1. Exercise Prescription For Diabetes Robert Goldstein, MS; Health Educator Fitness Therapist Disease Management For Diabetes Health Fitness Instructor American College of Sports Medicine

2. Exercise Prescription For Diabetes Your Moderate Exercise Program Robert Goldstein MS; Your Optimum Program Getting Started 7 Major Components of Fitness 1) Warm up 2) Cardiovascular Fitness 3) Muscular Strength 4) Flexibility Fitness 5) Cool Down 6) Body Composition 2

3. Disclaimer Today’s Lecture is for Educational Purposes and not Medical Advice. If you have certain medically related issues you should speak to your physician. Please Check with your physician about starting an exercise program

4. Blood Glucose The Good The Bad and The Ugly Body Requires Glucose as Energy Source. Broken down from food breaks food down into sugar. Insulin is necessary to regulate glucose from blood into cells. High blood Sugar harms the body. May do eye, heart nerve and kidney damage.

5. What are the Types Of Diabetes? What are the Treatments? Type 1 Diabetes Pancreas has a total inability to produce any insulin Daily Insulin Injections 5 to 10% Of all diabetes Diet and Exercise

6. Type 2 Diabetes The Most Common Pancreas is able to produce insulin but not enough to register with cells. 90% of all Diabetes Treated with oral medication. People over 40. High BMI or family history. Diet and Exercise!!!

7. Gestational Diabetes Develops During Pregnancy Develops in up to 5% of all Pregnancies. May disappear after birth. Large risk in future to develop type 2.

8. Childhood Diabetes May be first generation to not live longer than parents Often genetic 200,000 cases nationwide Large % have type 1 10 to 15 % children overweight Type 2 more prevalent Diet and Exercise Now!! Juvenile Diabetes Walking Away From Disease And Disability

9. Pre-Diabetes Time To make Change Your Wake Up Call 1) Blood Glucose Higher than normal. Positive for metabolic syndrome risk factors. High risk to develop type 2 diabetes. Estimated 54,000,000 Americans; many not diagnosed Diet and Exercise Now!

10. Benefits Of Moderate Exercise And Diabetes Benefits Of Exercise 1) Weight Loss 2) Lower Blood Pressure 3) Reduce Risk for Heart Disease 4) Improve Cholesterol Ratios 5) Control Blood Sugar 6) Reduce Back and Joint Pain 7) Improve Balance 8) Reduce Medications 9) Increase Self Confidence 10) Reduce Risk For Fall

11. Warm Up 1) Reduce risk for injury 2) Gradual increase of pressure and heart rate. 3) Increases circulation in legs. 4) Warms Muscles. 5) Types of Warm up Light Walking Light Cycling Balance Exercise Movement and Light Stretching 5 to 10 minutes

12. Cardiovascular Fitness 1) The heart, lungs and blood vessels deliver adequate supply of oxygen to large working muscles. 2) Also called aerobic fitness uses the oxygen pathway. 3) Examples- Walking, Cycling, Swimming,, Recumbent Step Machine. 4) Perform 3 to 5 times a week. May be done in short bouts or duration.

13. Risk Factors for Heart Disease 1)Family History of Heart Disease. 2) High Blood Pressure 140/90 0r above. 3) Sedentary Lifestyle. 4)High Cholesterol over 200 Low HDL under 35. 5) Cigarette smoking or those who have quit within the past 6 months. 6) Impaired Fasting Glucose over 100. 7) Obesity BMI over 30 and Men’s waist 40” Woman’s 35” 8) Age 45 0r over.

14. Muscular Strength and Endurance Strength Training 1) Helps to maintain lean body weight and muscle mass. 2) Perform 2 to 3 times a week with a day rest in between. 3) Light Dumbbells, Thera- Band, rubber tubing. 4) Exercise within range of motion without pain or excessive weight. 5) Start with one set of 10 until mastered and increase to two sets. 6 ) Extremely important and helpful in reducing blood sugar.

