevent osteoporosis, reduce fractures, and improve the role of patients with rheumatoid and degenerative arthritis. Physical activity is besides important in reducing musculoskeletal hurting and aiding the rehabilitation of injured patients. Practise therapy plays a major role in back pain, shoulder impingement syndrome, myopathy syndrome, fibromyalgia syndrome, plantar fasciitis, and ankle sprains.

The effect of do on mental health have been proven in depression, anxiety, stress, sleep, dementia, and psychological well-beingness. Physical activeness lowers the risk of depression and improves depressive symptoms, regardless of whether they are diagnosed with depression. It reduces symptoms of anxiety regardless on whether the episode is acute or chronic. Improvement in sleep quality later exercise tin can be attributed to reduced length of time it takes to get to sleep, reduced awakening, increased deep sleep, and reduced daytime sleepiness. Improvement in cognitive function, retentivity, concentration, and learning ability were also demonstrated.

Conversely, intensive physical activity pressure on the cardiopulmonary and musculoskeletal systems negatively. Undiagnosed ischemic heart disease can cause a myocardial infarction triggered by exercise. Nonetheless, it can exist prevented by advisable physical activity, and the overall run a risk of a heart attack from practise is relatively low compared its public health benefit.


ane. Guidelines for Physical Activity

The section of health and human services of the Usa has published guidelines for physical activity for Americans in 2018. It is the modified from one from the 2008 United states Physical Action Guidelines and the World Wellness Organization (WHO) Physical Action Guidelines in 2010 [two]. The Ministry of Health and Welfare of Korea issued guidelines of physical activeness for Koreans in 2013. The Korean and United states guidelines are like, and the revised guidelines accept the same basic principles, although some guidelines have been revised and supplemented.

In all the concrete activity guidelines, adults are encouraged to exercise moderate aerobic physical activeness for at least 150 minutes per week, or alternatively 75 minutes of high intensity exercise. High intensity exercise means vigorous intensity exercise. In this article, both words have been used as the same meaning. We can assume 1 minute of high intensity activity is equal to two minutes of moderate intensity activity. When combining high and moderate intensity activities, the guidelines of 150 minutes or more per week should be based on moderate intensity activeness. For example, if you lot have 50 minutes of high intensity activity per calendar week (100 minutes as moderate intensity) and lx minutes of moderate intensity activity, it will be calculated as 160 minutes of moderate physical activeness.

The latest US guidelines state that the moderate aerobic physical activity should be at least 150–300 minutes. This suggests that it is a minimum goal to increase to 300 minutes as much equally possible, rather than merely 150 minutes per week. It besides stated that more than than 300 minutes of moderate physical activity is linked to more health benefits.

Moderate physical intensity refers to the exercise intensity corresponding to iii to 5.9 metabolic equivalents (METs), while high intensity refers to vi METs and more than. 1 MET is an oxygen uptake of 3.5 mL/kg/min when an adult is resting and corresponds to an free energy consumption of 1 kcal/kg per 60 minutes. Moderate (3 to 5.9 METs) and high intensity (over vi METs) concrete activities are wide, just the high intensity is roughly double the intensity of moderate intensity.

During light-intensity activities near people are able to sing, during moderate-intensity they can talk but non sing, and during vigorous activities, even talking is hard.

In the past, concrete activity for more than 10 minutes at a time was recommended because evidence was based on the research that studied concrete activities for longer than 10 minutes. But it is now known that exercising for as little as ten minutes is effective, so exercise duration is no longer emphasized [iii].

Since sparse exercise, defined as between 1–two times per calendar week, increases the risk of injury, information technology is recommended to practise iii or more days a week, for as many days as possible. Especially, some papers showed that chronic disease patients should perform exercises for more than three days a calendar week. Because increased insulin sensitivity by acute bout of practice dissipate in 48–72 hours [iv].

Many data sets define the intensity of exercise by the type of physical activeness. The most extensive and accurate list is the compendium of concrete activities from the University of South Carolina [5]. Intensities of daily activities, such equally gardening, house chores, too every bit sports activities, are conspicuously defined.

It is inappropriate to express intensity of practise by the corporeality of sweat. Sweating ability varies from person to person and is affected past temperature and humidity. To exist more than precise, the intensity can be expressed every bit middle rate or maximum oxygen uptake, but this is too complicated to use in practice.

