Chapter 14 & 15

Question 1

What is diabetes?
Type 1?
Type 2?

Answer 1

 Abnormal glucose metabolism caused by
 Defect in insulin release (Type 1) and/or
 Defect in insulin action (Type 2)

Question 2

What percent of diabetes is type 2? Who does it affect?

Answer 2

90-95% of all cases are Type 2

 Affects both adults and children
 Disproportionately affects minority population

Question 3

What are long term complication of diabetes?

Answer 3

Long-term complications impact macrovascular, microvascular,
and neural function

Question 4

What are diagnostic criteria for diabetes?

Answer 4

Diagnostic criteria: HbA1C ≥6.5%; fasting blood glucose ≥126 mg .
dl−1

Question 5

What is key first step in diabetes managment?

Answer 5

Self-monitoring is key first step

Question 6

What is HbA1C and what is its target?

Answer 6

HbA1C: Time-averaged blood glucose concentration over prior 2-3
months; target is <7.0%

Question 7

What does exercise do for diabetics?

Answer 7

 Exercise helps improve blood glucose control, esp. in Type 2
 Improves insulin sensitivity of cells
 Also reduces risk of CVD (common comorbidity) and BP

Question 8

What are risks to consider for diabetes exercising? How to manage these risks?

Answer 8

Risks to consider
 Hypoglycemia
 Hyperglycemia
 Acutely uncontrolled diabetes = contraindication for exercise!!!!
 Self-monitoring before and after exercise is crucial

Question 9

When should BG be monitored and what criteria are there?

Answer 9

 Patient should check BG prior to beginning exercise

 Postpone exercise if >250–300 mg ∙ dL−1 (>13.88–16.65 mmol ∙ L−1) and
ketones are present

 If >250–300 mg ∙ dL−1 (>13.88–16.65 mmol ∙ L−1) without ketones, exercise
is okay but use caution;

 If <100 mg ∙ dL−1 (5.55 mmol ∙ L−1) and using insulin, consume a
carbohydrate-based snack based on insulin regimen and circulating
insulin levels during exercise;

 If 100–250 mg ∙ dL−1 (5.55–13.88 mmol ∙ L−1), exercise is recommended
without limitations

Question 10

What is the recommended frequency for aerobic exercise for diabetic patients?

Answer 10

 Recommended target for aerobic exercise: 150-300 min/wk of
moderate / 75-150 min/wk of vigorous
 No more than 2 consecutive days w/o PA/exercise – maintain
heightened insulin action
 Type 2 should target higher volume, similar to OWOB patients
 Start low and go slow!

Question 11

What are resistance training recommendations for diabetic patients?

Answer 11

 Resistance Training:
 Allow for adequate rest between sets
 15-60 s for lower intensity; 2-3 mins. for higher intensity
 Target 50-85% of 1RM
 If joint or health complications are present, start with 1 set of 10-15 and
progress to 15-20 before adding sets

Question 12

What can increased blood glucose put one at risk for?

Answer 12

 Elevated blood glucose increases risk of dehydration
 Effect can be exacerbated by heat – also increases glucose
metabolism
 Need to monitor blood glucose throughout exercise

Question 13

 Avoid ____ ____when lifting (↑BP)
 Break up sedentary time that is ____ minutes
 Encourage ____ ____!

Answer 13

 Avoid Valsalva maneuver when lifting (↑BP)
 Break up sedentary time that is >90 minutes
 Encourage active lifestyle!

Question 14

What order should resistance training and aerobic training be performed in for those with diabetes?

Answer 14

For those on insulin, consider doing RT before aerobic training and
lowering dose around PA

Question 15

Insulin and food use during diabetic exercise?

Answer 15

 For those on insulin, consider doing RT before aerobic training and
lowering dose around PA
 Also recommend whole milk or sports drink before, during and after 1
hour of exercise
 Should have rapidly absorbed glucose source available during exercise
 If post-exercise glucose levels are in excess of 250–300 mg · dL−1, conservative insulin use is recommended

Question 16

Journal findings of exercise on type 2 diabetes?

Answer 16

 Regular aerobic exercise improves overall QoL
 Physical components improved but mental did not
 RT training alone did not result in improvement
 A1C improved by approx. 0.5%

Question 17

What are the criteria for metabolic syndrome?

