الله بسمالرحیم الرحمن

Role of Physical Activity on Diabetes and Cardiovascular

diseases

Isfahan University of Medical Sciences

Faculty of Rehabilitation SciencesDr Javid Mostamand

Physical Activity Is Like Magic for Type 2 Diabetes and Cardiovascular Diseases

Physical Activity Is Like Magic for Type 2 Diabetes and Cardiovascular Diseases

سالمت ورزشو جامعه سالمت ورزشبر تاثير

فيزيولوژيك ورزشنياز ورزش كردن همگاني تالشبراي

..... جنيني دوره سالمتي رمز تحرك ورزشوجراحي

ميشود 5هر مبتال ديابت به نفر يك ثانيه افزايشوزن گرم كيلو افزايش% 5هر

خطرديابتقلبيعروقي هاي ورزشوبيماري

Proportion of disease prevalence attributable to obesity

Type 2 diabetes

Hypertension

Coronary heart disease

Gallbladder disease

Osteoarthritis

Breast cancer

Uterine cancer

Colon cancer

57%17%

17%

30%

14%

11%

11%

11%

WWBCopyright © Allyn & Bacon

2006

What Can Physical Activity Do For Us?

Give us more energy

What Can Physical Activity Do For Us?

Help us lose weight and keep it off

What Can Physical Activity Do For Us?

Increase flexibility and strength

Slow bone lossProvide better

quality of life

What Can Physical Activity Do For Us?

Build muscle

What Can Physical Activity Do For Us?

Lift our moodTreat

depressionReduce stress

and anxiety

What Can Physical Activity Do For Us?

In Diabetes type 2 Improve blood

glucose control

(lowers Hemoglobin A1C)

Physical activity lowers blood glucose in type 2 diabetes by helping: muscle cells become more

sensitive to insulin keep the liver from producing too

much glucose build more muscle We lose weight and keep it off

What Can Physical Activity Do For Us?

Keep our heart healthy

Physical activity helps our heart by:

Strengthening heart muscle Lowering resting heart rate Lowering blood pressure Improving cholesterol Reducing risk of heart attack

and stroke

“Sitting” through life increases our risk of:

heart disease high blood

pressure high cholesterol overweight type 2 diabetes

We now must plan physical activity into our schedule

We now must plan physical activity into our schedule

Getting Started Check with our doctor

if we:Are over age 35Have had diabetes

more than 10 yearsHave high blood

pressure, heart disease, poor circulation, or other diabetes complications

Aerobic Activity

Walking briskly Bicycling Hiking Jogging/running Skating Stair climbing Swimming Water exercise

Health Benefits of Physical Activity: Strong Evidence

Lower risk of:Early deathCoronary heart disease, strokeHigh blood pressure Type 2 diabetesCancers: Colon and Breast

Prevention of weight gain Weight loss (with reduction of caloric intake) Prevention of falls Depression, cognitive function (older adults)

20

Children and AdolescentsAges 6-17

22

Children and Adolescents (ages 6-17) 60 or more minutes of physical activity daily

Aerobic: Most of the 60 or more minutes per day should be either moderate- or vigorous-intensity aerobic physical activity. Include vigorous-intensity physical activity at least 3 days per week.

Muscle-strengthening: Include muscle-strengthening physical activity on at least 3 days of the week, as part of the 60 or more minutes.

Bone-strengthening: Include bone-strengthening physical activity on at least 3 days of the week, as part of the 60 or more minutes.

Encourage participation in physical activities that are: Age appropriate, enjoyable, and offer variety

AdultsAges 18-64

4 Key Adult Guidelines Avoid inactivity Substantial health benefits from medium

amounts of aerobic activity More health benefits from high amounts of

aerobic activity Muscle-strengthening activities provide

additional health benefits

Inactivity?

“All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.”

Substantial Health Benefits Guideline “For substantial health benefits, adults should do:

at least 150 minutes (2.5 hours) a week of moderate-intensity aerobic activityOR

75 minutes (1.25 hours) a week of vigorous-intensity aerobic physical activityOR

an equivalent combination of moderate- and vigorous-intensity aerobic activity.”

“Aerobic activity should be performed in episodes of at least 10 minutes, And preferably, it should be spread throughout the week.”

Additional & More ExtensiveHealth Benefits Guideline

““For additional and more extensive health benefits, For additional and more extensive health benefits, adults should increase their aerobic physical activity adults should increase their aerobic physical activity to:to:

300 minutes (5 hours) a week of moderate-intensity,300 minutes (5 hours) a week of moderate-intensity,OROR150 minutes a week of vigorous-intensity aerobic 150 minutes a week of vigorous-intensity aerobic

physical activityphysical activityOR OR an equivalent combination of moderate- and an equivalent combination of moderate- and

vigorous-intensity activity.”vigorous-intensity activity.”