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Muscle strengthening exercises or resistance exercises reduce the gamble of injury, and aid maintain weight. It is better to space muscle strengthening exercises to 2 to 3 times a calendar week past each muscle groups rather than on consecutive days. This is because micro-tears in muscle fibers caused by muscle strengthening exercises need time to recover. Moreover, if do is performed frequently, the risk of injury may increment.

Musculus strengthening exercises include dumbbells, weight-lifting, push-ups, sit down-ups, knee-flexion and extension, and moving objects. Most of the exercises using instruments at a gym are muscle strengthening exercises.

A typical method of determining the advisable weight for an individual is as follows:

First, there is a way to limited the load equally a percent of the maximum weight, or 1 repetition maximum (RM). Approximately sixty%–seventy% of 1 RM (moderate to difficult intensity) is for novice to intermediate exercisers to improve their strength. At 80% or higher of 1 RM (hard to very hard intensity) is when experienced forcefulness trainers to amend strength. With 40%–l% of one RM (very light to light intensity), older persons and sedentary people initially offset to exercise tin can start to improve strength.

The second is a method that estimates appropriate starting weight by what can be lifted. It is used largely because it is piece of cake to measure. Generally, the weight recommended for resistance exercise is the one that can be lifted 8 to 15 times at a fourth dimension.

Muscle forcefulness is usually increased past the weighted practise with eight repetitions, while muscular endurance is improved by the i 15 repetitions. Therefore, at the starting time, using a weight that can be lifted simply 8 times at a time is recommended. If the designated weight can be lifted 15 times at a time, and so it tin be increased.

The easiest way is to exhale while doing muscle strengthening exercises is slowly without a break while lifting a weight for 3 seconds, resting for 1 second, then lowering it for three seconds. This is repeated 8–15 times, which is called a ready. It is advisable to perform three sets of muscle strengthening exercise.

Guidelines recommend the elderly or 65 years of age or older should do same physical activities every bit adults. Peculiarly for the elderly, prevention of falls is important, then balance, leg strength, and flexibility should be improved.

Physical activities for fall prevention should be performed more than 3 times a week, which can include the following: standing on one leg, moving the upper body while continuing on one leg, standing or moving on a heel, standing with airtight optics, and standing on a soft, bumpy, or inclined floor. Physical activity should be modified according to the physical fettle and situation to forbid injury.

Children and adolescents should perform hour or more of concrete activity daily which includes aerobic, muscle and bone strengthening activities.

Well-nigh of the 60 minutes or more than per day should exist either moderateor vigorous-intensity aerobic concrete activity and should include vigorous-intensity concrete activity for at to the lowest degree iii days a calendar week. They should also include muscle and bone-strengthening physical activeness on at least three days a calendar week. Jumping, hopping, skipping, and dancing are activities that are good examples of these.

Warming upward and cooling downward should be washed pre- and post-exercise period. These are concrete activities with an intensity of about 50% of the originally planned practise and may include stretching [half-dozen]. For case, you can walk and stretch before and later jogging.

Although the prove of warming up for prevention of injuries is weak, it is recommended to be carried out to prevent musculoskeletal injuries and heart attacks. Cooling downwards is likewise recommended to promote recovery from minute injuries and to prevent dizziness after exercise.

Physical activity should also be performed for chronic patients because regular physical activity is very important for general health maintenance and prevention of cerebrovascular disease. Primary intendance physicians should encourage the patients with chronic diseases to perform concrete activity, educate them on how to practice safely in accordance with their physical force, and give them precautions for practise [7].

Table i
summarizes the recommendations of primary care physicians recommend physical activity for the patients based on the WHO, U.s.a., and Korea Physical Action Guidelines.

Table 1.

