Exercise and Diabetes Pt. 1 Flashcards
PCN:
network of doctors and healthcare professionals working together to improve community health
____ provides the funding for PCN services. All PCN services are …
- Government of Alberta
- free to patients
Interdisciplinary health care teams consists of…
- nurses
- pharmacists
- registered dieticians
- exercise specialists
- mental health psychologists
- social workers
- specialty physicians
PCN active living and exercise services:
- intro to PA
- individual exercise appointments
- supervised exercise program (8 weeks)
- living with osteoarthritis
- chronic pain program (8 weeks)
- living with prediabetes and diabetes, breathe better with COPD, heart healthy
Role of an exercise specialist:
- counselling
- assessment
- exercise prescription and instruction
- documentation and communication
- collaboration and consultation
Role of an exercise specialist: counselling…
counselling patients individually and in a group setting on active living and exercise
Role of an exercise specialist: assessment of….
patients cardiopulmonary, musculoskeletal, neuromuscular fitness and function to guide exercise prescriptions
Role of an exercise specialist: exercise prescription and instruction for…
the prevention and management of a range of endocrine, metabolic, musculoskeletal, cardiopulmonary and mental health conditions
Role of an exercise specialist: documentation and communication with…
patient’s physician
Role of an exercise specialist: collaboration and consultation with…
multi-disciplinary team members
ES =
exercise specialist
Typical ES patient:
- 18-92 years old
- no diagnosis to multiple diagnosis
- sedentary to exceeding exercise guidelines
Common reasons for referral to ES services:
- pre-diabetes/diabetes
- weight management
- osteoarthritis
- osteoporosis
- chronic back pain
- CV disease
- anxiety/depression
- chronic pain
- fibromyalgia
- neurological disorder
- PF dysfunction
- deconditioning
- balance concerns
Orthopedic triage referrals:
pain or other symptoms, restricted movement or reduced function from an Orthopaedic or Orthopaedic-type condition
ES required qualifications:
- B KIN, PE, Rec, or related
- CSEP or ACSM
- CPR
- min. 2 years experience
CSEP =
Canadian Society for Exercise Physiology
2 certifications you can obtain through CSEP:
- certified personal trainer (CPT)
- certified exercise physiologist (CEP)
CSEP-CPT jobs:
- private and public funded gyms
- municipal recreation centres
- university/college fitness facilities
- fitness establishments
CSEP-CPT’s clientele can include:
- apparently healthy individuals
- individuals with a stable health condition who are able to exercise independently
- individuals between the ages of 15-69 years
CSEP-CEP jobs:
- health promotion
- fitness development
- colleges and universities
- clinical rehabilitation
- sport and athletic programs
- hospitals
CSEP-CEP’s clientele can include:
- apparently healthy individuals
- individuals and/or populations with medical conditions, functional limitations or disabilities associated with musculoskeletal, cardiopulmonary, metabolic, neuromuscular, and aging conditions
- clients with chronic disease and injury
- high performance athletes
The prevalence of diabetes in Canada increased by ___% between the years 1999-2009 and has continued to rise to date.
70%
______ adults have diabetes.
422 million
Diabetes can lead to complications in many parts of the body and increase the risk of ….., including….
- dying prematurely
- damage the blood vessels, heart, eyes, kidneys and nerves
- increased risk of heart attacks and strokes
- reduced blood flow and neuropathy in the feet increases the chance of foot ulcers and infection
Diabetes: a _____ disorder of multiple ______ characterized by chronic ______.
- metabolic
- etiology
- hyperglycemia
Diabetes is a group of _____ diseases characterized by _____ resulting from defects in ____ ____, ____ ___, or both.
- metabolic
- hyperglycemia
- insulin secretion
- insulin action
Diabetes is a _____ disease.
progressive
Diabetes management requires continued …
- self-management
- lifestyle interventions
3 components of diabetes management:
- medication
- diet/nutrition
- PA
At diagnosis of type 2 diabetes, what should we do to manage?
