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Diabetes Contraindications To Exercise

Exercise And Type 2 Diabetes

Exercise And Type 2 Diabetes

Ann Albright, Ph.D., R.D.; Marion Franz, M.S., R.D., C.D.E.; Guyton Hornsby, Ph.D., C.D.E.; Andrea Kriska, Ph.D., FACSM; David Marrero, Ph.D.; Irma Ullrich, M.D.; Larry S. Verity, Ph.D., FACSM Physical activity, including appropriate endurance and resistance training, is a major therapeutic modality for type 2 diabetes. Unfortunately, too often physical activity is an underutilized therapy. Favorable changes in glucose tolerance and insulin sensitivity usually deteriorate within 72 h of the last exercise session; consequently, regular physical activity is imperative to sustain glucose-lowering effects and improved insulin sensitivity. Individuals with type 2 diabetes should strive to achieve a minimum cumulative total of 1000 kcalwk-1 from physical activities. Those with type 2 diabetes generally have a lower level of fitness (VO2max) than nondiabetic individuals, and therefore exercise intensity should be at a comfortable level (RPE 1012) in the initial periods of training and should progress cautiously as tolerance for activity improves. Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2 diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result, ratings of perceived exertion rather than heart rate may need to be used for moderating intensity of physical activity. Although walking may be the most convenient low-impact mode, some persons, because of peripheral neuropathy and/or foot problems, may need Continue reading >>

Working With Diabetic Clients

Working With Diabetic Clients

A look at the exercise implications and contraindications when working with clients who suffer from type 1 and type 2 diabetes, hypoglycemia or hyperglycemia. Look around your exercise floor. Although there are no outward or telltale signs, it is likely that several of your members or clients have some form of diabetes. It is also likely that many of these people either are unaware of their condition or have difficulty managing and regulating the disorder. According to the Centers for Disease Control and Prevention (CDC), 20.8 million people who live in the United States currently have diabetes, accounting for 7% of Americans (CDC 2005). In fact, it is estimated that 6.2 million of these people have not been diagnosed with diabetes (CDC 2005). Diabetes has an enormous medical and financial impact on our nation. Estimated diabetes costs in the U.S. in 2002 were $132 billion, of which $40 billion resulted from disability, work loss and premature death (CDC 2005). People with diabetes are at high risk for heart disease, stroke, blindness, and kidney and nervous-system diseases, which is why the medical costs of this condition are so high. While it is outside of your scope of practice as a fitness professional to dispense medical advice to diabetic clients about specific issues such as blood glucose levels or medications, you are in a unique position to help. As the number of people with diabetes (or related conditions like hyperglycemia and hypoglycemia) continues to grow, it is imperative that fitness professionals have a practical understanding of how exercise benefits and affects these clients. This article outlines the mechanisms of diabetes; risk factors; signs and symptoms; complications of the condition; exercise considerations and contraindications; and recommendat Continue reading >>

My Site - Chapter 10: Physical Activity And Diabetes

My Site - Chapter 10: Physical Activity And Diabetes

Moderate to high levels of physical activity and cardiorespiratory fitness are associated with substantially lower morbidity and mortality in people with diabetes. Both aerobic and resistance exercise are beneficial, and it is optimal to do both types of exercise. At least 150 minutes per week of aerobic exercise and at least 2 sessions per week of resistance exercise are recommended, though smaller amounts of activity still provide some health benefits. A number of strategies that increase self-efficacy and motivation can be employed to increase physical activity uptake and maintenance, such as setting specific physical activity goals, using self-monitoring tools (pedometers or accelerometers) and developing strategies to overcome anticipated barriers. For people with type 2 diabetes, supervised exercise programs have been particularly effective in improving glycemic control, reducing the need for noninsulin antihyperglycemic agents and insulin, and producing modest but sustained weight loss. Habitual, prolonged sitting is associated with increased risk of death and major cardiovascular events. Physical activity often improves glucose control and facilitates weight loss, but has multiple other health benefits even if weight and glucose control do not change. It is best to avoid prolonged sitting. Try to interrupt sitting time by getting up briefly every 20 to 30 minutes. Try to get at least 150 minutes per week of aerobic exercise (like walking, bicycling or jogging). Using a step monitor (pedometer or accelerometer) can be helpful in tracking your activity. In addition to aerobic exercise, try to do at least 2 sessions per week of strength training (like exercises with weights or weight machines). If you decide to begin strength training, you should ideally get some Continue reading >>

