1) Regular moderate exercise of at least 150 minutes per week can reduce the risk of developing diabetes in people who are predisposed.
2) Exercise improves physical fitness and cardiovascular health as well as glucose control for those with type 1 or type 2 diabetes. It works by increasing insulin sensitivity and glucose transporters.
3) An exercise prescription for diabetics includes 30-60 minutes per day of aerobic activity, moderate weight training 2 times per week, monitoring heart rate and blood glucose levels, and gradual progression of intensity over time.
Diabetes triad, physiology, role of physical activity, effects of exercise, clinical implications, potential adverse effect of exercise, evaluation, types of physical activity, peripheral and autonomic neuropathy, summary
Diabetes triad, physiology, role of physical activity, effects of exercise, clinical implications, potential adverse effect of exercise, evaluation, types of physical activity, peripheral and autonomic neuropathy, summary
Sports nutrition is the study and practice of nutrition and diet as it relates to athletic performance. It is a science that provides and maintains food necessary for health, growth and physical performance.
Researchers suggests that athletes can benefit from nutrition education – increasing KAP i.e. knowledge, Attitude and practices (Abood et al, 2006).
the endocrine system, types of hormones, endocrine glands in the body, various hormones of pituitary gland, exercise respone to these hormones, upregulation and downregulation, growth hormone, cortisol, glucose, short term and long term effects of exercise, glucose metabolism and fat metabolism, exercise training, resistance, various evidence of previous studies.
Exercise testing is a non invasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercises
“To enjoy the glow of good health, you must exercise”
Fitness is a big part of who I am !!!
“Your Health is Our Mission”. Fitness is a big part of who I am !! To keep the body in good health is a duty…..otherwise we shall not be able to keep our mind strong and clear.
Dear all,
This ppt includes the acute and chronic effect of exercise on different body system which includes musculoskeletal systems, cardiovascular systems, respiratory system, endocrive system, psychological effects etc. I hope this is helpful for you.
Thank you
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
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Diabetes support site diabetes & exercise presentationMaureen Coughlan
Most people find physical activity improves their feelings of wellness and vitality. It also helps in managing stress.
Physical activity makes your body’s cells more sensitive to the action of insulin.
Your body remains more sensitive to insulin for up to 24 hours after physical activity. You may need to reduce your post physical activity insulin and / or eat more carbohydrates following physical activity.
The key to managing physical activity safely with diabetes, is to monitor your blood glucose frequently and use this information to adjust your food and physical activity accordingly.
Avoid injecting pre-physical activity insulin into any area of working muscle (it may get absorbed much more quickly than usual if you do).
There are risks to physical activity. You should have a thorough medical check and consult with your diabetes specialist team before starting a physical activity routine.
Keeping up a physical activity schedule if you have diabetes is a challenge for your diabetes management skills.
Sports nutrition is the study and practice of nutrition and diet as it relates to athletic performance. It is a science that provides and maintains food necessary for health, growth and physical performance.
Researchers suggests that athletes can benefit from nutrition education – increasing KAP i.e. knowledge, Attitude and practices (Abood et al, 2006).
the endocrine system, types of hormones, endocrine glands in the body, various hormones of pituitary gland, exercise respone to these hormones, upregulation and downregulation, growth hormone, cortisol, glucose, short term and long term effects of exercise, glucose metabolism and fat metabolism, exercise training, resistance, various evidence of previous studies.
Exercise testing is a non invasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercises
“To enjoy the glow of good health, you must exercise”
Fitness is a big part of who I am !!!
“Your Health is Our Mission”. Fitness is a big part of who I am !! To keep the body in good health is a duty…..otherwise we shall not be able to keep our mind strong and clear.
Dear all,
This ppt includes the acute and chronic effect of exercise on different body system which includes musculoskeletal systems, cardiovascular systems, respiratory system, endocrive system, psychological effects etc. I hope this is helpful for you.
Thank you
PRE PARTICIPATION EXAMINATION I Dr.RAJAT JANGIR JAIPUR
knee injury, ligament injury knee, pcl injury, sports injury, Acl injury in football player surgery, Acl injury in football players, Acl injury in taekwondo, Acl reconstruction in jaipur, Acl reconstruction in taekwondo, Acl reconstruction surgery in football, Acl surgery in jaipur, Acl surgery ke baad physiotherapy, Best acl surgeon in india, Best acl surgeon in jaipur, Best knee surgeon in jaipur, Best ligament doctor in hindi, Meniscus repair surgery in jaipur, Sports injury doctor, acl surgery, acl surgery recovery, acl tear
Diabetes support site diabetes & exercise presentationMaureen Coughlan
Most people find physical activity improves their feelings of wellness and vitality. It also helps in managing stress.
Physical activity makes your body’s cells more sensitive to the action of insulin.
Your body remains more sensitive to insulin for up to 24 hours after physical activity. You may need to reduce your post physical activity insulin and / or eat more carbohydrates following physical activity.
The key to managing physical activity safely with diabetes, is to monitor your blood glucose frequently and use this information to adjust your food and physical activity accordingly.
Avoid injecting pre-physical activity insulin into any area of working muscle (it may get absorbed much more quickly than usual if you do).
There are risks to physical activity. You should have a thorough medical check and consult with your diabetes specialist team before starting a physical activity routine.
Keeping up a physical activity schedule if you have diabetes is a challenge for your diabetes management skills.
Pre & Postprandial Brief Muscle Training for Prevention and Management of Dia...diabeticrecovery
Description of short interval muscle training technique to help diabetics and pre-diabetics maintain good glycemic control to prevent disease progression. This technique also seems to prevent weight regain, which will lead to recovery with enough weight loss.
The technique could be used also for dieters who easily regain their weight, it selectively puts carbohydrates into muscle rather than fat cells.
The root cause of chronic diseases, cancer and aging is recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin resistance. 2- Mitochondrial dysfunction. Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
If you’re concerned about controlling your Type 1 or Type 2 diabetes, try coming up with a treatment plan with your doctor, which might include medications, lifestyle changes, and regular office visits. Then, be sure to check your blood sugar every day to keep track of your blood sugar levels, using an at-home monitor or tests at your doctor’s office. You can also follow a low-calorie diet that’s high in nutrients, which will keep your blood sugar stable and control your diabetes naturally. To learn more from our Registered Nurse co-author, like what foods can help control your blood sugar, keep reading the article!
TAKING MEDICATIONS Why take insulin? How does Insulin work?
Diabetes is a progressive condition. Depending on what type a person has, their healthcare team will be able to determine which medications they should be taking and help them understand how your medications work. They can demonstrate how to inject insulin. Effective drug therapy in combination with healthy lifestyle choices, can lower blood glucose levels, reduce the risk for diabetes complications and produce other clinical benefits. The goal is for the patient to be knowledgeable about insulin, including its action, side effects, efficacy, toxicity, prescribed dosage, appropriate timing and frequency of administration, effect of missed and delayed doses and instructions for storage, travel and safety.
High blood sugar occurs when your body doesn’t make enough or effectively use insulin, a hormone that regulates blood glucose and helps it enter your cells for energy.
Intermittent Fasting is the new kid on the block in terms of weight loss. But is it just a fad or are the proclaimed benefits backed by science?
http://blackbeltwhitehat.com/mma/nutrition/intermittent-fasting-diet-plan/
Who would not want to have an athletic, toned body? In addition to being in good health conditions. Because it is a great challenge that not many people can be achieved, mainly due to the mental weakness, regardless of whether a slim wants to increase its weight, or as in the majority of cases, a person with overweight want to get off.
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Exercise in DiabetesExercise in Diabetes
Exercise in
Diabetes Mellitus
Dr Shahjada SelimDr Shahjada Selim
Department of EndocrinologyDepartment of Endocrinology
Bangabandhu Sheikh Mujib Medical UniversityBangabandhu Sheikh Mujib Medical University
EmailEmail::selimshahjada@gmail.comselimshahjada@gmail.com
January 1, 2016January 1, 2016 11
2. DefinitionsDefinitions
Any bodily movement produced by the
skeletal muscles resulting in energy
expenditure above resting state.
Exercise in DiabetesExercise in Diabetes
Physical Activity
Caspersen, et al., Public health Rep,1985
11
January 1, 2016January 1, 2016 22
3. DefinitionsDefinitions
Exercise in DiabetesExercise in Diabetes
A set of attributes that people have or
achieve, which relates to the ability to
perform physical activity.
Caspersen, et al., Public health Rep,1985
11
January 1, 2016January 1, 2016 33
Physical Fitness
4. DefinitionsDefinitions
The amount of energy expended during
exercise relative to the energy expenditure
during rest.
Exercise in DiabetesExercise in Diabetes
Metabolic Equivalent (MET)
Energy expenditure during rest = 1 MET
= 3.5 ml of O2 / kg. min
= 1 kcal / kg. hr
22
January 1, 2016January 1, 2016 44
6. Classification of Exercise
Aerobic exercise:
Endurance type exercise, rhythmic,
sustained for sometimes.
Example:
Walking, jogging, running, cycling,
swimming, etc…
Exercise in DiabetesExercise in Diabetes
January 1, 2016January 1, 2016
66
7. Classification of ExerciseClassification of Exercise
Exercise in DiabetesExercise in Diabetes
Strength (Resistance) exercise:
Weight training with free weight,
machine, elastic rope, calisthenics, etc…
Flexibility exercise:
Stretching exercise.
January 1, 2016January 1, 2016
77
8. Physical Activity Intensity in MET
Light: Less than 3 MET
Exercise in DiabetesExercise in Diabetes
Moderate: 3 – 6 MET
Vigorous: Above 6 MET
CDC, 1996 January 1, 2016January 1, 2016
88
10. Exercise in DiabetesExercise in Diabetes
What is the Amount of Physical ActivityWhat is the Amount of Physical Activity
that Promotes Health?that Promotes Health?
Moderate Intensity Physical Activity.
Energy Expenditure = 3 - 6 MET
That is: ≥ 30 min/day, ≥ 5 days/week.
150 min. per week.
ACSM, 2000; CDC, 1996
≥ 1000 k. calories/week.
Drygas, et al., 2000; Fletcher, et al., 1996; Lee, et al., 2000
January 1, 2016January 1, 2016 1010
11. Exercise in DiabetesExercise in Diabetes
ExerciseExercise &&
DiabetesDiabetes
January 1, 2016January 1, 2016 1111
12. Exercise in DiabetesExercise in Diabetes
Can Exercise PreventCan Exercise Prevent
oror Delay DiabetesDelay Diabetes ??
Evidences fromEvidences from
Randomized Clinical TrialsRandomized Clinical Trials
January 1, 2016January 1, 2016 1212
13. Malmo
Study
Sweden 260males
(6 yrs)
Eriksson & Lindgarde,Eriksson & Lindgarde,
Diabetologia,Diabetologia, 1999119991
Da Qing, China China 577males &
Females (6 yrs)
Pan, et al,Pan, et al,
Diabetes Care,Diabetes Care, 19971997
The Nurse’s
Health Study
USA 70,000
Nurses (8 yrs)
Hu, et alHu, et al.,.,
JAMA,JAMA, 19991999
Finnish
Experimental
Study
Finland 523males&
Females (4 yrs)
Tuomilehto, et al.,Tuomilehto, et al., NN
Engl J Med,Engl J Med, 20012001
Diabetes
Prevention Study
USA 3234males &
Females (3 yrs)
Diabetes Prev. ProgramDiabetes Prev. Program
Research GroupResearch Group,,
N Engl J Med,N Engl J Med, 20022002
Exercise inExercise in
DiabetesDiabetes
Exercise in the Prevention of DiabetesExercise in the Prevention of Diabetes
Participants are either normal or haveParticipants are either normal or have ++ GTTGTT
15. Exercise in DiabetesExercise in Diabetes
Moderate Physical ActivityModerate Physical Activity
Performed Regularly for 120 – 200Performed Regularly for 120 – 200
min. per week reduces themin. per week reduces the
Incidence of diabetes in PeopleIncidence of diabetes in People
Predisposed to DiabetesPredisposed to Diabetes..
Exercise in the Prevention of diabetesExercise in the Prevention of diabetes
Summary of the ResultsSummary of the Results
January 1, 2016January 1, 2016 1515
16. Exercise in DiabetesExercise in Diabetes
ExerciseExercise in thein the
Management ofManagement of
DiabetesDiabetes
January 1, 2016January 1, 2016 1616
17. Exercise in DiabetesExercise in Diabetes
Exercise & Type 1 DiabetesExercise & Type 1 Diabetes
Improves physical fitness.Improves physical fitness.
Increases self confidence.Increases self confidence.
Improves CV function & CHD risk profile.Improves CV function & CHD risk profile.
It has no direct effect on glucose control.It has no direct effect on glucose control.
Proper timing of Exercise & Insulin.Proper timing of Exercise & Insulin.
Avoid strenuous exercise before bed time.Avoid strenuous exercise before bed time.
January 1, 2016January 1, 2016 1717
19. 0
5
10
15
20
0 30 60 90 120 150 180
Before After
Exercise inExercise in
DiabetesDiabetes
Response toResponse to 100100 gg of glucose in mild Type 2 Diabeticsof glucose in mild Type 2 DiabeticsPlasmaGlucosePlasmaGlucose(mmol/l)(mmol/l)
TimeTime (min)(min)
12 months of Training12 months of Training
Holloszy, et al.Holloszy, et al. Acta Medica ScandActa Medica Scand 1986, 711: 55-651986, 711: 55-65
20. 0
400
800
1200
1600
0 30 60 90 120 150 180
Before After
Exercise inExercise in
DiabetesDiabetes
Response toResponse to 100100 gg of glucose in mild Type 2 Diabeticsof glucose in mild Type 2 Diabetics
PlasmaInsulinPlasmaInsulin(pmol/l)(pmol/l)
TimeTime (min)(min)
12 months of Training12 months of Training
Holloszy, et al.Holloszy, et al. Acta Medica ScandActa Medica Scand 1986, 711: 55-651986, 711: 55-65
22. Exercise in DiabetesExercise in Diabetes
Exercise Prescription for DiabeticExercise Prescription for Diabetic 1/41/4
Aerobic activity for 30Aerobic activity for 30 min.min. extendedextended (gradually)(gradually)
to 60to 60 min.min. every day or most days/week/ 150every day or most days/week/ 150
mins per wk.mins per wk.
HR during activity should be graduallyHR during activity should be gradually
increased to reach 60 – 70% of HR max.increased to reach 60 – 70% of HR max.
Exercise session should include 5-10 min. ofExercise session should include 5-10 min. of
warm-up and a 5 min of cool-down.warm-up and a 5 min of cool-down.
Exercise must involve most major muscles inExercise must involve most major muscles in
both lower and upper parts of the body.both lower and upper parts of the body.
January 1, 2016January 1, 2016 2222
23. Exercise in DiabetesExercise in Diabetes
Exercise Prescription for DiabeticExercise Prescription for Diabetic 2/42/4
Moderate intensity weight training programModerate intensity weight training program
is recommended to maintain muscle strengthis recommended to maintain muscle strength
( 8-12 repetitions 2 times /week).( 8-12 repetitions 2 times /week).
Exercise must be regular. Benefits areExercise must be regular. Benefits are
diminished after 1 -2 weeks of stopping .diminished after 1 -2 weeks of stopping .
For those with feet problems, avoid running.For those with feet problems, avoid running.
Alternate between walking, swimming, and cycling.Alternate between walking, swimming, and cycling.
January 1, 2016January 1, 2016 2323
24. Exercise in DiabetesExercise in Diabetes
Exercise Prescription for DiabeticExercise Prescription for Diabetic 3/43/4
When using insulin, avoid exercise if glucoseWhen using insulin, avoid exercise if glucose
levels below 100 mg/dl or above 250 mg/dl.levels below 100 mg/dl or above 250 mg/dl.
Use proper shoes, with silica gel or air-filledUse proper shoes, with silica gel or air-filled
soles, and always keep feet dry.soles, and always keep feet dry.
Avoid dehydration by keeping your bodyAvoid dehydration by keeping your body
always hydratedalways hydrated..
Do not inject insulin into a body part that isDo not inject insulin into a body part that is
expected to be used during exercise.expected to be used during exercise.
January 1, 2016January 1, 2016 2424
25. Exercise in DiabetesExercise in Diabetes
Graded Exercise Testing for DiabeticGraded Exercise Testing for Diabetic 4/44/4
It is recommended before any moderate toIt is recommended before any moderate to
high intensity exercise, especially if:high intensity exercise, especially if:
Age is > 35 yrs.Age is > 35 yrs.
Type 2 diabetes for > 10 yrs duration.Type 2 diabetes for > 10 yrs duration.
Type 1 diabetes for > 15 yrs duration.Type 1 diabetes for > 15 yrs duration.
Presence of any CHD risk factors.Presence of any CHD risk factors.
Presence of microvascular diseasePresence of microvascular disease
(retinopathy, nephropathy).(retinopathy, nephropathy).
Presence of peripheral vascular disease.Presence of peripheral vascular disease.
ADA Position Statement, Diabetes Care, 2002ADA Position Statement, Diabetes Care, 2002
January 1, 2016January 1, 2016 2525
26. Exercise in DiabetesExercise in Diabetes
ExerciseExercise
Prescription forPrescription for
Special CasesSpecial Cases
January 1, 2016January 1, 2016 2626
27. Exercise in DiabetesExercise in Diabetes
Diabetic withDiabetic with Peripheral NeuropathyPeripheral Neuropathy
Repetitive exercise on insensitive feet canRepetitive exercise on insensitive feet can
lead to ulceration & fractureslead to ulceration & fractures..
Peripheral neuropathy may results in lossPeripheral neuropathy may results in loss
of sensation in the feet.of sensation in the feet.
Limit weight-bearing exerciseLimit weight-bearing exercise (Treadmill,(Treadmill,
Prolonged walking, Jogging, Step exercise, etc..)Prolonged walking, Jogging, Step exercise, etc..)
Use proper shoes, and always monitor the feetUse proper shoes, and always monitor the feet..
Alternative exercises areAlternative exercises are: Swimming,: Swimming,
Bicycling, Arm exercise, Chair exercise, etc..Bicycling, Arm exercise, Chair exercise, etc..
January 1, 2016January 1, 2016 2727
28. Exercise in DiabetesExercise in Diabetes
Diabetic withDiabetic with Autonomic NeuropathyAutonomic Neuropathy
Hypotension and hypertension are moreHypotension and hypertension are more
likely to develop after vigorous exercise.likely to develop after vigorous exercise.
This condition may limit exercise capacity &This condition may limit exercise capacity &
increase the risk of CV event during exercise.increase the risk of CV event during exercise.
Those patients may have difficulty withThose patients may have difficulty with
thermoregulation:thermoregulation:
Avoid exercise in hot or cold environments.Avoid exercise in hot or cold environments.
encourage adequate hydration.encourage adequate hydration.
January 1, 2016January 1, 2016 2828
29. Hypoglycemia during or after ExerciseHypoglycemia during or after Exercise
It will most likely occur if the patient:
Takes insulin or diabetes pill.
Skips a meal.
Exercises for a long time.
Exercises strenuously.
Exercise in DiabetesExercise in Diabetes
If it occurs, what can be done?
Patient must eat a snack before exercise, or.
Adjusts the medication dose.
Remember: Patient should always carry a source
of CHO with him ( An apple or orange juice, or a piece of
fruit).
January 1, 2016January 1, 2016 2929
30. Exercise in DiabetesExercise in Diabetes
Energy ExpenditureEnergy Expenditure
duringduring
Physical Activity!Physical Activity!
January 1, 2016January 1, 2016 3030
31. ActivityActivity CaloreiCalorei
Brisk walkingBrisk walking 0.070.07
RunningRunning (7.5 min per km)(7.5 min per km) 0.130.13
RunningRunning (5 min per km)(5 min per km) 0.2080.208
SwimmingSwimming 0.1620.162
Rope skippingRope skipping (70/min)(70/min) 0.1620.162
Rope skippingRope skipping (80/min)(80/min) 0.1650.165
BadmintonBadminton 0.0970.097
TennisTennis 0.1090.109
SquashSquash 0.2120.212
BasketballBasketball 0.1380.138
Energy Cost of Physical ActivityEnergy Cost of Physical Activity
((kilocalorie/kg. minkilocalorie/kg. min))
McArdle, et., 1991
January 1, 2016 Exercise in Diabetes 31
32. ActivityActivity METMET
WalkingWalking (slow)(slow) 2.52.5
Walking (Walking (Brisk)Brisk) 44
RunningRunning (7.5 min per km)(7.5 min per km) 88
SwimmingSwimming 66
Rope skippingRope skipping (slow)(slow) 88
Weight trainingWeight training 66
BadmintonBadminton 4.54.5
TennisTennis (single)(single) 88
SquashSquash 1212
BasketballBasketball 88
Energy Cost of Physical ActivityEnergy Cost of Physical Activity
((METMET))
Ainsworth, et., 2000
January 1, 2016 Exercise in Diabetes 32
33. Exercise in DiabetesExercise in Diabetes
How to CalculateHow to Calculate
Energy ExpenditureEnergy Expenditure
during Brisk Walkingduring Brisk Walking!!
January 1, 2016January 1, 2016 3333
34. Exercise in DiabetesExercise in Diabetes
== 0.070.07 k.k. caloriecalorie per kg of body weightper kg of body weight //
min.min.
Energy Expenditure during Brisk WalkingEnergy Expenditure during Brisk Walking
An Example:An Example:
aa person weighing 76 kg would expend:person weighing 76 kg would expend:
0.070.07 X 76 =X 76 = 5.35.3 k.k. calorie per min.calorie per min.
January 1, 2016January 1, 2016 3434
35. Exercise in DiabetesExercise in Diabetes
Energy Expenditure during Brisk WalkingEnergy Expenditure during Brisk Walking
If he has to expend 1200 k.If he has to expend 1200 k. calories per week.calories per week.
How much time he should walk per week?How much time he should walk per week?
1200 / 5.3 = 226.4 min.1200 / 5.3 = 226.4 min.
= 45 min / 5 days per week, or= 45 min / 5 days per week, or
= 57 min / 4 days per week.= 57 min / 4 days per week.
January 1, 2016January 1, 2016
3535
36. Preparing For Exercise
Proper warm-up
consisting of 5–10 min of
aerobic activity
Activity session 15- 30
mins
cool-down should be
structured similarly to
the warm-up and
should last about 5–10
min
37. Types of Physical Activity
The Mnemonic: “SAFE” exercises are
recommended:
Strengthening exercises
Aerobic exercises
Flexibility exercises
Endurance exercises
38. Aerobic exercise
With Oxygen
Aerobic exercise is the type
that moves large muscle
groups and causes you to
breathe more deeply and
your heart to work harder to
pump blood. It's also called
cardiovascular exercise. It
improves the health of your
heart and lungs.
39. Anaerobic (Resistance) Exercise
Anaerobic exercise
uses large muscles
that do not require
oxygen for short
periods of exercise. It
helps build strong
muscles; lowers blood
glucose makes the
action of insulin more
effective.
40. Flexibility (Stretching) Exercise
Flexibility exercises are
aimed at increasing or
maintaining range of
motion at joints, also
improve tone in muscles
and keep it supple.
They develop better
muscular and body
control.
41. Endurance Exercises
Low Resistance, High
Repetition Exercises
Examples:
Walking, cycling,
swimming, or upper
extremity ergometry
that involve the use of
the large muscle of the
body.
42. How much exercise?
Exercises should be done according to FITT principle.
FREQUENCY: Exercising 4 to 6 times a week.
INTENSITY: 30-40 min of exercise at 50- 60 % of target
heart rate.
TYPE: SAFE exercises are recommended.
TIME: Morning is ideal
43. A SAMPLE WALKING PROGRAM
Warm Up Target Zone Exercising Cool Down Time Total
Week 1
Session A Walk normally 5 min. Then walk briskly 5 min. Then walk normally 5 min. 15 min.
Session B --Repeat above pattern--
Session C --Repeat above pattern--
Continue with at least three exercise sessions during each week of the program. If you find a particular week's pattern tiring, repeat it before going on to the next pattern. You
do not have to complete the walking program in 12 weeks.
Week 2 Walk 5 min. Walk briskly 7 min. Walk 5 min. 17 min.
Week 3 Walk 5 min. Walk briskly 9 min. Walk 5 min. 19 min.
Week 4 Walk 5 min. Walk briskly 11 min. Walk 5 min. 21 min.
Week 5 Walk 5 min. Walk briskly 13 min. Walk 5 min. 23 min.
Week 6 Walk 5 min. Walk briskly 15 min. Walk 5 min. 25 min.
Week 7 Walk 5 min. Walk briskly 18 min. Walk 5 min. 28 min.
Week 8 Walk 5 min. Walk briskly 20 min. Walk 5 min. 30 min.
Week 9 Walk 5 min. Walk briskly 23 min. Walk 5 min. 33 min.
Week 10 Walk 5 min. Walk briskly 26 min. Walk 5 min. 36 min.
Week 11 Walk 5 min. Walk briskly 28 min. Walk 5 min. 38 min.
Week 12 Walk 5 min. Walk briskly 30 min. Walk 5 min. 40 min.
Week 13 and thereafter:
Check your pulse periodically to see if you are exercising within your target zone. As you get more in
shape, try exercising within the upper range of your target zone. Gradually increase your brisk
walking time to 30 to 60 minutes, three or four times a week.
53. Hypoglycemia Management
The person should be instructed to stop
exercising. People at risk for hypoglycemia
should always carry a source of glucose with
them such as glucose tablets, candy or juice in
order to treat hypoglycemia.
Remember- it is a medical emergency
54. Snacking to prevent hypoglycemia
Basic Rules:
Snack prior to activity to prevent hypoglycemia
Adjust quantity based on pre-activity BG or direction of BG
BG low or dropping: usual carbs
BG OK or stable: usual carbs
BG High or rising: usual carbs
Snack at least once per hour during prolonged activity
Choose high-glycemic forms of carbohydrate
Source: Scheiner, Gary: Think Like A Pancreas, Marlowe Publishing, NY, 2005
55. Useful Tips For Exercise
Always carry an
identification card with you
Check your feet before you
walk
Choose good footwear,
light clothing
Drink lots of water
Don’t exercise during hot
seasons, and when not
feeling well
63. What Can Physical Activity Do
For You?
Improve
blood
glucose
control
(lowers A1C)
64. Physical activity lowers blood
glucose in type 2 diabetes by
helping:
muscle cells become more sensitive to insulin
keep the liver from producing too much glucose
build more muscle
you lose weight and keep it off
67. “Sitting” through life increases
your risk of:
heart disease
high blood pressure
high cholesterol
overweight
type 2 diabetes
68. We now must plan physical
activity into our schedule
69. Getting Started
Check with your doctor if you:
Are over age 35
Have had diabetes more than 10
years
Have high blood pressure, heart
disease, poor circulation, or other
diabetes complications
72. Stretching
Improves your balance and
coordination
Makes you more flexible
Reduces stiffness
Reduces your risk of injury
73. How Can You Begin?
Choose activity (example: brisk walking)
Set a long-term goal - at least 30
minutes a day, 3-5 days a week
Buy comfortable walking shoes
Get a partner
Point to discuss:
Exercise is ONE of the ingredients that contributes to diabetes management
People with peripheral neuropathy should not undertake weight-bearing exercise. They should be advised to undertake non-weight-bearing exercise such as exercise bike, swimming etc.
Exercise that increases blood pressure, and therefore renal perfusion, is contraindicated in people with nephropathy.
Caution needs to be taken to avoid a bleed in people with significant diabetic retinopathy.
Some people feel like they don’t have enough energy to exercise. But, if you give it a chance, you’ll find that physical activity gives you more energy than you’ve ever had – allowing you to do the things you previously felt you didn’t have enough energy to do.
Exercise boosts your metabolism and helps you burn extra calories, even after you’re done exercising.
Exercise combined with eating less can help you lose weight and keep if off. The pounds come off faster and stay off if you add exercise.
Even a small amount of weight loss (10-20 lbs) can improve your blood glucose levels if you’re overweight.
Exercise can help you stay independent as you get older. It decreases the risk of muscle and joint injury, aches and pains. It slows bone loss as you age.
We naturally lose muscle as we age. Physical activity helps not only prevent muscle loss, but also build muscle and lose fat.
Studies show that regular physical activity can help prevent some of the sexual problems that can be caused by aging, lack of physical activity, and high blood glucose levels.
Regular physical activity can improve your self-image, make you feel better about yourself, and lift your mood. You can not only make yourself happier, but also those around you. In fact, exercise training has been shown to be comparable to seeing a therapist or taking medication for depression.
Stress and anxiety can lead to overeating. If you overeat as a way to cope with stress, you’ll find that exercise is a better coping mechanism.
If you have type 2 diabetes, exercise can improve your blood glucose control.
Let’s look at how it does that.
Physical activity helps your muscles use insulin more efficiently, so you need less insulin. This blood-glucose lowering effect only lasts a few days after exercise, so to get the most out of your exercise, try to do some physical activity every day (or at least 3-5 days a week).
Your liver begins making less glucose as it becomes more sensitive to insulin.
More muscle means lower glucose. Muscle uses more glucose, even at rest.
Exercise helps you lose weight and keep it off. A loss of even 10-20 lbs can really improve your blood glucose.
Exercise is also beneficial for type 1 diabetes, but usually does not improve blood glucose control unless insulin and food intake are well balanced with physical activity.
When you have diabetes, you have a much higher risk of heart disease, so exercise is especially beneficial to your heart.
1. A strong heart does a better job of pumping blood throughout the body.
2. Reducing the resting heart rate and blood pressure put less work on the heart.
3. Exercise lowers total cholesterol, raises HDL (good) cholesterol, and lowers triglycerides
4. All of these help reduce your risk of heart attack and stroke.
Modern technology like elevators, dishwashers, washing machines, remote controls, and computers has eliminated the daily chores and activities of your grandparents era.
Inactivity has made us sitting ducks for diseases like heart disease, high blood pressure, high cholesterol and other blood fats, obesity and overweight, and type 2 diabetes.
(Ask audience to stop and figure how much time each day is spent sitting and being inactive.)
It’s not a leisure activity that you do only if you have time. It’s necessary if you want to stay healthy.
It’s been said that instead of checking with your doctor to see if you can exercise, people with diabetes should check with their doctor if they are thinking of NOT exercising.
It is recommended to find out if you have any limitations (we don’t mean excuses!) and if you should emphasize certain types of activities over others if you are over 35 years old, have had diabetes for more than 10 years, or have certain medical conditions. This does NOT mean you shouldn’t exercise! It simply means talk to your doctor so they can support you in your effort and help you come up with safe and enjoyable ways of increasing your activity level.
When you do activities like walking, mowing the lawn, dancing, swimming, biking, or vacuuming, you use the large muscles in your body in a continuous, repetitive way. These types of activities can improve your health by strengthening your muscles (including your heart), promoting weight loss, reducing blood glucose, and improving your stamina and energy level.
Activities that require pushing, pulling, and lifting – or resistance activities – can help strengthen specific muscles or groups of muscles. They also improve balance and reduce risk of falls, reduce your risk of osteoporosis and bone fracture, increase your energy level and increase your body’s sensitivity to insulin.
You can do stretching anytime, anywhere. Stretching improves your balance and coordination. Stretch during breaks throughout the day and after you complete your exercise during the cool-down to increase flexibility and prevent soreness and injury.
First choose a type of activity that you will enjoy and that’s convenient for you. Walking is the most popular type of exercise and it’s safe for most people to do. If you are unable to walk, you might choose swimming, chair exercises, or water exercises.
Set your long-term goal – to get the most benefit from physical activity, it’s recommended to be moderately active at least 30 minutes, 3-5 days a week.
Be sure to wear appropriate clothing and shoes for the activity you select.
Walking with a partner can help keep you motivated and provide some support. But, don’t rely on a partner who is not totally committed – that can actually be detrimental to your success.
Regular physical activity can do more for type 2 diabetes than any pill could ever do. Like a magic wand, exercise can transform your body, your health and you.