1. بسم الله الرحمن الرحیم

2. Role of Physical Activity on Diabetes and Cardiovascular diseases Isfahan University of Medical Sciences Faculty of Rehabilitation Sciences Dr Javid Mostamand

3. Physical Activity Is Like Magic for Type 2 Diabetes and Cardiovascular Diseases

4. ورزش و سلامت تاثير ورزش بر سلامت جامعه ورزش نياز فيزيولوژيك تلاش براي همگاني كردن ورزش تحرك رمز سلامتي.....دوره جنيني ورزش وجراحي هر 5ثانيه يك نفر به ديابت مبتلا مي شود هر كيلو گرم افزايش وزن 5% افزايش خطرديابت ورزش وبيماري هاي قلبي عروقي

5. Proportion of disease prevalence attributable to obesity Type 2 diabetes Hypertension Coronary heart disease Gallbladder disease Osteoarthritis Breast cancer Uterine cancer Colon cancer 57% 17% 30% 14% 11%

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7. What Can Physical Activity Do For Us? Give us more energy

8. What Can Physical Activity Do For Us? Help us lose weight and keep it off

9. What Can Physical Activity Do For Us? Increase flexibility and strength Slow bone loss Provide better quality of life

10. What Can Physical Activity Do For Us? Build muscle

11. What Can Physical Activity Do For Us? Lift our mood Treat depression Reduce stress and anxiety

12. What Can Physical Activity Do For Us? In Diabetes type 2 Improve blood glucose control (lowers Hemoglobin A1C)

13. Physical activity lowers blood glucose in type 2 diabetes by helping: muscle cells become more sensitive to insulin keep the liver from producing too much glucose build more muscle We lose weight and keep it off

14. What Can Physical Activity Do For Us? Keep our heart healthy

15. Physical activity helps our heart by: Strengthening heart muscle Lowering resting heart rate Lowering blood pressure Improving cholesterol Reducing risk of heart attack and stroke

16. “Sitting” through life increases our risk of: heart disease high blood pressure high cholesterol overweight type 2 diabetes

17. We now must plan physical activity into our schedule

18. Getting Started Check with our doctor if we:  Are over age 35  Have had diabetes more than 10 years  Have high blood pressure, heart disease, poor circulation, or other diabetes complications

19. Aerobic Activity Walking briskly Bicycling Hiking Jogging/running Skating Stair climbing Swimming Water exercise

20. Health Benefits of Physical Activity: Strong Evidence Lower risk of:  Early death  Coronary heart disease, stroke  High blood pressure  Type 2 diabetes  Cancers: Colon and Breast Prevention of weight gain Weight loss (with reduction of caloric intake) Prevention of falls Depression, cognitive function (older adults) 20

21. Children and Adolescents Ages 6-17

22. 22 Children and Adolescents (ages 6-17) 60 or more minutes of physical activity daily  Aerobic: Most of the 60 or more minutes per day should be either moderate- or vigorous-intensity aerobic physical activity. Include vigorous-intensity physical activity at least 3 days per week.  Muscle-strengthening: Include muscle- strengthening physical activity on at least 3 days of the week, as part of the 60 or more minutes.  Bone-strengthening: Include bone-strengthening physical activity on at least 3 days of the week, as part of the 60 or more minutes. Encourage participation in physical activities that are:  Age appropriate, enjoyable, and offer variety

23. Adults Ages 18-64

24. 4 Key Adult Guidelines Avoid inactivity Substantial health benefits from medium amounts of aerobic activity More health benefits from high amounts of aerobic activity Muscle-strengthening activities provide additional health benefits

25. Inactivity? “All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.”

26. Substantial Health Benefits Guideline “For substantial health benefits, adults should do:  at least 150 minutes (2.5 hours) a week of moderate-intensity aerobic activity OR  75 minutes (1.25 hours) a week of vigorous- intensity aerobic physical activity OR  an equivalent combination of moderate- and vigorous-intensity aerobic activity.” “Aerobic activity should be performed  in episodes of at least 10 minutes,  And preferably, it should be spread throughout the week.”

27. Additional & More Extensive Health Benefits Guideline “For additional and more extensive health benefits, adults should increase their aerobic physical activity to: “For additional and more extensive health benefits, adults should increase their aerobic physical activity to:  300 minutes (5 hours) a week of moderate- intensity,  OR  150 minutes a week of vigorous-intensity aerobic physical activity  OR  an equivalent combination of moderate- and vigorous-intensity activity.”

