Exercise Prescription For DiabetesRobert Goldstein, MS;

Health Educator Fitness Therapist Disease Management

For Diabetes

Health Fitness Instructor

American College of Sports Medicine

Exercise Prescription For DiabetesYour Moderate Exercise Program

Robert Goldstein MS;

Your Optimum Program Getting Started

7 Major Components of Fitness

1) Warm up 2) Cardiovascular Fitness 3) Muscular Strength 4) Flexibility Fitness 5) Cool Down 6) Body Composition

2

Disclaimer Today’s Lecture is for

Educational Purposes and not Medical Advice. If you

have certain medically related issues you should speak to your physician.

Please Check with your physician about starting an

exercise program

Blood Glucose The Good The Bad and The Ugly

Body Requires Glucose as Energy Source.

Broken down from food breaks food down into sugar.

Insulin is necessary to regulate glucose from blood into cells.

High blood Sugar harms the body. May do eye, heart nerve and kidney damage.

What are the Types Of Diabetes?What are the Treatments?

Type 1 Diabetes Pancreas has a total

inability to produce any insulin

Daily Insulin Injections 5 to 10% Of all diabetes Diet and Exercise

Type 2 DiabetesThe Most Common

Pancreas is able to produce insulin but not enough to register with cells.

90% of all Diabetes Treated with oral

medication. People over 40. High BMI

or family history. Diet and Exercise!!!

Gestational DiabetesDevelops During Pregnancy

Develops in up to 5% of all Pregnancies.

May disappear after birth. Large risk in future to

develop type 2.

Childhood Diabetes May be first generation to not

live longer than parents Often genetic 200,000 cases nationwide Large % have type 1 10 to 15 % children

overweight Type 2 more prevalent Diet and Exercise Now!!

Juvenile DiabetesWalking Away From Disease And

Disability

Pre-DiabetesTime To make Change

Your Wake Up Call

1) Blood Glucose Higher than normal.

Positive for metabolic syndrome risk factors.

High risk to develop type 2 diabetes.

Estimated 54,000,000 Americans; many not diagnosed

Diet and Exercise Now!

Benefits Of Moderate Exercise

And Diabetes Benefits Of Exercise 1) Weight Loss 2) Lower Blood Pressure 3) Reduce Risk for Heart

Disease 4) Improve Cholesterol Ratios 5) Control Blood Sugar 6) Reduce Back and Joint Pain 7) Improve Balance 8) Reduce Medications 9) Increase Self Confidence 10) Reduce Risk For Fall

Warm Up 1) Reduce risk for injury 2) Gradual increase of pressure

and heart rate. 3) Increases circulation in legs. 4) Warms Muscles. 5) Types of Warm up Light Walking Light Cycling Balance Exercise Movement and Light Stretching 5 to 10 minutes

Cardiovascular Fitness 1) The heart, lungs and blood

vessels deliver adequate supply of oxygen to large working muscles.

2) Also called aerobic fitness uses the oxygen pathway.

3) Examples- Walking, Cycling, Swimming, , Recumbent Step Machine.

4) Perform 3 to 5 times a week. May be done in short bouts or duration.

Risk Factors for Heart Disease

1)Family History of Heart Disease.

2) High Blood Pressure 140/90 0r above. 3) Sedentary Lifestyle.

4)High Cholesterol over 200 Low HDL under 35.

5) Cigarette smoking or those who have quit within the past 6 months.

6) Impaired Fasting Glucose over 100.

7) Obesity BMI over 30 and Men’s waist 40” Woman’s 35”

8) Age 45 0r over.

Muscular Strength and Endurance Strength Training

1) Helps to maintain lean body weight and muscle mass.

2) Perform 2 to 3 times a week with a day rest in between.

3) Light Dumbbells, Thera- Band, rubber tubing.

4) Exercise within range of motion without pain or excessive weight.

5) Start with one set of 10 until mastered and increase to two sets.

6 ) Extremely important and helpful in reducing blood sugar.

Flexibility 1) Flexibility Decreases after the

age of 25. Increasing risk for injury.

2) The biggest reason for missing work after the common cold is low back pain.

