On a winter morning, the biting wind along the Yellow River in Lanzhou felt like knives against the face. Many diabetics believe that consistent exercise is a good way to control blood sugar, but Director Ye Aiguo, a chief physician and outpatient specialist at Lanzhou Ruijing Diabetes Hospital, warns: for diabetics who also have hypertension, outdoor exercise in cold weather may become a double-edged sword.

"Inadequate preparation before exercise can be more dangerous than not exercising at all," said Ye Aiguo, Deputy Chief Physician at Lanzhou Ruijing Diabetes Hospital. "Especially for diabetic patients with concurrent hypertension, winter outdoor exercise requires scientific guidance and thorough preparation."

01 Pre-Exercise Risk Assessment

The impact of cold winter weather on diabetic patients cannot be ignored. Cold stimulation can lead to vasoconstriction, elevated blood pressure, and increased cardiac load. For diabetic patients with concurrent hypertension, this effect is even more significant.

Before considering outdoor exercise, patients need to assess whether they are suitable for physical activity. Ye Aiguo noted that patients with stable type 2 diabetes—those with controlled blood sugar levels, no hypoglycemia, and no severe complications—are suitable for exercise.

However, exercise may pose risks if the following conditions are present: significant fluctuations in blood sugar, marked hypoglycemia, combined with various acute infections, acute diabetic complications, severe diabetic nephropathy, severe diabetic foot, severe fundus lesions, heart insufficiency, arrhythmias that worsen with activity, and uncontrolled hypertension.

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The "Nutritional and Exercise Guidelines for Hypertension (2024 Edition)" issued by the National Health Commission recommend that hypertensive patients, on the basis of standardized medication, should control their blood pressure before exercising if their systolic blood pressure before exercise exceeds 180 mmHg or diastolic blood pressure exceeds 110 mmHg.

02 Key Preparations

For diabetic patients with hypertension planning outdoor exercise, thorough preparation is crucial. The timing of exercise should avoid cold periods in the early morning and late at night.

The optimal time to exercise is about one hour after a meal when blood sugar levels are relatively high, reducing the risk of hypoglycemia during physical activity. The duration of exercise can be gradually increased from 5 minutes per session to 30 minutes per session, and the frequency can be gradually increased from once per week to five times per week.

Regarding equipment, choose loose-fitting, warm, lightweight, and breathable clothing, well-fitted and comfortable athletic shoes, and breathable cotton socks. Wear necessary protective gear, such as knee pads and ankle braces.

Blood sugar and blood pressure must be monitored before exercise. If blood sugar is below 5.6 mmol/L, consider having a snack, and if it is below 3.9 mmol/L, avoid exercising. Carry candy or sugary drinks for emergencies.

For patients using insulin or oral hypoglycemic drugs, if exercise will delay a meal, they can have a small snack in advance, such as a slice of toast or half a glass of milk, to prevent hypoglycemia.

03 Precautions During Exercise

Selecting appropriate types of exercise is crucial for patients with diabetes combined with hypertension. Winter is a season of closure and storage in the year, during which the body’s metabolic rate is relatively slow. It is advisable to choose relatively low-intensity exercises based on factors such as age, physical condition, preferences, and environment.

Recommended types of exercise include walking, practicing Tai Chi, jogging, and cycling. The guidelines issued by the National Health Commission also recommend that individuals with high blood sugar should reduce their daily sedentary time, increase daily activities and structured exercise, with exercise programs incorporating aerobic exercise, resistance training, and flexibility training.

Mastering exercise intensity is key. A simple calculation method is: maintain a pulse rate (beats/minute) = 170 - age during exercise, this exercise intensity represents the optimal workout level. The bodily sensations at optimal exercise intensity include: feeling warm all over, sweating, but not profuse sweating or gasping for breath, being able to speak but not sing.

During exercise, diabetic patients should pay attention to their body's sensations, monitor changes in heart rate and how they feel, to better manage exercise intensity. If you feel thirsty, you can drink a small amount of warm water. If you cannot carry water with you, you can drink a glass of water before exercising and another after exercising.

04 Recognizing Danger Signals

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During exercise, patients need to be especially vigilant for danger signals from their bodies. If any of the following situations occur, exercise should be stopped immediately:

Weakness, chest tightness, breathlessness, or leg pain and other discomfort symptoms; dizziness, palpitations, abnormal sweating; and any sudden onset of pain.

The most severe problem faced by diabetic patients during exercise is hypoglycemia. Symptoms include trembling, weakness, sweating, anxiety, and numbness in the mouth and hands. Neurogenic hypoglycemia symptoms include headache, visual disturbances, slow reaction times, memory loss, and even coma.

It should be noted that hypoglycemia may occur within 12 hours after exercise.

For hypertensive patients, if symptoms such as chest pain, chest tightness, palpitations, or difficulty breathing occur during warm-up and exercise, they should stop exercising immediately and take appropriate measures.

If you experience symptoms such as dizziness, chest tightness, shortness of breath, loss of appetite, or fatigue the next day after exercise, it may indicate excessive exercise intensity, and adjustments should be made. If discomfort persists even after reducing the exercise intensity, you should stop exercising and, if necessary, seek medical attention.

05 Situations Requiring Immediate Medical Attention

Some situations require more than just stopping exercise—they demand immediate medical intervention:

When symptoms of hypoglycemia persist even after consuming sugar. When blood glucose levels remain consistently high above 15 mmol/L and do not decrease, as elevated blood glucose increases the risk of ketosis. Exercising under such conditions can lead to ketoacidosis, which is potentially life-threatening.

For individuals with diabetes, if blood glucose levels are significantly elevated, exceeding 14-16 mmol/L, it is advisable to temporarily refrain from exercise, especially for those with positive urine ketones. Exercise should be resumed only after blood glucose stabilizes and ketones disappear.

If redness, swelling, bruising, blisters, blood blisters, or signs of infection are observed on the feet, prompt medical attention should be sought. Many people with diabetes also experience peripheral neuropathy, which can reduce sensitivity to pain and injury, making it particularly important to pay close attention to foot health.

If symptoms such as persistent fatigue, an abnormal increase in weakness, reduced range of motion in joints, worsening swelling, or pain that does not subside one hour after exercise occur, the exercise plan should be paused and medical attention sought promptly.

06 Post-Exercise Follow-up and Monitoring

The end of exercise does not mean you can let your guard down. As the exercise session nears its conclusion, perform 5-10 minutes of cool-down and recovery exercises, gradually bringing your heart rate back to pre-exercise levels—do not stop abruptly.

After exercising, rest for a while and wait until your heart rate returns to pre-exercise levels before taking a shower. In winter, it is best to take a warm bath. Monitor your blood sugar once after exercising to understand the relationship between exercise intensity and blood sugar changes. If hypoglycemia occurs, consider appropriately reducing the exercise intensity.

It is particularly important to check for redness, swelling, bruising, blisters, blood blisters, and infections on both feet. People with diabetes should maintain the habit of daily foot inspections, observing whether any injuries occur. If damage, calluses, corns, or paronychia are present, prompt treatment is necessary.

After exercise, it is essential to replenish fluids promptly, but it is not recommended to consume sugary beverages or sports drinks, as they can easily lead to excessively high blood sugar levels. Patients with hyperuricemia should maintain a daily urine output of over 2,000 milliliters.

Ye Aiguo finally reminds us: For diabetics exercising in winter, "it's not about being slow, but about not moving at all; it's not about doing too little, but about doing nothing." Safety should always be the top priority. The exercise plan needs to be individualized and is best developed and adjusted under the guidance of a physician or a professional diabetes care and education specialist.