Recommendations for physical activities for the patients in primary intendance

ane. Primary care physicians should frequently bank check on the corporeality of concrete activity performed by the patients and encourage concrete activities.
2. Educate patients to perform the post-obit physical activities:
ane) Motility as much as possible and avoid sedentary activities.
2) For substantial health benefits, adults should perform at least 150–300 min/wk of moderate-intensity, 75–150 min/wk of vigorous-intensity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. Additional health benefits are gained by engaging in physical action across the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity per week.
3) Adults should also perform muscle-strengthening exercises of moderate or greater intensity that involve all major musculus groups on 2 or more days a calendar week, as these activities provide additional wellness benefits.
iv) Guidelines for the elderly (aged 65 years or older) are every bit follows:
(1) The central guidelines for adults also utilize to the elderly patients depending on their condition.
(ii) Balance preparation and fall prevention exercises should be performed more than 3 times a calendar week
(3) Older adults should determine their level of effort for physical activeness relative to their level of fitness.
v) Guidelines for children and adolescents
Patients should perform hr or more of moderate-to-vigorous concrete activity daily with the post-obit distribution:
(1) Aerobic: Almost of the daily activity should be either moderate-or vigorous-intensity aerobic physical activity and should also include vigorous-intensity physical activity on at least iii d/wk.
(2) Muscle-strengthening: Children and adolescents should include muscle-strengthening concrete activity every bit part of their lx minutes or more than of daily activity on at least iii days a calendar week.
(3) Os-strengthening: Children and adolescents should include os-strengthening physical activity on at to the lowest degree iii days a week.
3. Warming upwardly and cooling down exercises are recommended in the pre- and post-practice catamenia, respectively.
4. If patients have chronic diseases, they must engage in physical activity, as outlined in a higher place; yet, the post-obit considerations should be kept in mind:
1) Regular physical activeness is crucial to maintaining health and preventing cardiovascular disease complications.
2) Patients must consult their doctor and work out safely co-ordinate to their fitness level.

2. Status of Physical Action in the Korean Population

Co-ordinate to the Korea National Wellness and Diet Test Survey about fifty% of Korean adults met the guidelines for aerobic physical activity. Unfortunately this percent has been decreasing yearly from 2014 to 2017 (Figure 1) [8]. About 20% of Korean adults who met the guidelines of muscle strengthening physical activity (Figure 2) [8]. Muscle strengthening activities should exist encouraged more, especially for women.

Proportion of Korean adults who met the aerobic physical activeness guidelines, 2014–2017. From Korea Heart for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey reports [Net]. Cheongju: Korea Center for Affliction Control and Prevention [cited 2019 May 4]. Available from: https://knhanes.cdc.get.kr/knhanes/sub04/sub04_03.practise?classType=7.[viii]

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Proportion of Korean adults who met the muscle-strengthening activeness guidelines, 2005–2017. From Korea Center for Affliction Control and Prevention. Korean National Health and Diet Examination Survey reports [Internet]. Cheongju: Korea Center for Disease Control and Prevention [cited 2019 May 4]. Available from: https://knhanes.cdc.get.kr/knhanes/sub04/sub04_03.do?classType=7.[8]

Korean adults who met the concrete action guidelines in 2014 were 15.six% of the total population, comprising of 22% of total men, nine.4% of full women (Figure iii) [8]. As age increased, fewer physical activities were performed. In the United States, about 26% of men, xix% of women, and 20% of adolescents met the guidelines in 2016 [9].

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Object name is kjfm-19-0038f3.jpg

Proportion of Korean adults who met the aerobic and musclestrengthening guidelines, 2014. From Korea Center for Affliction Control and Prevention. Korean National Health and Nutrition Test Survey reports [Internet]. Cheongju: Korea Center for Affliction Control and Prevention [cited 2019 May 4]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.[8]

3. Exercises for Musculoskeletal Health

Practice is ane of the master handling methods for some musculoskeletal disorders [ten]. Chronic pain leads to muscle atrophy and joint contracture, fatigue and even depression, which exercise tin and so alleviate.

Muscle strengthening exercises and flexibility and residue training are the cornerstones for the treatment of musculoskeletal diseases.

Muscle strengthening exercise is recommended to exist performed 2–iii times a week. It is necessary to go out more than one solar day of rest in between to relax and strengthen muscles.

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Stretching is required for whole body muscles. Larger muscles such every bit the calves, thighs, hamstrings, lumbosacral spine, and anterior shoulder muscles especially should be stretched to be flexible. For those with back pain, information technology is essential to stretch the muscles backside the waist and femur. Range of move exercises are helpful for the arthritic joints.

A sense of residue prevents injuries acquired by falls. Although balance improves to some extent with musculus strengthening or stretching exercises, information technology is preferable to take active residue training.

Exercise therapy is constructive in the treatment of some musculoskeletal problems such as shoulder instability and/or impingement syndrome, myofascial pain syndromes (upper trapezius, sternocleidomastoid muscle, levator scapulae, and other such muscles), adhesive capsulitis, tennis and golf game elbows, osteoarthritis, patellofemoral hurting syndrome, and chronic depression dorsum pain.

