Your organization needs a type 2 diabetes strategy. Here’s why.


 

Type 2 diabetes is a significant burden on our healthcare system and likely worse than current estimates. Despite this, the real issue is what will happen in the next 10, 15 or 20 years.

There are at least three reasons for concern.

1. Current population estimates are wrong.

Recently published research would suggest that screening with fasting blood glucose is inadequate – significantly under-reporting actual numbers. For example, research using HbA1c as a screening tool showed that more than 50% of the adult population has some form of diabetes – diagnosed type 2 diabetic, prediabetic or undiagnosed. This means if you use fasting blood glucose as the primary measure for screening, you’re only getting part of the picture from your employee population.

This is an easy issue to fix and I discuss it below.

2. Long-term, it is the most expensive condition to treat.

While medications for some diseases and conditions receive headlines for high cost – hepatitis and cancer, for example. Costs for type 2 diabetes medications receive little press. This lack of coverage doesn’t mean treatment is inexpensive, as anyone who knows the cost of insulin understands.

Without getting into a discussion of why certain prescription drugs receive media attention and others do not, drugs for hepatitis and cancer are taken for a short time – usually no longer than 24 months. By comparison, type 2 diabetics can take insulin and other medications for years, even decades. These costs add up. And as the condition deteriorates and co-morbidities increase, additional medication and more expensive treatment options are needed.

A recent study looked at the long-term costs of more than 100 conditions over more than 10 years. Type 2 diabetes was the most expensive condition to have and treat, even more expensive than cancer.

3. Treatment protocols keep people diabetic

Current guidelines target a symptom of the condition rather than the cause. While there is mention of weight loss, exercise and diet, the primary method of treatment involves medication to control blood sugar. This is problematic for two reasons: 1) Individuals become dependent on medication to control their blood sugar; and, 2) It implies that elevated blood sugar is the problem.

Elevated blood sugar is a symptom, insulin resistance is the cause. Since diabetics are taking medication for a symptom of the problem, the cause of the problem doesn’t get better. In fact, it gets worse over time. This means type 2 diabetics will eventually need additional medication and will also further increase their risk for co-morbidities.

With this as our approach to treatment, there is little hope to eliminate the condition once a person has been diagnosed. They get stuck in our healthcare system. And since almost no one is eliminating the condition, the percentage of people with type 2 diabetes only grows.

Looking down the road

This is why there is a tidal wave on the horizon and it forms the crux of why every organization needs to implement a type 2 diabetes strategy. If we continue in this manner, things will be exponentially worse in a few short years. Since diabetes is already the most expensive condition to have and treat, this does not bode well.

So it is important we all do something and here is what you can do.

Commit to a type 2 diabetes strategy

Your organization can have a significant impact by implementing three steps.

Step 1. More appropriate screening

Earlier I mentioned that population estimates are wrong. You can get accurate population estimates within your organization by making a small change. Measure HbA1c (or simply A1c) in your annual HRA or biometric screenings.

HbA1c provides information on blood sugar control over the previous 2-3 months, which is a better indicator of diabetes risk than fasting blood glucose. Request this test from your provider. The same blood test used to measure fasting glucose can be used, so there is zero impact on your employee population.

If your provider is unable or doesn’t want to do this, contact me. I will help you find someone that can. If there is additional cost, the benefits of having accurate information outweigh the additional costs.

Step 2. Find providers with proven results

Do this specifically as it relates to type 2 diabetes. You should be able to find providers that can work with your existing wellness offerings. General programs that offer health/phone coaching usually don’t meet the standard of proven results for type 2 diabetes. Their message tends to be directed at the masses, which is not helpful or productive for type 2 diabetics. This step is important since, as noted above, more than 50% of adults have some form of type 2 diabetes.

