Lec 1 nutrition therapy diabetes mellitus and physical activates

1,238 views
901 views

Published on

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,238
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
30
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • adapted from; Melvin H Williams 2010; Nutrition for Health, Fitness and Sport
  • Lec 1 nutrition therapy diabetes mellitus and physical activates

    1. 1. Postgraduate Diploma in Diabetes Education (PDDE lec 1 Nutrition therapy: Diabetes Mellitus and physical activates Prepared by; Dr. Siham M.O. Gritly Dr. Diham Mohamed Osman Gritly 1
    2. 2. Objectives • • • • • • the participant will be able to: Describe the benefits of exercising. Describe the different types of exercise. Identify the risks of exercise for people with diabetes. Give recommendations for exercising. Know how to assess the person with diabetes before the exercise session. • Monitor the person with diabetes during the exercise session. • Recognize that individuals have barriers to exercise. • Give recommendations for particular cases Dr. Diham Mohamed Osman Gritly 2
    3. 3. glossary • Physical activity; Bodily movement produced by the contraction of skeletal muscle that requires energy expenditure in excess of resting energy expenditure. includes cardiorespiratory fitness, muscular fitness, and flexibility • Exercise; A subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness (Strength, Power, Balance, Flexibility, Cardiovascular Endurance, Local Muscle Endurance, Strength Endurance Dr. Diham Mohamed Osman Gritly 3
    4. 4. • Physical fitness is ―a set of abilities individuals possess to perform specific types of physical activities • Fitness is the state or conditions of being healthy, or good health and condition as a result of exercise and balance nutrition Dr. Diham Mohamed Osman Gritly 4
    5. 5. • Maximal oxygen consumption (VO2); is An important measure of sports fitness; aerobic capacity, where the amount of oxygen body can consume and turn into energy • -respiratory quotient (RQ) -is the ratio of carbon dioxide expired/moles of oxygen consumed or the ratio of oxygen used in metabolism (and therefore heat generated), to carbon dioxide eliminated) • The respiratory quotient (RQ) is calculated from the ratio: RQ = CO2 eliminated / O2 consumed Dr. Diham Mohamed Osman Gritly 5
    6. 6. Diabetes Mellitus and physical activates • Physical activity (exercise) is an important component of diabetes management with physiological and psychological benefits. • Regular exercise is highly recommended for many people who have either Type 1 or Type 2 Diabetes Mellitus (DM). Dr. Diham Mohamed Osman Gritly 6
    7. 7. • physical exercise and balance nutrition provide better performance; including: • -Cardiovascular health (blood flow, blood pressure and oxygen delivery) • -Respiratory function • -Hormones • -Immune response • -Muscles and bones • -Metabolism Dr. Diham Mohamed Osman Gritly 7
    8. 8. Health professional recommended physical activity program including • 1-Aerobic exercise provides health benefits; moderate physical activity about 30 minutes or three 10-minutes exercise daily is recommended by most of the fitness professionals • 2-resistance exercise; exercise that increase muscular strength and endurance is recommended. 8-10 exercises that stress the major muscle group of the body at least twice a week Dr. Diham Mohamed Osman Gritly 8
    9. 9. • 3-flexibility and balance exercise; activities that help increase flexibility 2 days a week for 10 minutes is recommended • 4-exercise programs especially design for older individual should based on physical fitness level and health status Dr. Diham Mohamed Osman Gritly 9
    10. 10. Types of exercises aerobic exercises Aerobic exercise; consists of rhythmic, repeated, and continuous movements of the same large muscle groups for at least 10 min at a time. Examples include walking, bicycling, jogging, cont inuous swimming, water aerobics, and many sports. When performed at sufficient intensity and frequency, this type of Dr. Diham Mohamed Osman Gritly exercise increases 10
    11. 11. Intensity of aerobic exercise Intensity of aerobic exercise. This will be described as ―moderate‖ when it is at 40– 60% of V̇o2max (∼50–70% of maximum heart rate) and ―vigorous‖ when it is at >60% of V̇o2max (>70% of maximum heart rate). “Resting heart rate averages 60 to 80 beats/min in healthy adults” Dr. Diham Mohamed Osman Gritly 11