Answer 17

Metabolic syndrome diagnostic criteria: 3 or more of following
factors:
 Hyperglycemia (or current medication use): FPG ≥ 100 mg ∙ dL−1
 Hypertension (or current treatment for): SBP ≥130 mm Hg or DBP ≥85 mm
Hg
 Dyslipidemia (or current treatment for): HDL-C <40 mg ∙ dL−1 in men or
<50 mg ∙ dL−1 in women;
 Hypertriglyceridemia (or current treatment for): TG ≥150 mg ∙ dL−1
 Central Adiposity: waist circumference ≥94 cm (≥37 in) in men or ≥80 cm
(≥31.5 in) in women; or WHR of >0.9 for males and >0.85 for females

Question 18

What is the prevalence of metabolic syndrome?

Answer 18

Estimated prevalence of 34% in U.S. adults

Question 19

What does metabolic syndrome increase the risk for?

Answer 19

2-3x higher risk for CVD morbidity and mortality

Question 20

What are the lifestyle risk factor of Metsyn?

Answer 20

Lifestyle risk factors for Metsyn include
 Low levels of PA and fitness
 High consumption of soft drinks (including diet), fried foods, meat, and
carbs
 Behaviors such as skipping breakfast and heavy alcohol use

Question 21

Modifiable risk factors of Metsyn?

Answer 21

Modifiable risk factors:
 Reduce BW by 7-10 %
 Change diet
 30 min. of activity 5 days per week
 Consider medication as well (not instead)

Question 22

What is the most important CVD risk factor?

Answer 22

Hypertension

Question 23

What percent of deaths does hypertension account for?

Answer 23

Accounts for 40% of all CVD deaths

Question 24

What are risk factors of hypertension?

Answer 24

Risk factors include
 Age, race/ethnicity, family history, and genetic factors
 Lower education and socioeconomic status
 Greater weight and lower physical activity
 Tobacco use
 Psychosocial factors
 Sleep apnea
 Dietary factors: dietary fats, high sodium intake, low potassium intake, and
excessive alcohol intake

Question 25

What are the most modifiable risk factors for hypertension?

Answer 25

Modifiable factors (diet & exercise) seem to be most important

Question 26

How is dyslipidemia often managed?

Answer 26

Often managed
pharmacologically

Lifestyle changes are important
also

Question 27

Primary goal of managing dyslipidemia? Percent increase in LDL associated with what percent increase of CVD?

Answer 27

 Primary goal is typically to reduce LDL-C
 10% increase associated with 20% increase in CHD risk

Question 28

Majority of patients with Metsyn, hypertension, and dyslipidemia ____ medical clearance or exercise testing

Answer 28

Don’t require

Question 29

 Physician evaluation can be helpful for identifying ____ or
undiagnosed ____
 Medical clearance recommended for ___________

Answer 29

 Physician evaluation can be helpful for identifying comorbidities or
undiagnosed CVD
 Medical clearance recommended for Stage 2 hypertension

Question 30

Standard exercise testing protocol are ok for ____ and ____

For hypertension, consider:
1.
2.
3.
4.

Answer 30

Standard exercise testing protocol are ok for Metsyn & dyslipidemia

For hypertension, consider:
 Magnitude
 Controlled or uncontrolled?
 Timing of medications
 The need to monitor BP responses

Question 31

Aerobic exercise for metsyn?

Answer 31

Aerobic exercise
 Start 40-59% HRR; may progress over 60% if tolerated
 Progress from 30 to 60 min. per day
 Goal of 150-300+ minutes per week

Question 32

Describe function of resistance training for Metsyn?

Answer 32

Resistance exercise is critical component
 ↑ metabolically active tissue
 Attenuate hypoglycemic effects

Question 33

Exercise prescription of hypertension?

Answer 33

 Target frequency of 5-7 days per week
 Gradual progression and smaller bouts adding up to >30 minutes
per day
 Dynamic RT may be as or more effective at lowering BP than
aerobic exercise
 Encourage morning exercise!

Question 34

Exercise prescription of dyslipidemia? Additional consideration?

Answer 34

 Maximize energy expenditure with whole-body, large-muscle
aerobic exercise
 Combination with RT (2-3x per week) may be most effective
 Statin drugs associated with muscle weakness, pain, and cramping
in 5-10% of patients