Exercise & Diabetes Complications | Joslin Diabetes Center

Exercise & Diabetes Complications | Joslin Diabetes Center

Exercises to Avoid When You Have Diabetes Regular physical activity is an important part of a healthy lifestyle when you have diabetes. It is good for your cardiovascular system and can help control blood glucose levels . However, there are times when you need to be careful about exercising with diabetes . If you have certain diabetes complications, there are exercises that you should avoid. Michael See, MS, RCEP, Clinical Exercise Physiologist at Joslin Diabetes Center, discusses certain situations that may require you to modify your fitness program The following complications may affect your exercise routine:. Proliferative diabetic retinopathy (PDR)Patients with diabetes and active PDR should avoid activities that involve strenuous lifting; harsh, high-impact activities; or placing the head in an inverted position for extended periods of time. Diabetic peripheral neuropathy Diabetic peripheral neuropathy may result in loss of sensation and position awareness of your feet . Repetitive exercise on insensitive feet can lead to ulceration and fractures. Limit your choice of exercise to low impact or non-weight bearing activities, says See. Advanced kidney disease Individuals with diabetes and advanced kidney disease can engage in moderate intensity activities, but should avoid strenuous activity. High blood glucose levels Individuals with type 1 diabetes should avoid exercise if fasting blood glucose is higher than 250 mg/dl and ketones are present. Caution should be used if glucose levels are higher than 300 and no ketones are present. Individuals with type 2 diabetes should avoid exercise if blood glucose is higher than 400 mg/dl. Monitoring blood glucose before, after and possibly during physical activity is necessary to keep blood glucose within an appropriate range Continue reading >>

Exercise And Type 1 Diabetes (t1dm).

Exercise And Type 1 Diabetes (t1dm).

1. Compr Physiol. 2013 Jul;3(3):1309-36. doi: 10.1002/cphy.c110040. (1)Department of Pediatrics, University of California Irvine, Irvine, California, USA. [email protected] Physical exercise is firmly incorporated in the management of type 1 diabetes(T1DM), due to multiple recognized beneficial health effects (cardiovasculardisease prevention being preeminent). When glycemic values are not excessivelylow or high at the time of exercise, few absolute contraindications exist;practical guidelines regarding amount, type, and duration of age-appropriateexercise are regularly updated by entities such as the American DiabetesAssociation and the International Society for Pediatric and Adolescent Diabetes. Practical implementation of exercise regimens, however, may at times beproblematic. In the poorly controlled patient, specific structural changes mayoccur within skeletal muscle fiber, which is considered by some to be adisease-specific myopathy. Further, even in well-controlled patients, severalhomeostatic mechanisms regulating carbohydrate metabolism often become impaired, causing hypo- or hyperglycemia during and/or after exercise. Some alteredresponses may be related to inappropriate exogenous insulin administration, butare often also partly caused by the "metabolic memory" of prior glycemic events. In this context, prior hyperglycemia correlates with increased inflammatory andoxidative stress responses, possibly modulating key exercise-associatedcardio-protective pathways. Similarly, prior hypoglycemia correlates withimpaired glucose counterregulation, resulting in greater likelihood of furtherhypoglycemia to develop. Additional exercise responses that may be altered inT1DM include growth factor release, which may be especially important in childrenand adolescents. These Continue reading >>

