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Exercise

Exercise is the Low Carb Diabetes Association’s 2nd Essential since lack of exercise is associated with the development of type-2 and gestational diabetes and exercise prevents complications in all types of diabetes. Exercise positively effects directly or indirectly all of the other Eight Essentials ™ of diet, sleep, stress management, a healthy gut/microbiome, detoxification, supplements and medications. The potential for exercise to improve people’s health who have diabetes is tremendous. Research suggests that exercise is associated with significantly lower all-cause, cardiovascular disease, chronic kidney disease, sepsis, pneumonia and influenza mortality in people with diabetes (Williams 2014). However, diabetics merely meeting current exercise recommendations are not shown to have these beneficial effects (Williams 2014). Only diabetics who exceed the current exercise recommendations enjoy the reduction of diseases and death indicating higher exercise recommendations are warranted (Williams 2014).

Research demonstrates functional endpoints such as walking speed, ability to easily sit and rise from the floor, cardiorespiratory fitness (CRF) and muscle strength are better predictors of all-cause mortality than just participation in physical activity (Brito, Ricardo et al. 2014; Franklin, Brinks et al. 2015; Dankel, Loenneke et al. 2016; Despres 2016). Both high CRF and muscular strength can prevent and improve metabolic syndrome and diabetes. No modifiable risk factor was shown to be a more powerful predictor of disease and death than a poor level of CRF (Despres 2016). CRF can be easily measured using the YMCA Bench Step Test, Rockport Walking Test or 1.5 mile run (Pescatello and American College of Sports Medicine. 2014). High CRF also reduces the risks of common complications of diabetes, such as hypertension and hypercholesterolemia (Williams 2008). When muscular strength falls below the 20th percentile for age and gender, people are at higher risk for developing metabolic syndrome especially in younger people (Senechal, McGavock et al. 2014). Higher muscular strength is associated with better physical function and lower systemic inflammation and all-cause mortality independent of CRF (Brill, Macera et al. 2000; FitzGerald, Barlow et al. 2004; Buckner, Loenneke et al. 2015). Muscular strength can be straightforwardly assessed with the Vertical Jump, Grip, Bench Press and Leg Press Tests (Pescatello and American College of Sports Medicine. 2014). Focusing on the functional endpoints of activity and exercise produces superior health benefits compared to the amount of regular participation.

Exercise is wonderful at lowering glucose, but this means that blood sugar levels need to be tightly monitored at the beginning, during and after exercise. The effect of exercise on lowering blood sugar depends on the length and intensity. A 30-minute moderate pace on a treadmill might have a mild effect on glucose; while a 10-mile hike with significant elevation will have a massive impact on lowering glucose. It is important for diabetic patients, especially those on medications, (and, of medications, especially those on insulin), to have their exercise routine approved and guided by their medical practitioner, so that diet, medications and glucose levels are all organized and well managed. The LCDA educates diabetics, alongside their medical practitioners, to ensure that exercise does not cause significant low blood sugar.

Getting Started

The best way to start or continue exercising is with specific direction and written goals. Assessing your body composition and fitness level and comparing it to age and gender normative data is a great way to prioritize your exercise. Request your healthcare team to thoroughly assess your body composition, CRF and muscular strength. Keeping your waist circumference to less than half your height can help increase your life expectancy (Ashwell, Mayhew et al. 2014). If your waist circumference is more than half your height, fat loss should be one of your exercise goals. For fitness, the LCDA recommends achieving at least a 40th percentile for your age and gender in all areas before trying to excel in any other areas. Test yourself to know what you need to do next and make goals accordingly.

The advice to “drink ahead of thirst” or advice that endurance athletes should take drinks that replace electrolytes is not recommended. “By trying to stay ahead of thirst, an endurance athlete can drink enough to dilute electrolyte concentration, leading to a condition called exercise-associated hyponatremia” (Noakes 2012).

Requiring too many people to have a pre-participation health screening before initiating physical activity or an exercise program can put another unnecessary blockade for people to start exercising. The LCDA recommends the Physical Activity Readiness Questionnaire (PAR-Q) from the Canadian Society for Exercise Physiology since it is simple, quick and effective for determining who should have a cardiovascular work-up before exercising. There are also questionnaires for special populations such as pregnant women (PARmed-X for Pregnancy).

The LCDA will teach pre-diabetic and diabetic patients how to improve CRF and strength using different types of exercise, different ways to exercise, how to exercise when traveling, ideas for adjusting medications when exercising; many, many aspects of exercise! Please JOIN the LCDA so you can safely add this vital Essential to your comprehensive integrative care.

References
Ashwell, M., L. Mayhew, et al. (2014). “Waist-to-height ratio is more predictive of years of life lost than body mass index.” PLoS One 9(9): e103483.
Brill, P. A., C. A. Macera, et al. (2000). “Muscular strength and physical function.” Med Sci Sports Exerc 32(2): 412-416.
Brito, L. B., D. R. Ricardo, et al. (2014). “Ability to sit and rise from the floor as a predictor of all-cause mortality.” Eur J Prev Cardiol 21(7): 892-898.
Buckner, S. L., J. P. Loenneke, et al. (2015). “Lower extremity strength, systemic inflammation and all-cause mortality: Application to the “fat but fit” paradigm using cross-sectional and longitudinal designs.” Physiol Behav 149: 199-202.
Dankel, S. J., J. P. Loenneke, et al. (2016). “Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality?” Mayo Clin Proc 91(2): 166-174.
Despres, J. P. (2016). “Physical Activity, Sedentary Behaviours, and Cardiovascular Health: When Will Cardiorespiratory Fitness Become a Vital Sign?” Can J Cardiol 32(4): 505-513.
FitzGerald, S. J., C. E. Barlow, et al. (2004). “Muscular fitness and all-cause mortality: prospective observations.” Journal of Physical Activity and Health 1(1): 7.
Franklin, B. A., J. Brinks, et al. (2015). “Reduced walking speed and distance as harbingers of the approaching grim reaper.” Am J Cardiol 116(2): 313-317.
Noakes, T. (2012). Waterlogged: the serious problem of overhydration in endurance sports, Human Kinetics.
Pescatello, L. S. and American College of Sports Medicine. (2014). ACSM’s guidelines for exercise testing and prescription. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins Health.
Senechal, M., J. M. McGavock, et al. (2014). “Cut points of muscle strength associated with metabolic syndrome in men.” Med Sci Sports Exerc 46(8): 1475-1481.
Williams, P. T. (2008). “Vigorous exercise, fitness and incident hypertension, high cholesterol, and diabetes.” Med Sci Sports Exerc 40(6): 998-1006.
Williams, P. T. (2014). “Reduced total and cause-specific mortality from walking and running in diabetes.” Med Sci Sports Exerc 46(5): 933-939.

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