Week 11 Flashcards
(28 cards)
What is diabetes and how do Type 1 and Type 2 differ?
Major health problem; leading cause of death; characterized by hyperglycemia.
Type 1 Diabetes (defect in insulin secretion)
* Onset: Under 20 years * Symptom development: Rapid * Population: ~5% * Ketoacidosis: Common * Obesity association: Rare * Beta cells: Destroyed * Insulin secretion: Decreased * Autoantibodies to islet cells: Present (Beta cell damage) * Histocompatibility complex: Yes (autoimmune component) * Treatment: Insulin injections
Type 2 Diabetes (defect in insulin action)
* Onset: Over 40 years * Symptom development: Slow * Population: ~95% * Ketoacidosis: Rare * Obesity association: Common * Beta cells: Not destroyed * Insulin secretion: Normal to increased * Autoantibodies to islet cells: Absent * Histocompatibility complex: Unclear * Treatment: Diet and exercise; oral stimulators of insulin sensitivity
Diabetes type 1 and exercise
Exercise and Diabetes Management
• Regular exercise benefits diabetics but depends on maintaining good glucose control.
• Without enough insulin before exercise, blood glucose can rise, leading to exercise-induced hyperglycemia.
Warning Signs of Type 1 Diabetes:
• Frequent urination and unusual thirst
• Extreme hunger
• Rapid weight loss, weakness, and fatigue
• Irritability, nausea, and vomiting
Insulin Imbalance Risks:
• Too little insulin ➔ Hyperglycemia ➔ Ketosis ➔ Diabetic coma
• Too much insulin ➔ Hypoglycemia ➔ Insulin shock
Exercise Tips for Diabetics:
• A regular exercise routine helps reduce the risk of exercise-induced hypoglycemia.
• Adjustments may be needed in exercise intensity, frequency, and duration.
• Diet and insulin doses might require fine-tuning:
➔ Identify necessary changes in food intake or insulin.
➔ Monitor how blood glucose responds to exercise and adapt accordingly.
Exercise prescription – type 1 diabetes?
Medical clearance prior to exercise
• Currently active (40% to 60% HRR, 30min+, 3+ days/week) can
continue without medical clearance.
• Those planning >60% HRR should obtain medical clearance prior to start of the program.
Problems associated with the disease due to chronically high blood
glucose (also relevant for type 2 diabetes):
• Autonomic neuropathy (can lead to abnormal heart rate and blood
pressure),
• Peripheral neuropathy (pain, impaired balance, weakness, decreased
proprioception)
• Retinopathy and nephropathy (due to blood pressure abnormalities)
Other considerations
• Carry identification
• Exercise with someone incase of emergency.
Diagnosing type 2 diabetes progression?
Oral glucose tolerance test
- 75g sugary drink consumed rapidly and blood glucose and insulin responses tracked for several hours.(up to 3)
Normal people blood glucose peaks at 30 mins with a pronounced blood muslin counteraction response.
Pre diabetic has more exaggerated response, requires more to get to resting due to tolerance as it gets worse glucose stays elevated as resistance is worse and worse.
Prediabetics become type 2 diabetics as glucose tolerance worsens
over time (i.e., progressive condition)
Preventing or delaying Type 2 diabetes with exercise?
Smith et al 2016.
Exercise is a primary treatment.
• Helps treat obesity (↓ body fat).
• Helps control blood glucose (kept
within normal/healthy range)
- Reduces insulin resistance.
• Helps treat CVD risk factors (e.g.,
high blood pressure and lipid profile,
inflammation)
Diet and exercise combo may eliminate need for diabetic drug
treatments.
• Aim for a weight loss of around 5% to 10%
May need to adjust medication doses when sedentary become
trained.
• Prevent hypoglycemia during exercise.
Exercise recommendations for people
with diabete?
General Tips:
• Exercise 1+ hour after eating.
• Reduce sitting time throughout the day.
Aerobic Training:
Type 1 Diabetes:
• Frequency: 3–7 days/week
• Intensity: 50–80% HRR or RPE 12–16
• Time: 20–60 min/session; accumulate 150 min moderate or 75 min vigorous/week
• Type: Non-weight bearing, low-impact activities
Type 2 Diabetes:
• Frequency: 4–7 days/week
• Intensity: 50–80% HRR or RPE 12–16
• Time: Start with 10 min bouts; longer duration = better; accumulate >150 min moderate or >75 min vigorous/week
• Type: Brisk walking, Zumba, circuit training
Resistance Training:
(Same for Type 1 and Type 2 Diabetes)
• Frequency: 2–3 days/week
• Intensity: 60–80% 1-RM or RPE 12–16
• Time: 1–3 sets of 8–12 reps
• Type: Focus on major muscle groups
Cancer?
