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Exercise & Diabetes Mellitus

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Presentation on theme: "Exercise & Diabetes Mellitus"— Presentation transcript:

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

2 Definitions Physical Activity Physical Fitness
1 Physical Activity Any bodily movement produced by the skeletal muscles resulting in energy expenditure above resting state. Physical Fitness A set of attributes that people have or achieve, which relates to the ability to perform physical activity. KSU Caspersen, et al., Public health Rep,1985

3 Definitions Metabolic Equivalent (MET)
2 Metabolic Equivalent (MET) The amount of energy expended during exercise relative to the energy expenditure during rest. Energy expenditure during rest = 1 MET = 3.5 ml of O2 / kg. min = 1 kcal / kg. hr KSU

4 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. KSU

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

6 Moderate & Vigorous Intensity Physical Activities
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 KSU

7 What is the Amount of Physical Activity
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 ≥ k. calories/week. Drygas, et al., 2000; Fletcher, et al., 1996; Lee, et al., 2000 KSU

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

9 Exercise & Diabetes KSU

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

11 Exercise in the Prevention of Diabetes
Participants are either normal or have + GTT Malmo Study Sweden 260 males (6 yrs) Eriksson & Lindgarde, Diabetologia, 19991 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 3234 males & Females (3 yrs) Diabetes Prev. Program Research Group, N Engl J Med, 2002 KSU

12 KSU

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

14 Exercise in the Management of Diabetes
KSU

15 Exercise & Type 1 Diabetes
Improves physical fitness. Increases self confidence. Improves CV function & CHD risk profile. It has no direct effect on glucose control. Proper timing of Exercise & Insulin. Avoid strenuous exercise before bed time. KSU

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

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

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

19 Exercise Prescription for Diabetic
KSU

20 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. KSU

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

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

23 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). Presence of peripheral vascular disease. KSU ADA Position Statement, Diabetes Care, 2002

24 KSU

25 Prescription for Special Cases
Exercise Prescription for Special Cases KSU

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

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

28 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). KSU

29 Energy Expenditure during Physical Activity!
KSU

30 Energy Cost of Physical Activity
(kilocalorie/kg. min) Calorei Activity 0.07 Brisk walking 0.13 Running (7.5 min per km) 0.208 Running (5 min per km) 0.162 Swimming Rope skipping (70/min) 0.165 Rope skipping (80/min) 0.097 Badminton 0.109 Tennis 0.212 Squash 0.138 Basketball McArdle, et., 1991

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

32 How to Calculate Energy Expenditure during Brisk Walking!
KSU

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

34 Energy Expenditure during Brisk Walking
If he has to expend k. calories per week. How much time he should walk per week? 1200 / 5.3 = min. = 45 min / 5 days per week, or = 57 min / 4 days per week. KSU

35 Case Studies KSU

36 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? KSU

37 Case Study 1 (A) BMI = 80/ (1.52 * 1.52) = 34.6 kg/m2
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; 285.7/5 days = 57.1 min. OR approx. 1 hour a day for 5 days per week KSU

38 Thank You KSU


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