Prescribing Exercise For Diabetes

Prescribing Exercise For Diabetes

Prescribed effectively, regular exercise is extremely safe, effective and essential in managing diabetes and its complications. It can play a significant role in reducing associated cardiovascular and lifestyle risk factors. The cornerstone of effective exercise prescription lies in the consideration of the various barriers, motivators and medical concerns that face people with diabetes and understanding how exercise may impact both positively and negatively upon these factors. Introduction Pre-exercise screening and testing Certain exercise intensities and modalities may be contraindicated or inappropriate for some people.3,4,6 Before prescribing an exercise program for a person with diabetes it is imperative that the patient is screened and assessed for cardiovascular disease risk factors or other conditions that may pose significant health risks.3,6 The patient should be asked about any symptoms of cardiovascular disease including unusual shortness of breath, chest pain with exertion, dizziness, light-headedness, swelling of the ankles and pain in the calves that is not associated with muscle pain. If these symptoms are present, further investigation is needed before the patient can begin an exercise routine.7 Other cardiovascular risk factors that should be assessed include blood pressure, cholesterol and lipid profiles, resting heart rate, weight, body mass index, waist circumference, family history and previous cardiac history.6 The presence of cardiovascular risk factors and other complications does not preclude a person with diabetes from undertaking an exercise program.6 Screening provides a useful risk stratification tool to guide exercise prescription or identify those who should undergo cardiac stress testing before starting to exercise.3,6 Currently there a Continue reading >>

Exercise Assessment And Prescription In Patients With Type 2 Diabetes In The Private And Home Care Setting: Clinical Recommendations From Axxon (belgian Physical Therapy Association)

Exercise Assessment And Prescription In Patients With Type 2 Diabetes In The Private And Home Care Setting: Clinical Recommendations From Axxon (belgian Physical Therapy Association)

Exercise Assessment and Prescription in Patients With Type 2 Diabetes in the Private and Home Care Setting: Clinical Recommendations From AXXON (Belgian Physical Therapy Association) D. Hansen, PT, PhD, Hasselt University, Faculty of Medicine and Life Sciences, Agoralaan, Building A, 3590, Diepenbeek, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; and Flemish Working Group from AXXON (Belgian Physical Therapy Association), Antwerp, Belgium. Search for other works by this author on: S. Peeters, PT, Flemish Working Group from AXXON. Search for other works by this author on: B. Zwaenepoel, PT, Flemish Working Group from AXXON; Ghent University, Faculty of Medicine and Life Sciences, Ghent, Belgium; and Department of Cardiopulmonary Rehabilitation, Algemeen Ziekenhuis Jan Palfijn, Ghent, Belgium. Search for other works by this author on: D. Verleyen, PT, Flemish Working Group from AXXON. Search for other works by this author on: C. Wittebrood, PT, Flemish Working Group from AXXON. Search for other works by this author on: N. Timmerman, PT, MSc, Flemish Working Group from AXXON. Search for other works by this author on: M. Schotte, PT, Flemish Working Group from AXXON. Search for other works by this author on: Physical Therapy, Volume 93, Issue 5, 1 May 2013, Pages 597610, Dominique Hansen, Stefaan Peeters, Bruno Zwaenepoel, Dirk Verleyen, Carla Wittebrood, Nicole Timmerman, Michel Schotte; Exercise Assessment and Prescription in Patients With Type 2 Diabetes in the Private and Home Care Setting: Clinical Recommendations From AXXON (Belgian Physical Therapy Association), Physical Therapy, Volume 93, Issue 5, 1 May 2013, Pages 597610, Type 2 diabetes mellitus (T2DM) is a disease associated with many complications: the likelihood for the development of heart Continue reading >>

