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KSU Exercise & Diabetes Mellitus Abdulrahman Mohammed AL-Howikan Director of Cardiopulmonary Exercise Testing And pulmonary function test Lab, Medicine.

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Presentation on theme: "KSU Exercise & Diabetes Mellitus Abdulrahman Mohammed AL-Howikan Director of Cardiopulmonary Exercise Testing And pulmonary function test Lab, Medicine."— Presentation transcript:

1 KSU Exercise & Diabetes Mellitus Abdulrahman Mohammed AL-Howikan Director of Cardiopulmonary Exercise Testing And pulmonary function test Lab, Medicine dep., College of Medicine Director of Cardiopulmonary Exercise Testing And pulmonary function test Lab, Medicine dep., College of Medicine King kalied university hospital Diabetes Educator Course, KA Med City, April 2007

2 KSU Definitions Any bodily movement produced by the skeletal muscles resulting in energy expenditure above resting state. Physical Activity Physical Fitness 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 1

3 KSU Definitions The amount of energy expended during exercise relative to the energy expenditure during rest. Metabolic Equivalent (MET) Energy expenditure during rest = 1 MET = 3.5 ml of O 2 / kg. min = 1 kcal / kg. hr 2

4 KSU Classification of Exercise Aerobic exercise: Endurance type exercise, rhythmic, sustained for sometimes. Example: Walking, jogging, running, cycling, swimming, etc… Strength ( Resistance ) exercise: Weight training with free weight, machine, elastic rope, calisthenics, etc… Flexibility exercise: Stretching exercise.

5 KSU Physical Activity Intensity in MET Light : Less than 3 MET Moderate : 3 – 6 MET Vigorous : Above 6 MET CDC, 1996

6 KSU Moderate & Vigorous Intensity Physical Activities Moderate : Brisk walking, Recreational swimming, Volleyball, Slow aerobics, Moderate cycling Gardening, Tennis-double, Badminton etc.. Vigorous : Jogging, Running, Tennis-single, Basketball, Rope skipping, Squash, Fast aerobics, Fast cycling, Stepping, Soccer, etc

7 KSU What is the Amount of Physical Activity that Promotes Health? that Promotes Health?   Moderate Intensity Physical Activity.   Energy Expenditure = 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

8 KSU ACSM, 2000 Health-Related Dimensions of Physical Activity Health-Related Dimensions of Physical Activity أبعاد النشاط البدني المعزز للصحة الطاقة المصروفة ( Caloric Expenditure ). الطاقة المصروفة ( Caloric Expenditure ). الأنشطة الهوائية المرتفعة الشدة (). الأنشطة الهوائية المرتفعة الشدة (Aerobic Intensity). القوة العضلية (). القوة العضلية (Muscular Strength). المرونة ( ). المرونة (Flexibility ). الأنشطة البدنية التي يتم فيها حمل الجسم الأنشطة البدنية التي يتم فيها حمل الجسم (). ( Weight-bearing physical activity ). Caspersen, et al., 1998

9 KSU Exercise & Diabetes

10 KSU Can Exercise Prevent or Delay Diabetes ? Evidences from Randomized Clinical Trials

11 KSU Exercise in the Prevention of Diabetes Malmo Study Sweden 260 males (6 yrs) Eriksson & Lindgarde, Diabetologia, Da Qing, China China 577 males & Females (6 yrs) Pan, et al, Diabetes Care, 1997 The Nurse’s Health Study USA 70,000 Nurses (8 yrs) Hu, et al., JAMA, 1999 Finnish Experimental Study Finland 523 males & Females (4 yrs) Tuomilehto, et al., N Engl J Med, 2001 Diabetes Prevention Study USA 3234 males & Females (3 yrs) Diabetes Prev. Program Research Group, N Engl J Med, 2002 Participants are either normal or have + GTT

12 KSU

13 Moderate Physical Activity Performed Regularly for 120 – 200 min. per week Reduces the Incidence of Diabetes in People Predisposed to Diabetes. Exercise in the Prevention of diabetes Summary of the Results

14 KSU Exercise in the Management of Diabetes Exercise in the Management of Diabetes

15 KSU Exercise & 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.

16 KSU Exercise & Type 2 Diabetes Improves physical fitness & reduces fat %. Improves physical fitness & reduces fat %. Increases self confidence. Increases self confidence. Improves CV function & CHD risk profile. Improves CV function & CHD risk profile. Improves glucose control: Improves glucose control:  Improving insulin sensitivity.  Increasing Glu T4 (glucose transporters).

17 KSU Response to 100 g of glucose in mild Type 2 Diabetics Plasma Glucose (mmol/l) Time (min) 12 months of Training Holloszy, et al. Acta Medica Scand 1986, 711: 55-65

18 KSU Response to 100 g of glucose in mild Type 2 Diabetics Plasma Insulin (pmol/l) Time (min) 12 months of Training Holloszy, et al. Acta Medica Scand 1986, 711: 55-65

19 KSU ExercisePrescription for Diabetic

20 KSU Exercise Prescription for Diabetic 1/4 Aerobic activity for 30 min. extended (gradually) to 60 min. every day or most days/week. HR during activity should be gradually increased to reach 60 – 70% of HR max. Exercise session should include 5-10 min. of warm-up and a 5 min of cool-down. Exercise must involve most major muscles in both lower and upper parts of the body.

