Exercise Prescription For Diabetes

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Exercise Prescription For Diabetes

  1. 1. Exercise Prescription For Diabetes Your Moderate Exercise Program Robert Goldstein MS; <ul><li>Your Optimum Program Getting Started </li></ul><ul><li>7 Major Components of Fitness </li></ul><ul><li>1) Warm up </li></ul><ul><li>2) Cardiovascular Fitness </li></ul><ul><li>3) Muscular Strength </li></ul><ul><li>4) Flexibility Fitness </li></ul><ul><li>5) Balance </li></ul><ul><li>6) Cool Down </li></ul><ul><li>7) Body Composition </li></ul>
  2. 2. Benefits Of Moderate Exercise And Diabetes <ul><li>Benefits Of Exercise </li></ul><ul><li>1) Weight Loss </li></ul><ul><li>2) Lower Blood Pressure </li></ul><ul><li>3) Reduce Risk for Heart Disease </li></ul><ul><li>4) Improve Cholesterol Ratios </li></ul><ul><li>5) Control Blood Sugar </li></ul><ul><li>6) Reduce Back and Joint Pain </li></ul><ul><li>7) Improve Balance </li></ul><ul><li>8) Reduce Medications </li></ul><ul><li>9) Increase Self Confidence </li></ul><ul><li>10) Reduce Risk For Fall </li></ul>
  3. 3. Moderate Exercise Defined <ul><li>ACSM Definition </li></ul><ul><li>Activities that are 3 to 6 mets in intensity, </li></ul><ul><li>Walking 1 mile between 15 and 23 minutes. </li></ul><ul><li>Biking between 15 and 90 Watts. </li></ul><ul><li>Activity in an 11 to 13 RPE range. </li></ul>
  4. 4. Warm Up <ul><li>1) Reduce risk for injury </li></ul><ul><li>2) Gradual increase of pressure and heart rate. </li></ul><ul><li>3) Increases circulation in legs. </li></ul><ul><li>4) Warms Muscles. </li></ul><ul><li>5) Types of Warm up </li></ul><ul><li>Light Walking </li></ul><ul><li>Light Cycling </li></ul><ul><li>Balance Exercise </li></ul><ul><li>Movement and Light Stretching </li></ul><ul><li>5 to 10 minutes </li></ul>
  5. 5. Cardiovascular Fitness <ul><li>1) The heart, lungs and blood vessels deliver adequate supply of oxygen to large working muscles. </li></ul><ul><li>2) Also called aerobic fitness uses the oxygen pathway. </li></ul><ul><li>3) Examples- Walking, Cycling, Swimming, , Recumbent Step Machine. </li></ul><ul><li>4) Perform 3 to 5 times a week. May be done in short bouts or duration. </li></ul>
  6. 6. The Heart <ul><li>The Heart is a Muscle </li></ul><ul><li>1) Divided into four chambers. Two upper Atria. Two Lower Ventricles. </li></ul><ul><li>2) Right Atrium receives de oxygenated blood sends the blood to the right ventricle and to the lungs to re oxygenate. </li></ul><ul><li>3) Blood come back through the left Atria and goes to the left ventricle and pumped to working muscles. </li></ul>
  7. 7. Muscular Strength and Endurance <ul><li>Strength Training </li></ul><ul><li>1) Helps to maintain lean body weight and muscle mass. </li></ul><ul><li>2) Perform 2 to 3 times a week with a day rest in between. </li></ul><ul><li>3) Light Dumbbells, Thera- Band, rubber tubing. </li></ul><ul><li>4) Exercise within range of motion without pain or excessive weight. </li></ul><ul><li>5) Start with one set of 10 until mastered and increase to two sets. </li></ul><ul><li>6 ) Extremely important and helpful in reducing blood sugar. </li></ul>
  8. 8. Flexibility <ul><li>1) Flexibility Decreases after the age of 25. Increasing risk for injury. </li></ul><ul><li>2) The biggest reason for missing work after the common cold is low back pain. </li></ul><ul><li>Stretching </li></ul><ul><li>1) Best when muscles are warm; during and after workout. </li></ul><ul><li>2) Static Stretching. Holding Stretch for 30 seconds on each side. </li></ul><ul><li>3) Only stretch to comfortable range of motion increasing as muscle allows. </li></ul>
  9. 9. Cool Down <ul><li>1) Brings Blood Pressure and Heart rates down gradually. </li></ul><ul><li>2) Aids in preventing muscle stiffness or soreness. </li></ul><ul><li>3) Prevents pooling of blood and promotes adequate flow to muscles and heart. Increases circulation. </li></ul><ul><li>Slow Walking </li></ul><ul><li>Stretching </li></ul><ul><li>Slow Movement </li></ul>