Exercise

Exercise

Everybody benefits from regular exercise. If you have diabetes, or are at risk of diabetes it plays an important role in keeping you healthy. For a person with diabetes exercise helps: Insulin to work better, which will improve your diabetes management Maintain a healthy weight Lower your blood pressure Reduce your risk of heart disease Reduce stress. Warning- Don’t take part in strenuous physical activity if you are feeling unwell or have ketones present in your blood or urine. Before commencing a regular exercise program see your doctor for a full medical examination. Initially take it slow - you don’t want to start off too hard, if you are not used to the exercise you will be sore the next day and this will not make exercising a fun experience! Over time, you can slowly increase the intensity of the exercise. If you have any diabetes complications like retinopathy, nephropathy, you should talk to your doctor or an accredited exercise physiologist before you start increasing the intensity of your exercise. Anything that gets you moving. Here are some suggestions for you to discuss with your doctor: Walking Swimming Cycling/ exercise bike Dancing Gardening Golfing Weight training Tai Chi Water aerobics Increasing your general physical activity is also helpful, e.g. taking the stairs instead of the lift, getting up to change the TV station instead of using the remote control, housework, and gardening. Avoid watching too much TV or sitting at the computer for a long time. For good health, you should be doing about 30 minutes of exercise every day. If this is not possible, then this time can be divided in 3 x 10 minutes sessions. You can break up exercise throughout the day. If you need to lose weight, 45-60 minutes everyday. You do not need to puff to gain the benefi Continue reading >>

Diabetes Mellitus And Exercise

Diabetes Mellitus And Exercise

During exercise, whole-body oxygen consumption may increase by as much as 20-fold, and even greater increases may occur in the working muscles. To meet its energy needs under these circumstances, skeletal muscle uses, at a greatly increased rate, its own stores of glycogen and triglycerides, as well as free fatty acids (FFAs) derived from the breakdown of adipose tissue triglycerides and glucose released from the liver. To preserve central nervous system function, blood glucose levels are remarkably well maintained during exercise. Hypoglycemia during exercise rarely occurs in nondiabetic individuals. The metabolic adjustments that preserve normoglycemia during exercise are in large part hormonally mediated. A decrease in plasma insulin and the presence of glucagon appear to be necessary for the early increase in hepatic glucose production during exercise, and during prolonged exercise, increases in plasma glucagon and catecholamines appear to play a key role. These hormonal adaptations are essentially lost in insulin-deficient patients with type 1 diabetes. As a consequence, when such individuals have too little insulin in their circulation due to inadequate therapy, an excessive release of counterinsulin hormones during exercise may increase already high levels of glucose and ketone bodies and can even precipitate diabetic ketoacidosis. Conversely, the presence of high levels of insulin, due to exogenous insulin administration, can attenuate or even prevent the increased mobilization of glucose and other substrates induced by exercise, and hypoglycemia may ensue. Similar concerns exist in patients with type 2 diabetes on insulin or sulfonylurea therapy; however, in general, hypoglycemia during exercise tends to be less of a problem in this population. Indeed, in patie Continue reading >>

Key Points From The Updated Guidelines On Exercise And Diabetes

Key Points From The Updated Guidelines On Exercise And Diabetes

Key Points from the Updated Guidelines on Exercise and Diabetes 1Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA Edited by: Jonathan Peter Little, University of British Columbia, Canada Reviewed by: Normand Boule, University of Alberta, Canada; Jamie F. Burr, University of Guelph, Canada *Correspondence: Sheri R. Colberg, [email protected] Specialty section: This article was submitted to Diabetes, a section of the journal Frontiers in Endocrinology Received 2017 Jan 14; Accepted 2017 Feb 7. Keywords: physical activity, exercise, diabetes, guidelines, American Diabetes Association This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. No doubt remains that the adoption and maintenance of physical activity is important for overall health and blood glucose management in individuals with diabetes and prediabetes. Recently, the American Diabetes Association (ADA) published updated recommendations and precautions about physical activity and exercise in people with type 1 diabetes, type 2 diabetes, and gestational diabetes ( 1 ). Given the importance of these topics, it is worth discussing the key changes and updates included in this ADA position statement (PS). Pre-Exercise Health Screening and Evaluation This PS reiterates that pre-exercise medical clearance is not necessary for asymptomatic, sedentary individuals who wish to begin low- or moderate-intensity physical activi Continue reading >>

Jeffrey Janot, M.s. And Len Kravitz, Ph.d.

