Wednesday, May 23, 2007

Olahraga untuk Penderita Diabetes Mellitus

Olahraga untuk Penderita Diabetes Mellitus
Oleh: Amrizal Muchtar
(Tulisan ini pernah dimuat di Harian Fajar, Makassar)

Diabetes mellitus atau lazimnya disebut penyakit kencing manis kini menjadi momok bagi masyarakat. Ini disebabkan oleh karena diabetes dapat menimbulkan komplikasi-komplikasi yang di mata awam sangat mengerikan, yaitu berupa kaki diabetes yang tidak bisa sembuh sehingga harus diamputasi, tekanan darah tinggi, kerusakan jantung, kerusakan otak, kebutaan, sampai kehilangan kesadaran atau koma. Ironisnya, jumlah penderita penyakit gula ini semakin meningkat setiap tahun. Penelitian epidemiologis menyebutkan bahwa prevalensi penyakit ini pada 1998 di Makassar sudah mencapai 2, 9 % dari penduduk berusia di atas lima belas tahun.
Sebenarnya komplikasi-komplikasi di atas tidak perlu terlalu ditakutkan kalau penderita menyadari atau mengetahui dengan baik pengelolaan penyakit ini. Ada tiga macam pengelolaan diabetes yaitu dengan mengatur pola makan, latihan jasmani, dan mengkonsumsi obat-obat pengendali gula darah secara teratur. Yang akan dibahas dalam tulisan ini adalah pengelolaan yang kedua yaitu latihan jasmani atau olahraga.
Olahraga telah menjadi bagian yang tidak terpisahkan dari perawatan diabetes. Banyak sekali manfaat yang diperoleh dari olah raga untuk penderita. Salah satunya, olahraga terbukti bisa menurunkan kadar gula darah penderita diabetes. Pengaruh olahraga pada kontrol gula darah telah dibuktikan pada beberapa studi. Menurut studi-studi tersebut, olahraga meningkatkan sensitifitas insulin sehingga ambilan glukosa darah meningkat dan otomatis kadar gula darah berkurang.
Olahraga yang bisa dilakukan ada beberapa macam. Olahraga ringan yaitu berjalan kaki selama 30 menit, olahraga sedang adalah jalan cepat selama 20 menit, dan olahraga berat adalah jogging. Tentu saja tidak semua olahraga ini boleh dilakukan oleh setiap penderita karena stadium penyakit mereka belum tentu sama. Dengan intensitas latihan 3-4 kali seminggu, terbukti HbA1c, yaitu penanda diabetes kalau kadarnya lebih dari 7 %, dapat turun sampai 20 %. Penurunan terbaik dihasilkan pada kelompok penderita diabetes ringan dan kelompok resisten insulin, yaitu penderita yang insulin dalam tubuhnya telah resisten terhadap glukosa, yang telah mengubah gaya hidupnya menjadi gaya hidup sehat. Gaya hidup sehat yang dimaksud di sini yaitu pengaturan pola makan yang sesuai kesehatan.
Penderita diabetes yang tidak diterapi dengan baik dapat terkena penyakit jantung koroner (PJK). Tapi dengan olahraga secara teratur, faktor resiko PJK yaitu hiperinsulinemia, hipertensi, kelainan metabolisme seperti hipertrigliseridemia, HDL rendah, LDL dan FFA tinggi dapat diatasi. Dengan demikian, potensi terjadinya PJK ini dapat dikurangi.
Pada diabetes tipe 2 dapat terjadi gangguan aktifitas fibrinolis. Dengan olahraga aerobic (aerobic fittness) secara teratur, terbukti gangguan aktifitas fibrinolisis dapat diperbaiki. Akan tetapi, mekanisme yang mendasari hubungan ini belum bisa dijelaskan.
Pengaruh lain olahraga terhadap diabetes yaitu dapat menurunkan berat badan pada penderita diabetes yang pada umumnya memang memiliki tubuh yang gemuk. Menurunnya berat badan ini terutama berkaitan dengan perbaikan dari metabolisme tubuh dan pemakaian lemak tubuh secara berlebihan pada saat olahraga.
Yang menarik dari pengaruh olahraga ini yaitu bahwa ternyata olah raga dapat juga mencegah atau menunda manifestasi diabetes pada orang yang belum menderita tetapi mempunyai resiko tinggi terhadap diabetes tipe 2 di masa depannya. Salah satu contoh orang yang beresiko tinggi ini adalah orang yang punya turunan penderita diabetes.
