Physical Activity and Exercise

1
Physical Activity and Exercise
2
Objectives

• List 3 benefits of regular activity or exercise
• Describe the difference between aerobic and
  anaerobic exercise
• State effects of activity/exercise on blood
  glucose levels

3
Objectives

• State the benefits of a consistent exercise
  program
• Determine target heart rate
• State how to tell if it is suitable to inject
  insulin at a particular site

4
Objectives

• State possible signs and symptoms of hypoglycemia
  during and after exercise
• Describe when changes in a meal plan are needed
  to balance increases in physical activity
• Develop a personal exercise plan

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Benefits of Regular Exercise

• Exercise can
• Lower blood pressure and cholesterol levels
• Strengthen your heart and circulatory system
• Decrease body fat and increase muscle tone
• Helps you feel more relaxed
• Relives tension and stress
• Be something you enjoy

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Benefits of Regular Exercise

• While calories are burned with any exercise,
  regular exercise increases metabolism so more
  calories are burned all the time, even at rest.
• People often eat when stressed. Exercise lowers
  your level of stress and most people find that
  they eat less.

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Effects on blood glucose

• Activity will lower your blood glucose because
  body cells take in glucose more efficiently
• In type 2 diabetes, exercise may cause cells to
  be more sensitive to the effects of insulin,
  independent of weight loss.
• Exercise also reduces the amount of glucose
  released by the liver.

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Effects on blood glucose

• Regular exercise may reduce insulin requirements
• Initially, exercise may make blood glucose
  control more difficult, because exercise needs to
  be balanced with your meal plan and medicines.
  Try not to get discouraged planning, monitoring,
  and working with your health care team can help
  achieve this balance.

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Choosing an exercise program

• There are two types of exercise aerobic and
  anaerobic.
• Aerobic exercise uses oxygen to help release
  energy from fat cells.
• Anaerobic exercise does not use oxygen to burn
  fuel.

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Choosing an exercise program

• Choose an exercise you enjoy and will do
  regularly.
• One approach to exercise is the lifetime activity
  model. In this model, you accumulate a total of
  30 minutes of moderately intense exercise each
  day. Lower intensity exercises (e.g., light
  housework) can be more often or for a longer
  period of time.

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Choosing an exercise program

• The idea is to fit 10 minutes of aerobic physical
  activity into your usual routine, 3 different
  times every day.
• Another approach is a planned aerobic exercise
  program. Aerobic exercise is steady exercise for
  at least 12 minutes that increases the heart rate
  to at least 70 of maximum. This increases
  oxygen use.

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Choosing an exercise program

• Aerobic exercise burns glucose and fat and
  provides the greatest benefit for blood glucose
  and weight management.
• It also helps you to cope with stress and
  decreases hunger.

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Choosing an exercise program

• Activities such as bowling and baseball are not
  aerobic because long periods of inactivity occur
  between short spurts of activity.
• Anaerobic exercise helps build muscle tissue. It
  can cause stiff and sore muscles and hunger after
  exercise.

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Level and Duration

• Level of exercise is described as light,
  moderate, or strenuous.
• Light exercise for one person may be moderate
  exercise for someone else, depending on the
  persons level of fitness.
• Your own response to exercise will change as you
  grow stronger.

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Level and Duration

• Light exercise does not make you breathe heavily,
  but your pulse rate may increase slightly.
• Light exercise done for less than 10 minutes will
  not affect blood glucose done for longer than 10
  minutes, it can lower blood glucose.

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Level and Duration

• Moderate exercise involves noticeably heavier
  breathing, with a pulse rate increase to more
  than 100 beats per minute.
• Moderate exercise done for less than 10 minutes
  may raise blood glucose. If done for longer than
  10 minutes, it will lower blood glucose for a
  sustained period of time.

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Level and Duration

• Strenuous exercise involves rapid breathing with
  a pulse rate between 125 and 160 beats per
  minute, depending on age.
• Strenuous exercise done for less than 10 minutes
  may raise blood glucose. If done for longer than
  10 minutes, it will lower blood glucose for a
  sustained period of time.

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Level and Duration

• Another way to evaluate exercise is to determine
  your perceived level of exertion.
• Perceived exertion is a method of rating how hard
  you are working during an activity.

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Level and Duration

• As you exercise, decide what you believe your
  rate of exertion is, using a scale of very, very
  light to very, very hard.
• Aim to work out in the somewhat hard to hard
  range.