In guild to treat musculoskeletal pain of the shoulder, exercises for shoulder stability and rotator cuff strengthening are important. Muscle strengthening and stretching of the wrist are needed for tennis and/or golf elbow. To prevent and treat knee joint osteoarthritis, walking, cycling and swimming are recommended. Aerobic practise and muscle strengthening training around the joints are needed for the treatment of osteoarthritis. Weight reduction of 5% of total body weight improves osteoarthritis if the patient is overweight. Overall, exercise reduces musculoskeletal pain and improve function, quality of life as well equally mental health.

Exercise is not recommended for acute lower back pain although it is effective for chronic lower back pain (LBP). Cadre stabilization exercises are recommended for chronic LBP. Aerobic exercise is likewise good for chronic LBP.

Exercise should exist modified co-ordinate to the individual’due south response. For example, if the patient feels pain during the musculoskeletal exercise, it is recommended to hold the do. If the patient feels hurting next day as well, the amount of exercise should be reduced 50%. From at that place, they can gradually increment the amount.


Practice should be washed safely and effectively. Master care physicians should have 4 basic principles in mind for the recommendation of physical activities.

First, do should not impair or damage patients’ health. Second, do should be constructive; it should improve illnesses and promote health. 3rd, overloading is needed since it is effective when the patient applies a load greater than what is usually experienced in normal routine. Fourth, slow progression is needed. Depending on the patient’s fitness level, the patient should increase their load from low to high, gradually.

Exercise prescription should include v elements of exercise: blazon, intensity, duration, frequency, and speed of movement. Primary care physicians should inform the patient of the risks and provide them with precautions for that particular do.

1. Exercise-Induced Heart Assail or Musculoskeletal Injuries

People with chronic diseases who take cardiovascular risk factors may not have whatever problems even if they are agile. However, since in that location may exist a component of underlying cerebrovascular affliction, information technology is recommended to determine if the patients have any abnormal symptoms or signs before they showtime their activity. If they are planning for higher intensity physical activity, a more thorough bank check-up is needed. If the run a risk of cardiovascular affliction is high, information technology is important to exclude the possibility of ischemic heart disease. Recent myocardial infarction, unstable angina, acute heart failure, and complete heart block are contraindications to practise.

Patients with chronic diseases or disability can accept health benefits even with depression intensity activities. Physical activeness should exist modified on an private basis. Patients who have non exercised before should begin with mild activity for less than 10 minutes. Activity time is increased gradually, and if there are no problems, the number of days of activeness per calendar week are increased. It is safe to increase do intensity after an increase in exercise time. If periodic physical activity is temporarily suspended due to illness or injury, it is safe to start over again with lower activity intensity and gradually increase it to previous activity levels.

A center assail may occur when the patients exercise violently due to undiagnosed arteriosclerosis. However, the risk of a center assail due to exercise is relatively small compared to the hazard reduction of myocardial infarction by exercise. The sudden decease chance of an active person is about 30% of inactive people.

If the patient is a novice who undergoes sudden, strenuous exercise, overuse syndromes such as sprains, tendinopathies, shin splints, fasciitis, bursitis, and stress fractures may occur. In club to prevent overuse syndromes, information technology is necessary to use acceptable footwear with arch support, obtain proper diet and hydration, perform acceptable warming up, gradually increase exercise time and intensity, have a good posture during practise, and appoint in cantankerous preparation [xi]. Cross training alternates the blazon of exercises engaged, which reduces boredom and prevents overuse syndrome.

Once a patient is injured or sprained, resting of the joints and muscles are recommended. For instance, if a knee trouble occurs with jogging or aerobics, free style swimming or aquatic exercise may be practical to rest the injured knee.

Overtraining syndrome refers to myalgia, chronic fatigue, and overuse syndrome caused past excessive practise. When the exercise ability is reduced, reduction of the amount of exercise or rest is recommended to rule out overtraining syndrome.

2. Full general Exercise Precautions

When exercising outdoors, patients should exist mindful nearly temperature, humidity, and air pollution. Generally, exercising for more than 30 minutes at 27℃–29℃ and above lxx% relative humidity is harmful to the body and is a contraindication to practice, especially for eye disease patients. In hot weather it is better to practise early on in the morning or evening or indoors.

When pollen-sensitive asthmatic patients exercise outdoors, preventive measures are needed, such as bronchodilator inhalation. In cold weather, asthma is easily induced by do because of dry air, thus, indoor activities are recommended.

