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Kitchener, Ontario,    519-572-0986    debbailey@rogers.com

 

 

 

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Diabetes and Exercise

 DIABETES AND EXERCISE

Health Canada reports that approximately 6.6% of Canada’s population, age 20 and older, have been diagnosed with diabetes, and researchers expect an increase to 2.4 million Canadian diabetics by 2016. Also, 6% of Canadian women 46-64 years old, have this disease, and that increases to 10% in the 65 and older group. A woman with type 2 diabetes has an 8 times greater chances of developing heart disease than a women without diabetes. These are sobering numbers, especially in view of the fact that much of that is preventable by making some lifestyle changes.

Some of the changes that will lower your risk of diabetes include: 

 1. stop smoking

 2. limit use of alcohol

 3. monitor blood pressure and cholesterol levels

 4. lose weight through a healthy diet – check out Health Canada for tips on healthy eating

 5. get active – physical activity plays a strong role in preventing type 2 diabetes.

Training with Diabetes

Exercise is a very important tool in diabetic care. The benefits of a diabetic person adding exercise to medical treatment include:

1. possible improvement in the blood glucose levels of type 2 diabetics

2. exercise can create an improved insulin sensitivity, which means that the type 2 diabetic might be able to reduce the amount of medications taken (always under advice of your doctor).

3. cardiovascular health improves, reducing the risk of cardiovascular diseases, not just for diabetics, but for everyone. About 80% of diabetics will die of heart disease or stroke.

People living with diabetes may be taking insulin or oral hypoglycaemic medications. Exercise often increases the absorption of injected insulin and so it’s very important to monitor blood glucose levels before, during, and after an exercise session. The most significant effect of both these kinds of medications is that they may cause hypoglycaemia during exercise testing and exercise training. So it is vital to keep a close eye on the timing of medication, food intake, and blood glucose levels.

Physical activity for diabetics without significant complications should include suitable endurance and resistance work. This can increase cardiovascular conditioning, muscle strength and endurance, and improve body composition, i.e., decreasing stored body fat and increasing lean muscle mass. Physical activity should include large muscle activities, such as walking, swimming and cycling. Strength training could include free weights, machines, or tubing. Consult Deb for programming specific to your individual needs.

 

A diabetic should not exercise if:

 

1. s/he has any active retinal haemorrhage, or has recently had treatment for retinopathy, such as laser treatment

2. is sick, or is suffering with an infection

3. blood glucose is above 14 mmol/L (250 mg/dl) and ketones are detected (blood glucose must be reduced before you engage in exercise)

4. blood glucose is lower than 4 mmol/L (70 ml/dl), because of the increased risk of hypoglycaemia. You may be able to eat some carbs to increase the blood glucose levels before exercise

A diabetic should also make sure that there are some carbs on hand during exercise. Drinking enough fluids before, during and post-exercise is important. Diabetics also need to exercise good foot care, checking the feet carefully after exercise, especially if there is damage to the nerves in the feet, or peripheral neuropathy.

 

Exercise and Parkinson’s Disease

 Exercise and Parkinson’s Disease

Parkinson's Disease (PD) is a chronic progressive neurologic disease that affects the part of the nervous system that controls muscle reflexes. It is believed that PD is caused by a reduction in dopamine, which is a neurotransmitter, and so the muscle reflexes are adversely affected. Over time, the person will likely experience slow movements (bradykinesia), a resting tremor, rigidity, and negative changes in his gait and posture.

PD is classified as early, moderate or advanced.  Someone newly diagnosed with early PD will experience only minor symptoms.  In the moderate stage, the person will start to show limitations in his movements, and have a mild to moderate tremor. Substantial limitations in activity, in spite of treatment, mark the advanced stage of PD. Exercise is not a solution to PD, but it will be helpful with balance and rigidity problems.

Some of the concerns with exercising with PD include the fact that rigidity affects a person's ability to move freely, including fingers and toes. He may also be unable to stand easily from a seated position, or to walk without shuffling. Freezing is also a challenge to carrying out exercise. Communication can also be quite affected, and the person with PD may not be able to speak clearly verbally, nor be able to use facial expressions to help communication, due to a loss of motor skills.

Since each person with PD has a unique set of symptoms and challenges, it's not really possible to list a universal set of rules for exercise. Sometime a person with PD has trouble with thermoregulation, because the autonomic nervous system is malfunctioning; and so becoming overheated during exercise is a common concern.  Freezing can make certain activities more challenging than others, as can the stooped-over posture (kyphosis) that is prevalent in persons with PD.

In spite of these challenges, there are several documented benefits to bringing exercise to someone with PD.  They may experience positive changes in motor performance, ability to rotate their trunks, hand-eye coordination, muscle size and strength, and better balance and stability.

Exercise may not have a significant impact on the specific symptoms of the disease, but appropriate exercise may help combat the effects of PD on the patient's muscle structure and cardiovascular health. Some of the recommendations include aerobic work three times a week, short supervised walks, as the person is able, 4-6 times per day. Strength training with light weights, 8-12 reps, three times a week, will help maintain the strength in the upper and lower body. Stretching up to three times a week will help maintain their ROM (range of motion), and help cope with the spasticity. Exercise can play an important part in retaining as much physical ability as possible. The trainer must be able to adapt exercises to the ability of the PD client on any given day. For instance, exercise in the pool is a good choice on a day when balance is less stable.

As with any condition, it is important to take medications into consideration when investigating exercise. Most medications have significant to minor side effects, such as confusion, poor sleep and gastrointestinal problems. Also, medications tend to lose their effectiveness over time, and each person will respond differently to different medications, thus changing the exercise response.  Some medications are metabolized in peripheral muscle, such as legs and arms, and that decreases the amount of medication going to the target, the brain. Therefore it is crucial to discuss with the medical staff the optimal time and level of exercise appropriate for that person.

Some people with PD have widely varied response to aerobic exercise, and this makes it hard to achieve their target heart rates. These people should also be monitored for any changes in symptoms that occur during exercise, as this may be a sign that there are changes in drug absorption. Choose a trainer experienced in this type of population, and ensure that there is frequent communication between the trainer and the medical staff.

 

Exercising with Osteoporosis

 Exercising with Osteoporosis

 Osteoporosis has become a part of our normal vocabulary these days; it seems we all know someone who has this significant loss of bone mass, or its precursor, osteopenia (low bone mass).

All of us experience some small degree of bone loss every year, after we’re thirty-five, but it is very common amongst older adults in industrialized countries. Once the bone begins to lose mass, it takes on a “honeycomb” appearance, and it loses its ability to withstand fracture. Seniors are much more likely than, say, a young adult, to sustain a fracture through a minor fall or even a sneeze.

More women seem to develop primary osteoporosis in their post-menopausal years, about 50-75 years old, due to the normal estrogen deficiency, and the rate of bone loss exceeds the rate of bone formation. This disease tends to show up in men in their 70’s. Secondary osteoporosis can develop because of various medications, such as ongoing prednisone (glucocorticoid) therapy.

But menopause and medication are not the only risk factors for this disease; some others are:

Low body mass index (BMI), being too thin

Not enough exercise, being sedentary

Smoking

More than 3 alcoholic drinks per day

Not enough Vitamin D (helps to absorb calcium into the bones)

Taking in too much protein, caffeine, sodium and Vitamin A

Diseases such as anorexia, bulimia, celiac disease and rheumatoid arthritis (RA)

 

People with this disease are likely to be quite deconditioned, due to their physical limitations and fear of injury and falling. However, regular physical activity, such as walking, aerobic activity and resistance training can improve the bone mineral density (BMD) in this population. Exercise also provides significant improvements in cardiovascular health, stronger muscles, and better balance. Stronger muscles also help safeguard bone mass.

 

Ideally, someone with osteoporosis should consult with both a physician and a personal trainer certified in dealing with exercise as treatment for this disease. An exercise program should include:

Exercises to improve balance

Exercises for the upper and lower body, and the core muscles – adaptations in bone are site specific, so all areas of the body must be worked

Core exercises that do NOT include forward flexion or twisting of the spine, such as crunches, sit-ups, and bicycle crunches. Exercises that flex the spine forward increase the risk of fractures in the vertebrae

Exercises that limit weight bearing – doing water-based exercise, swimming, or chair exercises may be better choices than traditional exercise programs

Start with light weights and more reps; as bone mass and muscle strength improve, you may be able to progress to heavier weights and fewer reps

 

Your workout environment should be evaluated for tripping hazards, such as mats or obstacles on the floor. Wall railings and side rails on cardio equipment are useful in protecting you from falls. Regular physical activity, modified correctly, is crucial to dealing effectively with osteoporosis, as it is a long-term and ongoing condition.

Exercising with Osteoarthritis

Exercising with Osteoarthritis (OA)

People who struggle with OA often find themselves unable to do the kinds of exercise they have done for many years. The consequences of not exercising because OA may include weight gain, osteoporosis, muscle atrophy, and loss of flexibility.

There are a number of things  that you can do to introduce exercise into a daily routine again. The first thing to do is to consult with your doctor about limits for exercise, and pain/inflammation management particular to you. Once that is set out, you should check back with your practitioner at regular intervals to review these concerns, or sooner if your condition worsens.

Braces that limit the range of motion (ROM) are available for knee, ankle and thumb, which may help support movement during exercise. It would be wise to consult with a physiotherapist, preferably one well versed in sports injuries and/or OA specifically, before buying a brace. He may guide you to an informed choice of brace. Some physios also do taping to reposition and support a joint before exercise.

As with any exercise program, it's important to warm up. A longer warm up period, say, 10-15 minutes of low intensity cardio, will be beneficial. After that, move on to a selection of low- or no-impact activities. Having several choices available, such as water exercise, elliptical, recumbent bicycle, yoga, and low-impact group exercise will give you options on days when the OA flares up, so you're not stuck feeling as if you can't do any exercise at all that day.

Other prep work should include getting a new pair of shoes that will absorb shock well and give arch support, to minimize the impact on knees and hips. Keep an eye on your shoes' condition and replace them as soon as they show signs of wear, or are less supportive.

 

Deb Bailey Personal Trainer - in Home (Now On-line!)
Phone: 519-572-0986
debbailey@rogers.com
Kitchener, Ontario

Special Events/Training Coordinator: Jessica Bailey 
Administrative Assistant: James Steele
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