    12. 12. Maximum oxygen consumption V̇o2max An important measure of sports fitness is aerobic capacity or VO2 max, which is the amount of oxygen your body can consume and turn into energy. Maximum oxygen consumption;-VO2 is the Ability to Deliver and Use Oxygen • As work rate is increased, oxygen uptake increases linearly, No further increase in VO2 with increasing work rate Dr. Diham Mohamed Osman Gritly 12
    13. 13. Cardiorespiratory fitness (also known as cardiorespiratory endurance or aerobic fitness The ability of the circulatory and respiratory systems to supply oxygen during sustained physical activity. The standard for measurement of cardiorespiratory fitness is a test of maximal oxygen uptake (V̇o2max), using indirect calorimetry on a treadmill or bicycle ergometer Dr. Diham Mohamed Osman Gritly 13
    14. 14. Anaerobic exercises Anaerobic exercises may last only two minutes or less, but this type of workout actually burns more calories than aerobic exercise. Unlike aerobic exercise, anaerobic exercise burns a higher percentage of calories from glycogen These are less adapted to the needs of most people with diabetes Dr. Diham Mohamed Osman Gritly 14
    15. 15. Anaerobic exercise include, strengthbased activities, such as sprinting or bodybuilding Anaerobic exercise is high in intensity and short in duration Dr. Diham Mohamed Osman Gritly 15
    16. 16. Resistance exercise. • Resistance exercise. • Activities that use muscular strength and endurance to move a weight or work against a load. • Examples include weight lifting and exercises using weight machines. ‗When performed with regularity and moderate to high intensity, resistance exercise increases muscular fitness’. Dr. Diham Mohamed Osman Gritly 16
    17. 17. Muscular Strength; tests muscular strength of the upper body, (Push Up Strength Test), or Muscular Endurance which tests the ability of the muscles to exert force over an extended period of time Muscular fitness.This refers to strength (the amount of force a muscle can exert) and muscular endurance (the ability of the muscle to continue to perform without fatigue) Muscular endurance is assessed by counting the maximum number of repetitions of a muscular contraction a person can perform to fatigue (Repetition Maximum Testing 1 RM) Dr. Diham Mohamed Osman Gritly 17
    18. 18. Flexibility and balance exercise. This term refers to the range of motion available at joints. Flexibility; the capacity of the joints to move through a full range of motion; the ability to bend and recover without injury Flexibility is an important component of fitness and physical performance Dr. Diham Mohamed Osman Gritly 18
    19. 19. • stretching for 5 to 10 minutes helps your body warm up and get ready for activities and cool down afterwards Dr. Diham Mohamed Osman Gritly 19
    20. 20. The benefits of exercise for diabetic patients • Improves cardiovascular fitness in type 1 and 2 diabetes. • Reduces cardiovascular risk factors, such as hypertension and hyperlipidaemia in type 1 and 2 diabetes. • Contributes to the flexibility, endurance, and muscle strength. • Improves glucose control in type 2 diabetes. • Increases peripheral use of glucose. • Decreases glucose hepatic output. • Increases insulin sensitivity Dr. Diham Mohamed Osman Gritly 20
    21. 21. • Decreases counter regulatory hormones. A counter regulatory hormone is a hormone that opposes the action of another. • Helps maintaining weight in addition to meal planning among people with type 2 diabetes whose weight is normal, and helps to reduce weight in obese people. • Gives a sense of well being and a better quality of life in people with types 1 and 2 diabetes. Dr. Diham Mohamed Osman Gritly 21
    22. 22. What are the risks of exercise for people with diabetes? • Developing hypoglycaemia during or after exercise, especially in a person on insulin. • Increased hyperglycaemia in poorly controlled persons and under-insulinised persons with pre-exercise blood glucose levels of 250-300 mg/dl (14-17 mmol/l). Dr. Diham Mohamed Osman Gritly 22
    23. 23. • Myocardial infarction or arrhythmia in persons with diabetes who also have atherosclerotic disease, if exercise is not properly paced. • Possible worsening of microvascular diabetes complications especially retinopathy Dr. Diham Mohamed Osman Gritly 23
    24. 24. • Damage to soft tissue/joints in the presence of peripheral neuropathy. • Damage to the feet, when not wearing the proper shoes Dr. Diham Mohamed Osman Gritly 24