  10. 10. Balance and Reducing Fall <ul><li>After age 50 we lose 1% of lean body weight per year or 10% per decade. </li></ul><ul><li>Fall Statistics For CC County </li></ul><ul><li>1) 108 Deaths 2002 to 2004 for people over 65. </li></ul><ul><li>2) 6667 hospitalizations for people over 65. </li></ul><ul><li>3) Average cost of hospitalization $52,447 </li></ul><ul><li>4) 1 out of every 5 hip fractures dies within a year and each fall becomes indicator for more falls. </li></ul><ul><li>5) The time to act is immediately. The fierce urgency of now. </li></ul>
  11. 11. How to Reduce Fall <ul><li>1 ) Start Exercise Program. Maintain muscle and bone density. </li></ul><ul><li>2) Have your eyes checked. </li></ul><ul><li>3) Reduce hazards in home. </li></ul><ul><li>4 )Use assistive devices. </li></ul><ul><li>Minimal Transfers. </li></ul><ul><li>5) Check Medications and if you get week or dizzy. </li></ul>
  12. 12. Blood Sugar Levels for Exercise <ul><li>American College of Sports Medicine </li></ul><ul><li>Type 1 insulin dependent should be 120 or above and below 250 before and after exercise.. </li></ul><ul><li>Type 2 should be above 100 and below 300 before and after exercise. </li></ul><ul><li>Goal is to avoid hypoglycemia for people who exercise. If your number is close to either the high or the low end it is recommended that you test in the middle to avoid hypo or hyperglycemia. </li></ul><ul><li>Light snack as crackers, rice cakes, pretzels are of low caloric content and can help raise blood sugar. </li></ul>
  13. 13. How Hard do I Need to Work <ul><li>A great question </li></ul><ul><li>1) Very individual prescription. </li></ul><ul><li>2)Heart rate % method 220 minus age. Safety is number one concern. </li></ul><ul><li>3) Full evaluation of your medical history, medications, surgeries and orthopedic conditions. </li></ul><ul><li>4) Doctors approval and contraindications. </li></ul><ul><li>5) The good news, you can exercise even if you don’t think you can and if you never did before. </li></ul>
  14. 14. Intensity <ul><li>Exercise Prescription </li></ul><ul><li>1) Mode – Type of exercise. Determined on an individual basis. </li></ul><ul><li>2) Intensity – How hard do I work. Workload. Starting low and graduating when perfecting current intensity. </li></ul><ul><li>3) Duration – How long. Also based on individual needs. Short bouts to start. </li></ul>
  15. 15. Rated Perception Of Exertion and Meds <ul><li>1) Beta blockers, Alpha blockers, Calcium Channel and Diuretic Medications blunt heart rate and blood pressure. </li></ul><ul><li>2) With this in mind heart rate end blood pressure will not be the best indicator of how hard you work. </li></ul><ul><li>RPE Borg Scale </li></ul><ul><li>6 </li></ul><ul><li>7 very Very Light </li></ul><ul><li>8 </li></ul><ul><li>9 very light </li></ul><ul><li>10 </li></ul><ul><li>11fairly light </li></ul><ul><li>12 moderate </li></ul><ul><li>13 somewhat hard </li></ul><ul><li>14 </li></ul><ul><li>15 hard </li></ul><ul><li>16 </li></ul><ul><li>17 very hard </li></ul><ul><li>18 </li></ul><ul><li>19 very very hard </li></ul><ul><li>20 </li></ul>
  16. 16. Other Methods of Rating Intensity <ul><li>1) The talk test- You should be able to carry on a conversation while exercising. </li></ul><ul><li>The Reggie test – Get a 4 month old puppy and work until exhaustion </li></ul><ul><li>2) Evaluating Range of Motion. Stopping when feeling pain. </li></ul><ul><li>3) The no pain no gain mentality is not appropriate. You should not feel pain. </li></ul><ul><li>4) If you are feeling pain you are possible hurting yourself and preventing improvement. </li></ul>
  17. 17. Body Composition <ul><li>Body Composition and Risk for Heart Disease. </li></ul><ul><li>1) Body Mass Index. </li></ul><ul><li>2) Body Fat Percentage. </li></ul><ul><li>3) Waist Hip Ratio. </li></ul><ul><li>4) Circumference Measurements </li></ul>
