Baijayanti (57) and Brajakishor Swain (61) walk religiously every day. The Nagpur-based professor couple goes for a 45-minute outing every evening. Brajakishor, who has been a regular walker for almost 30 years now, doubles it up with another 45 minutes in the morning.
Brajakishor began with moderately paced 45-minute outings twice a day after he got diagnosed with early-onset diabetes. Walking has helped him in keeping fit, he says, “by maintaining body weight constant over the years and preventing sugar levels from fluctuating”.
Baijayanti has been accompanying Brajakishor for the past 10 years. It has helped keep her weight in check. Getting a healthy dose of “fresh air” and maintaining “fitness” have been the motivators for them, while Brajakishor’s journey with diabetes is the additional incentive.
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“My mother has had massive weight loss thanks to her walking regimen,” says their daughter Dr Bishakha Swain (MD, general medicine), before elaborating on how Brajakishor used walking to alter the course of diabetes.
“In all these years, my father has had a really good course with diabetes. His sugar levels were fine for a very long time, and it is only recently that he has had to rely on insulin. So, walking has a huge implication, and lifestyle modification (diet and exercise) in general can alter the course of diabetes, which people often do not understand.”
Walking, weight loss and diabetes
Bodyweight has a direct correlation with diabetes since weight loss improves insulin sensitivity. So, exercises and a regular diet which leads to healthy weight loss all work in tandem to bring diabetes under control, at times even facilitating a remission.
Diabetes is essentially “glucose toxicity arising from deficiency of insulin which is responsible for disposal of glucose,” says Dr Swain. “There is also a condition called insulin resistance, wherein despite adequate, [or] rather plenty of, insulin, the target organs — muscle, liver and fat deposits or adipose tissue — do not respond to insulin. Insulin is a master regulator in fat metabolism, responsible for avoiding fat breakdown or lipolysis. In insulin resistance, excessive lipolysis leads to high free fatty acids which are building blocks for more glucose.”
Elaborating on how weight loss leads to an improvement in insulin sensitivity, she says, “Restriction in calories has a profound and immediate effect on improvement in insulin sensitivity, even before change in weight. Exercise alters metabolism in favour of insulin sensitivity, and thus helps [people with diabetes] with control of blood glucose. Increasing physical activity is an important component of successful long-term weight management. The amount of exercise that is associated with weight-loss maintenance is considerable and requires expending approximately 2,500 kcal/week. This level of energy expenditure can be accomplished through vigorous activity (aerobics, cycling or jogging) for approximately 30 minutes a day, or more moderate activity (brisk walking) for 60 to 75 minutes a day.”
If one cannot regularly carve out an hour or more of brisk walking a day or if chronic health conditions or injuries force one to keep away from vigorous activities, a variation called interval walking can be tried.
Research further suggests that type 2 diabetes and hypertension — common comorbidities (or illnesses that occur together) — are strongly correlated.
“Hypertension is twice as frequent in patients with diabetes compared with those who do not have diabetes,” according to a 2018 review article published in the Canadian Journal of Cardiology. “Moreover, patients with hypertension often exhibit insulin resistance and are at greater risk of diabetes developing than are normotensive individuals [people having normal blood pressure]. The major cause of morbidity [sickness] and mortality [death] in diabetes is cardiovascular disease, which is exacerbated by hypertension.”
Obesity is among the many underlying risk factors that closely interlink diabetes and hypertension, besides vascular inflammation and complications, the review says. Hence, working out, in one’s own capacity, becomes imperative to prevent as well as manage chronic health conditions.
Walking to curb hypertension, anxiety
A regular routine of 30 to 40-minute walk, five days a week, helps reduce blood pressure (BP) by 5 to 10mmHg, says Dr Divya Marina Fernandes, consultant, heart failure specialist and interventional cardiologist, Aster RV Hospital, Bengaluru. “Walking is one of the easiest and most economical form of exercises. Regular walks strengthen the heart muscle. The pumping of blood improves as the muscle strength improves, [which] causes the blood flow to improve and move better, thus lowering BP.”
Dr Swain agrees, and says that walking, in combination with a DASH diet, helped her mother keep her hypertension under check.
Anxiety and hypertension have a correlation too.
“Anxiety can cause a temporary increase in the blood pressure, which reduces once you are calm,” says Dr Fernandes. “However, recurrent episodes of anxiety and stress can cause fluctuations in blood pressure, ultimately leading to high BP readings. This, along with smoking and an unhealthy lifestyle, can lead to hypertension.”
And walking is a natural means to overcome anxiety.
“With walking, you tend to become calmer, enjoy your surroundings, make new friends on your walks, and this helps to work out together and keep your mind at peace,” says Dr Fernandes. “As you enjoy the early-morning breeze or late-evening chill, you feel satisfied and happiest, causing your anxiety levels to drop.”
Dr Fernandes prescribes a holistic approach with not just exercises but lifestyle modifications.
“Walk for 30 to 40 minutes for five days a week, stop smoking, eat a healthy diet with lots of fibre and a good amount of protein, sleep for at least six hours, and monitor blood pressure, cholesterol and sugars regularly,” says Dr Fernandes, who encourages activities such as singing, dancing, painting, cooking and playing sports. All these keep stress hormones in check.
- Weight loss and exercise improve insulin sensitivity and metabolism, helping people with diabetes keep glucose levels in check.
- Diabetes and hypertension share common underlying risk factors, and the presence of one of the two conditions can give way to or worsen the other.
- Thirty to 40 minutes of walking for at least five days a week regularly helps reduce blood pressure or hypertension.
- Recurrent episodes of anxiety and stress can also lead to increased blood pressure or hypertension. Walking outdoors helps reduce stress levels and manage pangs of anxiety.