Mindful Exercise: Mind & Body Connection for Persons with Diabetes Mindfulness Exercise Marilyn Gordon EdD RDN CSSD LDN Registered Dietitian Nutritionist Board Certified Specialist in Sports Dietetics Mindfulness Menu Benefits of exercise/movement Special considerations Types of movement F.I.T.T. principle Mindful Movements Benefits of Exercise Lowers blood glucose & Hgb A1C Increases cell insulin sensitivity Helps to prevent weight gain Reduces risk of heart disease Lowers blood pressure Reduces stress Improves mood and quality of life Sense of well being Special Considerations Monitor glucose levels before, during, and after exercise Risk of hypoglycemia after exercise Sx: Shakiness, weakness, headache, mental dullness, visual disturbances, confusion May need to dose of rapid or short acting insulin or basal rate of insulin pump Use continuous glucose monitoring Exercise with a partner Foot care
Special Considerations Cardiovascular health Monitor HR & BP response to exercise Use RPE scale Nervous System Autonomic or peripheral neuropathy Renal System Begin with low intensity and volume Visual At risk for vitreous hemorrhage Avoid activities that greatly BP Avoid jumping/jarring & head down activities F.I.T.T. Principle: Exercise Prescription Frequency: how often? Intensity: how hard? Time: for how long? Type: Cardiovascular Muscular strength Muscular Flexibility Types of Movement Cardiorespiratory Endurance: the ability to perform prolonged, large-muscle, dynamic exercise at mod-high levels of intensity. Muscular Strength: the amount of force a muscle can produce with a single maximum effort Muscular Endurance: the ability to resist fatigue (repetitive movements) and sustain a given level of muscle tension. Flexibility: the ability to move the joints through their full range of motion. F.I.T.T. Recommendations for DM: Aerobic Frequency: 3-7 days per week Intensity: Moderate R.P.E. scale 11-17 on a 6-20 scale (light to very hard) Time: 150 min per week Type: large muscle group, rhythmic activity Modify exercise Rx to address limitations Resistance Training Benefits Improves muscular strength and Enhances body composition % lean muscle mass Improves glucose tolerance Improves insulin sensitivity GLUT 4: a glucose transporter in skeletal muscle F.I.T.T. Recommendations for DM: Resistance/Strength Frequency: 2-3d/wk Intensity: Moderate-Vigorous Time: 8-10 exercises 1-3 sets, 10-15 reps to near fatigue Gradually progress to heavier weights Type: resistance machines and free weights
F.I.T.T. Recommendations DM: Flexibility Frequency: 2-3 d/wk Intensity: stretch to slight discomfort Time: hold static stretch 10-30s 2-4 reps each exercise Type: static, dynamic Mind-Body Medicine National Center for Complementary and Alternative Medicine: The interactions among the brain, the rest of the body, the mind, and behavior The ways in which emotional, mental, social, spiritual, experiential, and behavioral factors can directly affect health. http://nccam.nih.gov/ Mindfulness Paying attention on purpose Being in a flow state Freedom from worry of failure Immersed in the activity Sense of time disappears Action & awareness merge The experience itself is the reward Being present creates a calmer mind Reduced sense of stress The Mind-Body Approaches Guided imagery Biofeedback Clinical Hypnosis Yoga* Expressive art therapy Meditation* Progressive relaxation* Health Benefits of Mindful Exercise/Movement Stress reduction Improved mood & sleep Reduced tendency to overeat Improved physical function Strength, balance, flexibility, CV Improved BP & glycemic control Increased self-confidence Awareness of the present moment and not worried about the past or the future Mindful Activities/Exercises How could you approach each of these with mindful awareness? Breathing Walking Biking Strength Training Stretching Yoga/TaiChi
Yoga & Diabetes Increased insulin sensitivity Reduced fasting glucose levels Increased HR depending on style Increased muscular strength and Books: The Principles and Practice of Yoga in Healthcare by Sat Bir Singh Khalsa, et al. Yoga as Medicine by Timothy McCall M.D. Mindful Moving Connect breath to the movement Potential mindful moving meditations: Walking, stretching, swimming, yoga, cycling, gardening, strength training, showering, washing dishes How could we mindfully wash the dishes? How could we approach strength training as a moving meditation? Mindful Moving Mindful Exercise Prolonged sitting should be interrupted with bouts of light activity every 30 min Create 3 minute movement breaks Walk in place, knee lifts Lunges, squats, torso twists Overhead & side to side stretches Other ideas? References American College of Sports Medicine position stand: Exercise and type 2 Diabetes. Med Sci Sports Exerc. 2010;42: 2282-2303. American College of Sports Medicine. ACSM s Guidelines for Exercise Testing and Prescription. 10 th ed. Philadelphia: Lippincott Williams & Wilkins, 2018. American Diabetes Association. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39: 2065-2079. References Innes, KE, & Vincent, HK. The influence of yogabased programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evidence-Based Complementary and Alternative Medicine. 2007; 4:469-486. McCall, T. (2007). Yoga as medicine: The yogic prescription for health and healing. New York: Bantam Dell. National Institutes of Health, U.S. Department of Health and Human Services. Mind-Body Practices in Complementary and Alternative medicine https://report.nih.gov/nihfactsheets/viewfacts heet.aspx?csid=102 Accessed 11/07/2017.
References Singh Khalsa, S.B., Cohen, L., McCall, T., & Telles, S. (Eds.). (2016). The principles and practice of yoga in healthcare. United Kingdom: Handspring. Whitebird, R.R., Kreitzer, M.J., O Connor, P.J. (2009). Mindfulness-based stress reduction and diabetes. Diabetes Spectrum 22; 226-230.