- start healthy behaviour interventions
- nutritional therapy, weight management, PA, +/- metformin
Diabetes management for A1C <1.5% above target:
if not at glycemic target within 3 months, start/increase metformin
Diabetes management for A1C > or equal to 1.5% above target:
- start metformin immediately
- consider a second concurrent antihyperglycemic agent
Diabetes management for symptomatic hyperglycemia and/or metabolic decompensation:
initiate insulin / +/- metformin
Diabetes management: achieve and maintain optimal ____ ____, _____ and _____ _____ to prevent or delay ____ _____ of diabetes.
- blod glucose
- lipids
- blood pressure
- chronic complications
How is exercise medicine for diabetes?
- exercise promotes glucose uptake, independent of insulin
- chronic exercise training increases insulin sensitivity and decreases A1C
- beneficial in diabetes where glucose levels are chronically elevated
Diabetes Canada clinical practice guidelines:
- aerobic
- resistance
- interval
- sedentary time
- aquatic
Structured exercise training of more than ____ min/week is associated with greater _____ declines than that of ____ min/week or less.
- 150
- HBA1C
- 150
Best exercise for diabetes management:
combined aerobic and resistance
Metformin: expected decrease in A1C and side effects:
- 1.0-1.5%
- GI side effects
DPP4-inhibitor: expected decrease in A1C and side effects:
- 0.7%
- GI side effects
TZD’s: expected decrease in A1C and side effects:
- 0.8%
- edema, CVD controversy
Insulin: expected decrease in A1C and side effects:
- 0.9-1.1%
- risk of hypoglycemia
Exercise: expected decrease in A1C and side effects:
- 0.7%
- ???
Exercise can lead to…
- improvements in A1C (similar to many hypoglycemic agents)
- improved insulin sensitivity (decrease meds requirements)
- decreased adipose tissue
- increased muscle mass
- decreased risk of CVD
- improved mood
- improved quality of life
- increased strength
PA participation is recommended and beneficial for …
- all asymptomatic persons
- persons with chronic diseases
For most people with and without diabetes, being sedentary is associated with…
far greater health risks than exercise would be
_____ would increase over time with continued sedentary behaviours.
risks
The majority (___% to ___%) of people with diabetes will die from _____ ____.
- 65% to 80%
- heart disease
A high proportion of deaths occur in people with diabetes with ……
no prior signs or symptoms of CVD
Screening tools:
- CANRISK
- get active questionnaire/PAR-Q+
- risk factors for CVD (ACSM)
- Rose Angina Questionnaire
- health history
8 risk factors for CVD:
- hypertension
- hypercholesterolemia
- high serum HDL cholesterol (negative risk factor)
- impaired fasting glucose
- obesity
- sedentary lifestyle
- smoking
- family history
Signs and symptoms suggestive of CVD:
- pain/discomfort (or other anginal equivalent) in the chest, jaw, arms, or other areas that may result from ischemia
- dizziness or syncope
- ankle edema
- intermittent claudication
- unusual fatigue or shortness of breath with usual activities
- shortness of breath at rest or with exertion
- palpitations or tachycardia
- known heart murmur
- orthopnea or paroxysmal nocturnal dyspnea
CVD risk classification: low risk:
- individual without signs of symptoms of CVD
- less than 2 risk factors
CVD risk classification: moderate risk:
- individual without signs or symptoms of CVD
- 2 or more risk factors
CVD risk classification: high risk:
- individual with signs or symptoms of CVD
- or with documented CV, pulmonary, or metabolic disease
When should ECG be performed?
- exercise more intense than brisk walking
- typical or atypical chest discomfort
- unexplained dyspnea
- peripheral arterial disease
- carotid bruits
- history of angina, MI, stroke, TIA
Value and utility of ECG:
- appropriate exercise prescription
- accuracy with exercise intensity
- keep intensity below ischemic threshold
- risk stratification
- detection of coronary disease
When should more conservative testing be preformed (over ECG)?
