by Shannon Seeley MSPT

Transcription

1 by Shannon Seeley MSPT

2 The importance of physical activity DPP reports that changes in diet and physical activity resulted in a larger reduction in incidence of type 2 diabetes then medications alone. Despite these results these behaviors have not been widely adopted. Therefore the prevalence of diabetes and associated risk factors has continued to increase. Between 1999 and 2010 prevalence of hyperglycemia increased from 12.9 to 19.9% Waist size above recommended level increased to 56.1% Diabetes among the elderly increased by 1.69% 86 million American s now have pre-diabetes. Reducing Environmental Risks to Modify Lifestyle Behaviors; Deborah A. Cohen& Susan Babey. Diabetic Spectrum Winter 2015

3 The importance of physical activity Exercise has large impact on the body s metabolism-can complicate the management of blood sugar levels most important influence on fuel utilization = glycemic balance are intensity and duration of physical activity. Findings show that even very short bouts of exercise(2-15 minutes) of physical activity are associated with improvements in glycemic control. This would allow people who are not candidates or not compliant with traditional exercise programs to implement this into their daily life. Before beginning and exercise program people with diabetes need to undergo an extensive medical evaluation with screening for diabetes related complications that could worsen with exercise.=poor glycemic control, joint issues, and various macro/microvascular complications ; Marni j. Armstrong, Sheri Colberg, and Ronald J. SigalMoving Beyond Cardio: The value of Resistance Training, Balance training, and other forms of exercise for Diabetic management

4 The importance of physical Activity Current recommendations include consuming a balanced diet rich in fruits, vegetables, and fiber and low in sugars, saturated fats, processed meats, and low-nutrient foods engaging in regular moderate to vigorous physical activity, limiting alcohol, and avoiding harmful substances such as tobaco and other drugs. Risk factors for physical inactivity include sedentary employment, sedentary entertainment, and absence of marketing, programs, events, and reminders to encourage physical activity.

5 The Importance of Physical Activity Of particular importance is the positive effect that almost any type of exercise appears to have on both postprandial peaks(post meal) in blood glucose and amt of time during 24 hour period spent in hyperglycemic state. Marni j. Armstrong, Sheri Colberg, and Ronald J. SigalMoving Beyond Cardio: The value of Resistance Training, Balance training, and other forms of exercise for Diabetic management

6 The importance of physical activity Functional mobility issues for the diabetic patient Peripheral Neuropathy 1. Balance issues 2. Increased risk of falls. Gait deviations 1. lower extremity deformities and decreased flexibility ex. Charcot foot, or equinovarus deformities. 2. Musculoskeletal pain syndromes or degenerative joint disease. Sedentary lifestyles 1. Deconditioning 2. Muscle Weakness

7 Motivating our patient s to keep moving Tips for motivating our patients 1. Education 2. Taking the time to understand what motivates and interests the individual. 3. Devising a realistic plan based on what the patient s interests and goals are. 4. Setting attainable goals that allow for success. 5. Changing mindsets for lifestyle change

8 Education

9 Education The overall goal: is to get the patient to buy into the fact that physical activity and exercise needs to be a priorty in their life. We need to become salesmen: selling the idea that fitness and exercise can be fun and empowering and improve their quality of life. It does not have to be drudgery or overwhelming. Many patients have made attempts to exercise in the past and have had bad experiences or been unsuccessful.

10 Successful Exercise Programs Education needs to include: 1. Benefits of exercise to the patient. 2. How to manage blood levels with the addition of exercise. 3. Causes of exercise induced hyperglycemia vs. hypoglycemia 4. They need exercise to be a lifestyle change and strategies to help the patient achieve that including utilization of technology, social media, and other resources. 5. Interactions between medications and exercise.

11 Benefits of exercise Aerobic Enhance insulin sensitivity Lowers blood glucose and improves AIC Improved cardiovascular risk factors including Visceral adipostity, lipid profile, arterial stiffness, and endothelial function Lowers blood pressure and improves blood circulation. Improve lipids profile by reducing level of triglycerides and free fatty acids as well as enhancing high density lipoproteins. Improve cardiovascular endurance.

