Beads of sweat sprinkled the foreheads of women trying to move left-to-right in unison with a woman leading a workout on a big-screen television.
“Am I backwards?” a woman asked and laughed as she nearly bumped into the woman to her right.
“Just go with it,” said Renee Ingalls, sweating front row and center.
Keeping in motion for 30 minutes was what mattered.
The exercisers, most older than 50 and all carrying a few extra pounds, have diabetes or have been diagnosed at risk of it. As the dietitian/health educator at the Fresno American Indian Health Project, Ingalls leads and motivates the exercise group. Each week she picks an exercise video. So far, a Richard Simmons video has been a favorite.
The weekly exercise class is part of a special diabetes program for American Indians who live in Fresno. The program also offers a walking class, provides one-on-one nutrition counseling, a group nutrition class, diabetic supplies and transportation to medical appointments. Grants from Indian Health Service cover the costs.
About 10,000 American Indians live in Fresno. Their heritage puts them at increased risk of diabetes: About 16% of American Indian and Alaska native adults have diabetes, more than twice as high as whites. Many have Type 2 diabetes, in which the body does not use insulin properly. It often can be controlled through diet and exercise.
This year, the American Indian Health Project in Fresno has 72 people participating in the diabetes program out of about 250 who have been identified as eligible.
The Fresno program is part of a nationwide diabetes intervention for American Indians that began 17 years ago. In that time, the program has decreased blood sugar levels from 9% to 8% on average. Every percentage point drop can reduce the risk of eye, kidney and nerve complications by 40%. End-stage kidney disease also has decreased by 27.7%, leading to cost savings. For example, dialysis to clean a kidney patient’s blood costs about $82,000 a year.
Irene Morales, 50, credits the Fresno diabetes program with helping her lose weight and keep her blood glucose at healthier levels. “I used to weigh 300 pounds,” she said. “I’m now at 180.”
But she has had diabetes for 27 years and it’s taken a toll on her body. Nerve damage to her feet had made it painful to walk recently, and last week a blister on her right foot became infected. Doctors amputated one of her toes on Tuesday.
Her condition is a “wake-up” call about diabetes, Morales said hours before the operation.
Morales’ aunt, Andrea Moreno, 69, said it should erase “any doubts or denials” about the need to prevent and control diabetes. Moreno has diabetes, too, and participates in the Fresno diabetes program with her niece.
Morales likely will be back in the exercise class once her foot heals. She hasn’t let pain in the past keep her from participating. When her feet hurt, she sits down.
The class is designed to accommodate people at different levels of fitness. No one is excluded, Ingalls said. “We’ve had people in walkers and on canes.”
The nutrition class is equally flexible. “I’ve had a couple who only wanted to eat out,” Ingalls said. She has a bookshelf of plastic foods to demonstrate healthy alternatives and portion sizes for home-cooked or restaurant meals. Most of her clients, however, appreciate the cooking demonstrations, which include food tastings. Ground turkey as a substitute for ground beef has been embraced.
Moreno has changed her diet “little by little” in the four years she has attended the nutrition class. She is eating less red meat and more turkey, chicken and fish. “And I went from using a lot of salt to onion powder, garlic powder, Mrs. Dash, things like that.”
The payoff: Moreno has lost 85 pounds and no longer needs one of her diabetes medications.
A diabetes diagnosis can be overwhelming, said Nancy Pierce, a registered nurse at the American Indian Health Project. The participants get information on how to check blood glucose levels and take medications, how to read laboratory results, how often to see a medical provider, and the complications that can occur from diabetes, such as circulation, vision and nerve-related problems.
The goal is to give patients the knowledge and skills to control their diabetes, Ingalls said. “It’s not anybody else’s job to manage their diabetes, not the doctors’ job or ours; it’s their job.”
A teacher’s aide before she had to stop working because of her health, Morales said that without the diabetes classes she most likely would be at home and depressed.
Depression is common among people with diabetes, Ingalls said. “Almost 80% of diabetics suffer from depression at one time or another.” Participants in the diabetes program receive a depression screening. Therapists also are available.
Morales said she has made friends in the diabetes classes. “They’re my second family. We’re all like sisters. We keep in contact with each other, and we always touch base when someone is sick.”
At the end of a recent 30-minute workout, the women gathered in a circle for meditation, where dream catchers made by American Indian youths waved slightly in the breeze from the open classroom door. The women asked for prayers for friends and relatives who were sick.
As their heads bowed, Ingalls said, “We’re going to think about gratitude today.”