  18. 18. BODY MASS INDEX Classification for Disease and Risk Based on Body Mass Index and Waist Circumference. Disease Risk Relative To Normal Weight and Waist Circumference BMI Men < 40” Men >40” Woman < 35” Woman > 35” ___________________________________________ Under Weight < 18.5 Normal Weight 18.5 to 24.9 Overweight 25 to 29.9 High High 1 30.0 to 34.9 High Very High 2 35.0 to 39.9 Very High Very High 3 > 40 Extremely High Extremely High   Keep in mind that BMI is a quick snapshot for large populations but does not take into account fat-free density and skeletal mass. Calculate your BMI at the following site:
  19. 19. Waist Hip Ratio Waist to Hip Norms for Men and Woman Disease Related to Obesity   The knowledge of waist hip ratio and reduction of even small amounts of abdominal fat plays a huge part in risk factor reduction for diabetes and heart disease. To determine the waist hip ratio you divide the waist circumference by the hip circumference. Example if your waist is 34’ and your hips are 37’. Your waist hip ratio will be 0.92.     Age Low Moderate High Very High ______________________________________________________   Men 30 to 39 0.84 0.84 to 0.91 0.92 to 0.96 > 0.96 40 to 49 0.88 0.88 to 0.95 0.96 to 1.00 > 1.00   50 to 59 0.90 0.90 to 0.96 0.97 to 1.02 > 1.02   Woman 30 to 39 0.72 0.72 to 0.78 0. 0.79 to 0.84 > 0.84   40 to 49 0.73 0.73 to 0.79 0.80 to 0.87 > 0.87   50 to 59 0.74 0.74 to 0. 81 0.82 to 0.88 > 0.88  
  20. 20. Weight Loss Taking it Slow <ul><li>How Weight Loss Works . </li></ul><ul><li>1) Negative caloric expenditure. </li></ul><ul><li>2) Negative expenditure thru diet </li></ul><ul><li>and exercise. </li></ul><ul><li>3) 3500 calories one pound. 1 pound </li></ul><ul><li>a week is a reasonable weight loss. </li></ul><ul><li>4) Eliminate about 250 calories per </li></ul><ul><li>day thru diet </li></ul><ul><li>5) Another 250 calories through exercise. </li></ul>
  21. 21. How Can I Start <ul><li>Stages of Change </li></ul><ul><li>Pre-Contemplation </li></ul><ul><li>Contemplation </li></ul><ul><li>Action: </li></ul><ul><li> The Fierce Urgency of Now!! </li></ul><ul><li>Maintenance </li></ul><ul><li>Relapse </li></ul>
  22. 22. Smart Goals KISS <ul><li>Specific </li></ul><ul><li>Measurable </li></ul><ul><li>Attainable </li></ul><ul><li>Realistic </li></ul><ul><li>Timely </li></ul>
  23. 23. Reduce Risk factors for Heart Disease <ul><li>Modifiable Risk factors </li></ul><ul><li>Cigarette Smoking </li></ul><ul><li>Hypertension </li></ul><ul><li>Hypercholesterolemia </li></ul><ul><li>Impaired Blood Glucose </li></ul><ul><li>Obesity </li></ul><ul><li>Sedentary Life Style </li></ul><ul><li>Stress </li></ul>
  24. 24. Pre and Post Exercise Blood Sugar Averages 1 Year <ul><li>Pre exercise 140 </li></ul><ul><li>Post Exercise 100 </li></ul>
  25. 25. Exercise Met Levels Start and 20 Sessions On Treadmill <ul><li>Starting Session </li></ul><ul><li>1.4 MPH 0% Grade </li></ul><ul><li>20 Sessions </li></ul><ul><li>2.9 MPH 0% Grade </li></ul><ul><li>48% Increase in Workload </li></ul>
  26. 26. First Session and 20 th Session Aerobic Time Minutes <ul><li>Session One </li></ul><ul><li>9 Minutes Total </li></ul><ul><li>3 Minutes Bike </li></ul><ul><li>3 Minutes Treadmill </li></ul><ul><li>3 Minutes Bike </li></ul><ul><li>Session Twenty </li></ul><ul><li>Total Time 29 Minutes </li></ul><ul><li>14 Minutes Bike </li></ul><ul><li>15 Minutes Treadmill </li></ul><ul><li>300% increase </li></ul>
  27. 27. Abe and Arline Aronowitz A Testimonial Exercise Prescription For Diabetes[1].ppt
  28. 28. Thank You Very Much Ready eXercise <ul><li>Robert Goldstein MS </li></ul><ul><li>Exercise Physiologist </li></ul><ul><li>readyexercise.com </li></ul><ul><li>925-457-5346 </li></ul>

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