POPULATION OF INTEREST: DIABETICS JOINT/MUSCLE GROUP: QUADRICEPS EXERCISE ROLODEX

CONCERNS/LIMITATIONS: ▪ Exercise is key to controlling type II diabetes. Exercising helps lower blood glucose and improves the body’s efficiency at moving glucose into the cells where it can be used as fuel. In a study performed by researchers at the University of Calgary and the University of Ottawa, they found that a combination of resistance training and cardiovascular training was the best at lowering A1C levels. The A1C is a laboratory blood test for people with diabetes which measures the average of the extra glucose in your blood during the last 2 to 3 months. In short, in indicates your long term blood sugar (Song, 1). ▪ To create the largest possible effect we want to utilize large amounts of muscle mass, for this reason it is good to start with the lower body, ie. The quadriceps group and the lower body in general. Many type II diabetics are overweight and sedentary so it is important to introduce them to exercise slowly. In addition to that, diabetics also tend to have microvascular disease from their condition. This happens from elevated blood sugar levels and poor blood flow which can result in loss of function in the extremities or even amputation (American Diabetes Association). ▪ To prevent this from happening we want to get these people moving, to improve the uptake of blood glucose which will reduce damage to the circulatory system and increase blood flow. Exercising using the large muscles of the legs will increase blood flow to the entire body and especially to the toes and feet so we can keep the cells alive and healthy and avoid amputation or nerve/tissue damage. Sources: American Diabetes Association. 6/7/2010. DIABETES BASICS. American Diabetes Association. Retrieved from Song, Sora. 9/17/2007. STUDY: THE BEST EXERCISE FOR DIABETES. TIME Health & Family. Retrieved from

EXERCISE PROGRESSIONS ▪ Step 1: Walking: walking will build up the cardiovascular system and give a basic strength to the legs, this is where you should start when you are at a very low fitness level. Continue to walk even when you start doing the other leg exercises in your routine, they compliment each other. ▪ Work up to 30 minutes, every day. ▪ Step 2: Jackknife Squats: These are a good movement to start practicing loading the legs in a bent position, the upper body will be able to assist quite a bit, lessening the load on the legs. ▪ Start with 1 set of 10 repetitions, work up to 3 sets of 30. ▪ Step 3: Upright Assisted Squats: Similar to step two but now you cannot rely on the arms nearly as much, now they only assist your balance. Work into a deeper squat position as time goes on, but pay attention to your knees tracking over your ankles but staying behind your toes, and heels on the ground. ▪ Start with 1 set 10 repetitions, work up to 3 sets of 20. Jackknife Squats Upright Assisted Squats

EXERCISE PROGRESSIONS CONTINUED ▪ Step 4: Half Squats: Now it is time to use your entire bodyweight, but to start, don’t go down all the way, just half way. If you can, increase your depth over time but focus on nice controlled movements and go to 90 degrees at the knees. ▪ Start with 1 set of 10 repetitions, work up to 3 sets of 20. ▪ Step 5: Assisted Backward Lunge: These will start to work one leg more than the other, which will be similar to adding resistance. It will also challenge your balance since you will be changing your stance. Whatever you use for balance, place it on the same side as the stepping leg. Use your prop for balance so you don’t fall, but don’t rely on it for strength, keep the weight in your legs. Do all of your reps on one side then switch. ▪ Start with 1 set of 10 repetitions for each leg, work up to 3 sets of 20 each leg. Half Squats Assisted Backward Lunge

EXERCISE PROGRESSIONS CONTINUED ▪ Step 6: Assisted Forward Lunge: This is the same as the last exercise but now you want to step forward instead of backward. Start with your arm extended toward your support (a chair) while in your stance then step forward, when you come back to your starting position it will be more difficult than before, it will require more quadriceps activation from the front leg. Do all of your reps on one side then switch. ▪ Start with 1 set of 10 repetitions for each leg, work up to 3 sets of 20 each leg. ▪ Step 7: Walking Lunges: We have now come full circle back to walking. Now we will use the lunge to move continuously in a straight line. Step out into a lunge, then bring the back foot forward into your new stance, next take a step out with the opposite leg you used last time. This pattern is similar to walking, only with much more exaggerated steps. Once you have mastered this movement, feel free to hold onto some light dumbbells, hanging at your side, to increase resistance. ▪ Start with 1 set of 10 steps (5 reps each leg), work up to 3 sets of 30 continuous steps (15 each leg). Assisted Forward Lunge Walking Lunges