The Secret to Successful Aging: Exercise for Aging Adults with Diabetes Karen Kemmis, PT, DPT, MS, GCS, CDE kemmisk@upstate.edu AADE Board of Directors 3rd Year Director, 2015 Treasurer Physical Therapist/Diabetes Educator Joslin Diabetes Center affiliate @ SUNY Upstate Medical University Syracuse, NY Objectives 1. Describe the natural changes of aging and the possible impact of diabetes. 2. Identify the effect of aging and diabetes on movement, function and health. 3. State the benefits of exercise and physical activity for the older adult with diabetes and the recommendations for physical activity/exercise. 4. Perform tests to determine mobility-related impairments, dysfunction and disability for an aging adult with diabetes. 5. Create an effective exercise prescription for an aging adult with diabetes. Cases: JN is a 72 yr old female, h/o type 2 diabetes x 5 yrs, no complications; some restrictions due to LBP; A1c=7.2% RK is a 80 yr old male, h/o type 2 diabetes x10 yrs; complication of neuropathy; lymphedema, lumbar stenosis, h/o 2 falls; A1c=8.2% AS is a 78 yr old female, h/o type 2 diabetes x 20 years; complications of neuropathy and retinopathy; fallen twice even using her rollator; HTN, COPD, uses O 2, has bil knee pain 2 to DJD but is not a good surgical candidate for TKA; A1c=7.8%; never been active, doesn t enjoy exercise and doesn t like leaving her home Goals are to lose weight and improve BG control w/o problems 1
I. Natural Changes of Aging and the Possible Impact of Diabetes Changes of aging Cardiovascular Pulmonary Musculoskeletal Ophthalmologic Neurological Cognitive Chronic complications of diabetes and impact on aging CV disease Retinopathy & other eye conditions Neuropathy Loss of Muscle Strength with Age Leg strength loss at rate of 1-3% per year > age 30 100 Strength % 90 80 Leg Strength 70 60 50 40 30 20 10 0 20 30 40 50 60 70 80 90 Age II. Effect of Aging and Diabetes on Movement, Function and Health Movement impairment Impact on general health and potential disability 2
Functional Limitations in Aging Adults % adults 60 yrs having any difficulty performing functional activities or unable to perform these activities by age: NHANES, 1999 2002 Functional Activities 60-69 yrs 70-79 yrs 80-89 yrs Walking ¼ mile 21 30 49 Walking 10 steps without resting 18 26 41 Stooping, crouching, or kneeling 42 52 66 Lifting or carrying as heavy as 10 pounds 22 28 46 Going out to shop, movies, events 15 21 39 Social activities 13 16 34 CDC: Ervin EB, Division of Health and Nutrition Examination Surveys, 2006. Slippery Slope of Aging (Schwartz RS, 1997) Sedentary Lifestyles and Chronic Diseases Inactivity is responsible for/associated with many diseases Type 2 diabetes CAD CHF Stroke PVD Osteoarthritis Depression 20% U.S. adults meet both aerobic and muscle strengthening PA recommendations (MMWR, 2013 at http://www.cdc.gov/vitalsigns/walkin g) ~50% meet aerobic activity and 30% meet muscle-strengthening activity 3
County-level Estimates of Leisure Time Physical Inactivity among Adults aged 20 years old Trends 2004-2011 2011 County-level Estimates of Diagnosed Diabetes Incidence among Adults aged 20 years old Trends 2004-2011 4
2011 5
Age-Adjusted Percentage of Adults with Diabetes Reporting a Mobility Limitation, United States, 1997 2011 http://www.cdc.gov/diabetes/statistics/mobility/health_status/fig1.htm Percentage of Adults with Diabetes Reporting a Mobility Limitation, by Age, United States, 1997 2007 http://www.cdc.gov/diabetes/statistics/mobility/health_status/fig3.htm 6
III. Exercise and Physical Activity for the Older Adult with Diabetes Benefits of physical activity and exercise 7
If exercise could be packed into a pill, it would be the single most widely prescribed and beneficial medicine in the Nation Dr. Robert Butler Past Director of the National Institute on Aging Response to Exercise Cardiovascular System Musculoskeletal System Neuromuscular System Endocrine System Cognitive Slippery Slope of Aging (Schwartz RS, 1997) I have the wish to die young, but as late in life as possible. (Anonymous) 8
IV. Testing for Mobility-related Impairment, Dysfunction, and Disability Standardized test with norms then simple clinic test Aerobic capacity/endurance 2-minute Step Test Gait, locomotion, and balance Timed Up and Go Test One-Limb Stance Test Muscle performance Chair Stand Test Arm Curl V. Exercise Prescription Evidence-based recommendations for physical activity/exercise Exercise prescription for an aging adult with diabetes without mobility-disability Exercise prescription for aging adults with diabetes and mobility-disability Case studies Recommendations for PA ACSM/ADA position statement for prevention of type 2 DM 2.5 h/wk moderate to vigorous PA should be undertaken as part of lifestyle changes to prevent type 2 diabetes onset in high-risk adults ACSM/ADA position statement for those with type 2 DM 150 min/week of moderate to vigorous aerobic exercise spread out during at least 3 d/wk, with no more than 2 consecutive days between bouts of aerobic activity (Colberg SR, et al, 2010) 9
Recommendations for PA ACSM/AHA : Can be done in bouts of 10 mins To further improve fitness, reduce disease and disability, and prevent weight gain, exceed the minimum (Haskell WL et al, 2007) ADA: Reduced risk of CVD 4 hrs/wk moderate to vigorous aerobic and/or resistance exercise (Hu FB et al, 2001; Wei M et al, 2000) Recommendations for PA ACSM/ADA position statement for weight loss Recommended levels of PA may help produce weight loss Up to 60 min/day may be required when relying on exercise alone for weight loss (Colberg SR, et al, 2010) Recommendations for PA ACSM/ADA resistance training (RT) guidelines In the absence of contraindications At least 2 but ideally 3 times/wk 5-10 exercises involving major muscle groups 3-4 sets Moderate to vigorous intensity (8-10 reps) Weight that can be lifted only 8-10 times (Colberg SR, et al, 2010.) 10
Special Considerations? Older Adults Individuals with Disabilities Exercise Prescription FITT principle Frequency Intensity Type Time Exercise Prescription Cases Aging adult with diabetes without mobilitydisability Aerobic/cardiovascular training Resistance training Frequency Intensity Type Time 11
Exercise Prescription Cases Aging adults with diabetes with mobility-disability Aerobic/cardiovascular training Resistance training Frequency Intensity Type Time Cases: JN is a 72 yr old female, h/o type 2 diabetes x 5 yrs, no complications; some restrictions due to LBP; A1c=7.2% RK is a 80 yr old male, h/o type 2 diabetes x10 yrs; complication of neuropathy; lymphedema, lumbar stenosis, h/o 2 falls; A1c=8.2% AS is a 78 yr old female, h/o type 2 diabetes x 20 years; complications of neuropathy and retinopathy; fallen twice even using her rollator; HTN, COPD, uses O 2, has bil knee pain 2 to DJD but is not a good surgical candidate for TKA; A1c=7.8%; never been active, doesn t enjoy exercise and doesn t like leaving her home Goals are to lose weight and improve BG control w/o problems Tests? FITT 12