Week 11 Flashcards
(27 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 exercise management? Warning signs? Risks? Tips?
Exercise Benefits:
- Supports glucose control and overall health.
- Requires careful insulin and diet management to avoid complications.
Warning Signs of Type 1 Diabetes:
- Frequent urination, extreme thirst
- Rapid weight loss, fatigue
- Hunger, irritability, nausea, vomiting
Insulin Imbalance Risks:
- Too little insulin → Hyperglycemia → Ketosis → Diabetic coma
(Glucose can’t enter cells → fat breakdown → ketones ↑ → acid buildup) - Too much insulin → Hypoglycemia → Insulin shock
(Excess glucose removal → brain lacks fuel → fainting/seizures)
Exercise Tips:
- Regular exercise reduces hypoglycemia risk with proper management.
- Adjust exercise intensity, frequency, and duration as needed.
Fine-tune diet and insulin doses:
- Monitor glucose response to exercise
- Make necessary food/insulin adjustments
Exercise prescription – type 1 diabetes?
Medical Clearance:
- Currently active individuals (40–60% HRR, ≥30 min, ≥3 days/week) can continue exercise without medical clearance.
- Those planning to exercise at >60% HRR should get medical clearance before starting.
- HRR = Heart Rate Reserve which = ((Max HR - Resting HR) x %) + Resting
Disease-related Problems:
- Autonomic neuropathy: May cause abnormal heart rate and blood pressure responses.
- Peripheral neuropathy: Can lead to pain, impaired balance, weakness, and decreased proprioception.
- Retinopathy and nephropathy: Related to blood pressure abnormalities; exercise intensity should be managed carefully.
Other Important Considerations:
- Always carry identification.
- Exercise with a partner in case of emergency.
Diagnosing type 2 diabetes? progression??
Oral Glucose Tolerance Test (OGTT):
- Involves consuming 75g of glucose quickly.
- Blood glucose and insulin levels are measured over up to 3 hours.
Normal response:
- Blood glucose peaks at ~30 minutes, followed by a strong insulin response that returns glucose to baseline.
Prediabetic response:
- Higher and more prolonged glucose levels.
- Insulin response is delayed or less effective due to insulin resistance.
Progression to Type 2 Diabetes:
- As insulin resistance worsens, glucose remains elevated for longer.
- Prediabetes gradually develops into type 2 diabetes if unmanaged
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.
General tips and Exercise recommendations for people
with diabetes?
General Tips:
- Exercise 1+ hour after eating.
- Break up sedentary 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
- Aim for 150 min moderate or 75 min vigorous/week
- Type: Non-weight bearing, low-impact (e.g., cycling, swimming)
Type 2 Diabetes:
- Frequency: 4–7 days/week
- Intensity: 50–80% HRR or RPE 12–16
- Time: Start with 10 min bouts
- Progress to >150 min moderate or >75 min vigorous/week
- Type: Brisk walking, circuit training, Zumba
Resistance Training (Both Types):
- Frequency: 2–3 days/week
- Intensity: 60–80% 1-RM or RPE 12–16
- Time: 1–3 sets of 8–12 reps
- Type: Major muscle group exercises
Cancer Overview? Prevalence? & Lifestyle links??
- Cancer = uncontrolled division of abnormal cells.
- Can invade normal tissues and disrupt physiological function.
Prevalence:
- 1 in 2 people will develop some form of cancer in their lifetime.
- In the UK , someone is diagnosed every 2 minutes.
- Over 100 types exist.
- 2nd leading cause of death worldwide.
Lifestyle factors strongly influence cancer risk:
- Inactivity accounts for ~3% of all cancers.
- Overweight/obesity: Linked to 5–8% of cancer cases.
- Regular physical activity reduces risk of several major cancers by 12–25%
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)
What are the impacts of cancer treatment on physical health??
- Survival & Fitness:
- Treatments include chemotherapy, radiation, surgery, hormone therapy, immunotherapy
- Common outcome: ↓ Aerobic capacity and ↓ Muscular strength
- Physical activity improves survival odds and helps preserve fitness - Muscle Loss:
Caused by:
- Treatment side effects (e.g., inactivity, inflammation)
- Cachexia: Muscle wasting driven by cancer-related metabolic signals - Bone Mineral Density (BMD) Loss:
- Some treatments (e.g., estrogen-lowering therapy for breast cancer) lead to accelerated BMD loss, increasing risk of osteoporosis
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
Effects/Role of Physical activity in every stage
of cancer care??
Physical activity plays a beneficial role at every stage, enhancing outcomes and quality of life throughout the cancer journey.
- Pre-diagnosis (prevention):
Physical activity can reduce cancer risk by 12–25%. - Pre-treatment (prehab):
Improves fitness and prepares patients for treatment stress. - Treatment (symptom control):
Helps manage side effects like fatigue, nausea, and muscle loss. - Post-treatment (rehab):
Supports recovery, rebuilds strength, and improves function. - Survivorship (health promotion):
Promotes long-term health and reduces risk of recurrence. - End of life (palliation):
Improves quality of life, maintains independence, and reduces symptoms
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?
Caused by atherosclerosis:
- Buildup of plaque (fat, cholesterol, calcium) in the coronary arteries.
- Leads to reduced blood and oxygen supply to the heart muscle.
Can result in:
- Angina (chest pain)
- Heart attack (myocardial infarction)
- Heart failure, if left untreated.
Risk Factors for Coronary Artery Disease (CAD)
Non-modifiable (Cannot be changed):
- Age
- Family history
Modifiable:
- Cigarette smoking
- Sedentary lifestyle
- Obesity (~28% of adults)
- Hypertension (linked to ~50% of heart attacks and strokes)
- Dyslipidemia (unhealthy cholesterol levels)
- Prediabetes/Diabetes (1 in 3 adults with diabetes die from heart or circulatory disease)
Key point:
- The more risk factors present, the greater the chance of developing CAD.
- Removing risk factors lowers the risk.
Coronary Artery Disease (CAD) and Exercise?
Exercise is often more effective and cost-efficient than Percutaneous Coronary Intervention (PCI) in reducing the risk of future cardiac events in stable CAD patients.
Key Point:
- Regular aerobic exercise improves endothelial function, reduces inflammation, and promotes collateral circulation.
- PCI may relieve symptoms but doesn’t significantly reduce long-term mortality or prevent future heart attacks better than exercise in stable CAD.
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.
Control of Common 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%)
Cardiometabolic Component Risk and if it increases prevalence in persons with SCI
compared to the general population?
Cardiometabolic Component Risk
Increased (abdominal) obesity - Yes
Hypertension - No (impact of injury level)
Hypertriglyceridemia - No
Fasting hyperglycaemia - Mixed
Postprandial lipaemia - Yes
Postprandial hyperglycaemia - Yes
Reduced HDL-cholesterol - Yes
Chronic inflammation - Yes
Endothelial dysfunction - Yes (below the lesion level)
