1. Exercise for Diabetes and Hypertension Based on NASM CPT Textbook & ACE CPT Textbook
© 2018 NPTI Colorado  | Slide 1 | Revision 7 (6/15/18) DM

2. Lecture Objectives Students should be able to:
Define CVD, heart disease, diabetes, and hypertension
Understand risk factors for each chronic condition
Understand the benefits of exercise for clients with diabetes and hypertension
Adhere to exercise guidelines and recommendations for diabetic and hypertensive clients

3. Cardiovascular Disease
Cardiovascular Disease (CVD) affects the heart and blood vessels
Leading cause of death across the globe
Accounts for 1 out of 3 deaths
Estimated costs associated with CVD currently exceed $329.7 billion
Expected to reach $749 billion by 2035
Heart disease, a type of CVD, directly affects the structure and function of the heart.
Coronary heart disease
Hypertension
Stroke

4. Heart Disease
“Life’s Simple 7” are health factors and behaviors that increase risk for heart disease
Diabetes
Hypertension
Smoking
Overweight/Obesity
Dyslipidemia
Nutrition
Physical inactivity

5. Diabetes and Hypertension
An estimated 9.1% of Americans are diabetic
3.1 % of adults are undiagnosed
Hypertension affects 45.6% of U.S. adults
The number of deaths directly attributable to hypertension increased by 10% in the past decade, accounting for 37.5% of all deaths in the U.S.
The alarming statistics reinforce the need for a PAR-Q, CVD risk classification, and a medical evaluation and/or medial supervision if warranted.

6. Diabetes and Hypertension
The answers to a PAR-Q and CVD risk factor assessment provide the personal trainer with important information for fitness testing and program design for clients with diabetes and hypertension. Recall the 8 CVD Risk Factors…

7. Risk Classification

8. Risk Classification

9. Diabetes and Hypertension
Physical activity is critical for the prevention and management of diabetes and hypertension
Recommendations and precautions vary depending on individual characteristics and health status.

10. Diabetes
Diabetes is a group of diseases characterized by high levels of blood glucose
Diabetes: fasting blood glucose level ≥126 mg/dL
Pre-diabetes: fasting blood glucose level mg/dL
Primary types:
Type 1 diabetes
Type 2 diabetes
Gestational diabetes (discussed later)

11. Type I Diabetes Type 1 diabetes: Accounts for 5-10% of all cases
Most common in youth, but can occur at any age
Insulin-dependent diabetes mellitus (IDDM)
Body’s immune system destroys pancreatic beta cells that produce insulin
Video: Type 1 diabetes

12. Type II Diabetes Type 2 diabetes: Accounts for 90-95% of cases
Non-insulin dependent diabetes mellitus (NIDDM)
Progressive load of insulin secretion usually along with insulin resistance
Frequent states of hyperglycemia
Video: Type II diabetes

13. Type II Diabetes Primary Goals: Glucose control Weight loss
Prevent hyper- and hypo-glycemia
Oral medication and less frequently, injectable medications
Weight loss
Weight loss through regular exercise and a healthy diet can improve or reverse the condition

14. Aerobic Exercise for Diabetes
Benefits of aerobic exercise:
Lower cardiovascular and overall mortality
In type I -increases cardiorespiratory fitness, decreases insulin resistance, and improves lipid levels and blood vessel functioning
In type II -reduces hyperglycemia, triglycerides, blood pressure, and insulin resistance
High-intensity interval training (HIIT) promotes skeletal muscle oxidative capacity, insulin sensitivity, and glycemic control

15. Resistance Training for Diabetes
Benefits of resistance training:
In type I -effect of RT on glycemic control is unclear
Minimizes risk of exercise-induced hypoglycemia
When performed in a single bout, performing RT first results in less hypoglycemia than when aerobic exercise is performed first
In type II - improvements in glycemic control, insulin resistance, fat mass, blood pressure, strength, and lean body mass

16. Exercise for Diabetes
In the absence of contraindications, exercise program guidelines match those used for inactive and overweight/obese clients
Maximizing caloric expenditure always a priority
Emphasize activities that use large muscle groups
For increased adherence, consider personal interests
Care must be taken when recommending walking
Prevent blisters by using gel insoles and polyester or blend socks

17. Exercise for Diabetes
150 min or more of light-to-moderate intensity on at least 3 days/week.
Can be performed in 10+ minute bouts
Avoid no more than 2 consecutive days without activity
2–3 sessions/week of resistance exercise on nonconsecutive days.
Flexibility training and balance training are recommended 2–3 times/week for older adults

18. Diabetes & Exercise
1. Review Table 16.8

19. Diabetes & Exercise
1. Review Table 16.7.

20. Physical Activity for Diabetes
Increase total daily incidental (non-exercise) physical activity (i.e. errands, household tasks, dog walking, gardening, etc.) for additional health benefits
Increased daily energy expenditure
Weight management 
Decreased hyperglycemia and improved glucose control after meals

21. Any questions?

22. Hypertension
Blood pressure is defined as the pressure exerted by blood against the walls of the blood vessels.
Factors affecting blood pressure:
Strength of heartbeat
Elasticity of arterial walls
Volume and viscosity of blood
Health status
Age
Physical condition

23. Hypertension
Hypertension occurs when arterial blood pressure is consistently high
Hypertension is diagnosed by a doctor when a client has had two or more resting blood pressure measurements on separate days that include one of the following:
Systolic BP: ≥ 130 mm Hg
Diastolic BP: ≥ 80 mm Hg
Video: Hypertension

24. Blood Pressure guidelines updated in 2017
Hypertension
Blood Pressure guidelines updated in 2017

25. Hypertension Modifiable risk factors for hypertension: Smoking
Excess weight
High-sodium diet
Stress
Excessive alcohol consumption
Physical inactivity

26. Hypertension

27. Hypertension Hypertension treatment: Antihypertensive medication
Comprehensive lifestyle changes
Smoking cessation
Moderation of alcohol consumption
Supportive nutrition
DASH eating plan
Reduce sodium intake
Weight management
Daily physical activity and exercise

28. Exercise for Hypertension
Moderately intense physical activity, such as 30–45 min of brisk walking most days of the week, has been shown to lower blood pressure (~ 5-7mmHg).
Regular exercise may lower blood pressure, necessitating dose adjustment of antihypertension medications.
Low-to-moderate intensity aerobic training shown to be just as effective as high-intensity activity in reducing blood pressure.

29. Exercise for Hypertension
150 min or more of light-to-moderate intensity on at least 3 days/week.
Can be performed in 10+ minute bouts
Avoid no more than 2 consecutive days without activity
2–3 sessions/week of moderate-intensity resistance exercise on nonconsecutive days.
Warm-up and cool-down guidelines should be adhered to

30. Hypertension and Exercise
Personal trainers should:
Evaluate client’s heart rate response to exercise
RPE and talk test may be more reliable
Accurately assess both resting and exercise blood pressures
Monitor the body position of clients with hypertension at all times during a session
Supine and prone positions can increase blood pressure, making them potentially contraindicated
Keep in mind, hypo- and hypertensive responses to exercise are possible in clients with hypertension.

31. Hypertension and Exercise

32. Hypertension and Exercise

33. Recommended Readings American Diabetes Association Position Statement
American Heart Association
Exercise is Medicine for Hypertension handout (available in the document library)
CVD and Heart Disease handout
(available in the document library)

34. Any questions?