28. Muscle-Strengthening Guideline “Adults should also do muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.”

29. Comments on Muscle-Strengthening Guideline Requires moderate to high level of intensity or effort:  Relatively few repetitions (e.g. 8-12)  If do resistance training, 1 set sufficient At least 2 days a week Major muscle groups:  legs, hips, back, chest, abdomen, shoulders, arms

30. Knee Strengthening Exercises

32. Hip Strengthening Exercises

33. Back Strengthening Exercises Birddog (Opposite Arm and Leg Extension), Bridge, One-Leg Bridge, Plank

34. What about Flexibility Activities? Flexibility activities are acceptable  Flexibility activities are usually part of exercise programs  Flexibility is a component of fitness  People need sufficient flexibility to be active  Flexibility activities, like stretching, do increase flexibility

35. Back Stretching Exercises

36. Older Adults Ages 65+

37. Key Older Adult Guidelines The 4 key guidelines for adults apply to older adults, but there are 4 additional qualifying guidelines  Guideline for adults who cannot do 150 minutes/week  Balance exercise  Only use relative intensity to determine the level of effort  Chronic conditions and injury risk

38. Guideline for Older Adults Who Cannot Do 150 Minutes/Week “When older adults cannot do 150 minutes of moderate- intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.” Comment:  For example, physical activity has a beneficial effect on functional limitations in older adults, meaning adults with limitations should be active as their abilities allow

39. Balance Exercise Guideline “Older adults should do exercises that maintain or improve balance if they are at risk of falling.” Comment:  Insufficient evidence to make this a general guideline for all older adults  Research has studied mainly exercise programs, and hence guideline uses “exercise.”

40. Resistance Activities (for diabetes) “Push, Pull, and Lift” Activities  increase muscle strength  prevent falls  increase mobility  improve blood glucose control

41. Stretching Improves our balance and coordination Make us more flexible Reduces stiffness Reduce our risk of injury

42. How Can we Begin? Choose activity (example: brisk walking) Set a long-term goal - at least 30 minutes a day, 3-5 days a week Buy comfortable walking shoes

43. Gradually Increase Activity Beginning Exercisers: First Week - 3 times a week Morning: Walk 5-10 minutes Lunch: Walk 5-10 minutes After dinner: Walk 5-10 minutes Keep track of how long and how far you walk each day

44. Keep Track of Our Steps Use a pedometer Keep track of how many steps you normally take in a day for one week Gradually add 500-1,000 steps a day Set a goal of at least 3,000 to 4,000 steps more than your baseline

45. Vary Your Activities MondayTuesdayWedThursdayFriday WalkSwim/ Water Aerobics WalkSwim/ Water Aerobics Walk MondayTuesdayWedThursdayFriday Exercise bike Aerobic class Exercise Bike Aerobic Class Exercise Bike

46. Effect of Physical Activity on Blood Glucose Depends on:  our blood glucose level before we exercise  diabetes medication  when and how much we ate last  our physical fitness  type of activity

47. Effect of Physical Activity on Blood Glucose Blood glucose checks before and after exercise are the key

48. Effect of Physical Activity on Blood Glucose Physical activity usually lowers blood glucose Physical activity can raise our blood glucose if:  our BG is >250 mg/dl before our exercise and we have ketones  we’re starting a new vigorous exercise program

49. Exercising With Heart Disease Caution: Very strenuous activity Heavy lifting or straining Exercise in extreme cold or heat Choose: Moderate activity such as walking, swimming, biking, gardening Moderate lifting, stretching

50. Exercising with Hypertension (high blood pressure) Caution Very strenuous activity Heavy lifting or straining Choose Moderate activity like:  walking  weight lifting with light weights  stretching Make sure your blood pressure is in control first

51. Exercising with Neuropathy (nerve disease) Caution Weight-bearing, high impact, strenuous, or prolonged exercise:  jogging/running  step exercise  jumping  exercise in heat/cold Choose Low impact, moderate activities:  biking  swimming  chair exercises  stretching  light to moderate daily activities Check feet after exercise

52. Exercise Safely (Diabetes) Check your blood glucose before and after exercise Don’t exercise if your blood glucose is too high or too low Carry carbohydrate to treat low blood glucose if you are at risk

53. Exercise Safely (Diabetes) Stop exercising if you feel pain, lightheaded, or short of breath Avoid strenuous activity in extremely hot, humid, or cold weather Wear proper shoes for the activity to reduce the risk of injury

54. Exercise Safely (Diabetes) Wear diabetes identification Drink plenty of fluid

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