    25. 25. Recommendations for exercising • • • • Adequate fluid intake during exercise. Use of proper footwear. Wearing an identification bracelet. Avoidance of exercise in extreme temperatures (heat or cold). • Inspection of feet after exercise. • If possible, exercise with a friend. Dr. Diham Mohamed Osman Gritly 25
    26. 26. Recommendations For type 1 diabetes • Individuals with type 1 diabetes should avoid exercise if fasting blood glucose is higher than 250 mg/dl and ketones are present. • recommendation can be made for hypoglycaemia prevention and improving metabolic control. • self-monitoring of blood glucose needs to be integrated into the exercise programme and the information to be used to adjust the insulin dosage and food intake • Increase intake of carbohydrates if glucose levels are < 100 mg/dl Dr. Diham Mohamed Osman Gritly 26
    27. 27. General recommendations for type 2 diabetes: • Individuals with type 2 diabetes should avoid exercise if blood glucose is higher than 400 mg/dl. • Monitoring blood glucose before, after and during physical activity is necessary to keep blood glucose within an appropriate range. • Frequency: at least 3 days per week. • Duration: according to the individual. • Intensity: 50-70% of person’s maximal heart rate (maximum heart rate = 200-age) • heart rate averages 60 to 80 beats/min in healthy adults Dr. Diham Mohamed Osman Gritly 27
    28. 28. • People using hypoglycaemic agents or insulin should self-monitor their blood glucose to determine glycaemic response to exercise. • They should adhere to the recommended different phases of exercise as follows: • Warm-up: 10 - 15 minutes • Actual exercise: 30 - 45 minutes • Cool down: 5 - 10 minutes. Dr. Diham Mohamed Osman Gritly 28
    29. 29. • • • • Insulin administration Avoid exercise during peak insulin action. Reduce insulin dose if exercise is anticipated. Administer insulin away from the working limbs. Dr. Diham Mohamed Osman Gritly 29
    30. 30. Exercise is highly recommended—for most people with type 2 diabetes, including those with complications. A person with type 2 diabetes can use exercise to help control their blood sugar levels and provide energy their muscles need to function throughout the day. Dr. Diham Mohamed Osman Gritly 30
    31. 31. What is Fitness Assessment • fitness assessment provide an accurate measure of the current fitness and health level of an individual • A fitness assessment provides a baseline measurement of • 1-cardiovascular endurance, • 2- body composition, • 3- muscular endurance, • 4-muscular strength • 5- flexibility. Dr. Diham Mohamed Osman Gritly 31
    32. 32. Assessment of the person with diabetes before exercise • History and physical examination • They must detect diseases of the heart, blood vessels, eyes, kidneys, and nervous systems • Persons with diabetes especially at risk must have a more detailed medical examination. This includes people: • aged > 35 years • with type 2 diabetes for longer than 10 years • with type 1 diabetes for longer than 5 years Dr. Diham Mohamed Osman Gritly 32
    33. 33. • with any additional risk factors for coronary heart disease. • with microvascular disease (retinopathy, nephropathy). • with peripheral vascular disease, autonomic neuropathy. • Always examine feet and footwear. Dr. Diham Mohamed Osman Gritly 33
    34. 34. • Basic tests • These can be done depending on the individual situation • Cardiovascular system: ECG, exercise ECG. • Peripheral arterial disease: toe pressure, ankle Doppler • Retina: retina screening (fundoscopy) • Kidneys: urine microprotein • Peripheral neuropathy test: 10 g monofilament test. Dr. Diham Mohamed Osman Gritly 34
    35. 35. Monitoring during exercise • 1. Metabolic control before physical activity • Avoid exercise if fasting level is > 250 mg/dl (14 mmol/l) and urine ketones present, or • if > 16.6 mmol/l irrespective of whether ketosis is present. • Increase intake of carbohydrates if glucose levels are < 100 mg/dl (6 mmol/l). Dr. Diham Mohamed Osman Gritly 35
    36. 36. • 2. Blood glucose monitoring before and after physical activity – Identify when changes in insulin or food in take are necessary. – Gain knowledge of the glycaemic response to different exercise/physical activity conditions. Dr. Diham Mohamed Osman Gritly 36
    37. 37. • 3-Food intake – Consume added carbohydrates as needed for avoiding hypoglycaemia. • Carbohydrate-based food should be readily available during and after exercise, e.g. Fresh juice, commercially available high-energy drinks Dr. Diham Mohamed Osman Gritly 37
