Physical Activity and Diabetes Welcome participants and ask how they are doing supporting each other. Remind them: When a person has diabetes, their blood glucose level is too high. Taking part in physical activity is one of the ways to manage your diabetes. Managing your diabetes will lower your risk for heart disease and problems with your kidneys, eyes, nerve, feet and teeth. UNIT 1, LESSON 3 Physical Activity and Diabetes

Objectives At the end of the lesson, participants should be able to: Describe the importance of physical activity for people with diabetes State the recommendations for physical activity State the types of physical activity Describe how to safely engage in physical activity Describe feelings and experiences of living with diabetes Identify ways to modify everyday recipes to fit into the diabetes meal plan Read and briefly describe objectives to participants.

L-esson

Physical Activity and Diabetes Physical activity plays an important role in the life of a person with diabetes If you have diabetes, physical activity can: Help control your blood glucose and blood pressure Help your body use insulin better Help control your weight Protect against heart disease and stroke Improve mood and self-esteem Reduce stress Ask participants if they are aware of all the benefits of physical activity. You can also mention that physical activity can help prevent type 2 diabetes. One particular study, by the Diabetes Prevention Program, showed that if a person who weighs 200 pounds loses 10 to 15 pounds, he or she could delay or even prevent the onset of type 2 diabetes. Tell participants they can look at Factsheet – Physical Activity and Diabetes – FCS3-541 as you go through the lesson. This should be in their folders.

Types of Physical Activity Lifestyle activities Endurance exercises Moderate endurance or aerobic exercises Vigorous endurance or aerobic exercises Strength-building exercises Balance exercises Stretching exercises Let us look at the types of physical activity.

Lifestyle Activity This type of physical activity requires that you be active each day This is a good place to start if you have not been very active previously Some examples include: Playing with children or grandchildren Parking at the end of the parking lot and walking to your destination Washing the car Taking the stairs instead of the elevator These activities are lifestyle focused. They rarely require medical clearance from a doctor, and they do not require special training.

Moderate Endurance Exercises Examples include: Walking Jogging Bicycle riding (stationary or outdoors) Swimming Water aerobics Hiking Ask which of these exercises participants prefer to do on a regular basis.

Moderate Endurance Exercises Examples include: Aerobic exercise classes Dancing Tennis Golf Gardening, such as raking or pushing a lawnmower Question: How do you know if an activity is of moderate endurance or intensity? Answer: The talk test is a simple way to measure relative intensity. As a rule of thumb, if you're doing moderate-intensity activity you can talk, but not sing, during the activity. Remember to start slowly and build up your endurance.

Vigorous Endurance Exercises Examples include: Climbing stairs or hills Brisk bicycling uphill Shoveling snow Digging holes Question: How do you know if an activity is of vigorous endurance or intensity? Answer: The talk test is a simple way to measure relative intensity. As a rule of thumb, if you're doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.

Strength-Building Exercises Examples include: Exercises using exercise bands, weight machines, and hand-held or free weights Callisthenic exercises (body weight provides the resistance to movement) Digging, lifting, and carrying as part of gardening Carrying groceries Some yoga or Tai Chi exercises Strength-building exercises make it easier for you to do chores. These exercises strengthen your bones, and they improve balance and coordination. Some strength-building exercises, such as heavy lifting, can increase the blood pressure in the vessels of the eyes. You should check with your doctor before you begin these and other related exercises.

Balance Exercises Strengthens the lower body Can be done anywhere and at any time These exercises are especially helpful for people with diabetes due to possible neuropathy, which can cause muscles to respond less effectively and increase the risk for falls. Read information on slide.

Type of Balance Exercises Standing on one foot Walking heel to toe Balance walk Back leg raise Side leg raise Hip extension Use Factsheet – Don’t Let a Fall Get You Down – FCS7-193 as a reference. Demonstrate some of these balance exercises. Participants can find this factsheet in their folders.

Stretching Exercises Examples include: Shoulder rolls Arms and back stretch Side lunge Lower leg stretch Stretching exercises help you to become more flexible, helps lower stress levels and prevent muscles from becoming sore after you have exercised.

