This document discusses several systemic conditions including diabetes mellitus, hypertension, and obesity. It defines each condition and covers classification, pathogenesis, clinical features, aims of management, measurement methods, causes and associated conditions, and impact on quality of life. Diabetes is classified into type 1 and 2 and is characterized by chronic hyperglycemia. Hypertension is defined based on systolic and diastolic blood pressure levels and is primarily or secondarily caused. Obesity is characterized by excess body fat and is measured using BMI, waist-hip ratio, and other methods. Each condition can impact quality of life.

1. Physiotherapy in
systemic
conditions
A. Thangamani ramalingam
PT, MSc(psy),PGDRM, ACspss MIAP

2. Diabetes Mellitus
 Diabetes mellitus is defined as a metabolic
disorder of multiple aetiology characterised by
chronic hyperglycaemia with disturbances of
carbohydrate, protein and fat metabolism
resulting from defects in insulin secretion, insulin
action, or both. The clinical diagnosis of diabetes
is often indicated by the presence of symptoms
such as polyuria, polydipsia, and unexplained
weight loss, and is confirmed by measurement of
abnormal hyperglycaemia

3. Classification

4. Type I Type II
Epidemiology Younger/lean/< 30 yrs Older> 30 yrs, obesity
Family heredity,
Sedentary lifestyle
Heredity Genetic susceptibility,
Hla-dr3 or dr4> 90%
Identical twins >50% chances,
Polygenic
Pathogenesis Auto immune disease
(islet cell abnormality),
Insulitis,
No immune involvement,
Insulin resistance/
Secretory failure of beta cell,
Beta cell exhaustion.
Clinical features Weight loss,
No response to diet and tablet
treatment,
Persistent ketonuria
Biochemical C-pepide disaapears
TNF- ALPHA, CRP is increased.
C-peptide persists
TNF- ALPHA, CRP is increased

5. Aims of management

6. Hypertension
 It is a medical condition in which blood pressure is
chronically elevated. (Systemic arterial
hypertension). Hypertension is a disease of blood
vessels in which the vascular biology is altered
structurally and functionally due to traditional and
non- traditional risk factors.
 Primary HTN (Essential) (No medical cause)
 Secondary HTN (With medical cause)
 An elevated blood pressure (BP) is defined as a
systolic blood pressure (SBP) > 140 mm Hg or
diastolic blood pressure (DBP) > 90 mm Hg or both.

7. Classification
Systolic pressure(mm Hg) Diastolic pressure(mm Hg)
Normal 90-119 60-79
Pre-hypertension 120-139 80-89
Stage I HTN 140-159 90-99
Stage II HTN >=160 >=100
Isolated Systolic HTN >=140 < 90

8. Hypertension Syndrome

9. Recommended Methods for
Measuring Blood Pressure

10. Drugs
Anti-hypertensive drugs:
 ACE inhibitors
 Angiotensin II receptor antagonists
 Calcium channel blockers
 Diuretics
 Alpha/ Beta blockers

11. Diagnosis and Management of
Hypertension Algorithm

12. Impact of health behaviours on
blood pressure

13. Obesity
 Obesity is a medical
condition which is
characterized by excess
amount of fat deposition
subcutaneously which
might lead to adverse
effect on health of an
individual and also life
expectancy. There are two
type of obesity: Android
and Gynoid.
World Health Organization
guidelines(based on BMI)
 27 underweight (<18.5kg/m2)
 normal weight (18.5-24.9kg/m2)
 preobese (overweight) (25–
29.9kg/m2),
 obesity class I/moderate obesity
(30–34.9 kg/m2),
 obesity class II/severe obesity
(≥35kg/m2).

15. Causes and risk factors/ associated
conditions
 Early Child Disorder
 Lack Of Physical Activity
 Post Drug Overdose
 Psychiatric Illness
 Hormonal Imbalance
 Genetic Susceptibility
 Obesity Associated Mood
Swings (Depression,
Inferiority Complex, Social
Introvert behaviour)
 The risk of being obese
increases with age, reaching
a peak between the age of
45-54 for men and between
the age of 55-64 for women

17. Measurement methods
 Girth measurement,
 Skin fold measurement,
 Waist-hip ratio,
 Body fat percentage
assessment,
 bioelectrical impedence
analysis,
 biopsy
 Body mass index.

18. QUALITY OF LIFE
 The World Health
Organization (WHO) defines
quality of life as “an
individuals’ perception of
their position in life in the
context of the culture in
which they live and in
relation to their goals,
expectations, standards and
concerns” .
 The sense of total well-
being that encompasses
both the physical and
psychological aspect of
patient’s life.