There will likely be additional cost for this but a program with proven results will pay for itself. For example, if you have 100 type 2 diabetics using insulin in your organization, the cost for insulin alone is about $500,000 per year! When you consider other medications, lost productivity, time at the doctor’s office, etc., actual costs are higher. A good provider should be able to cut this in half or even eliminate it completely. If you save more than $500,000 per year, their costs are almost irrelevant.

Step 3. Everyone wants the same thing

At HPI, our most important corporate mission is to eliminate type 2 diabetes in the US population by the year 2020. You can help us achieve this, because all business leaders want the same thing – happy, healthy and productive employees. Guess what? Your employees want to be happy, healthy and productive too.

However, those needing our help (and yours) the most, don’t get too excited about the standard “wellness” offerings. Why? Because it is too generic and not focused on them. Besides, they’ve heard the message before.

So what to do?

Leadership by example is often used, but it is appropriate in this case. From the top of your organization, implementing a strategy for type 2 diabetes needs to be important. And when you implement steps 1 and 2 above, the importance message filters down. We see it all the time in our work.

When you do this correctly, it is easy to see, feel and measure.

We are here to help!

By now, I hope you realize that implementing a strategy for type 2 diabetes is important. Done properly, it will help your organization and your employees. The proverbial win-win. However, if you do nothing, all the negatives mentioned above will be exponentially worse.

I also understand the prospect of this can be a bit overwhelming. So we are here to help. If you have questions about anything within this article or need additional information on implementing any of these steps, let me know. Send me an email. Message me on Twitter, Facebook or LinkedIn or comment below and I will help.

Since this is an important message, please share with your colleagues, co-workers and leadership within your organization.

Thank you!

3 Snacks for Type 2 Diabetics

3 Snacks Type 2 Diabetics need to keep with them at ALL times!

No blood sugar impact snacks

Most type 2 diabetics struggle with controlling their blood sugar. Since almost all foods seem to raise their blood sugar, they also tend to stress out over what kind of snacks they can eat.

But since they also get hungry, this is a problem. So…what to eat?

Listed below are three different snacks you should have on “your person” at all times. Under most circumstances, they have a zero to minimal impact on your blood sugar, which means you should be able to eat them without worry (at least regarding your blood sugar).

Nuts

Nuts are high in fat, good fiber, vitamins and minerals. While they vary slightly – from one variety to another – in nutrient content, they are all high in fat, which means they will have minimal impact on your blood sugar. Additionally, the fat, vitamin and mineral content will help keep you full (or sated) until your next meal.

They are pretty hardy and travel well, making them an excellent snack choice for just about anyone, but type 2 diabetics in particular.

Eat them raw (our preference) or roasted. Just don’t eat them loaded with sugar or syrup or covered in chocolate (but you already knew that).

And if you happen to be allergic to nuts, seeds are good too. Pumpkin and sunflower seeds do essentially the same things!

Beef Jerky

Another snack high in protein and fat – the combination you need to keep your blood sugar from spiking.

Our preference: Buy it from a meat market or butcher shop (or make it yourself) so you know that it has been minimally processed. Another tip: If you buy from the store, check the label and look at the sugar content. Many types of beef jerky sold at the store have a lot of added sugar. Try to keep it below 5 grams of sugar per serving.

Best bet: Sugar free beef jerky.

A Boiled Egg

This is the least hardy of our recommendations but unless you have to leave these snacks in your car and it’s hot outside, you don’t really have to worry about the boiled egg.

Eggs are a great source of healthy fats, vitamins and minerals and an excellent source of protein.

Our recommendation: Always keep a dozen boiled eggs in the refrigerator. They are great snacks at any time!

Stay away from those…

Those little packets of 100 calorie snacks should be avoided by most people, especially type 2 diabetics. They are little more than sugar-spiking food products. It does not matter that they contain only 100 calories. It matters that they consist of some type of flour and sugar, both of which spike your blood sugar. Who thinks it’s better to eat a 100 calorie pack of cookies over one triple-double-stuffed Oreo cookie, which is also 100 calories?