How Much Physical Activity? The American Diabetes Association (ADA) makes recommendations for individuals with Type 2 Diabetes: Moderate endurance exercises: 150 minutes or 2 hours and 30 minutes each week OR Vigorous endurance exercises: 75 minutes or 1 hour and 15 minutes each week This could mean walking briskly for 30 minutes on five days of the week. On each of these five days you can divide your 30 minutes of physical activity into 15 minutes in the morning and 15 minutes in the evening or in a way that works best for you. Physical activity could also be broken up into 10-minute segments. Let participants know that some physical activity is better than no physical activity. True or false: If you have not been physically active before or if you have not been meeting these requirements, you can start out slowly. Answer: True Ask: How can you meet the requirement for physical activity? What barriers do you face when starting to become active and how can you overcome these?

Guidelines for Starting Exercise Obtain medical clearance from your doctor before beginning any exercise program Read information on slide.

Guidelines for Starting Exercise Avoid strenuous activity if you have: Blood pressure higher than 180/100 mm Hg Active eye damage (proliferative retinopathy) Recent laser eye surgery Recent foot problems or no feeling in hands or feet Heart problems Over age 40 Over age 30 with 10 or more years since diabetes diagnosis Read information on slide. Tell them: mm Hg = millimeters of mercury (standard unit for blood pressure)

Guidelines for Starting Exercise Have a consistent exercise schedule Include the different types of exercises Exercise at least 2 times per week Exercise for at least 20 minutes at a time Each person’s plan needs to be individualized based on: (a) Age; (b) Weight; (c) Medical history; (d) Fitness level; (e) Personal goals. Work with your doctor to: (a) Select the type of exercises; (b) Set exercise schedule (how often). In a physical activity log, record the following information for each session: (a) Blood glucose level at 20 minutes before and after exercise; (b) Type, duration and intensity of exercise; (c) Any strange symptoms, such as: pain, dizziness or shortness of breath.

Guidelines for Starting Exercise Start with a little exercise and as you become stronger, you can add a few more minutes to your plan It is better to walk on several days each week than doing it all on one day If you feel pain, slow down or stop to wait for it to go away If the pain returns, talk to your doctor as soon as possible Choose an activity you really enjoy so that you are more likely to continue with it. Walking, doing yard work and dancing are good ways to start exercising. Bring a friend or family member to make it more fun. Ask participants: How physically active they are at this present time? What are some of the consequences of not being physically active? What are your feelings related to starting an exercise plan?

Safety Tips Carry glucose tablets or a carbohydrate snack with you in case you begin to have low blood glucose Wear or carry an identification tag or card saying you have diabetes Drink plenty of water before, during and after exercise Ask participants why it is important to follow the safety tips for exercise.

Safety Tips Check blood glucose levels before, during and after exercise Do not exercise if blood glucose is: Below 70 mg/dL (hypoglycemia) Below 100 mg/dL (eat additional carbohydrates) Over 240 mg/dL or if you have ketones in your urine Do not exercise right before going to sleep because it could cause low blood glucose while sleeping If blood glucose is low, you should wait until it is up to at least 100mg/dL before exercising. Ketones in the urine signal insulin deficiency. High blood glucose due to insulin deficiency may increase with exercise. This mainly occurs in type 1 diabetes.

Diabetes Education Series: Physical Activity and Diabetes E-mpowerment Diabetes Education Series: Physical Activity and Diabetes At this time, show the Diabetes Education Series CD and select the section on “Physical Activity and Diabetes.”

Diabetes Education Series What are some of the benefits of participating in physical activity? What are some of the risks of participating in physical activity? What keeps you from being physically active? Allow time for participants to share their feelings and experiences.

A-ction Did you accomplish the goal you set last week? Set a goal to help you become physically active. One of the program goals is for you to reach the point where you are able to participate in 30 minutes of physical activity on five or more days during the week. 1. Ask participants how they did in accomplishing their goal from last week. For those who accomplished their goals, ask what actions were taken to be successful. Provide incentives for those who met their goals; (b) For those who did not accomplish their goals, ask if they took steps to meet their goals. If they did, acknowledge that they are moving in the right direction. 2. Move onto setting a new goal for this week. Talk with your participants about how goal setting can help them with diabetes management. 3. Tell participants to set a goal that they can accomplish in the upcoming week. 4. This week, the goal should be related to physical activity. 5. The participants can record their goals on the Goal Setting Worksheet (found in the Appendix for Lesson 1 and should be in their folders from last week). NOTE: Now is the time to introduce both the 9-Week Plan for Physical Activity and Physical Activity Record handouts. These will help participants achieve their goals for the upcoming week. 6. Discuss SMART goals. Is your goal Specific, Measurable, Action-oriented, and Realistic, and Time framed? 7. Select goals from some of the participants to share with the group.

