Page 1Diabetes Education Services© www.DiabetesEd.net
Burn that Sugar
Get Moving
Beverly Dyck Thomassian, RN, MPH, BC-ADM, CDEPresident, Diabetes Education Services
Objectives
� Current state of exercise in
U.S.
� Benefits of exercise
� Re-igniting or finding the
spark
� Teaching strengthening
exercises
� Listening to the exercise
story
How most people regard exercise
Rabbits jump and they live for 8 years
Dogs run and live for 15 years
Turtles do nothing and live for 150 years
Lesson learned
www.facebook.com/humormeetscomic2
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Quick Quiz
How many steps do Americans walk on average
a day?
A. 8,000 to 10, 000 steps
B. Less than 3000 steps
C. About 5000 steps
D. More than 10, 000 steps
Exercise Stats
� 75% of adults said being in shape and looking good are important
� 31% make exercise a regular habit
� Average walking steps per day4,700 (little over 2 miles)
� 20% of American meet the 150 min/week target
www.stateofobesity.org
Quick Quiz
How many hours a day do kids spend in front of
a screen?
A. About 3 hours
B. 5 hours a day
C. 7 hours a day
D. The number is on the decline
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Physical Activity Stats – Kids
� 1 in 3 children are physically active
� 80% of kids do NOT meet aerobic, muscle-strengthening activities guidelines
� Children spend 7+ hrs a day in front of a screen
� 20% of homes have parks or recreation centers w/in ½ mile
� Only 6 states (Illinois, Hawaii, Massachusetts,
Mississippi, New York and Vermont) require PE President's Council on Fitness, Sports & Nutrition –www.HHS.gov 2013
Environment Influences Activity
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Quick Quiz
What is the most active state in the country?
A. Colorado
B. Oregon
C. California
D. New Mexico
www.stateofobesity.org
Current State of InActivity
� Average sitting time a day –
“Sitting Disease”
� 10 hours a day (office
worker)
� Goal – stand up at work
for at least 2 hours a day,
then work up to light
activity 4 hours a day
� Metabolism slows down 90%
after 30 min sitting – just
getting up for 5mins helps
� WHO estimates 95% of
the world’s adult
population does NOT
meet target of 30mins
activity a day
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Sitting Disease leads to
� 2xs risk of diabetes
� 15% increased risk of
cardiovascular disease
� 13% increased risk of
cancer
� 17% increased risk of
dying
Body Image and Keeping Healthy
� Body dissatisfaction is not the best motivator.� If that is motivator, most people
won’t stick with it.
�Keeping healthy is the BEST motivation� Better chance of sticking with it
� Poor body image can keep people from exercising, especially women
People are more likely to keep active
� Motivated by keeping healthy
� Benefits are beyond physical
� Host of psychological benefits� More energized
� Less stressed
� Encourage exercise to promote well being
� These effects keep people on track
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A hard truth
� Exercise alone doesn’t cause weight loss
� But….� It helps keep weight off
� Decreases visceral fat
� Decreases CV Risk
� To combat obesity, we need to change the food environment
� “You cannot outrun a bad diet”.
Definitions
� Sedentary behavior� Little on no movement or physical activity
� Physical activity� Bodily movement produced by the
contraction of skeletal muscle that requires more energy than when resting
� Exercise� Subset of physical activity that is planned,
structured and includes repetitive body movements
� Performed to improve or maintain physical fitness
Where are (you) your patients on
this continuum?
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After dinner stroll “Passegiatta”
� Walk 10-15 minutes after
dinner (and other meals if
possible)
� Maximize the walking benefit
� Get the most BG lowering
effect
� Especially after high carb meals
Diabetologia, Oct 2016.
Each minute of activity lowers
BG by 1 point
� Each minute of exercise lowers BG 1 point
� 15 minutes of walking drops BG 15 points
� 30 minutes of biking drops BG 30 points
� 40 minutes of housework drops BG 40 points
� 50 minutes of walking and window shopping lowers
BG 50 points
Good Exercise Info / Quotes
� “Passagiata” –
take an after meal
stroll
� Exercise decreases A1c 0.7%
� No change in body wt, but 48% loss in visceral fat
� ADA PostGrad 2010
“Every minute of
activity lowers blood
sugar one point.”
“I don’t have time to
exercise, I MAKE
time.” Mike Huckabee
Page 8Diabetes Education Services© www.DiabetesEd.net
What Medication works best to
prevent and treat type 2 Diabetes?
This medication has been around since beginning of time, but lost popularity due to new life styles, technology and public transportation.
Major side effects: sore muscles, improved energy, less depression, increased strength and balance.
Main action: improved insulin sensitivity and one dose can lower blood glucose for up to 48 hours.
Dosing: Patients can use treatment on most days with instruction to gradually increase dose as tolerated.
What Medication works best to
prevent and treat type 2 Diabetes?
Cost: Free with or without a prescription. Actually, due to its effect on blood pressure and lipid reduction, it may end up saving money as the need for other medications diminishes.
Safety: Safe and effective for those at risk for diabetes and those diagnosed with diabetes.
Availability: Generic - Walking 30 minutes on most days. Designer brands: Dancing, Water Aerobics, Juggling, Gardening, Shopping ++
Benefits of Exercise and Diabetes
� Increase muscle glucose uptake 5-fold
� Glucose uptake remains elevated for 24 - 48 hours (depending on exercise duration)
� Increases insulin sensitivity in muscle, fat, liver.
