Pilates and Diabetes. Hannah Voigt. 1 March Course Year Body Intellect Pretoria

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1 Pilates and Diabetes Hannah Voigt 1 March 2013 Course Year 2012 Body Intellect Pretoria 1

2 Abstract: Diabetes is a highly common disease internationally and in South Africa. Being diabetic is a huge lifestyle adjustment and diabetics have to make wise decisions to avoid serious complications. Correct diet and exercise practices are very important. Pilates is one such form of exercise that can benefit diabetics both physically and emotionally. This paper briefly outlines what diabetes is, how Pilates can be beneficial and provides some insight into teaching diabetic clients. 2

3 Contents Page Introduction 4 What is Diabetes?...5 Diabetes and Pilates...6 Teaching Diabetic Clients: What should an instructor understand?...7 The Conditioning Program.9 Conclusion.12 Bibliography.13 3

4 Introduction Diabetes is a very serious and common illness in society today. Pilates is an exercise form that is controlled and can be tailored for specific needs. The principles of Pilates make it suitable and beneficial for Diabetic clients. Instructors working with diabetic clients should have an understanding of the condition and the possible risks and complications; they should also understand that the emotional complications related to the illness. Pilates, being a mind body form of exercise can be highly beneficial to this aspect of the client and their diabetes/ how it affects them. Classes should be tailored specifically taking into consideration the patients condition, as will be explained in this brief research paper. 4

5 What is Diabetes? Diabetes is a lifelong disease, characterized by high levels of sugar in the blood. This is because the body cannot transport sugar (from food and drink) out of the blood and into the body s cells where it can be stored or used as fuel for energy. This problem is caused by insulin (The transporter of sugar from the blood to the body s cells), the body either does not produce insulin; or, the body cells do not respond correctly/ efficiently to insulin, (insulin resistance). As described above there are two types of diabetes: Type 1: This is where the body or the pancreas makes very little or no insulin. It is often referred to as juvenile diabetes, as the onset is most commonly in children, teenagers and young adults. It can be caused by a variety of things but is not necessarily lifestyle related. It can be caused by a virus / auto immune response, where the cells of the pancreas are attacked and therefore do not function as they should. Type one is irreversible and cannot be cured as of yet, patients need to be carefully medicated by injecting insulin and their lifestyles need to be carefully controlled, healthy eating and exercise play a large role in the management of type one diabetes. Patients are required to test their blood sugar levels by pricking a finger and placing the blood sample onto test strips, which are then interpreted by a test kit, and the blood sugar levels are recorded. Blood Sugar Levels should ideally be between 4.5 and 7 units. High blood sugar levels- above 7 units (hyperglycemia) causes long term damage to the body, the nerves in particular, the kidneys, etc. Suffer from nerve ending damage (no felling in hands and feet), Poor circulation, blindness, Kidney failure, Heart damage (at risk of heart attacks, and various other complications. Low blood sugar levels- below 4 units (Hypoglycemia) do not pose long term threats but are dangerous for the individual at that specific point in time. If sugar levels are not increased the individual can go into a coma, which result in death. This hyperglycemia is what Pilates instructors should be aware of as exercise reduces blood sugar levels and clients could experience sugar lows, this will be elaborated on more later in the paper. Due to the various, very serious and often debilitating complications, and the lack of a cure, along with the strict lifestyle management and unpleasant medication procedures (injecting insulin up to 6 times a day) Diabetes can have an emotionally unsettling component. All of the above needs to be understood by the Pilates instructor so as to approach and teach the client in an appropriate manner. 5

6 Type 2: Type 2 diabetes (insulin resistance) is when the body produces adequate insulin but the body s cells do not respond to that insulin in the correct way, thus not transporting it from the blood, causing sugar highs. 90 % of all diabetics are type 2, and it is mostly caused by genetics or unhealthy lifestyle choices. Obesity also causes type 2 diabetes. An increase in fat makes it harder for the body to use insulin in the correct way. However type 2 also affects thin people. Type 2 diabetics do not need to inject insulin; it can be controlled by lifestyle, diet and exercise. Oral medication is prescribed if lifestyle changes are not enough. Diabetes and Pilates: Pilates is a form of exercise that could be highly beneficial to diabetics, not only for their general health and wellbeing but also in managing their diabetes, physically and emotionally. The principles of Pilates; namely awareness, balance, breathing, control, centre, concentration, flow, efficiency, harmony and precision, make it a mind-body form of exercise and distinguish it from other forms of exercise. Pilates encourages ideal posture balance throughout the body s musculature, balance between body and mind as well as strength and flexibility, allowing body and mind the to function optimally. It is low impact and practiced in a controlled environment with the guidance of trained instructors. It is specifically tailored to each client. The ability to start slowly, modify exercises and even do an entire work out without standing make this the perfect form of exercise for diabetics. These are just a few of the benefits Pilates would provide for anyone and which could be especially beneficial for diabetics. Diabetics, both type 1 and type 2 are encouraged to exercise because exercise increases heart and breathing rate, which in turn lowers blood sugar levels. It improves blood flow / circulation, increases energy levels and decreases tension, It also improves ones ability to handle stress and thus doctors insist that diabetics do at least 30 minutes of exercise each day. Aerobic exercises increase insulin sensitivity and restore the metabolism, decreasing fat. Resistance training decreases fat and increases the glucose uptake by the muscle cells, enhancing the body s ability to store glucose. This further substantiates why Pilates is beneficial for diabetics, as it can incorporate both aerobic and resistance training. As mentioned above suffering from diabetes and trying to manage the condition as best as possible to avoid the complications can cause immense stress, so an exercise program must not cause any more worry or discomfort for the individual. A program that is tailored exactly to the individuals needs and likes is important to make it enjoyable from the start and 6

7 hopefully inspire the individual to want to exercise, not because they are forced to. Pilates is thus an appropriate form of exercise for diabetics. A Pilates program will be most effective for diabetics if it can inspire the individual to take what they learn in Pilates, the principles, and employ it in their everyday life and management of their condition. Pilates can be a partner for a diabetic client, on a journey to knowing and appreciating their mind and body, making better lifestyle choices and controlling their diabetes in the best way possible. Teaching diabetic clients: what instructors should be aware of: Before embarking on the Pilates journey with a diabetic client, the instructor should always have a doctor s letter giving the client to go ahead to exercise and stating any possible complications. The Pilates instructor teaching a diabetic client must understand the complexity of the condition, he or she should be aware of the serious complications it can cause and the medication involved (particularly for type 1) in order to understand the lifestyle and probable emotional state of the client. The Pilates session must be enjoyable in order to reduce stress and anxiety levels, encourage the client to become in tune with their body and realize its true potential. The client should be encouraged to be aware and in control of the body and hopefully develop a new appreciation for the functionality of their body, so that they are inspired to manage their diabetes more carefully and make better lifestyle decisions. He or she should be sensitive in their approach and attempt to make that Pilates session the highlight of the individual s week, in order for it to be truly beneficial. The client should not be treated as disabled, or get the feeling that they are in anyway inadequate or unable, only motivated. Pilates instructors working with diabetics must also understand the complications of the illness so that they can be of assistance should the client experience such complications during the class. As mentioned above exercise causes the blood sugar levels to drop so the client could possibly experience a sugar low. Muscles that are working use more glucose than those that are resting and muscle movement leads to greater sugar uptake by the muscle cells, which in turn lowers blood sugar levels. Although most diabetics can anticipate a sugar low and deal with it accordingly the instructor should know how to deal with such circumstances as well. The following applies mostly to Type 1 diabetics but may also be applicable to type 2 diabetics on medication. 7

8 - Always make sure that the client has a snack and their glucose injection with them, or that the studio has snacks / sugary foods/drinks available. - It would be a good idea to ask the client to show you how to operate their test kit and if and where they keep any emergency glucose injections/ information/kits. - The following are indications of a sugar low that the instructor should be aware of: trembling or shakiness, increased heart rate or palpitations, increased perspiration, excessive hunger, headaches, drowsiness, confusion, abrupt mood changes. Usually the client will be able to inform you that they need to stop and eat something before carrying on, however if the indications are vividly present and the client does not notice the instructor needs to take control and ask how the client is feeling and perhaps suggest a break for the client to test their sugar and eat something. The class can be continued once the indications are no longer present. - If in the rare case that the client does not show any symptoms of a sugar low and does not notice until it is too late and is then unable to test their sugar (beginnings of convulsions or unconsciousness) or help themselves, the instructor must stay calm and if test the clients sugar, if the result is below 4 units the client must be given their glucose injection (which they should carry with them) and if they do not have it with them they should be given something liquid, containing sugar (eg. honey) in the mouth. The client should be taken to the nearest doctor or emergency rooms. 1 When dealing with diabetic clients it is also important to know the symptoms or signs of heart attacks and cardiovascular problems. As diabetics are as vulnerable to heart conditions as individuals who have had heart attacks before. (This paper is only dealing with diabetes; please see other research for the symptoms of cardiovascular problems). The following are other complications of diabetes that the instructor should be aware of and tailor the program to accommodate if present. 1 Severe hypoglycemia very low blood glucose-can cause a person to pass out and can even be life threatening. Severe hypoglycemia is more likely to occur in people with type 1 diabetes. People should ask a health care provider what to do about severe hypoglycemia. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. A health care provider can prescribe a glucagon emergency kit. Family, friends, or coworkers the people who will be around the person at risk of hypoglycemia can learn how to give a glucagon injection and when to call 911 or get medical help. 8