That is insane

These snacks help you better control your blood sugar

While the 100 calorie snack packs are insane, these three snacks are not. Eat them when hungry. Your blood sugar will thank you!

If you liked these tips and would like more, sign up for our email newsletter below.

As a bonus, there are 3 gifts from the HPI Diabetes Academy included!

Glycemic Control for Patients With Type 2 Diabetes Mellitus



Controlling blood sugar is not enough!

A recently published article confirms what many other articles have shown:

For type 2 diabetics, controlling blood sugar does not reduce the risk of complications.

Link to Abstract

A pull-quote from the conclusion in the abstract:

“Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications.”

In other words, what type 2 diabetic patients are being told about controlling their blood sugar and it reducing their risk for kidney disorders, vision problems or pain-related issues, is not consistent with the research.

In fact…

“This evidence reported no significant impact of tight glycemic control on the risk of dialysis/transplantation/renal death, blindness or neuropathy. …however, most published statements and guidelines unequivocally endorsed” the benefits.

So we have a conundrum…

Not really. There are at least three issues here

One off blood tests indicate nothing

When we visit the doctor and have a fasting blood sugar test done, it indicates almost nothing regarding blood sugar control. A step in the right direction would be to monitor blood sugar control with regular A1c tests.

Wholly invested in controlling blood sugar

Everything we do regarding treatment of type 2 diabetes and/or prediabetes (a terrible term) is geared to control blood sugar – we’ve built the entire industry around it. Whether it be the medication, a fasting blood sugar test, or “official statements” from AHA, CDC, NIH or the ADA, it’s all about controlling blood sugar and reducing risk.

This leads to zero positive impact on the cause of type 2 diabetes – insulin resistance.

Maybe type 2 diabetes really is an insidious condition

It is quite possible that insulin resistance and blood sugar dysregulation are more complicated than we currently think and/or know.

It is amusing, telling and disturbing when a complicated concept is taken to a point where it is too simple – simple beyond reason.

But…if the risk for these complications in type 2 diabetics is higher, it means those without type 2 diabetes have a lower risk. So it plays some role – maybe we don’t really understand if the risk is causative or associative. But the risk is there.

So what should you do?

First, understand and come to grips with the fact that artificially controlling your blood sugar (in other words, through medication) is not enough. In spite of what your healthcare professional(s) tell you, the evidence simply does not support it.

Second, take steps to improve insulin sensitivity, which will decrease insulin resistance. Some of these steps include the right diet, proper exercise and ensuring enough sleep (I recently hosted a live webinar on these very topics. If you’d like to view it, enter your name and email address below).

If you can improve insulin sensitivity, you make progress on naturally controlling blood sugar – as opposed to artificially. The more consistent you are, the more your insulin sensitivity improves. The more it improves, the more your body starts acting like someone who doesn’t have type 2 diabetes.

In the long run, and as noted above, this reduces your risk.

View the Webinar

Enter your name and email address below to view the webinar on improving insulin sensitivity mentioned above.

6 hours of Mozart!

One of the many recommendations we have for managing stress is through background music. Here is a favorite from our Classical Music Playlist on Youtube.

Start the video, find a volume for background music that suits you and just let it go. It’s 6+ hours, so it will go almost a full work-day. At 15+ million views, a lot of people are doing just that.

You can work to this, you can study to this and you can probably even fall asleep to this (we don’t recommend that at work).

And see…you just thought YouTube was for watching people do stupid stuff.

Enjoy and if you have a favorite classical music video, share in the comments below. We’ll add it to our playlist!

A note on our classical music playlist. If/When you search “Classical Music” at YouTube, you will get over 1 million hits. That’s a lot! Our playlist contains only 7 videos, but it is more than 25 hours of music. Plus, we tried to pick videos with excellent sound quality and longer than 1 hour. Just like this one!

 



Sleep patterns in the absence of electricity

The focus of our discussion in the Sleep Module is to improve sleep quality so that we are well-rested. Most of “How to do this” is targeted at the last 1-2 hours before going to bed, what we refer to as transition time. While there are several aspects to this, particularly with what we have at our disposal, a major part of what we discuss is light exposure.

So we were glad to see this: A recent study in Current Biology looked at sleep patterns of three pre-industrial societies, one each in Tanzania, Namibia and Bolivia. Some key observations include the following:

  • The groups lived absent of electricity – no lights or external temperature controlling systems. So they were exposed to seasonal variations in weather, temperature and sunlight. Perfect groups for studying sleep patterns!
  • Not a single person had a BMI greater than 30. Not one. Obesity was non-existent!
  • On average, the three groups spent 7.0-8.5 hours in bed with 6-7 of those hours spent sleeping. So for the most part, they don’t sleep through the night.
  • Two of the three groups lived far enough south of the equator to experience significant changes in darkness and light exposure depending on the season. During the time of year when darkness was longer, these groups slept, on average, nearly one hour longer than when days were shorter.
  • They don’t take naps! Sensors used to determine whether they were awake or asleep recorded 10 naps over 574 days. Additionally, all of these were during the summer, when days were longer. This could be related to shorter nights and tiredness or maybe a rest period during the hottest times of the summer days. But one nap every two months doesn’t show much of a pattern.
  • Less than 3% have trouble falling asleep and staying asleep (1.5% for the former and 2.5% for the latter). This is very different than industrialized societies, where it can be as high as 30%.

As we discuss in our seminars, the transition time is important. It prepares our body to fall asleep and enter a normal sleep pattern throughout the night. Given the statistics on sleep deprivation and the fact that so many are tired all the time, it’s safe to say that most of us don’t do a good job of “transitioning” our body for sleep.

Takeways and things at our disposal.

There were a lot of important observations in this study, but a couple stand out. The first is that obesity is non-existent!

While there are certainly differences in physical activity, given that their primary mode of transportation is on foot. Other “things” are probably more important. For example, the absence of electricity means no lights, which means no TV, cell phone, tablet, computer or even lights. When it is dark and they are tired, they go to sleep. In industrialized societies, when it is dark and people are tired, they have cake, chips, ice cream, etc… at their disposal. So they plop on the sofa, eat and stare at the TV or other technology device. This light exposure (and snacking) is not a good mix for our transition time.

Another important observation: For the most part, they don’t sleep throughout the night! In every seminar we do on sleep, we are guaranteed to get a question like this:

I wake up and sometimes don’t fall back asleep for 15, 30, 45 minutes or even an hour. Why?

The conventional wisdom is that we are supposed to fall asleep and stay asleep. This is clearly not the case, as shown in this study (and countless others). But it is apparent, based on how frequently we get this question, the message isn’t being conveyed. So as health professionals, we need to do a better job of letting people know this is normal. And this is important. When you make a statement like this and ask why, there is clearly some concern. Concern leads to worry, worry leads to stress and stress makes it harder to fall back asleep.

So we clearly need to do a better job at letting people know, that for the most part, this is a normal occurrence.

2 things to do right now and improve your sleep transition time!

Sleep better tonight by:

  • Start limiting your exposure to light about one hour before bed time. Turn off the bright lights and turn on softer ones so you you can see. This includes the television and all of your electronic gadgets. If you can’t do without your computer, download this and install it on your computer. It blocks the most offensive lights.
  • If you think you are hungry and not tired, think again. And if you are hungry, eat a little something that is not processed (In other words, skip the stuff mentioned earlier).

Overall, sleep is important to your health – a lack of quality sleep is associated with nearly every chronic condition you can imagine. The fact that obesity was non-existent in these groups provides further support. To improve your health, you must sleep better. To sleep better, you need to be better during the transition time. These two tips will help you do that.

After a few days of better sleep, you won’t believe how good you feel.

Webinar: Why Wellness Fails April 2016

Below is the recording from our webinar on Why Wellness Fails to control medical costs, recorded on April 13, 2016.