Muscle-Strengthening Guideline “Adults should also do muscle-strengthening

activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.”

Comments onMuscle-Strengthening Guideline

Requires moderate to high level of intensity or effort:Relatively few repetitions (e.g. 8-12)If do resistance training, 1 set sufficient

At least 2 days a week Major muscle groups:

legs, hips, back, chest, abdomen, shoulders, arms

Knee Strengthening Exercises

Hip Strengthening Exercises

Back Strengthening Exercises Birddog (Opposite Arm and Leg Extension), Bridge,

One-Leg Bridge, Plank

What about Flexibility Activities?

Flexibility activities are acceptable

Flexibility activities are usually part of exercise programs

Flexibility is a component of fitnessPeople need sufficient flexibility to be activeFlexibility activities, like stretching, do

increase flexibility

Back Stretching Exercises

Older AdultsAges 65+

Key Older Adult GuidelinesKey Older Adult Guidelines

The 4 key guidelines for adults apply to older adults, but there are 4 additional qualifying guidelinesGuideline for adults who cannot do 150

minutes/weekBalance exerciseOnly use relative intensity to determine the level of

effortChronic conditions and injury risk

Guideline for Older AdultsWho Cannot Do 150 Minutes/Week

“When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.”

Comment:For example, physical activity has a

beneficial effect on functional limitations in older adults, meaning adults with limitations should be active as their abilities allow

Balance Exercise Guideline

“Older adults should do exercises that maintain or improve balance if they are at risk of falling.”

Comment: Insufficient evidence to make this a general guideline

for all older adults Research has studied mainly exercise programs, and

hence guideline uses “exercise.”

Resistance Activities (for diabetes)

“Push, Pull, and Lift” Activities increase muscle

strengthprevent falls increase mobility improve blood glucose

control

Stretching

Improves our balance and coordination

Make us more flexible Reduces stiffness Reduce our risk of

injury

How Can we Begin?

Choose activity (example: brisk walking)

Set a long-term goal - at least 30 minutes a day, 3-5 days a week

Buy comfortable walking shoes

Gradually Increase Activity

Beginning Exercisers:

First Week - 3 times a week Morning: Walk 5-10 minutes Lunch: Walk 5-10 minutes After dinner: Walk 5-10

minutes

Keep track of how long and how far you walk each day

Keep Track of Our Steps

Use a pedometer Keep track of how many steps you

normally take in a day for one week Gradually add 500-1,000 steps a

day Set a goal of at least 3,000 to

4,000 steps more than your baseline

Vary Your Activities

Monday Tuesday Wed Thursday Friday

Walk Swim/

Water Aerobics

Walk Swim/

Water Aerobics

Walk

Monday Tuesday Wed Thursday Friday

Exercise bike

Aerobic class

Exercise Bike

Aerobic Class

Exercise Bike

Effect of Physical Activity on Blood Glucose Depends on:

our blood glucose level before we exercise

diabetes medicationwhen and how much we ate last our physical fitnesstype of activity

Effect of Physical Activity on Blood Glucose

Blood glucose checks before and after exercise are the key

Effect of Physical Activity on Blood Glucose

Physical activity usually lowers blood glucose

Physical activity can raise our blood glucose if:our BG is >250 mg/dl before our exercise and

we have ketones we’re starting a new vigorous exercise

program

Exercising With Heart Disease

Caution: Very strenuous

activity Heavy lifting or

straining Exercise in extreme

cold or heat

Choose: Moderate activity

such as walking, swimming, biking, gardening

Moderate lifting, stretching

Exercising with Hypertension (high blood pressure)

Caution Very strenuous

activity Heavy lifting or

straining

Choose Moderate activity

like: walking weight lifting with

light weights stretching

Make sure your blood pressure is in control first

Exercising with Neuropathy (nerve disease)

Caution Weight-bearing, high

impact, strenuous, or prolonged exercise: jogging/running step exercise jumping exercise in heat/cold

Choose Low impact,

moderate activities: biking swimming chair exercises stretching light to moderate

daily activities

Check feet after exercise

Exercise Safely (Diabetes)

Check your blood glucose before and after exercise

Don’t exercise if your blood glucose is too high or too low

Carry carbohydrate to treat low blood glucose if you are at risk

Exercise Safely (Diabetes)

Stop exercising if you feel pain, lightheaded, or short of breath

Avoid strenuous activity in extremely hot, humid, or cold weather

Wear proper shoes for the activity to reduce the risk of injury

Exercise Safely (Diabetes)

Wear diabetes identification Drink plenty of fluid

WWBCopyright © Allyn & Bacon

2006