1 in 2 will develop some form of cancer in their life.
In the UK every 2 mins someone is diagnosed.
Cancer caused by an uncontrolled division of abnormal
cells
- Second leading cause of death worldwide
- Cancers impact is made worse by the fact that more than
100 types of cancers exist.
- Cancer cells invade normal tissues, alter normal
physiologic function.
Cancer incidence is heavily influenced by lifestyle factors
- Inactivity linked to increased cancer incidence.
• 3% of all cancers attributable to inactivity.
• 5% to 8% of cancers related to being overweight.
- Being physically active linked to cancer prevention.
• Lowers the risk of many major forms of cancer by 12%
to 25%.
Physical activity and risk of cancer?
Physical Activity and Cancer Risk Reduction
• Physical activity reduces the relative risk of developing certain cancers, more for some types than others.
By improving immune function and delaying/preventing progression (see diagram for more)
Cancer Types with Strong Evidence:
• Bladder: 15% reduction (dose response: Yes)
• Breast: 12–21% reduction (dose response: Yes)
• Colon: 19% reduction (dose response: Yes)
• Endometrial: 20% reduction (dose response: Yes)
• Esophageal: 21% reduction (dose response: No)
• Gastric: 19% reduction (dose response: Yes)
• Renal (Kidney): 12% reduction (dose response: Yes)
Cancer Type with Moderate Evidence:
• Lung: 21–25% reduction (dose response: Yes)
Impact of cancer treatment?
Survival
A wide variety of treatment options/combinations.
- Chemotherapy, radiation, surgery, hormone therapies, immunotherapies.
- Common outcome - cancer patients experience a drop in aerobic
capacity and muscular strength.
Survival odds are improved in those who are physically active.
- Aerobic capacity and muscular strength losses are minimized with
exercise training.
Muscle loss
1. Due to cancer treatments (considered collateral damage)
2. Due to cachexia signals from cancer cells
Bone mineral density (BMD) loss
e.g. one treatment approach for certain
breast cancers is to lower estrogen levels,
results in an accelerated loss in BMD
Physical Activity and Cancer Recurrence?
Physically active cancer survivors have lower rates of
cancer recurrence.
- 35% lower recurrence for all types of cancer.
- 28% to 44% lower mortality rates for various types of
cancer.
- Plus lower rates of all-cause mortality (i.e. prevents
other noncancer-related illnesses)
The higher the activity the lower the recurrence.
Physical Activity considerations during
different stages of cancer?
Physical activity and exercise now recognized to benefit chemotherapy patients.
• Limits fatigue associated with treatment.
• Preserves muscle mass & BMD* (requires higher level to preserve)
• 90 minutes of combined aerobic and strength exercise, 3 times/week
recommended.
• Clinically-based cancer rehabilitation programs becoming more
popular.
Physical activity can improve the quality and duration of life in
terminally ill cancer patients.
• Slows cachexia, preserves lean body mass.
• Improves sleep quality & mood states.
• Limits fatigue symptoms, as well as depression incidence and
severity
Exercise prescription - cancer?
Because cancer diagnoses and treatment course are so variable, individualized exercise prescriptions are needed.
Should consider:
- Tumor site (e.g. brain, breast, blood),
- Cancer stage (e.g. Stage 1 [localized] vs. stage 4 [spread to distance tissue]),
- Treatment type (e.g. chemotherapy, radiation, surgery)
- Other medical considerations (for example, neuromotor deficits).
- Responses to exercise can also vary.
Managing functional limitations
Due to cancer/treatment physical limitations may exist.
- Severe tissue edema, surgical trauma, amputation.
- Determine appropriate/inappropriate exercises.
- Match exercise goals to medical realities.
- Patients with compromised functional capacities may require
supervised exercise
Physical activity has a role in every stage
of cancer care?
Pre diagnosis (prevention) - reduce 12-25%
>
Pre-treatment (prehab) -
>
Treatment (Syptom control)
>
Post treatment (rehab)
>
Survivorship (health promotion)
/
End of life (Palliation) - improve quality of life
Exercise recommendations for cancer
patients?