12 Benefits of Exercise Resistance training Enhance insulin sensitivity Enhance daily energy expenditure and quality of life Decreased AIC due to improvements in lean body mass Lowered LDL cholesterol and reduced fasting triglycerides Increased in muscle glycogen storage Increased lean tissue mm mass Decrease systolic blood pressure Reductions in the diabetes medications

13 Benefits of non-traditional exercise Exercise related nontraditional activities with potential include: resistance, balance, flexibility, yoga, and Tai chi Resistance benefits: maintains muscle mass and functional independence Balance and flexibility lower risk of falls.

14 The importance of managing your diabetes with physical activity

15 The importance of managing your diabetes with physical activity

16 Exercise and Glucose Monitoring What type of exercise is optimal for glycemic control? Traditionally cardiovascular endurance exercise has been preferred In last 10 years resistance training has been associated with improvements in insulin sensitivity and glucose tolerance. Frequency, intensity and duration also need to be considered = volume of exercise. Volume of exercise has been found to be the key component with regard to glycemic control. Exercise strategies to Optimize Glycemic control in type 2 Diabetes; Jan-Willem Van Dijk

17 Education on monitoring blood sugars with exercise Continuous glucose monitoring (24-hour period) vs A1C = measure of overall glycemic control and glucose tolerance. Exercise by insulin users require balancing insulin and food intake to remain in as close to a euglycemic state as possible. Exercise as Medicine for Diabtetes: Prescribing Appropriate Activities and Avoiding Potential pitfalls; Sheri R. Colberg. Diabetes Spectrum Winter 2015

18 Motivating Patients Take time to get to know patients What are interests the patient? What do they like to do? What are they passionate about? What resources to they have available? What is the persons financial resources? Find ways to work physical activity into their normal daily routine. Do little exercises while sitting at stop lights or standing in line. Take stairs rather then elevator Park farther away.

19 Motivating Patients Does the person prefer to activities on an individual/one on one basis or in a class. What will assist the person to be accountable. Utilize support groups if that is something that the patient is interested in. Social media can be a good resource utilizing apps or face book that keep track of steps or log exercises performed. Utilizing Fit bit or jawbone if that is some thing that interests the patient.

20 Devising a Plan Based on what the patients interest and passions devise a plan that incorporates these things. Ex. The patient being in water develop a plan with pool exercise. If the patient likes dancing encourage the patient to join and exercise class. If the patient has a specific goal ex. Dance at daughters wedding or go see the Grand Canyon utilize that to motivate the patient to do exercise to work towards that. Be Creative and think outside the box.

21 Goal Setting Start small with simple attainable goals that allow for early success and build from their. If things are to hard or overwhelming people tend to get frustrated or give up. Most likely if they have failed in past it is secondary to trying to do to much too fast. Avoid taking one step forward two steps back syndrome.

22 Life style Change Activity and exercise need to be a life style along with eating healthy and taking their medication appropriately. It needs to be incorporated into their daily life just like brushing their teeth or taking a shower. It needs to be made a priority that is incorporated into what they do so that it becomes a habit and improves their quality of life.

23 Treatment Options Aerobic and High force Resistance

24 Balance Training

25 Body weight resisted exercise

26 Core Strengthening and Yoga

27 High intensity interval training

28 Moderate Intensity Weight bearing

29 Combined Resistance and Aerobic Exercise

30 Resistance Exercise Training

31 Conclusion Currently diabetic patient s are not consistently involved in exercise despite the overwhelming evidence that it there are many benefits for managing diabetes and improving quality of life. Exercise comes in many forms and does not have to be costly or time consuming. It can be incorporated into any activity or hobby that a person might have. Health care providers have the ability to change this by educating, motivating, and assisting the diabetes patient to incorporate exercise into their lifestyle. Be Creative