Stretching 1) Best when muscles are warm;

during and after workout. 2) Static Stretching. Holding

Stretch for 30 seconds on each side.

3) Only stretch to comfortable range of motion increasing as muscle allows.

Cool Down 1) Brings Blood Pressure and

Heart rates down gradually. 2) Aids in preventing muscle

stiffness or soreness. 3) Prevents pooling of blood and

promotes adequate flow to muscles and heart. Increases circulation.

Slow Walking Stretching Slow Movement

Blood Sugar Levels for Exercise

Goal is to avoid hypoglycemia for people who exercise.

Type I may have larger drops with exercise and risk for hypoglycemia

Type II Lower risk of hypoglycemia but still possible

Dizziness, Headaches, Weakness Headache, Pale Skin

Initially check blood sugar before and after exercise

Light snack as crackers, rice cakes, pretzels are of low caloric content and can help raise blood sugar.

How Hard do I Need to Work A great question 1) Very individual prescription. 2)Heart rate % method 220

minus age. Safety is number one concern.

3) Full evaluation of your medical history, medications, surgeries and orthopedic conditions.

4) Doctors approval and contraindications.

5) The good news, you can exercise even if you don’t think you can and if you never did before.

Intensity Exercise Prescription

1) Mode – Type of exercise. Determined on an individual basis.

2) Intensity – How hard do I work. Workload. Starting low and graduating when perfecting current intensity.

3) Duration – How long. Also based on individual needs. Short bouts to start.

4) Frequency – How many days per week,

Rated Perception Of Exertion and Meds 1) Beta blockers, Alpha blockers, Calcium Channel

and Diuretic Medications blunt heart rate and blood pressure.

2) With this in mind heart rate end blood pressure will not be the best indicator of how hard you work.

RPE Borg Scale 6 7 very Very Light 8 9 very light 10 11fairly light 12 moderate 13 somewhat hard 14 15 hard 16 17 very hard 18 19 very very hard 20

Other Methods of Rating Intensity 1) The talk test- You should be

able to carry on a conversation while exercising.

The Reggie test – Get a 4 month old puppy and work until exhaustion

2) Evaluating Range of Motion. Stopping when feeling pain.

3) The no pain no gain mentality is not appropriate. You should not feel pain.

4) If you are feeling pain you are possible hurting yourself and preventing improvement.

Body Composition Body Composition and Risk

for Heart Disease.

1) Body Mass Index.

2) Body Fat Percentage.

3) Waist Hip Ratio.

4) Circumference Measurements

Weight LossTaking it Slow

How Weight Loss Works.

1) Negative caloric expenditure.

2) Negative expenditure thru diet and exercise.

3) 3500 calories one pound. 1 pound a week is a reasonable weight loss.

4) Eliminate about 250 calories per day thru diet

5) Another 250 calories through exercise.

How Can I StartStages of

Change Pre-Contemplation

Contemplation Action:

The Fierce Urgency of Now!!

Maintenance Relapse

Smart GoalsKISS

Specific Measurable Attainable Realistic Timely

Reduce Risk factors for Heart Disease

Modifiable Risk factors

Cigarette Smoking Hypertension Hypercholesterolemia Impaired Blood Glucose Obesity Sedentary Life Style Stress

Pre and Post Exercise Blood Sugar Averages 1 Year

0

20

40

60

80

100

120

140

PreEx

3-DColumn 13-DColumn 23-DColumn 3

Pre exercise 140 Post Exercise 100

Exercise Levels Start and 20 Sessions On Treadmill

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0.5

1

1.5

2

2.5

3

3.5

Start

3-DColumn13-DColumn23-DColumn3

Starting Session

1.4 MPH 0% Grade 20 Sessions

2.9 MPH 0% Grade 48% Increase in

Workload

First Session and 20th SessionAerobic Time Minutes

0

5

10

15

20

25

30

BegTime

20Sess

Session One

9 Minutes Total

3 Minutes Bike

3 Minutes Treadmill

3 Minutes Bike Session Twenty

Total Time 29 Minutes

14 Minutes Bike

15 Minutes Treadmill 300% increase

Thank You Very MuchReady eXercise

Robert Goldstein MS

Exercise Physiologist

readyexercise.com

925-457-5346