9 Diabetic Neuropathies: The Nerve Damage of Diabetes 2. Clients suffering from Neuropathies can still do Pilates however the program will need to be more specifically tailored for that particular clients condition and comfort, the client must explain what is painful or uncomfortable. Due to this complication the client should always take good care of their feet, wear socks or specialized shoes during training, never have feet in tight straps or on surfaces or in positions, which could impair circulation. Diabetic Retinopathy (Eye Disease) causes loss of vision and ultimately blindness. Instructor should be sensitive to impaired vision and design and implement a program that the client is comfortable with and able to do. Conditioning Program for a Diabetic Client: As mentioned above before commencing with the conditioning program, obtain a letter from the client s doctor stating any complications and giving the client to go ahead to exercise. Start slowly and gradually and then increase the intensity and duration of the program, make sure the client has water to drink during the session and be aware of any warning signs for complications. Most importantly the client must enjoy the workout and feel good afterwards. The level of the program and the exercises chosen will be specific to the client and their particular complications (if any) as described above. If the client has no complications to their diabetes as of yet, they can exercise as a normal client, the instructor must however keep in mind the possibility of hypoglycemic attacks as described above. The following exercises were selected because they strengthen and provide a bit of cardio vascular, working the body as a whole in a balanced fashion. Feet and hands should not be in straps for extended periods of time and should never be in uncomfortable positions for the client. The client should feel like they have worked and most of all enjoy the work out. 2 - Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness-loss of feeling-in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers. wasting of the muscles of the feet or hands. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia (sugar lows) difficult to recognize. 9

10 Proposed Conditioning program for a complication free client: Warm up Footwork Abdominals Hipwork Spinal Articulation Stretches Intermediate warm up Wunda Chair Sitting Pike + Full Pike Reformer Bottom Lift + Bottom Lift with Extensions (do not have feet in straps for extended periods of time) Ladder Barrel leg stretching series Full body Integration Reverse Knee Stretch + Up Stretch 3 Arms Full body integration 2 Legwork Lateral Flexion Arms Sitting Balance control back Jumping (cardiovascular component) Side Lift with push through bar Back Extension Prone 1 10

11 Proposed Conditioning Program for a client suffering from Peripheral Neuropathy: ( little or no feeling in feet, prefers to not stand for very long) Warm up Footwork Abdominals Hipwork Spinal Articulation Stretches Full body Integration Arms Full body integration 2 Legwork Lateral Flexion Back Extension Basic - Intermediate warm up on mat Depending on client: Cadillac (light): so client can see positioning of feet Reformer (very light): with guidance from instructor Reformer or Mat: 100 s Prep + Co-ordination On mat with small ball under pelvis or on step barrel (no feet in straps) Roll over on mat or jack knife on Wunda chair (feet are free) On mat or side lying shoulder stretch on step barrel Sitting fwd. and The reach (Feet supported) Arms Sitting or Arms on Armchair (feet not involved) n.a Magic Circle series or side lying gluteal series Side Lift on Step Barrel Swimming 11

12 Conclusion: Although Diabetes is a very serious condition and can have fatal complications, Pilates can be highly beneficial for a diabetic client. Helping them to manage their diabetes, reducing blood sugar levels, reducing emotional stress and helping them become more aware of their bodies and inspire them to manage their Diabetes in the best way possible. The Pilates instructor working with a diabetic client should have an understanding of the condition and its complications in order to make the sessions as beneficial as possible. Exercise is essential for controlling Diabetes, medication is not enough to make a diabetic feel good and have a full life, it must be enjoyable and inspiring, Pilates, if taught well can be one such exercise. 12

13 Bibliography: Bayer,2013. [O] Available: Accessed 19 July 2012 PubMed Health, [O] Available: Accessed 19 July 2012 Mullen, D, Exercise and Diabetes. [O]. Available: Accessed 19 July 2012 Diabetes.co.uk, [O]. Available: Accessed 19 July 2012 Tienamm, C. [sp]. Learn how diabetics can improve their health with Pilates. [O]. Available: Accessed19 July 2012 Ogle, M Pilates and Diabetes. [O]. Available: Accessed 18 June 2012 Pilates Lowers your Sugar Levels and helps you Prevent and Manage Obesity, [O]. Available: Accessed 18 June

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