To stay up-to-date with the latest news and offerings from us, we encourage you to sign up for our newsletter, which you can do at the bottom of this page.

Note You are already subscribed to our list if:

  • You are or were enrolled in The Academy, the HPI Diabetes Academy or one of our Preview Accounts.
  • If you filled out the form to attend one of our webinars or other online events.

If you are not sure, submit the form and if you get a notice that your email address already exists in the database, you are subscribed

Please share across all of your social networks!

The information included in this webinar is important. We know the drill – healthcare costs are crippling all of us. However, with the right approach to wellness and by implementing the right programs, we can have a significant impact!

Unfortunately, the standard, run-of-the-mill “Wellness Programs” are unable to accomplish this!

If you have questions or need help, download the vCard for Brian Sekula (below) and reach out. We are glad to help!

 

A pdf version of the slides.


 

Links for further reading

One slide in the webinar had links to additional articles on our website(s). Here the links:

Additional Readings
Type 2 Diabetes is killing your company.
Is exercise more difficult with type 2 diabetes?
RPE and determining exercise intensity.
Dinner with the husband, the shakes and metabolic flexibility.
2015 Member of the Year: Kathryn.
The IARC: Red Meat and Cancer.

 

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You’re doing eggs all wrong!

Image from bostonmagazine.com.

 

You’ve heard it before, maybe even believe it yourself:

Eat the egg whites and trash the yolks!

Egg yolks are full of saturated fat and cholesterol – they are bad for you!”

The list goes on…

It’s hard not to get caught up in this line of thinking because it seems to be everywhere. After all, nearly every restaurant that serves breakfast has a “healthy breakfast option” that removes the yolks from the eggs.

Thinking this way is doing eggs all wrong. It’s time to stop the egg-yolk-phobia!

Yolk is the healthiest part of the egg!

Look at the image below. From a single egg yolk (17 grams), it’s easy to see yolks are loaded with micronutrients!

These restaurants and their healthy egg options are getting rid of the healthiest part of an egg. Compare the nutrient density of the egg white from a single egg below.

Not much of a comparison. In fact, there are bunch of zeros when it comes to nutrient density of the egg white.

Beyond the direct comparison, the protein in egg whites is more difficult to digest when the fats from the egg yolks are not available to help your body digest them.

But, but saturated fat and cholesterol!

Yes, we all know the drill. Eating saturated fat raises cholesterol, which increases heart attack risk. This is simply not true. Although eating a “saturated” fat like Crisco certainly increases your risk, it’s not really a saturated fat.

Further, study after study after study has repeatedly shown that dietary cholesterol and saturated fat has little impact on your cholesterol levels. Cholesterol levels are internally regulated, when you consume more, your body makes less. And vice-versa.

Finally, studies show that consuming whole eggs improves cholesterol profile, increases HDL and improves metabolic syndrome here, here and here.

Beyond all of that, high cholesterol is (supposedly) a risk factor indicating an increased risk for cardiovascular disease. Some would argue against that.

See? Eggs aren’t so bad!

In fact, they are one of the best foods you can eat. Their awesome micronutrient profile means they go a long way to filling your satiety bucket, which means your body will stay full longer.

What about the calories?

What about them? A single, large boiled egg contains 70-80 calories, depending on size. So if you eat two boiled eggs for breakfast, you are consuming 150-160 calories. Compare that to a medium, plain bagel at nearly 300 calories! And the nutrient density in the whole egg completely blows away the bagel. So you are eating fewer calories and doing a better job of feeding your body.

Not much of a comparison!

Tell’em they’re doing eggs all wrong!

The next time someone tells you the egg yolk should be thrown out, tell them they are doing eggs all wrong. Then proceed to recite everything in this article.

And the next time you have breakfast at a restaurant, tell your waiter you want the healthy eggs, those WITH the yolk!