Memang tak bisa dipungkiri bahwa olahraga pada penderita diabetes dapat pula berdampak buruk. Olahraga ternyata dapat pula menyebabkan penyakit-penyakit yang justru ingin dihindari tadi. Akan tetapi itu hanya terjadi kalau dalam melakukan aktifitas olahraga keadaan fisik tubuh tidak diperhatikan . Karena itulah, diperlukan evaluasi awal sebelum berolahraga.
Evaluasi awal sebelum olahraga sangat penting. Tujuannya adalah menemukan berbagai komplikasi yang ada yang dapat menjadi pemicu timbulnya cedera atau dampak buruk waktu berolahraga. Selain itu, evaluasi juga diperlukan untuk mengetahui ragam dan dosis olahraga serta perlu tidaknya pengawasan saat melakukan olahraga pada individu tertentu.
Untuk penderita yang telah diketahui menderita penyakit jantung koroner, hendaknya olahraga dilakukan di bawah bimbingan seorang supervisor yang akan menilai dampak yang mungkin timbul seperti kelainan irama jantung atau kelainan lain yang mungkin terjadi akibat iskemia atau kekurangan oksigen pada saat berolahraga.
Bagi penderita yang telah diketahui menderita kelainan mata (retinopati), dianjurkan untuk menghindari olahraga berat yang bersifat anaerobik atau membutuhkan banyak oksigen seperti joging. Hal ini disebabkan karena olahraga ini dapat menimbulkan perdarahan retina (vitrous bleeding), atau timbulnya robekan retina (traction retina detachment).
Untuk diabetes yang disertai kelainan ginjal (nefropati) , tidak diketahui apakah juga memerlukan pembatasan olahraga seperti pada PJK dan retinopati. Tapi secara umum, agaknya diterima pendapat (walau alasan kurang jelas) sebaiknya tidak melakukan olahraga yang berat kalau sudah disertai komplikasi nefropati.
Bagi diabetes melitus yang disertai kehilangan rasa pada kaki (neuropati perifer) dianjurkan untuk menghindari olahraga yang bersifat weight bearing exercise atau olahraga yang mengandalkan kaki, seperti olahraga di atas treadmill atau alat jalan listrik, jalan kaki dalam waktu yang lama, jogging dan naik tangga. Olahraga yang dianjurkan antara lain renang, bersepeda, dan dayung.
Untuk mendapatkan keamanan dan kenyamanan berolahraga, maka setelah malakukan evaluasi terhadap komplikasi-komplikasi yang mungkin timbul tadi, juga perlu dilakukan persiapan yang teliti. Setiap aktivitas olahraga harus selalu diawali pemanasan (warming up), dan diakhiri dengan pendinginan (cooling down), masing-masing dengan waktu 5-10 menit.
Pemanasan dapat dilakukan dengan low grade intensity aerobic exercise misalnya jalan kaki atau bersepeda, dan selanjutnya diikuti dengan stretching otot-otot yang nantinya aktif dilatih selama 5-10 menit. Pendinginan dimaksudkan untuk mengembalikan denyut jantung ke keadaan sebelum olahraga dilakukan.
Persiapan untuk mencegah timbulnya lecet kaki waktu berolahraga juga sangat penting. Ini terutama untuk mencegah timbulnya komplikasi kaki diabetik, yaitu kaki yang membusuk karena infeksi yang tidak dapat diobati. Untuk hal ini perlu diperhatikan pemilihan sepatu olahraga, penggunaan kaos kaki khusus, pemakaian jeli silika atau kaos kaki poliester untuk perlindungan kaki.
Selain itu juga dianjurkan mengkonsumsi cairan secukupnya sebelum dan selama latihan untuk mengganti cairan yang hilang. Terakhir, kalau selama olahraga penderita diabetes mengalami kelemahan atau kekurangan tenaga yang berarti, itu tandanya terjadi hipoglikemia atau penurunan kadar glukosa darah. Karena itu setiap olahraga, jangan lupa membawa gula-gula manis dan makanlah kalau merasakan hipoglikemi tersebut.

Partner Link:

1. Low Diet for Diabetes Mellitus


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