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KIN 311 > Exercise and Diabetes Pt. 1 > Flashcards

Exercise and Diabetes Pt. 1 Flashcards

1
Q

PCN:

A

network of doctors and healthcare professionals working together to improve community health

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2
Q

____ provides the funding for PCN services. All PCN services are …

A
  • Government of Alberta

- free to patients

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3
Q

Interdisciplinary health care teams consists of…

A
  • nurses
  • pharmacists
  • registered dieticians
  • exercise specialists
  • mental health psychologists
  • social workers
  • specialty physicians
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4
Q

PCN active living and exercise services:

A
  • 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
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5
Q

Role of an exercise specialist:

A
  • counselling
  • assessment
  • exercise prescription and instruction
  • documentation and communication
  • collaboration and consultation
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6
Q

Role of an exercise specialist: counselling…

A

counselling patients individually and in a group setting on active living and exercise

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7
Q

Role of an exercise specialist: assessment of….

A

patients cardiopulmonary, musculoskeletal, neuromuscular fitness and function to guide exercise prescriptions

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8
Q

Role of an exercise specialist: exercise prescription and instruction for…

A

the prevention and management of a range of endocrine, metabolic, musculoskeletal, cardiopulmonary and mental health conditions

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9
Q

Role of an exercise specialist: documentation and communication with…

A

patient’s physician

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10
Q

Role of an exercise specialist: collaboration and consultation with…

A

multi-disciplinary team members

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11
Q

ES =

A

exercise specialist

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12
Q

Typical ES patient:

A
  • 18-92 years old
  • no diagnosis to multiple diagnosis
  • sedentary to exceeding exercise guidelines
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13
Q

Common reasons for referral to ES services:

A
  • pre-diabetes/diabetes
  • weight management
  • osteoarthritis
  • osteoporosis
  • chronic back pain
  • CV disease
  • anxiety/depression
  • chronic pain
  • fibromyalgia
  • neurological disorder
  • PF dysfunction
  • deconditioning
  • balance concerns
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14
Q

Orthopedic triage referrals:

A

pain or other symptoms, restricted movement or reduced function from an Orthopaedic or Orthopaedic-type condition

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15
Q

ES required qualifications:

A
  • B KIN, PE, Rec, or related
  • CSEP or ACSM
  • CPR
  • min. 2 years experience
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16
Q

CSEP =

A

Canadian Society for Exercise Physiology

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17
Q

2 certifications you can obtain through CSEP:

A
  • certified personal trainer (CPT)

- certified exercise physiologist (CEP)

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18
Q

CSEP-CPT jobs:

A
  • private and public funded gyms
  • municipal recreation centres
  • university/college fitness facilities
  • fitness establishments
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19
Q

CSEP-CPT’s clientele can include:

A
  • apparently healthy individuals
  • individuals with a stable health condition who are able to exercise independently
  • individuals between the ages of 15-69 years
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20
Q

CSEP-CEP jobs:

A
  • health promotion
  • fitness development
  • colleges and universities
  • clinical rehabilitation
  • sport and athletic programs
  • hospitals
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21
Q

CSEP-CEP’s clientele can include:

A
  • 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
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22
Q

The prevalence of diabetes in Canada increased by ___% between the years 1999-2009 and has continued to rise to date.

A

70%

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23
Q

______ adults have diabetes.

A

422 million

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24
Q

Diabetes can lead to complications in many parts of the body and increase the risk of ….., including….

A
  • 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
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25
Q

Diabetes: a _____ disorder of multiple ______ characterized by chronic ______.

A
  • metabolic
  • etiology
  • hyperglycemia
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26
Q

Diabetes is a group of _____ diseases characterized by _____ resulting from defects in ____ ____, ____ ___, or both.

A
  • metabolic
  • hyperglycemia
  • insulin secretion
  • insulin action
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27
Q

Diabetes is a _____ disease.

A

progressive

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28
Q

Diabetes management requires continued …

A
  • self-management

- lifestyle interventions

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29
Q

3 components of diabetes management:

A
  • medication
  • diet/nutrition
  • PA
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30
Q

At diagnosis of type 2 diabetes, what should we do to manage?

A
  • start healthy behaviour interventions

- nutritional therapy, weight management, PA, +/- metformin

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31
Q

Diabetes management for A1C <1.5% above target:

A

if not at glycemic target within 3 months, start/increase metformin

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32
Q

Diabetes management for A1C > or equal to 1.5% above target:

A
  • start metformin immediately

- consider a second concurrent antihyperglycemic agent

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33
Q

Diabetes management for symptomatic hyperglycemia and/or metabolic decompensation:

A

initiate insulin / +/- metformin

34
Q

Diabetes management: achieve and maintain optimal ____ ____, _____ and _____ _____ to prevent or delay ____ _____ of diabetes.

A
  • blod glucose
  • lipids
  • blood pressure
  • chronic complications
35
Q

How is exercise medicine for diabetes?

A
  • 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
36
Q

Diabetes Canada clinical practice guidelines:

A
  • aerobic
  • resistance
  • interval
  • sedentary time
  • aquatic
37
Q

Structured exercise training of more than ____ min/week is associated with greater _____ declines than that of ____ min/week or less.

A
  • 150
  • HBA1C
  • 150
38
Q

Best exercise for diabetes management:

A

combined aerobic and resistance

39
Q

Metformin: expected decrease in A1C and side effects:

A
  • 1.0-1.5%

- GI side effects

40
Q

DPP4-inhibitor: expected decrease in A1C and side effects:

A
  • 0.7%

- GI side effects

41
Q

TZD’s: expected decrease in A1C and side effects:

A
  • 0.8%

- edema, CVD controversy

42
Q

Insulin: expected decrease in A1C and side effects:

A
  • 0.9-1.1%

- risk of hypoglycemia

43
Q

Exercise: expected decrease in A1C and side effects:

A
  • 0.7%

- ???

44
Q

Exercise can lead to…

A
  • 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
45
Q

PA participation is recommended and beneficial for …

A
  • all asymptomatic persons

- persons with chronic diseases

46
Q

For most people with and without diabetes, being sedentary is associated with…

A

far greater health risks than exercise would be

47
Q

_____ would increase over time with continued sedentary behaviours.

A

risks

48
Q

The majority (___% to ___%) of people with diabetes will die from _____ ____.

A
  • 65% to 80%

- heart disease

49
Q

A high proportion of deaths occur in people with diabetes with ……

A

no prior signs or symptoms of CVD

50
Q

Screening tools:

A
  • CANRISK
  • get active questionnaire/PAR-Q+
  • risk factors for CVD (ACSM)
  • Rose Angina Questionnaire
  • health history
51
Q

8 risk factors for CVD:

A
  • hypertension
  • hypercholesterolemia
  • high serum HDL cholesterol (negative risk factor)
  • impaired fasting glucose
  • obesity
  • sedentary lifestyle
  • smoking
  • family history
52
Q

Signs and symptoms suggestive of CVD:

A
  • 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
53
Q

CVD risk classification: low risk:

A
  • individual without signs of symptoms of CVD

- less than 2 risk factors

54
Q

CVD risk classification: moderate risk:

A
  • individual without signs or symptoms of CVD

- 2 or more risk factors

55
Q

CVD risk classification: high risk:

A
  • individual with signs or symptoms of CVD

- or with documented CV, pulmonary, or metabolic disease

56
Q

When should ECG be performed?

A
  • exercise more intense than brisk walking
  • typical or atypical chest discomfort
  • unexplained dyspnea
  • peripheral arterial disease
  • carotid bruits
  • history of angina, MI, stroke, TIA
57
Q

Value and utility of ECG:

A
  • appropriate exercise prescription
  • accuracy with exercise intensity
  • keep intensity below ischemic threshold
  • risk stratification
  • detection of coronary disease
58
Q

When should more conservative testing be preformed (over ECG)?

A
  • 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
59
Q

CAD =

A

coronary artery disease

60
Q

Exercise testing in diabetes is to determine….

A
  • presence/extent of CAD

- appropriate intensity range for exercise prescription

61
Q

2 aerobic methods for exercise testing for diabetes:

A
  • cycle (increase by 25-50 Watts/3 min stage)

- treadmill (increase by 1-2 METS/stage)

62
Q

4 measures for exercise testing for diabetes:

A
  • 12 lead ECG
  • HR
  • BP
  • RPE (some medications may effect HR and BP response to exercise)
63
Q

6 endpoints for exercise testing for diabetes:

A
  • 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
64
Q

Exercise capacity is frequently impaired in people with diabetes due to:

A
  • high prevalence of obesity
  • sedentary lifestyle
  • peripheral neuropathy (both sensory and motor)
  • unknown vascular disease
65
Q

Imaging testing under pharmacologic stress (exercise testing in diabetes):

A
  • nuclear stress imaging
  • stress echocardiography
  • coronary artery calcium scoring
  • coronary computed tomography angiography may be required
66
Q

Most people with diabetes who have no symptoms of ____ _____ do not require medical clearance before starting a …

A
  • coronary ischemia

- low to moderate intensity exercise program

67
Q

Assess for conditions that may place them at increased risk for an ____ ____.

A

adverse event

68
Q

_____ or _____ _____ should be treated and stabilized prior to commencement of vigorous exercise.

A

preproliferative or proliferative retinopathy

69
Q

Someone with severe ____ ____ should be instructed to inspect their ____ daily, and should be careful with ____ ____ activity.

A
  • peripheral neuropathy
  • feet
  • weight bearing
70
Q

Without diabetes, exercise initiates a ______ response to help maintain ____ concentrations.

A
  • counterregulatory

- BG

71
Q

Without diabetes, _____ is released while ____ is suppressed.

A
  • glucagon

- insulin

72
Q

Blood glucose response - T2D:

A
  • impaired counterregulatory response
  • may experience decreases in glucose concentrations during exercise
  • hypoglycemia is NOT a major risk (unless using insulin)
73
Q

Exercise response may be dependent on many factors:

A
  • 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
74
Q

Precautions for individuals using insulin before exercise: T1D & T2D:

A
  • < 5.5 mmol/L

- delay exercise and consume 15-30g CHO

75
Q

Precautions for individuals using insulin before exercise: T1D:

A
  • > 16.7 mmol/L & keytones present = delay exercise

- > 16.7 mmol/L & keytones absent = proceed with exercise if feeling well, ensure good hydration

76
Q

Precautions for individuals using insulin before exercise: T2D:

A

> 16.7 mmol/L = proceed with exercise if feeling well, ensure good hydration

77
Q

Precautions for individuals using insulin during exercise: T1D & T2D:

A
  • monitor BG every 30 minutes (minimum in T1D)
  • fluid intake
  • if required, consume CHO
78
Q

Precautions fo individuals using insulin after exercise: T1D & T2D:

A

monitor BG, including overnight (especially if amount of exercise is not habitual)

79
Q

Comorbidities of diabetes:

A
  • depression
  • osteoarthritis
  • chronic back pain
  • high BP
  • dyslipidemia
  • overweight or obesity
  • hypothyroid
  • polycystic ovarian syndrome (PCOS)
80
Q

Most adults with diabetes have at least one _____ ____ _____ and as many as ___% have at least 3.

A
  • comorbid chronic disease

- 40%

81
Q

Other tools for diabetes:

A
  • 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

KIN 311 (19 decks)

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