15. Flexibility 1) Flexibility Decreases after the age of 25. Increasing risk for injury. 2) The biggest reason for missing work after the common cold is low back pain. Stretching 1) Best when muscles are warm; during and after workout. 2) Static Stretching. Holding Stretch for 30 seconds on each side. 3) Only stretch to comfortable range of motion increasing as muscle allows.

16. Cool Down 1) Brings Blood Pressure and Heart rates down gradually. 2) Aids in preventing muscle stiffness or soreness. 3) Prevents pooling of blood and promotes adequate flow to muscles and heart. Increases circulation. Slow Walking Stretching Slow Movement

17. Blood Sugar Levels for Exercise Goal is to avoid hypoglycemia for people who exercise. Type I may have larger drops with exercise and risk for hypoglycemia Type II Lower risk of hypoglycemia but still possible Dizziness, Headaches, Weakness Headache, Pale Skin Initially check blood sugar before and after exercise Light snack as crackers, rice cakes, pretzels are of low caloric content and can help raise blood sugar.

18. How Hard do I Need to Work A great question 1) Very individual prescription. 2)Heart rate % method 220 minus age. Safety is number one concern. 3) Full evaluation of your medical history, medications, surgeries and orthopedic conditions. 4) Doctors approval and contraindications. 5) The good news, you can exercise even if you don’t think you can and if you never did before.

19. Intensity Exercise Prescription 1) Mode – Type of exercise. Determined on an individual basis. 2) Intensity – How hard do I work. Workload. Starting low and graduating when perfecting current intensity. 3) Duration – How long. Also based on individual needs. Short bouts to start. 4) Frequency – How many days per week,

20. Rated Perception Of Exertion and Meds 1) Beta blockers, Alpha blockers, Calcium Channel and Diuretic Medications blunt heart rate and blood pressure. 2) With this in mind heart rate end blood pressure will not be the best indicator of how hard you work. RPE Borg Scale 6 7 very Very Light 8 9 very light 10 11fairly light 12 moderate 13 somewhat hard 14 15 hard 16 17 very hard 18 19 very very hard 20

21. Other Methods of Rating Intensity 1) The talk test- You should be able to carry on a conversation while exercising. The Reggie test – Get a 4 month old puppy and work until exhaustion 2) Evaluating Range of Motion. Stopping when feeling pain. 3) The no pain no gain mentality is not appropriate. You should not feel pain. 4) If you are feeling pain you are possible hurting yourself and preventing improvement.

22. Body Composition Body Composition and Risk for Heart Disease. 1) Body Mass Index. 2) Body Fat Percentage. 3) Waist Hip Ratio. 4) Circumference Measurements

23. Weight Loss Taking it Slow How Weight Loss Works. 1) Negative caloric expenditure. 2) Negative expenditure thru diet and exercise. 3) 3500 calories one pound. 1 pound a week is a reasonable weight loss. 4) Eliminate about 250 calories per day thru diet 5) Another 250 calories through exercise.

24. How Can I Start Stages of Change Pre-Contemplation Contemplation Action: The Fierce Urgency of Now!! Maintenance Relapse

25. Smart Goals KISS Specific Measurable Attainable Realistic Timely

26. Reduce Risk factors for Heart Disease Modifiable Risk factors Cigarette Smoking Hypertension Hypercholesterolemia Impaired Blood Glucose Obesity Sedentary Life Style Stress

27. Pre and Post Exercise Blood Sugar Averages 1 Year Pre exercise 140 Post Exercise 100

28. Exercise Levels Start and 20 Sessions On Treadmill Starting Session 1.4 MPH 0% Grade 20 Sessions 2.9 MPH 0% Grade 48% Increase in Workload

29. First Session and 20 th Session Aerobic Time Minutes Session One 9 Minutes Total 3 Minutes Bike 3 Minutes Treadmill 3 Minutes Bike Session Twenty Total Time 29 Minutes 14 Minutes Bike 15 Minutes Treadmill 300% increase

30. Thank You Very Much Ready eXercise Robert Goldstein MS Exercise Physiologist readyexercise.com 925-457-5346