Jeffrey Janot, M.s. And Len Kravitz, Ph.d.

Training Clients With Diabetes Jeffrey Janot, M.S. and Len Kravitz, Ph.D. Introduction The incidence of diabetes mellitus, a metabolic disease, is a growing problem in the American population. To date, 16 million Americans have diabetes, either known or unknown, with 1,700 new cases being diagnosed everyday (Nieman 1998). Diabetes has been linked to the development of a variety of diseases including heart disease, stroke, peripheral vascular disease, and neurological disorders. The cause of death in individuals with diabetes is not the disorder itself, but from the diseases associated with it, most notably heart disease. Diabetes is classified into two categories: Type I and Type II. Typically, Type I diabetes occurs in younger individuals (not always!) and comprises approximately 10% of all diabetic cases. Thereby, 90% of the cases are Type II, which is most common in older individuals. Effective management and prevention strategies for diabetes are of utmost importance. As exercise professionals, you can play a crucial role within these strategies, working collaboratively with other skilled health professionals. It should be noted that there are a number of opportunities for personal trainers to enhance their professional knowledge, such as obtaining clinical-type certifications (ACE clinical exercise specialist, ACSM exercise specialist, etc.). This article will present recommendations and clinical considerations for the development of a safe strength training program for individuals with diabetes. A brief discussion of the pathophysiology behind diabetes will be presented first, followed by specific exercise prescription guidelines for strength training. In addition, Table 1 summaries some cardiorespiratory guidelines according to frequency, intensity, time and type Continue reading >>

Diabetes And Exercise

Diabetes And Exercise

Tweet People with diabetes are encouraged to exercise regularly for better blood sugar control and to reduce the risk of cardiovascular diseases. The reason for this is that muscles which are working use more glucose than those that are resting. Muscle movement leads to greater sugar uptake by muscle cells and lower blood sugar levels. Additional benefits of exercise include a healthier heart, better weight control and stress management. Exercise is the common term used to describe any bodily activity that enhances or maintains physical fitness and overall health and wellness. Why is exercise important? As well as strengthening the cardiovascular system and the body’s muscles, many people exercise to keep fit, lose or maintain a healthy weight, sharpen their athletic skills, or purely for enjoyment. Frequent and regular physical exercise is recommended for people of all ages as it boosts the immune system and helps protect against conditions such as: Heart disease Stroke Cancer and other major illnesses In fact, it is known to cut your risk of major chronic illnesses/diseases by up to 50% and reduce your risk of early death by up to 30%. Other health benefits of exercising on a regular basis include: Improves mental health Boosts self esteem/confidence Enhances sleep quality and energy levels Cuts risk of stress and depression Protects against dementia and Alzheimer’s disease Furthermore, exercise is free, can be carried out anywhere at anytime and has an immediate effect on your health. What counts as exercise? In the UK, regular exercise is defined by the NHS as completing 150 minutes of moderate intensity aerobic activity a week. Aerobic activity at moderate intensity basically means exercising at a level that raises your heart rate and makes you sweat. This incl Continue reading >>

Exercise Guidelines For Patients With Diabetes

Exercise Guidelines For Patients With Diabetes

Your patient is a middle-aged man with type 2 diabetes who wants to start a weight-training program. What recommendations would you offer him? Another patient with diabetes has peripheral neuropathy; which types of exercise are safest for her? Answers to these and other questions about physical activity by patients who have diabetes mellitus can be found in guidelines from the American Diabetes Association (ADA).1 Highlights of those recommendations are presented here. GENERAL RECOMMENDATIONS Encourage your patients with diabetes to be as physically active as they are able. The goal is to follow the US Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommend that adults over age 18 years perform at least 150 minutes per week of moderate-intensity aerobic physical activity.2 In addition, encourage patients with type 2 diabetes to perform resistance training 3 times per week, unless they have diabetic complications that prohibit such exercise. TYPE 2 DIABETES AND EXERCISE Strongly encourage patients with type 2 diabetes to exercise regularly. Among the specific benefits of a long-term exercise program for these patients are: •Improved glycemic control. •Reduced risk of cardiovascular disease. •Improved lipid levels. •Reduced blood pressure. •Weight control. A meta-analysis found that structured exercise interventions of at least 8 weeks’ duration lowered hemoglobin A1c levels by an average of 0.66% in persons with type 2 diabetes, even when there was no significant change in body mass index.3 In addition, regular exercise may help forestall the development of diabetes in persons who are at high risk for the disease.4 TYPE 1 DIABETES AND EXERCISE Exercise can worsen hyperglycemia and ketosis in persons with type 1 d Continue reading >>