    38. 38. • 4- Insulin administration – Avoid exercise during peak insulin action. – Reduce insulin dose if exercise is anticipated. – Administer insulin away from the working limbs. Dr. Diham Mohamed Osman Gritly 38
    39. 39. Barriers to exercise • • • • Barriers may be real, e.g. lack of motivation, presence of debilitating illness, physical disability, e.g. polio, blindness, lack of available space, time, and security. • foot problems, • neuropathy. Dr. Diham Mohamed Osman Gritly 39
    40. 40. • • • • • There may also be perceived barriers, such as; having to go to the gym, exercising being expensive and a waste of time, not liking it or being tired. Dr. Diham Mohamed Osman Gritly 40
    41. 41. How to help patient to overcome barriers • Encourage group exercising. • Allow the person with diabetes to choose what he/she likes and can afford to do. • Discuss with the person and agree about a specific target, such as walking 30 minutes every day, and so on. • Explain that simple, regular exercise is possible in most cases, such as walking, climbing stairs, going uphill, and even the usual daily chores that can be organised. Dr. Diham Mohamed Osman Gritly 41
    42. 42. • Show a few exercises that the elderly people can perform regularly every day. • In young people, playing football or basketball, doing gym in a group, or jogging are suitable suggestions Dr. Diham Mohamed Osman Gritly 42
    43. 43. Recommendation in particular situation • Exercises for people with retinopathy • Diabetic retinopathy is a complication of diabetes that affects the eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). • Not recommended: excessive jogging, high-impact aerobics, weight lifting, and boxing. • Recommended: mild exercises, such as walking, lowimpact aerobics, and endurance exercising Dr. Diham Mohamed Osman Gritly 43
    44. 44. • Exercises for people with nephropathy • nephropathy loss of protein in the urine, and eventually chronic kidney disease requiring dialysis . • Moderate exercise is allowed (working at 65% of heart rate). • Heart Rate; Resting heart rate averages 60 to 80 beats/min in healthy adults. In sedentary, middle aged individuals it may be as high as 100 beats/min. In elite endurance athletes heart rates as low as 28 to 40 beats/min • In overt nephropathy: exercise is self-limiting. Dr. Diham Mohamed Osman Gritly 44
    45. 45. • Exercise for people with current or previous foot disease, Charcot’s arthropathy: • No weight-bearing exercises. • Avoid repetitive exercises, e.g. prolonged walking, jogging, step exercises. • Recommended: swimming, bicycling, rowing, chair exercises, and arm exercises. • Amputees can do exercise in a wheel chair, with arms and body. • In case of arthritis or arthrosis: mild exercising, e.g. walking, relaxed gym. Dr. Diham Mohamed Osman Gritly 45
    46. 46. • Exercise in children • Encourage them to do regular physical activity, such as sport, outdoor play, football, gym. • Pay attention to the need of balancing glycaemic control with normal playing. • To achieve control, parents, teachers, and caregivers have to work together. • Hormonal changes in adolescents may complicate control Dr. Diham Mohamed Osman Gritly 46
    47. 47. • Exercise in the elderly • Advancing age and obesity may hinder aerobic exercising. • Encourage mild exercise, e.g. walking regularly. Dr. Diham Mohamed Osman Gritly 47
    48. 48. references • American Diabetes Association. 2002. Diabetes and Physical activity. Position statements: Diabetes Care, 26 (suppl 1):73S. • Fitness Instruction Manual. 2001. Academy Vocational Training • Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. 2004. Physical Activity/Exercise and Type 2 Diabetes. Diabetes Care 27: 2518-2539. • American Diabetes Association (2002). Clinical Practice Recommendations:2002. Diabetes Care 25 (suppl. 1):S64S68. • Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human Metabolism, fifth ed. WADSWORTH Dr. Diham Mohamed Osman Gritly 48
    49. 49. • Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill Heymsfield, SB.; Baumgartner N.; Richard and SheauFang P. 1999. Modern Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike Moshe and Ross A. Catharine eds. 9th edition • Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B. Company • http://www.livestrong.com/article/500155-exampleof-anaerobic-exercise/#ixzz2S1NYa5jd • Dr. Diham Mohamed Osman Gritly 49

    ×