21 KSU Exercise Prescription for Diabetic 2/4 Moderate intensity weight training program is recommended to maintain muscle strength ( 8-12 repetitions 2 times /week). ( 8-12 repetitions 2 times /week). Exercise must be regular. Benefits are diminished after 1 -2 weeks of stopping. For those with feet problems, avoid running. Alternate between walking, swimming, and cycling. Alternate between walking, swimming, and cycling.

22 KSU Exercise Prescription for Diabetic 3/4 When using insulin, avoid exercise if glucose levels below 100 mg/dl or above 250 mg/dl. Use proper shoes, with silica gel or air-filled soles, and always keep feet dry. Avoid dehydration by keeping your body always hydrated. Do not inject insulin into a body part that is expected to be used during exercise.

23 KSU Graded Exercise Testing for Diabetic 4/4 It is recommended before any moderate to high intensity exercise, especially if:  Age is > 35 yrs.  Type 2 diabetes for > 10 yrs duration.  Type 1 diabetes for > 15 yrs duration.  Presence of any CHD risk factors.  Presence of microvascular disease (retinopathy, nephropathy). (retinopathy, nephropathy).  Presence of peripheral vascular disease. ADA Position Statement, Diabetes Care, 2002

24 KSU

25 Exercise Prescription for Special Cases

26 KSU Diabetic with Peripheral Neuropathy Repetitive exercise on insensitive feet can lead to ulceration & fractures. Peripheral neuropathy may results in loss of sensation in the feet. Limit weight-bearing exercise (Treadmill, Prolonged walking, Jogging, Step exercise, etc..) Use proper shoes, and always monitor the feet. Alternative exercises are : Swimming, Bicycling, Arm exercise, Chair exercise, etc..

27 KSU Diabetic with Autonomic Neuropathy Hypotension and hypertension are more likely to develop after vigorous exercise. This condition may limit exercise capacity & increase the risk of CV event during exercise. Those patients may have difficulty with thermoregulation:  Avoid exercise in hot or cold environments.  encourage adequate hydration.

28 KSU Hypoglycemia 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. 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).

29 KSU Energy Expenditure during Physical Activity!

30 CaloreiActivity 0.07 Brisk walking Brisk walking 0.13 Running (7.5 min per km) Running (7.5 min per km) Running (5 min per km) Running (5 min per km) Swimming Swimming Rope skipping (70/min) Rope skipping (70/min) Rope skipping (80/min) Rope skipping (80/min) Badminton Badminton Tennis Tennis Squash Squash Basketball Basketball Energy Cost of Physical Activity (kilocalorie/kg. min) McArdle, et., 1991

31 METActivity 2.5 Walking (slow) 4 Walking ( Brisk) 8 Running (7.5 min per km) Running (7.5 min per km) 6 Swimming Swimming 8 Rope skipping (slow) Rope skipping (slow) 6 Weight training Weight training 4.5 Badminton Badminton 8 Tennis (single) Tennis (single) 12 Squash Squash 8 Basketball Basketball Energy Cost of Physical Activity (MET) Ainsworth, et., 2000

32 KSU How to Calculate Energy Expenditure during Brisk Walking!

33 KSU = 0.07 k. calorie per kg of body weight / min. Energy Expenditure during Brisk Walking An Example: a person weighing 76 kg would expend: a person weighing 76 kg would expend: 0.07 X 76 = 5.3 k. calorie per min X 76 = 5.3 k. calorie per min.

34 KSU Energy Expenditure during Brisk Walking  If he has to expend 1200 k. calories per week. How much time he should walk per week? How much time he should walk per week?  1200 / 5.3 = 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.

35 KSU Case Studies

36 KSU Case Study 1 (Q) An obese sedentary women, her age = 55 yrs, weight = 80 kg, height = 152 cm. Has type 2 diabetes for 6 years, and BP under control with medication. Otherwise she is OK. Prescribe diet and physical activity to reduce her weight as well as to control her diabetes and hypertension, targeting energy expenditure with exercise of 1600 K. calories per week? Assuming a target body wt. of 60 kg, what is her daily energy needs?

37 KSU Case Study 1 ( A ) BMI = 80/ (1.52 * 1.52) = 34.6 kg/m 2 Walking: 0.07 K. calorie/kg. min. Energy cost of walking = 80 * 0.07 = 5.6 k cal. min. Time needed to expend 1600 k. cal. Per week = 1600/ 5.6 = minutes; 1600/ 5.6 = minutes; 285.7/5 days = 57.1 min /5 days = 57.1 min. OR approx. 1 hour a day for 5 days per week OR approx. 1 hour a day for 5 days per week

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