Risk And Benefits
Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes. Exercise has many physiologic and psychological benefits for patients with and without diabetes.
Hiking As A Solution
For the past several decades outdoor activities such as hiking have seen a surge in popularity. Nearly 50% of Americans participated in an outdoor recreational activity, 12% for hiking. Hiking is a lifelong activity, not only does it have a minute learning curve (easy to do), it is relatively inexpensive, is self-paced, is social in nature, and is low impact. Hiking is a viable option for patients with diabetes to actively engage in if their personal interests and health permit it.
Benefits Of Hiking: Physical
Hiking is an activity that readily burns calories, metabolizing approximately 210 calories per 30 minutes in a 70-kg male. If performed in hilly terrain, besides increasing the metabolic demand, improves the benefits of exercise in terms of weight loss, increasing lean body mass, and reducing hemoglobin A1c (improved glycemic control). Hiking incorporates double-support periods in the gait cycle; thus, it would be considered a low-impact activity. The impact is further reduced because hiking typically is performed on more forgiving dirt or natural terrain. It still provides important physical challenges created by an irregular surface, which is believed to better train the musculature with ever-changing stresses to the musculoskeletal system, balance, and core, which is especially beneficial to those with diabetes.
Irregular or ever-changing terrain presents an obvious challenge to individuals with diabetic peripheral neuropathy (DPN) because they have a higher risk of falling and injury. Paradoxically, this varied terrain may also lend an opportunity to train and, thus, upgrade the essential skills of balance and stability for patients with diabetes.
Unlike mindless ambulation on a treadmill or sidewalk, hiking requires people with and without diabetes alike to use an increased level of awareness to impending terrain changes and obstacles. People with diabetes may be able to transfer this increased level of balance and stability mindfulness cultivated on the trail to everyday walking. The diverse contours of hiking trails are essentially a training field on which to practice the skills of balance. This produces a reserve of muscle memory and skills that are above and beyond the normal techniques in everyday walking, and, hence, they can use these skills in their day-to-day life.
Hiking and Persons with Diabetes: Related Risk
Despite all the possible advantages of hiking, there are numerous potential risks and associated difficulties. Pebbles and organic material entering shoes is a minor annoyance for most hikers. For the hiker with diabetic neuropathy, coupled with the repetitive steps of hiking, these foreign objects are a significant threat to pedal health and can quickly lead to ulceration because hikers with diabetes may not be able to detect their entrance or irritation.
Lack of protective sensation and the associated deficit in coordination and balance leading to fall risk is of significant concern for people with diabetes, especially when amplified with hazards in nature, such as terrain that is likely to be uneven and loose. If the hiker with diabetes loses balance and falls, the consequences can be potentially deadly in the wilderness, where help can take hours or days to arrive. The irregular surface can further exacerbate fall risk in those with compromised vision secondary to diabetic retinopathy. Deficits in proprioception and balance can be exacerbated by the use of packs, which can raise the center of gravity and contribute to falls even in healthy hikers.
Gear and Equipment Choices
Hikers with diabetes should carry essential items:
- First Aid Kit supplemented with diabetes-specific supplies
- Pants and Gaiters (fabric sleeves that shield the leg as well as the boot-pant interface) to reduce and, hence, decreases the risk of ulceration.
- A cell phone
- Hikers with diabetes should strongly consider hiking with a partner who can assist if crises, such as diabetic ketoacidosis or diabetic hyperglycemic ensue.
- Hikers with distal peripheral neuropathy must take care not to hike on terrain that is outside of their functional abilities regarding balance.
- One countermeasure to this concern may be the use of trekking poles.