CDE Exercise Prescription 3 — Questions and Answers
Question 1: A patient on a sulfonylurea begins a new walking program. What is the most important counseling point regarding hypoglycemia risk?
- Sulfonylureas do not cause exercise-induced hypoglycemia
- Monitor blood glucose before, during, and after exercise and carry fast-acting carbohydrates (Correct answer)
- Exercise always raises blood glucose with sulfonylureas
- Reduce sulfonylurea dose only on rest days
Correct answer: Monitor blood glucose before, during, and after exercise and carry fast-acting carbohydrates
Sulfonylureas stimulate insulin secretion regardless of glucose level, increasing hypoglycemia risk during exercise; glucose monitoring and carbohydrate availability are essential.
Question 2: What is the recommended pre-exercise blood glucose target range for most people with diabetes before beginning moderate exercise?
- Less than 70 mg/dL
- 70-100 mg/dL
- 90-250 mg/dL (Correct answer)
- Greater than 300 mg/dL
Correct answer: 90-250 mg/dL
A pre-exercise blood glucose of 90-250 mg/dL is generally considered safe to begin moderate exercise for most people with diabetes.
Question 3: Which exercise modality has been shown to attenuate post-exercise nocturnal hypoglycemia in type 1 diabetes?
- Prolonged moderate aerobic exercise before bed
- Brief high-intensity interval exercise or resistance exercise (Correct answer)
- Yoga only
- Walking for 60+ minutes at bedtime
Correct answer: Brief high-intensity interval exercise or resistance exercise
Brief high-intensity intervals or resistance exercise can stimulate glucose-raising counterregulatory hormones that help stabilize blood glucose overnight.
Question 4: A patient with peripheral neuropathy wants to exercise. Which activity is most appropriate?
- Barefoot running on pavement
- Swimming or water aerobics (Correct answer)
- High-impact jumping exercises
- Step aerobics on hard surfaces
Correct answer: Swimming or water aerobics
Swimming and water aerobics are low-impact and reduce pressure on insensate feet, minimizing injury risk in peripheral neuropathy.
Question 5: What is the primary metabolic benefit of breaking up prolonged sitting with short bouts of light activity every 30 minutes for people with type 2 diabetes?
- It has no measurable metabolic effect
- It reduces postprandial blood glucose and insulin levels (Correct answer)
- It increases fasting glucose levels
- It decreases HbA1c only if done for 60+ minutes
Correct answer: It reduces postprandial blood glucose and insulin levels
Interrupting prolonged sitting with brief light-intensity walking significantly reduces postprandial glucose and insulin excursions in type 2 diabetes.
Question 6: Which heart rate formula is most commonly used to calculate target heart rate zones for exercise prescription?
- 220 minus resting heart rate
- 220 minus age (Karvonen adjustments optional) (Correct answer)
- 200 minus body weight in kg
- Maximum VO2 multiplied by age
Correct answer: 220 minus age (Karvonen adjustments optional)
The formula 220 minus age estimates maximum heart rate, which is then used with the Karvonen method to calculate target training zones.
Question 7: A patient with autonomic neuropathy begins an exercise program. What modification is most critical?
- Skip warm-up to save time
- Extend warm-up and cool-down periods and monitor for orthostatic hypotension (Correct answer)
- Avoid all aerobic exercise permanently
- Only perform exercises lying down
Correct answer: Extend warm-up and cool-down periods and monitor for orthostatic hypotension
Autonomic neuropathy impairs cardiovascular responses; longer warm-ups and cool-downs and postural blood pressure monitoring reduce risk of orthostatic hypotension and silent ischemia.
CDE Exercise Prescription 3
A patient on a sulfonylurea begins a new walking program.
What is the most important counseling point regarding hypoglycemia risk?