- over the age of 30 (type 2 diabetes)
- over the age of 35 (type 1 diabetes)
- have type 1 diabetes for > 15 years
- one or more of CAD risk factors
- suspected or known presence of CAD
- have microvascular or neurological complications
CAD =
coronary artery disease
Exercise testing in diabetes is to determine….
- presence/extent of CAD
- appropriate intensity range for exercise prescription
2 aerobic methods for exercise testing for diabetes:
- cycle (increase by 25-50 Watts/3 min stage)
- treadmill (increase by 1-2 METS/stage)
4 measures for exercise testing for diabetes:
- 12 lead ECG
- HR
- BP
- RPE (some medications may effect HR and BP response to exercise)
6 endpoints for exercise testing for diabetes:
- serious dysarrynmias (irregular HR)
- significant T-wave change
- ischemic threshold
- > 2mm ST-segment depression or elevation
- SBP > 250 mmHg, DBP > 115 mmHg
- onset peripheral pain, exercise intolerance
Exercise capacity is frequently impaired in people with diabetes due to:
- high prevalence of obesity
- sedentary lifestyle
- peripheral neuropathy (both sensory and motor)
- unknown vascular disease
Imaging testing under pharmacologic stress (exercise testing in diabetes):
- nuclear stress imaging
- stress echocardiography
- coronary artery calcium scoring
- coronary computed tomography angiography may be required
Most people with diabetes who have no symptoms of ____ _____ do not require medical clearance before starting a …
- coronary ischemia
- low to moderate intensity exercise program
Assess for conditions that may place them at increased risk for an ____ ____.
adverse event
_____ or _____ _____ should be treated and stabilized prior to commencement of vigorous exercise.
preproliferative or proliferative retinopathy
Someone with severe ____ ____ should be instructed to inspect their ____ daily, and should be careful with ____ ____ activity.
- peripheral neuropathy
- feet
- weight bearing
Without diabetes, exercise initiates a ______ response to help maintain ____ concentrations.
- counterregulatory
- BG
Without diabetes, _____ is released while ____ is suppressed.
- glucagon
- insulin
Blood glucose response - T2D:
- impaired counterregulatory response
- may experience decreases in glucose concentrations during exercise
- hypoglycemia is NOT a major risk (unless using insulin)
Exercise response may be dependent on many factors:
- use and type of diabetes medication (insulin vs oral agent)
- use of other medications (eg. beta blocker)
- timing of medication administration
- blood glucose concentration prior to exercise
- timing, amount, and type of food
- intensity, duration, and type of exercise
Precautions for individuals using insulin before exercise: T1D & T2D:
- < 5.5 mmol/L
- delay exercise and consume 15-30g CHO
Precautions for individuals using insulin before exercise: T1D:
- > 16.7 mmol/L & keytones present = delay exercise
- > 16.7 mmol/L & keytones absent = proceed with exercise if feeling well, ensure good hydration
Precautions for individuals using insulin before exercise: T2D:
> 16.7 mmol/L = proceed with exercise if feeling well, ensure good hydration
Precautions for individuals using insulin during exercise: T1D & T2D:
- monitor BG every 30 minutes (minimum in T1D)
- fluid intake
- if required, consume CHO
Precautions fo individuals using insulin after exercise: T1D & T2D:
monitor BG, including overnight (especially if amount of exercise is not habitual)
Comorbidities of diabetes:
- depression
- osteoarthritis
- chronic back pain
- high BP
- dyslipidemia
- overweight or obesity
- hypothyroid
- polycystic ovarian syndrome (PCOS)
Most adults with diabetes have at least one _____ ____ _____ and as many as ___% have at least 3.
- comorbid chronic disease
- 40%
Other tools for diabetes:
- patient health questionnaire 2 & 9 (PHQ-9) (depression)
- EQ-5D (overall health)
- motivational interviewing
- decision balance (contemplative)
- problem solving, SMART goal setting
- PA tracking and self monitoring techniques (eg. pedometers)
- education