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Level and Duration

• If taking insulin, any level of exercise done for
  longer than 10 minutes will probably require a
  change in your diabetes program.
• Discuss any changes with your health care team.

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Level and Duration

• A complete exercise program includes aerobic
  activity, stretching, and weight-bearing
  activity.
• Exercise continuously for 20-40 minutes.

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Planning your exercise program

• See our health professional. Have any tests done
  that are recommended.
• Determine your target heart rate. This is the
  rate at which you should aim to exercise. Your
  target heat rate is 70-80 of your maximum heart
  rate.

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Planning your exercise program

• To calculate your maximum heart rate subtract
  your age from 220. Multiply by 0.7 to find your
  target heart rate.
• To achieve the greatest benefit for your heart,
  exercise at your target heart rate for at least
  20 minutes 3-4 times a week.

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Planning your exercise program

• People with other medical problems, such as heart
  disease or hypertension,or diabetes
  complications, such as retinopathy, need
  individually developed exercise programs.

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Planning your exercise program

• You may need different meal plans or insulin
  doses for different levels of activity on
  different days.
• For example, one plan for work days, one for
  weekends.
• Seasonal changes in activity levels may also
  require a change in insulin dose or a snack.

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Starting to exercise

• Insulin is absorbed more rapidly over a working
  muscle if injected within 30 minutes of exercise,
  which increases the risk for hypoglycemia.
• If you take insulin, give your injection over a
  muscle that will not be working.

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Starting to exercise

• Test your blood glucose.
• If your blood glucose is low (below 70mg/dl)
  before you begin exercise, treat the hypoglycemia
  and do not exercise at that time.
• If your blood glucose is high (above 240mg/dl),
  test your urine for ketones.

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Starting to exercise

• Do NOT exercise if
• Your blood glucose is over 240mg/dl and you have
  ketones in your urine.
• Your blood glucose is over 300mg/dl, whether
  ketones are present or not. Your blood sugar
  levels may raise even further.

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Starting to exercise

• Gradually warm up your muscles.
• Do low-intensity exercises.
• Then stretch for 5-10 minutes before you begin
  aerobic exercise.
• This helps prevent muscle cramps and injury.

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During aerobic exercise

• Wear diabetes and personal ID, appropriate shoes
  to avoid skin breakdown and take coins for the
  phone in case of and emergency.
• Take your pulse every 10-15 minutes to be sure
  you are working at your target heart rate.

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During aerobic exercise

• Do not overexert. You should be able to talk
  easily as you work out.
• Know the signs and symptoms of overexertion
  increased shortness of breath, nausea or
  vomiting, irregular heartbeat, excessive fatigue,
  feeling faint or lightheaded, and pain or
  pressure in the chest or arm.

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After aerobic exercise

• Gradually decrease your intensity and finish your
  exercise period with about 5 minutes of
  stretching exercises. This is called a cool
  down.
• Cool downs will help to prevent aches and muscle
  cramping later.

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After aerobic exercise

• Test our blood to determine the effect of
  exercise on your blood glucose level.
• Everyone has his or her own response to different
  types of exercise.

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Hypoglycemia and exercise

• Exercise uses up glucose in your blood and helps
  insulin work better. Because of this, exercise
  usually lowers your blood glucose.
• Know the signs and symptoms of hypoglycemia
  during exercise
• Undue anxiety or shakiness
• Changes in gait
• Changes in coordination
• Changes in your ability to think
• Changes in your vision

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Hypoglycemia and exercise

• Carry a source of sugar to treat low blood
  glucose.
• Effects of activity on your blood glucose can
  last for many (over 12-24) hours. It is possible
  to have a reaction up to 48 hours after
  exercising.

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Hypoglycemia and exercise

• If you take insulin, you may need extra food for
  extra activity.
• Extra activity means the body is working harder
  and/or longer than usual.
• You may need extra food when you are involved in
  any activity that is not a usual part of your
  day this includes things like raking leaves and
  washing windows as well as sports activities.

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Hypoglycemia and exercise

• Any activity (e.g., walking to the store) may be
  a usual activity (requiring no snack) for one
  person and unusual activity (requiring a snack )
  for another.
• Just being more active in the summer may require
  a change in medication or meal plan.

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Hypoglycemia and exercise

• Extra food (exercise snack) is usually needed
  only for people taking oral agents.
• Some patients may prefer to take a lower insulin
  dose rather than eat extra food.
• People who manage their diabetes with diet alone
  do not need extra food before exercise.

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Hypoglycemia and exercise

• If you exercise regularly and take insulin, you
  probably need to decrease your insulin dose on
  exercise days or eat an exercise snack.
• A dietitian can help you plan exercise snacks
  based on your blood glucose response to exercise
  and food.

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Hypoglycemia and exercise

• Avoid planning your exercise program for the time
  when your insulin is peaking.
• Exercising around the same time each day will
  make planning insulin changes and snacks easier
  and more consistent.

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Planning snacks for different levels of activity

• The harder your body works during exercise, the
  more glucose it uses.
• The amount and timing of exercise snacks depend
  on the intensity of the exercise, the duration of
  the exercise, and your individual response.

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Planning snacks for different levels of activity

• Carbohydrate foods, such as fruit, juice, skim
  milk,and bread, turn to glucose the quickest.
• The harder your body works during exercise, the
  more carbohydrate is needed.

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Planning snacks for different levels of activity

• A small piece of fruit, a cup of skim milk, or a
  piece of bread may be needed to prevent
  hypoglycemia for exercise lasting less than 30
  minutes.
• Snacks that contain mixed nutrients (protein,
  carbohydrate, and some fat), such as half a
  sandwich with meat or toast with margarine, help
  prevent low blood glucose when exercise is longer
  than 30 minutes, and are especially helpful when
  exercise lasts longer than 45 minutes.

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Planning snacks for different levels of activity

• Several small carbohydrate snacks taken about
  every 30 minutes during exercise may provide
  about the same effect as the time release
  action of a single combined carbohydrate,
  protein, and fat snack.

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Planning snacks for different levels of activity

• It isnt always possible to stop every 30 minutes
  to eat during exercise.
• To avoid low blood glucose, eat twice as much
  before starting, and extra food after finishing.

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Planning snacks for different levels of activity

• Monitor blood glucose levels to determine your
  individual response to an exercise snack.
• Your dietitian can help you plan exercise snacks.

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Balancing snacks with activities

• Everyone has his or her own response to exercise.
  
• Youll have to experiment at first with how much
  to eat for each particular level of activity.

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Balancing snacks with activities

• The best way to know if the food is adequate to
  balance with the activity is to test your blood
  glucose before and after exercise.
• If the activity lasts longer than 30 minutes,
  blood glucose should also be tested during the
  activity to monitor response.

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Balancing snacks with activities

• The timing of snacks varies from person to person
  and with different lengths and intensities of
  exercise.
• If your blood glucose is between 80180mg/dl,
  take your planned extra food before you begin,
  and do your exercise.

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Balancing snacks with activities

• If your blood glucose is 180-240mg/dl, no snack
  is needed before starting exercise, but it may be
  needed in 30-60 minutes or afterward.
• You may need to eat extra food several hours
  after you have exercised. The longer and more
  intense the exercise, the longer that glucose
  will be lowered after exercise has stopped.

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General information

• Drink plenty of water before, during, and after
  exercise, especially if you sweat a lot.
• You can lose up to 2 liters of fluid per hour of
  exercise.

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General information

• For longer periods of strenuous exercise, such as
  running, drinks with 60-80 calories (15-20gm
  carbohydrate) per 8 oz. Provide the best solution
  for fluid and carbohydrate absorption.
• Most sports drinks (such as Gatorade) meet this
  criterion, but juices and soft drinks may not.

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General information

• Alcohol and exercise dont mix well. Less
  glucose is available (effect of alcohol) and more
  is used (effect of exercise).
• Alcohol taken before,during,or after exercise can
  cause a low blood glucose reaction.

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Tips for staying with your exercise program

• Choose an exercise you enjoy and can easily do.
• Start slowly. Work up to more strenuous activity
  as you grow stronger.
• If possible, exercise with your spouse or a
  friend.

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Tips for staying with your exercise program

• Set aside the same time each day for your
  exercise. Make it a habit. Choose a time that
  does not coincide with the peak action of your
  insulin.
• Take a class, or join an exercise club. Many
  malls have walking clubs.

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Tips for staying with your exercise program

• Choose activities that dont depend on good
  weather, or plan activities for good and bad
  weather.
• Record your progress.
• Reward yourself for progress made.

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Tips for staying with your exercise program

• Contact your healthcare team if you have
  problems.
• They can help you plan your activity, diet, or
  medication changes, and solve any problems that
  might occur as you continue your exercise program.

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Reminder

• Illness or infection can affect your blood
  glucose control. Sick day plans need to be made
  with your health care team before illness occurs.