� Reduce CV Risk factors (BP, cholesterol, A1c)
� Maintain wt loss
� Contribute to well being
� Muscle strength
� Better physical mobility
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Exercise decreases:
� Sleep apnea
� Diabetic kidney disease, retinopathy
� Depression
� Sexual dysfunction
� Urinary incontinence
� Knee pain
� Need for medications
� Health care costs
Importance of Exercise with Diabetes
� Vital component of prevention as well of the management of type 2 diabetes
� Greatest impact in improving metabolic abnormalities when started early (prediabetes, diabetes)
� Type 1 – emphasis on adjusting insulin to allow for safe participation in all forms of activity.
Exercise Standards
� Adults – 150 min/wk moderate
intensity
� over 3 days a week.
� Don’t miss > 2 consecutive days w/out
exercise
� Get up every 30 mins - Reduce
sedentary time
� T1 and T2 – resistance training 2 -3 xs
a week
� Flexibility and balance training 2-3 xs
a week (Yoga and Tai Chi)
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Physical Activity - Kids� Children should be
encouraged to engage
in at least 60 minutes
of moderate/vigorous
physical activity a day.
� Plus bone/muscle
strengthening 3 times
a week
Best Shake For People with Diabetes
From Debbie Nagata’s slide collection
Progressive Resistance exercise
� Improves insulin sensitivity
� Goal is 2 sessions a week
� Examples include:
� Exercise with free weights, wt
machines, resistance bands
� Each session consisting of
least:
� One set of five or more resistance
exercises using large muscle groups
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Resistance Training Guidelines
General Rules of Thumb
� Perform 2-3 Sets of 8-12 Repetitions, 2-3 Days a week
� If it hurts, stop. Talk to a physical therapist.
� If difficulty with balance, use a chair to stabilize
� Start slow with eventual goal of moderate intensity
� The last few repetitions should be slightly difficult
� Have fun
Squats
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Chicken wing
Flat Back Half Lift
Overhead punch
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curls
standing Half
Lift
Tricep challenge
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Quick Question
� Which of the following is an accurate exercise recommendations for people with diabetes?
� a. Exercise must be done daily for 30 mins to be effective
b. Must get stress test before starting an exercise program
c. Try not to miss more than 2 consecutive days of exercise
d. Incorporate resistance training 2 days a week
E. C and D
When to Consider Stress TestingPre-exercise medical clearance isgenerally unnecessary for asymptomaticindividuals prior to beginninglow- or moderate-intensityphysical activity not exceeding thedemands of brisk walking or everydayliving.
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Pre-exercise evaluation T2� In asymptomatic pts, routine
screening for CAD is not recommended.� Does not improve outcome as long as CVD
risk factors are treated.
� Assess CV risk factors annually� Dyslipidemia, HTN, smoking, positive
family history of premature coronary disease, and + albuminuria
� Candidates for advanced or invasive cardiac testing include:� Typical or atypical cardiac symptoms
� Abnormal resting ECG
Patients to discuss symptoms with provider
before starting exercise
� Chest pain and/or shortness of
breath
� Leg cramps that go away with rest
� Head, shoulder, neck and or back
aches.
� Any unexplained pain above the belt
line should be considered cardiac in
origin until proven otherwise.
Quick Question
� What are some exercise precautions
for people with diabetes? (multiple)
a. Carry some for of ID on you at all times
b. Always have a snack if BG <100
c. Look for signs of hypo for up to 24 hrs
after exercise
d. Carry a snack with you during exercise.
e. Let someone know your route
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Hypoglycemia Prevention Strategies
for Patients on Insulin/Secretagogues
� Carry carb snack
� Extra Carb in post exercise period
� Caution with alcohol post exercise
� Adjust carbohydrate prior to
planned activity:
� If using insulin and /or secretagogues
� BG < 90, consume 15 -30 gms
� BG 90-150, may need ~ 15gms(see ADA Exercise Position Statement, pg 2068)
Duration of Hypoglycemia Risk
� During exercise
� Immediately after exercise
� Post exercise late onset hypo
� More often in type 1
� More often at night
� Moderate to high intensity exercise
> 30 min
� 4 to 15 hours following an exercise
session
Hypoglycemia Prevention Strategies
� If planned activity, adjust insulin
in anticipation of activities
� Reduce insulin in post exercise
period
� Frequent monitoring in post
exercise period
� Pt to keep log to determine how
responds to different activities,
duration and intensity.
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How Exercise Saved my Life
� A brief testimonial by Beverly
Dancing offers special benefits� Offers physical and
cognitive stimulation
� Improves
neuroplasticity
� Mentally stimulating
� Reduce onset of
dementia
� Increase chances of
winning a Nobel Prize
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Exercise is best insurance policy� People who are active and
exercised regularly before their stroke were less likely to face disability after the attack, researchers say.
� “Body mass index was not a factor in predicting their level of disability after stroke”
� The research "provides additional evidence that regular exercise has health benefits that last into a person's future"
Andrew Rogove, M.D. Neurology, news release, April 5, 2017
Tips for Educators� Avoid use of the word,
“exercise”
� Help person identify how to get more active within the construct of their life
� Find a friend, a class, a gym
� Most popular activity (40%) training at a fitness center
� 30% jog, swim or play basketball
� 21% took yoga classes
� Do things that you enjoy
� Focus on your personal strengths
Behavior Change Strategies
� Five key techniques for success:
1. Prompt focus on past success
2. Barrier identification/problem-solving
3. Use of follow-up prompts
4. Provision of information on where & when to perform the behavior
5. Prompt review of behavioral goals.
Page 19Diabetes Education Services© www.DiabetesEd.net
Take Home Messages
� Make time for what’s really important
� Start your bucket list today
� Take risks
� Share your truth
� Walk into fear
� Do what you love
� Have fun
� Dance with your sword on
Thank You� Questions?
� Email [email protected]
� www.diabetesed.net