Wild Fermentation

Wild Fermentation by Sandor Ellix Katz is one of our favorite books!

Why? Because fermented foods are good for you.

From the foreword, written by Sally Fallon of the Weston A Price Foundation:

Unfortunately, fermented foods have largely disappeared from the Western diet, much to the detriment of our health and economy. Fermented foods are a powerful aid to digestion and a protection against disease. And because fermentation is, by nature, an artisanal process, the disappearance of fermented foods has hastened the centralization and industrialization of our food supply, to the detriment of small farms and local economies.

There are many things you can learn to ferment from this book, like making beer, wine or vinegar. There are also the standard recipes, like sauerkraut, dill pickles, yogurt, kimchi and kombucha. But the real benefit of this book is learning the technique of fermenting.

For example, it is rather simple to make sauerkraut. You need cabbage, salt and a couple of kitchen tools. That’s pretty much it. Katz takes three pages to explain and discuss this topic. Reading this book, you feel how much he enjoys preparing foods this way.

And if you take the time to read and absorb what he has written, you appreciate it more.

It’s why this is one of our favorite books!

Is Exercise More Difficult with Type 2 Diabetes?

Is Exercise More Difficult with Type 2 Diabetes?

We will answer this question shortly.

But first, when talking about whether exercise is more “difficult” for type 2 diabetics, the question is really referencing exercise intensity. There are a number of ways to measure/monitor exercise intensity. We prefer to use Ratings of Perceived Exertion (RPE).

The question refers to a scenario like this:

Given two individuals where everything is the same (age, gender, height, weight, etc…) when performing the same type of exercise, is it more difficult for the type 2 diabetic?

The answer to this question: Yes (in general)1

To illustrate, let’s say the exercise we referred to above is walking at 3 mph. The typical non-diabetic might rate the intensity of this activity at a 3 or 4 on a 10-point RPE scale, while the typical type 2 diabetic might rate it a 5 or 6 on the same scale.

Since RPE is a measure of intensity and 5 or 6 is higher than 3 or 4, we would have to say that, in general, type 2 diabetics have more difficulty with the same activity than non-diabetics.

Why is exercise harder for Type 2 Diabetics?

Look no further than resting metabolism. Metabolically unhealthy (which is what type 2 diabetics are) have a higher respiratory quotient at rest when compared to metabolically healthy individuals. This means type 2 diabetics are using a larger proportion of carbohydrates as a substrate to produce energy. Further, substrate utilization predicts intensity: The more carbohydrates, the higher the intensity.

For type 2 diabetics, this means that even at rest they are producing energy differently than non-type 2 diabetics. And when we change the intensity, like walking at 3 mph for example, this relationship holds true. So they continue to operate at a higher intensity, which is what makes exercise more difficult for type 2 diabetics.

If this is the case, how should we approach exercise and exercise intensity for type 2 diabetics?

Type 2 Diabetics and Exercise

From a metabolic perspective, type 2 diabetics operate at a higher intensity level in comparable exercise because their ability to use fat as a substrate to produce energy has been compromised. (See this for an example). In other words, the average type 2 diabetic has difficulty in using fat to produce energy.

This difficulty in using fat to produce energy makes it harder for type 2 diabetics to lose weight.

This should be addressed first.

Improving metabolic flexibility in type 2 diabetics

In the literature and even within both The Academy and the HPI Diabetes Academy, we refer to this as metabolic flexibility: The ability of the metabolism to switch between substrates (carbohydrates or fats) to produce energy. For someone lacking metabolic flexibility, their ability to switch is compromised. Since type 2 diabetics have difficulty in using fat to produce energy, their metabolic flexibility is compromised.

So the first objective should be to “un-compromise” them by improving metabolic flexibility.

The two best approaches to fixing this are with food and exercise. Since this article is about exercise, we will omit the food part.

We only have two recommendations for exercise: low-intensity and/or high-intensity. Both are effective for different reasons.