Diabetes Mellitus And Exercise

Diabetes Mellitus And Exercise

CLINICAL DIABETES VOL. 17 NO. 4 1999 POSITION STATEMENT American Diabetes Association Reprinted with permission from Diabetes Care 22 (Suppl 1):S49-53, 1999. The recommendations in this article are based on the evidence reviewed in the following publications: Exercise and NIDDM (Technical Review). Diabetes Care 13:785-89, 1990; and Exercise in individuals with IDDM (Technical Review). Diabetes Care 17:924-37, 1994. During exercise, whole-body oxygen consumption may increase by as much as 20-fold, and even greater increases may occur in the working muscles. To meet its energy needs under these circumstances, skeletal muscle uses, at a greatly increased rate, its own stores of glycogen and triglycerides, as well as free fatty acids (FFAs) derived from the breakdown of adipose tissue triglycerides and glucose released from the liver. To preserve central nervous system function, blood glucose levels are remarkably well maintained during exercise. Hypoglycemia during exercise rarely occurs in nondiabetic individuals. The metabolic adjustments that preserve normoglycemia during exercise are in large part hormonally mediated. A decrease in plasma insulin and the presence of glucagon appear to be necessary for the early increase in hepatic glucose production during exercise, and during prolonged exercise, increases in plasma glucagon and catecholamines appear to play a key role. These hormonal adaptations are essentially lost in insulin-deficient patients with type 1 diabetes. As a consequence, when such individuals have too little insulin in their circulation due to inadequate therapy, an excessive release of counterinsulin hormones during exercise may increase already high levels of glucose and ketone bodies and can even precipitate diabetic ketoacidosis. Conversely, the pres Continue reading >>

Exercise And Type 2 Diabetes

Exercise And Type 2 Diabetes

Go to: Introduction Diabetes has become a widespread epidemic, primarily because of the increasing prevalence and incidence of type 2 diabetes. According to the Centers for Disease Control and Prevention, in 2007, almost 24 million Americans had diabetes, with one-quarter of those, or six million, undiagnosed (261). Currently, it is estimated that almost 60 million U.S. residents also have prediabetes, a condition in which blood glucose (BG) levels are above normal, thus greatly increasing their risk for type 2 diabetes (261). Lifetime risk estimates suggest that one in three Americans born in 2000 or later will develop diabetes, but in high-risk ethnic populations, closer to 50% may develop it (200). Type 2 diabetes is a significant cause of premature mortality and morbidity related to cardiovascular disease (CVD), blindness, kidney and nerve disease, and amputation (261). Although regular physical activity (PA) may prevent or delay diabetes and its complications (10,46,89,112,176,208,259,294), most people with type 2 diabetes are not active (193). In this article, the broader term “physical activity” (defined as “bodily movement produced by the contraction of skeletal muscle that substantially increases energy expenditure”) is used interchangeably with “exercise,” which is defined as “a subset of PA done with the intention of developing physical fitness (i.e., cardiovascular [CV], strength, and flexibility training).” The intent is to recognize that many types of physical movement may have a positive effect on physical fitness, morbidity, and mortality in individuals with type 2 diabetes. Diagnosis, classification, and etiology of diabetes Currently, the American Diabetes Association (ADA) recommends the use of any of the following four criteria for di Continue reading >>

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