Active living with diabetes: Practical guidelines to Exercise Dr. Agnes Coutinho Registered Kinesiologist April 2018
AGENDA 1.Brief overview of diabetes 2.How does exercise/physical activity impact diabetes 3.Current physical activity guidelines 4.Benefits of using the whole body to exercise for diabetes management.
Why are we focusing on Exercise? Incidence of high blood pressure Incidence of Type 2 diabetes onset Incidence of heart diseases Risk of stroke Risk of colon cancer Mortality and risk of recurrent breast cancer Risk of developing Alzheimers Depression, anxiety and stress (better mental health) Risk of premature death
Benefits of Active Living for Everyone Canadian Physical Activity Guidelines Experts agree, exercise is powerful medicine! So how much should you exercise? The recommendations are dependent on your age, according to the CSEP guidelines for physical activity and general health promotion for adults aged 18-64, and 65+ are: 150 min/week of moderate-vigorous intensity aerobic physical activity most days/week Strength-training 2 days/week
INSIDENCE Exercise as Treatment = Success LIFESTYLE YEARS CDA, 2008
Type 1 Diabetes Type 2 Diabetes Gestational Diabetes https://loonylabs.files.wordpress.com/2015/04/type-1- diabetes-little-girl.jpg?w=590&h=427 childhood or adolescence pancreas does not produce insulin Patients are insulin dependent ~10% of those with diabetes http://foodmyths.org/wp-content/uploads/2013/02/type-2- diabetes.jpg Colourbox diagnosed in adulthood (increasing in children). Pancreas does not produce enough insulin OR when the body does not effectively use insulin. WordClip Temporary - during pregnancy 8-18% rate in Aboriginal population, ~4% of non- Aboriginal groups higher risk of diabetes for mother/child
3 Types of Diabetes Type 1- Usually diagnosed in childhood or adolescence. The pancreas is unable to produce insulin. People with type 1 diabetes are therefore insulin dependent. ~10% of those with diabetes have type 1. Type 2- Usually diagnosed in adulthood (though increasing prevalence in children). Occurs when the pancreas does not produce enough insulin OR when the body does not effectively use insulin. Gestational- Temporary condition that occurs during pregnancy. Affect 3.7% of pregnancies (8-18% in Aboriginal population). Increases risk of diabetes for both mother and child.
All Diabetes = high blood glucose (sugar) Non-diabetes Fasted: 3.9 and 5.5 mmol/l Non-diabetes non-fasted: below 6.9 mmol/l
Discussion about Exercise is Important Because it is Estimated that of diabetes is
What About Pre-Diabetes? ClipArt Non-modifiable; Member of high-risk group Genetics Modifiable Life style changes
In reality. http://www.womanhonorthyself.com/?p=5024 Trademark -Urban Poling
Physical Activity is a Key Strategy for Prevention & Management of Diabetes. But. Is this safe for patients with Diabetes? Is this enough to offset Diabetes? Are there special considerations for those with Diabetes? 12 Retrieved from: http://www.csep.ca/cmfiles/guidelines/csep_paguidelines_older-adults_en.pdf
How will these symptoms impact participation in exercise or sports? http://www.natural-homeremedies-for-life.com/images/diabetes-symptoms.jpg
How does Physical Activity Impact Diabetes? Physical activity allows the exercising muscles to take in glucose without the need for insulin. Your body needs less insulin when you exercise, but you still need some! Exercise causes the cells in our body to be more sensitive to insulin and helps to stabilize blood glucose levels. This response is localized to the muscles that you are exercising. With regular ongoing training this effect can be retained for extended periods of time (~72h). Diabetes = high blood (sugar) glucose Direct glucose uptake (acute) Insulin sensitivity (chronic)
How can our patients prevent hypoglycemia during exercise? >13.9 mmol/l 5.6 to 13.9 mmol/l Caution zone <5.6mmol/L Good to go! This is a safe preexercise blood glucose range Glucose may be too low to exercise safely Should test blood glucose every 30 minutes during exercise insulin or medications can cause hypoglycemia 3.9 mmol/l or lower STOP! What do you do when blood glucose is too low? http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697
Recommendation 1 People with diabetes should accumulate a minimum of 150 minutes of moderate to vigorous intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise [Grade B, Level 2, for T2DM; Grade C, Level 3 for T1DM]
Recommendation 2 People with diabetes (including elderly people) should perform resistance exercise at least twice a week, and preferably 3 times per week [Grade B, Level 2] in addition to aerobic exercise [Grade B, Level 2]. Initial instruction and periodic supervision by an exercise specialist are recommended [Grade C, level 3]
HIGHS The and of diabetes lows What are the signs of a low blood glucose level? What causes low blood glucose level (hypoglycemia)? http://imodraj.blogspot.ca/
So what do we do in case of mild to moderate low blood glucose - hypoglycemia? Eat a small snack containing 15 to 30 grams of carbohydrates, such as fruit juice, fruit, crackers or even glucose tablets before you begin your workout.
Blood glucose response varies based on type of exercise https://upload.wikimedia.org/wikipedia/commons/d/df/olympic-style_weight_lifting_training.jpg https://upload.wikimedia.org/wikipedia/commons/1/15/hockey.jpg
Blood glucose response varies based on type of exercise May results in spike in blood glucose May results in drop in blood glucose
Blood glucose response varies based on type of exercise
Resistance training before aerobic training can protect against (low blood glucose) Hypoglycemia during exercise and improve long term blood glucose Yadley et al., Diabetes Care 2012
POP-Quiz; which socks would you recommend to your diabetes patients when they exercise?