Low intensity is effective because it forces the body to get better at using/burning fat during the exercise session. There are a couple of caveats, however:

  1. The intensity must be lower than normal, due to the compromised ability to burn fat.

  2. To be most effective, duration must be longer than 30 minutes – the longer the better. As it takes time for the body to fully get into a fat burning mode, shorter duration activities are not as helpful.

High-intensity exercise is effective because it helps improve the body’s ability to burn fat outside of the session. Earlier, we mentioned that type 2 diabetics have a higher respiratory quotient at rest, which means they are using a higher proportion of carbohydrates to produce energy. As the body adapts to high-intensity exercise, it starts fixing this problem. The end result is a lower respiratory quotient, which means the body is using a larger percentage of fat to produce energy at rest.

On a related note, this is why we aren’t big fans of jogging for most people until they get to a point where metabolic flexibility has improved.

Yes, exercise is more difficult for type 2 diabetics

But this problem can be fixed with an appropriate exercise prescription, one that improves the body’s ability to burn fat during exercise and at rest.

This will result in the increased ability to perform comparable exercise at a lower intensity.

Endnotes

1We say in general, because there are always exceptions and this refers to the average.

RPE and Determining Exercise Intensity

While heart rate (HR) is a popular way to measure exercise intensity, we prefer Ratings of Perceived Exertion (RPE) and will explain why in this post.

When using HR, you workout at some percentage of Max HR; for example between 50-60% or 70-80% of Max HR. The usual way to determine Max HR is by subtracting your age from 220 (Max HR = 220 – age). Once you know Max HR, the upper and lower ends of your HR range can easily be determined.

This seems simple and straightforward but technology doesn’t always get it right. For example, there is a class action lawsuit against Fitbit, claiming their technology and/or algorithms are inaccurate. This can have serious consequences for the user, particularly at the higher end of intensity.

We prefer RPE

RPE stands for Ratings of Perceived Exertion and the key word here is “perceived.”

The “perception” of how hard you are exercising is important for evaluating the overall intensity of the workout. And it is probably more accurate than measuring heart rate only. For example, let’s say you were working out hard – near your maximum capacity. You would certainly “feel” like you were working hard, but if you were using a HR monitor to determine intensity and this HR monitor consistently under-reported your HR, you might think you weren’t working hard enough. This would be in spite of how you “feel” and might compel you to try or push yourself harder. This could lead to a dangerous situation.

The RPE scale takes this into account.

Using numbers on a scale and descriptors for how you should feel at various levels of intensity, a user can accurately identify exercise intensity.

This is probably the most popular RPE scale. If you’ve ever taken a treadmill test – either for a research project in college (or graduate school) or at the cardiologist office, you probably saw something like this.



Notice on the left there are numbers for rating the intensity of exercise and descriptors on the right for helping you pick the most appropriate rating. This is the perception part we refer to and think is important.

While the ratings correlate with HR, they are not 100% accurate.

In both The Academy and HPI Diabetes Academy, we use a slightly different RPE scale – the CR-10 Scale.



We use this version for a couple of reasons:

One, it starts at zero. Notice the scale above starts at 6. We prefer a scale that starts at zero so we have a better anchor point for a resting intensity.

Second, it is much more convenient than any type of HR monitor.

Once a person is comfortable with using the scale, nothing else is needed.

To finish this up, the green areas indicate how we prescribe exercise for those in our programs. We recommend either “light” or “hard” exercise and prescribe intensity using this scale. For example, light workouts should have an RPE of 2-5 while hard workouts should have an RPE of 7+. We skip “6” on purpose and it’s not because there is no descriptor. There is a metabolic reason.

Beyond the two points mentioned above, this also allows our users a lot of flexibility. They can do any activity they’d like, as long as it meets the RPE criteria. This means they aren’t restricted to walking, jogging, cycling or any activity where measuring HR might be problematic (like swimming).

This is why we like to use RPE for measuring exercise intensity.