When prescribing exercise, the main intendance physician needs to place the patients’ current medication and reply accordingly. For instance, if a patient is taking nitroglycerin, intervals equally needed between medication and exercise because exercising immediately afterwards taking nitroglycerin may cause hypotension. Insulin-dependent patients with diabetes should reduce the amount of insulin to preclude hypoglycemia, and administration should exist on the belly instead of extremities to prevent quick absorption. Beta blockers may deadening the middle rate; therefore, the primary care physician should not use eye rate every bit an index of exercise intensity in these patients. Subjective exercise intensity is a more appropriate and realistic indicator. Beta blockers may too reduce practise capacity by reducing cardiac contractility. Potassium sparing diuretics may crusade hyperkalemia, while other diuretics may cause potassium deficiency, resulting in arrhythmias during exercise. Information technology should besides be noted that anticholinergic drugs such as antispasmodics and antihistamines may inhibit sweating and can easily increment body temperature.

3. Precautions in Chronic Diseases

i) Diabetes mellitus

To date, there is no consensus on whether pre-exercise health screening should exist performed for patients with diabetes. Patients with diabetes who are asymptomatic and inactive may not be required to undergo screening if they perform low or moderate intensity practice; if the intensity is equivalent to brisk walking or less, screening is non necessary. Still, if they are going to engage in more intense activeness than usual, if they are at loftier risk for cardiovascular illness (high blood pressure, smoking, family history, and other such factors) and if they are suspected to have other exercise-related health problems, pre-exercise screening is needed [12].

Patients with diabetes are besides encouraged to exercise per standard guidelines merely with additional accent on exercising more than than 3 days a calendar week. Residuum for more than 2 days is avoided due to the temporary positive outcome of exercise on insulin sensitivity.

Do-induced hypoglycemia should be considered as insulin sensitivity increases for about 24–48 hours after active practise. Hypoglycemia can occur due to practise particularly when insulin secretagogues or insulin injections are used. Fortunately, there are many types of diabetes medications that rarely crusade hypoglycemia. To make up one’s mind effect of practice on blood glucose, measurements of blood glucose earlier and after practise are recommended. If the patient has a loftier risk of hypoglycemia, reduction of pre-exercise medication dose or having a pre-exercise meal is required. If the pre-exercise claret glucose is less than ninety mL/dL, carbohydrate intake is necessary. Insulindependent patients with diabetes should reduce their insulin dose to prevent development of exercise-induced hypoglycemia and should consume carbohydrates one time hypoglycemic symptoms occur. In addition, on the solar day of exercise, injection into the arms and the legs which muscles that are more often than not exercising should be avoided, injection into the abdomen is recommended to forbid besides rapid insulin absorption.

In social club to preclude hypoglycemia, it is advisable to perform resistance exercises or brusque-distance running earlier aerobic exercise. This is considering strenuous activity can signal counter-regulatory hormones which tin can prevent a decrease in the blood glucose.

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Practise-induced nocturnal hypoglycemia should also exist noted. Claret glucose levels tin can be reduced up to 48 hours later exercise. This can exist prevented past a reduction in evening insulin dose, incorporating midnight snacks, and engaging in continuous glucose monitoring.

Practice-induced hyperglycemia is besides possible, specially when high pre-practice claret glucose is elevated. It can be acquired by high intensity practise such every bit curt-distance running, strong aerobic exercise, and heavy weight-lifting exercises. If patients are going to perform these exercises, insulin dose command and interval training (alternate between high intensity and moderate intensity exercises) are recommended.

If uncontrolled blood force per unit area, severe autonomic or peripheral neuropathy, history of diabetic human foot disease, and/or unstable proliferative retinopathy are nowadays, it is appropriate to avert high intensity exercise and to perform moderate and lower intensity exercise.

If autonomic neuropathy is present, sudden vertical positional changes should be avoided to preclude orthostatic hypotension. Acceptable hydration is required for prevention of dehydration and hyperthermia. Considering of the possibility of diabetic foot ulcers, the patient should have well-plumbing fixtures shoes and carry a careful inspection for wounds earlier and after their workout.

If in that location is astringent non-proliferative retinopathy or unstable proliferative retinopathy, high intensity aerobic practice and resistance do should be avoided. In particular, jumping, exercises with a lowered head, and breath holding exercises should exist avoided. Breath holding during isometric exercise that does not change in altitude can increase intraocular pressure via the Valsalva upshot.

Unlike the previous guidelines, there is no limitation of practise when albuminuria or kidney disease is present. Physical activity can exist performed even during dialysis.