Why Nordic walking? The urban poling technique is designed specifically to: Most of the muscles in the body Increase caloric expenditure Target major core muscles Promote good posture, balance & stability Reduce impact on knee & hip joints Provide a safe and ergonomic handle (maintaining hand/wrist in neutral & wide grip position) 25
Why Nordic walking?
Research Supports Benefits Evidence based studies clearly identify Urban Poling, with the proper training, as a healthy mode of physical activity suited for primary and secondary prevention, as well as rehabilitation. Urban Poling offers proven beneficial effects on key heath parameters, including: Caloric expenditure Body Weight Total Fat mass BMI & Waist circumference Lowers cholesterol & Triglycerides Level of perceived claudication pain Social interaction Quality of life Exercise tolerance Personal exertion limits Self-Esteem Powerful Tool for not only Cardiac Rehab and vascular disease, but also Diabetes, Obesity, Mental Health *Am J Prev Med 2013;44(1):76-84
The Urban Poling technique is designed specifically to: Provide a safe and ergonomic handle (maintaining hand/wrist in neutral & wide grip position) The poles appear light with a good grip. The hand design of the grip offer even more support and thus, provide safety. The hand piece and length adjustments are convenient. Overall, the chance to suffer a Nordic walking thumb is probably reduced with your urban poles, especially among patients with Diabetes; with a potential impairment of balance and proprioception. (Knobloch, 2006) Prof. Dr. med. Karsten Knobloch 2014
The Benefits of Active Living with Urban Poling General Benefits: Works more muscles. Promotes healthy weight, glucose control and cardiovascular health. Improves quality of life! Healthy Aging Heart Health Diabetes Parkinson s, MS, ABI, CVA Healthy Weight Management PROMOTES: Posture, stability and balance Exercise tolerance Walking speed and distance Functional independence Social interaction and overall feeling of wellbeing Fall prevention PROMOTES: Healthy blood cholesterol Healthy weight loss Exercise tolerance Lower resting heart rate and lower blood pressure Increased peak (exercising) heart rate PROMOTES: Healthy weight loss and management Blood glucose management REDUCES: Waist size Pain caused by insufficient blood flow during exercise PROMOTES: Posture, stability and balance Exercise tolerance Walking speed and distance Aerobic and resistance training Core strength and functional independence Social Interaction and self confidence Fall prevention REDUCES: Body weight BMI Total body fat Waist size PROMOTES: Burns 20-46% more calories vs. walking without poles Exercise tolerance Social interaction and self-esteem
The Benefits of Active Living with Urban Poling General Benefits: Works more muscles. Promotes healthy weight, glucose control and cardiovascular health. Improves quality of life! Pre/Postnatal Safe mode of physical activity Incorporates aerobic and strength training PROMOTES: Posture, stability and balance Core strength Postnatal healthy weight loss Social interaction Mental Health PROMOTES: Social interaction Self-esteem and overall feeling of well being Improved exercise tolerance REDUCES: Anxiety Depression Vestibular Conditions PROMOTES: Posture, stability, and balance Exercise tolerance Walking speed and distance Functional independence and improved self confidence Arthritis reduces impact on knee and hip joints* PROMOTES: Walking speed and distance Upper extremity mobility and strength Posture, stability, and balance *ACTIVATORTM POLES Cancer Rehab REDUCES: Fatigue Depression Anxiety PROMOTES: Upper body mobility and strength Muscular endurance Pain management Social interaction and improved selfesteem Hip & Knee pre/post surgery reduces impact on knee & hip joints* PROMOTES: Posture, stability, and balance Increased gait speed Fall prevention *ACTIVATORTM POLES
3. Gestational Diabetes Please remember that any physical activity will affect your blood glucose and may affect your response to medication. If you have diabetes already, speak to your healthcare practitioner before starting any new activity. By increasing physical activity, even before pregnancy and especially during, you can significantly help reduce the risk of developing gestational diabetes, ensure better pregnancy outcomes and overall improved health both for you and your baby.
Thank you, Merci, Miigwetch Questions? Agnes.Coutinho@guelphhumber.ca
References 1.Church TS, Cheng YJ, et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004; 27(1): 83-88. 2.Knowler WC, Barrett-Connor E, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. 3.2008 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2008; 32 (suppl 1): S1- S201. 4. Sigal RJ, Kenny GP, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: A randomized trial. Ann Intern Med. 2007; 147(6): 357-69. 5. Kirk A, Mutrie N, et al. Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with type 2 diabetes. Diabetologia. 2004; 47(5): 821-32. 6. American College of Sports Medicine; American Heart Association. Exercise and acute cardiovascular events: Placing the risks into perspective. Med Sci Sports Exerc. 2007; 39(5): 886-97. 7. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 30(Suppl 1): S42 S47, 2007. 8. C.S. Moy T.J. Songer R.E. LaPorte Insulin-dependent diabetes mellitus, physical activity, and death Am J Epidemiol 137 1993 74 81 9. A. Chudyk R.J. Petrella Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis Diabetes Care 34 2011 1228 1237
Credentials & Professional Experience: Assistant Program Head of Kinesiology Undergraduate Kinesiology Degree, MSc in Exercise Physiology & Metabolism, PhD Endocrinology Past-Chairperson, Board of Directors, NADA Conflict of Interest Statement: Dr. Coutinho has received consulting fees from Urban Poling Inc. Apart from these consulting fees, Dr. Coutinho does not receive any other payments or compensation, in the form of stock options or otherwise from Urban Poling Inc., and does not benefit directly from sales made by Urban Poling Inc., in any form. Research findings describing health implications of Nordic walking, as discussed in the presentation, are based on peer reviewed research studies that are not funded in any way by Urban Poling Inc. An external panel of experts has been recruited to objectively assess walking poles made by Urban Poling, feedback and recommendations from these assessments will be discussed in the presentation. 34