Frequency – every other day with a goal to eventually exercise most days.
Intensity – start light and progress as appropriate.
- HR: <60% HRR to begin.
- MET: <3 METs or <12 RPE as tolerated.
Time – begin with multiple short sessions per day.
- Goal: 30+ min of continuous exercise sessions
- Progress to moderate-intensity exercise when weekly
duration >150 minutes total.
Type – preferred aerobic modalities (for example, walking).
Strength and flexibility – perform at least 2 days per week.
*Caution required (immune suppression due to focus on exercise) and an emphasis on progression
Coronary Artery Disease?
Refers to Atherosclerosis. Plaque built up in coronary artery leading to insuffiecent blood/oxygen to heart leading to heart attacks etc.
Risk factors for CAD?
Age.*
• Family History.*
^ Cannot be helped
• Cigarette Smoking
• Sedentary Lifestyle.
• Obesity. - Around 28% of adults are.
• Hypertension. - Around 50% of heart attacks and strokes are associated with high blood pressure
• Dyslipidemia.
• Prediabetes. - 1/3 of adults with diabetes die from heart or circulatory disease.
The more risk factors the higher chance of CAD, The more you take away the less chance.
CAD and Exercise
Exercise is better and cheaper than PCI (Percutaneous Coronary Intervention) in reducing risk of cardiac event.
Heart Failure and Exercise?
Heart failure is when function of heart slowly degrades over tie and enough blood is not pumped around the body
Symptoms: Fatigue, Shortness of breathe, Nausea, Loss of appetite, blood and body fluids back up into lungs, swelling due to fluid build up (usually in ankles,legs, abs and veins in the neck)
All patients with Chronic HF should be offered exercise based rehab.
Exercise improves HR, CO, VO2 max, Anaerobic threshold, 6min walking distance.
Overall improving quality of life, and exercise tolerance.
and decreases chance of hospitalisation.
controlCommon medications for cardiac
patients?
Medications are not a contraindication to exercise
β-blockers.
- ↓ HR and/or BP =↓ work of the heart.
Anti-arrhythmia medications (Calcium channel blockers and anticoagulants).
- Control dangerous heart rhythms however they do increase risk of bleeding.
Nitroglycerin.
- Relaxes smooth muscle in veins to reduce venous return which Reduce angina symptoms.
Patient implications: Taking medication can↓ maximal exercise capacity, ↑ muscle fatigue,
risk of postural hypotension
Absolute Contraindications to Exercise in
CAD?
1.New or uncontrolled arrhythmia
2.Resting or uncontrolled tachycardia (HR above 100bpm)
3.High BP at rest = Resting SBP >180mmHg or DBP >100mmHg
4.Symptomatic hypotension - dizziness, sometimes blurred vision.
5.Unstable angina - chest pains
6.Acute or unstable heart failure
7.Unstable diabetes
8.Acute fever
Any patients with unstable or uncontrolled symptoms must be reviewed.
Screen high risk patients before exercise and exclude them from vigorous activity.
Graded exercise testing (GXT)?
Anyone with coronary heart disease should undergo a baseline stress and fitness test with current ECG monitoring to assess risk and allow team to tailor exercise to their capacity.
• ECG (12-lead).
- Heart rate and rhythm.
- Signs of ischemia.
• Blood pressure.
• Ratings of perceived exertion (RPE)
Can use radioactive molecules to evaluate heart function, or direct angiography and then assessed via X-Rays
Stop exercise and promptly evaluate/refer if ANY of
these symptoms (inform patients of these)
• chest pain or tightness
• dizziness or faintness
• pain in the arm or jaw
• severe shortness of breath
• an irregular heartbeat
• excessive fatigue
Cardiac Rehabilitation?
Phase One
Inpatient exercise program
Phase Two
Outpatient exercise, close supervision
Phase Three
Less direct supervision, may be home-based
Odds of mortality decrease 20%
Safe and effective and should start within 10 days of discharge from hospital .
Physical activity recommendations and
benefits?
↓Overall mortality
↓ CVD mortality
↓ Re-infarction
↓ Hospital admissions
↓ BP, lipids, disability
↓ Time off work
↑ Cardiovascular function
BUT
Only 14-43% uptake following MI (Davies et al.,) Those most likely to benefit have lowest uptake
(Beswick et al., 2005)
UK referral rates range from 13-88% with large inequalities and low heart failure access (2%)