R-eal-Life Problem Solving Cindy’s Story The answers to the PowerPoint questions can be found in the appendix for this lesson. Show the next slide as you read the story.

Cindy’s Story Cindy is 45 years old and has just been diagnosed with diabetes. She has not been feeling well for the last month. She realized that she had to get up in the night frequently to go to the bathroom and was always thirsty. Cindy always had a problem with her weight. In the past three years, she gained more than 45 pounds. She used to enjoy walking, but when her husband died she found herself not wanting to go out. She stays inside and watches television most of the day. Now that she has been told by her doctor that she has diabetes, she feels like it is a death sentence and at this point does not know how this could happen to her.

Questions about Cindy’s Story What is Cindy’s problem? Why is this a problem for Cindy? What are some things that Cindy needs to do to solve her problem? (List as many suggestions as possible.) What might be the best way to solve her problem at this point? Why? What is Cindy’s problem? She has gained a lot of weight in the past three years; (b) She has been diagnosed with diabetes; (c) She seems to be in denial; (d) She is living a life of inactivity (that does not help with her diabetes).   Why is this a problem for Cindy? Diabetes that is not managed could lead to complications such as eye disease, kidney disease, amputations, heart disease, and stroke; (b) Being inactive could lead to chronic diseases such as diabetes, heart disease, hypertension, and some types of cancers; (c) Depression could also accompany the diagnosis, leading to further inactivity and issues with blood glucose control. What are some things that Cindy needs to do to solve her problem? (List as many suggestions as possible.) Take steps to manage her diabetes. These steps could include: healthy eating with attention to portion sizes, being active, monitoring blood glucose, taking medications as prescribed, problem solving, reducing risky behaviors such as smoking, and healthy coping; (b) Find some new friends; (c) Join an exercise group; (d) Develop a diabetes health care team that include her physician, dietitian, nurse, certified diabetes educator, pharmacist, eye specialist, foot specialist, dentist, and/or social and mental health workers. What might be the best way to solve her problem at this point? Why? This answer may vary with participants. The goal is to have participants be able to justify their answer.

Questions about Cindy’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Cindy’s story The handout with completed answers can be found in the Appendix for this lesson. The handout for participants to complete will be in their folders. The questions can be completed as group work or take-home work.

N-utrition Menu: Kentucky Breakfast Wrap Sliced cantaloupe or fruits in season Skim milk Tell participants to find the Recipe: Kentucky Breakfast Wrap. Breakfast is an important meal for everyone, especially so for a person with diabetes to “break-the-fast”. It is important to eat meals at regular times. Whole wheat tortillas add fiber, slowing down digestion, so spikes in blood sugar do not occur. Raw vegetables help to fill you up, making the meal more satisfying. Tips: Garnish with two tomato wedges and a sprig of curly parsley. Make wraps ahead of time. Cover each with plastic wrap as much as three days before using. Leave wrap on and microwave on high for 30 seconds to 1 minute. You may not want to be chopping vegetables in the morning as you are getting ready for work. Many of the vegetables can be chopped in advance then kept in sealable containers. By having veggies pre-chopped, you are ready to toss them into salads and other dishes when you cook or snack. Read about egg substitutes. American Egg Board Encyclopedia. Accessed on October 25, http://www.incredibleegg.org/e_egg_substitutes.html

See you next week! Topic: Hemoglobin A1C Take control of managing your diabetes Take some time to allow participants to share what they learned this week. Allow the group to discuss ways in which they can support each other.

Author: Ingrid Adams, Ph. D Author: Ingrid Adams, Ph.D., Assistant Professor , Nutrition and Food Science, University of Kentucky Date: References: Other Contributors Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE   Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist