D diseaseI insulinA annoyingB blood sugarsE exerciseT types (pre-diabetes, 1,2 gestational)

E eatingS sedentary

DIABETES and EXERCISEPresentation Overview

• Why Exercise is important in good diabetes management• Exercise guidelines

– How much, how often, how intense?– Resistance training

• Case Study 1• Patient Considerations/Precautions• GRGRxx H Healthy LLifestyle SSupport• Case Study 2• Recap

Nearly everyone with diabetes can derive some benefit from an appropriate physical activity programme.

Physical activity (PA) is a cornerstone of patient’s diabetes self-management.

• Aerobic exercise increases insulin sensitivity and, together with proper nutrition, helps restore normal glucose metabolism, by decreasing body fat.

• Strength training (resistance or weight training) also decreases body fat by raising metabolism.

• Its MAIN BENEFIT is increasing glucose uptake by muscles and enhancing ability to store glucose.

Why Exercise? Physical Activity

How does exercise affect BSLs?

When exercising, the body needs extra energy/fuel (glucose) for the exercising muscles.For short bursts (jogging to the car) muscles and the liver can release stores of glucose for

fuel.With continued moderate exercising however, muscles uptake glucose at almost 20 times

normal rate.This lowers blood sugar levels.

But intense exercise can have the opposite effect and actually decrease BSL. The body recognises intense exercise as a stress and releases hormones that tell your body to

increase available BSL to fuel the muscles.

For a variety of reasons, after exercise, people with diabetes may have an increase or decrease in BSL.

Specific health benefits for diabetics Helps control blood glucose Lowers triglycerides Assists with weight loss Lowers blood pressure Helps raise HDL Helps lower total cholesterol

and LDL (if there is weight loss) Increases cardiovascular fitness Increases muscle strength and balance

PA – yes, there’s more ..2

Builds/maintains healthy bones / reduce risk of osteoporosis Promotes psychological wellbeing Reduces risk of colon cancer Improves sleep patterns Increases cardiovascular fitness Decreases pain Helps rehab after medical/surgical events Helps maintain independent living / reduce risk of fractures

Exercise can mean the difference between ‘medical management’ and ‘lifestyle management’ of Type 2 Diabetes

PA / Exercise GuidelinesHow much? How often? How intense?

Reduce sedentary (sitting) time From the Latin: sedere – to sit

Latest findings show that a combination of AEROBIC and STRENGTH traininghas a profound impact on helping people manage diabetes.

30 minutes per day on at least 5 days a week (Pedometers 10,000 steps per day)

10 minutes x 3 during the day preferable to 0

Moderate intensity (Borg Scale Perceived Exertion of 6-7) (Talk Test)-Examples include brisk walking, cycling, swimming, dancing, rowing, lawn mowing- Preferred options include local pools, community classes, walking groups, gyms

PA / Exercise GuidelinesHow much? How often? How intense? Cont..

Weights/resistance training- Twice a week- 8 – 12 repetitions per set of 8 – 10 exercises

targeting major muscle groups- Build up to 3 sets - Light hand weights, Dyna bands (Fit Strips),

resistance balls cheap and effective- Qualified Trainer can set personalised, reviewable programme- Community options available i.e. ‘Shape-Up’

Case Study 1• 58 yrs old• 113 kg• Working full time• BP high, energy/mood low• Non-restorative, broken sleep• Diagnosed Type 2 early 2010• Took nutritional advice to heart• Green Prescription issued March• Began walking 10 minutes to/from work 3 x week• Persevered to 5 x week, walking faster• Added weekend walks• Began to ‘just feel better’• Now lost 17kgs and still feels fantastic!

Patient Considerationsfor PA

• Any additional risk factors for CVD• Peripheral arterial disease• Thermo regulation• Diabetic neuropathy• Retinopathy• Regular glucose monitoring

(self observation)• Routine of exercise, eating and medication • Foot care / eye care• Medically stable for exercise (GRx)

GRGRxx H Healthy LLifestyle SSupportYour first port of call when prescribing exercise for diabetes

12 or 24 weeks patient supportUse the 5 “A”s to assist patient to succeed (A=Assess, A=Advise, A=Assist, A=Agree, A=Arrange)

Employ the 3 “E”s to achieve sustainability(E = Enjoyment E = Exercise E = empowerment)

Monthly Face to face consultationsMonthly telephone top-upsSmart Goal Setting Hit The Target steps to the Smart GoalBehaviour Change identification

GRGRxx H Healthy LLifestyle SSupport cont..

Motivational text messages Effective Encouraging Emails

Physical activity options – the right choice at the right time Exercise Induction Process at venues Personalised Physical Activity Plans

Nutritional advice Using a Food Diary

Short-term pedometer hire Links to other community support groups

Transport assistance (St. Johns bus) Specific focus meetings

Volunteer opportunities

Case Study 2•65+ years old•Type 2 Diabetes•Overweight•No energy, too many medications•High BP•Mild Depression•Painful arthritis / reduced mobility•Nurse referred to GRx •Planned to look at Sit and be Fit and ‘Water-Worx’•Attended seated exercises with a friend•Achieved success, no negative side-effects, lots of fun•Warm water at pool fabulous, moving more freely•No longer needs ‘nana naps’•Lost 7 kgs•Regularly active and feeling so much happier!

To Recap

• PA crucial to good diabetes management• Refer to GRx team for Healthy Lifestyle Support

(patient doing less than 2.5hrs/exercise per week and 18+ yrs)

• Every little bit of exercise helps – 10mins x 3 x 5• Contact GRx team anytime for extra motivational

tips / phrases / helpful conversation guides

• GRx desk pad or• Your own MedTech

electronic practice referral• No electronic referral on

your computer? Arrangefor installation.

Referrals Forms

Please Contact Us

• Leigh Dalzell, GRx Co-ordinatorNelson Bays Primary HealthP.O. Box 177620 New Street, NelsonTel: 539 1772DD 539 1662Cell 021 547811