High-intensity exercise should exist avoided if there is business of ketoacidosis. However, if there is no ketoacidosis and the patient’due south overall systemic condition is practiced, information technology is not necessary to delay exercise even if hyperglycemia is present. Unlike previous guidelines, hyperglycemia itself is not a contraindication to exercise. Loftier-intensity exercise is safe when pre-exercise blood glucose is less than 250 mg/dL [13]. In add-on, if type 1 diabetes patients do non get insulin injections for a long fourth dimension, hyperglycemia may occur, and so it is desirable to prohibit vigorous activities.

2) Hypertension

The importance of physical action has become even greater as the levels designating of hypertension have decreased. In the case of systolic blood pressure level 130–140 mm Hg, lifestyle modification is recommended before taking medication. Physical activity lowers blood pressure by 5–eight mm Hg. Regardless of exercise intensity, elapsing, or blazon, blood pressure lowering effects are demonstrated.

Previously resistance exercises were prohibited in hypertensive patients because it was hypothesized to crusade a Valsalva result and subtract blood circulation, which then would result in a compensatory elevation in heart charge per unit and subsequent height in blood pressure level. Notwithstanding, this has been disproven past many studies and ultimately have shown that there are blood pressure lowering furnishings in the long term. Equally a outcome, patients with hypertension are now encouraged to perform resistance exercises. Dynamic resistance exercise is rubber and effective in hypertension if the load is not too heavy [14]. Generally, the weight that tin be lifted 8 times or more is non a problem. While isometric exercise is safe and constructive, there is not plenty show to support it, so it cannot be formally recommended.

Nevertheless, hypertensive patients may have problems if the weight is also heavy, thus should be encouraged to practise with proper weights and to avoid breath property.

3) Osteoarthritis

In patients with osteoarthritis, exercise reduces pain, improves quality of life, and improves physical function. Therefore, the guidelines have been changed from not recommending practice to highly recommending it. Recommendations for non-pharmacological treatment include weight loss (5% decrease in total body weight when overweight), aerobic physical activeness, range of motion exercises, resistance exercises, and proper footwear [xv].

For patients with hip and knee osteoarthritis, information technology is recommended to appoint in depression-impact exercises with low weight-bearing. Additionally, swimming and stationary bicycle exercises are preferable. However, it is important to consider that the bathe tin be a challenge for patients with knee osteoarthritis, because it requires wide knee flexion. If genu pain occurs, it is advised to swim using free manner, dorsum stroke or participate in an aquatic sport. Even when riding a stationary bicycle, genu pain worsen due to continuous knee flexion. Raising the saddle peak of the stationary bicycle to straighten the leg may relieve knee pain. Knee flexion and extension exercises in addition to cycling would be helpful in decreasing knee loads. For example, a semi-squat exercise is effective.

Muscle strengthening exercises around the knee, particularly the quadriceps, are essential in treating lower extremity osteoarthritis and also in alleviating patellofemoral pain syndrome.


Exercise or physical activity should be done at least moderately. Adult physical activity guidelines are for moderate intensity aerobic physical activity for 150–300 minutes per week and muscle strengthening do 2–iii times a week. The elderly have the same physical activity guidelines as adults, but additionally demand balance training to foreclose falls. Children and adolescents need at to the lowest degree one hour of physical action each day, including loftier intensity aerobic activity, resistance preparation, and os strengthening exercises for at least three days per week. Previously, physical activities for more 10 minutes were recommended, but now shorter activities are being encouraged considering evidence demonstrates that shorter activities are also effective. However, since the aerobic physical activity of Korean people is decreasing, various efforts are needed to promote physical activity.

Living a sedentary lifestyle is too an contained risk factor for disease, and even a little concrete activeness has a positive impact on our wellness.

The risk of injuries or negative outcomes from concrete activities should be identified and eliminated by pre-participation testing, for patients who are at hazard. Information technology is besides necessary to provide practise instructions and exercise precautions to prevent injuries.

In reality, information technology is non easy to deport out detailed practise counseling during busy outpatient clinic hours. However, during primary care appointments, physicians have an opportunity to assess and encourage concrete activity for their patients. It is necessary to caution patients with hypertension, diabetes and osteoarthritis on appropriate physical activity.


No potential conflict of interest relevant to this article was reported.


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Korean University of Family unit Medicine

What Exercise Should Be Performed Last

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536904/