World Diabetes Day – 14 November

Diabetes is a fairly dreaded word, as many people just think of pricking and injecting oneself numerous times a day. However, this is not always the case. Being World Diabetes Day today, as well as Diabetes Awareness Week this week, I thought I would provide some insight into this common, yet often misunderstood, condition.

What is Diabetes?

Diabetes is defined by ACSM as: “a chronic metabolic disease characterized by an absolute or relative deficiency of insulin that results in hyperglycaemia”. More simply put, diabetes is a condition resulting in prolonged high blood glucose (sugar) levels, as a result of little or no insulin production.

Various types of diabetes exist. I will discuss the two most common types – type 1 and type 2 diabetes. The first distinction to make is the difference between Type 1 and Type 2 diabetes mellitus. Type 1, or insulin-dependent, diabetes is usually present from a young age, although late onset type 1 diabetes may also occur later in life. Type 1 diabetes is an autoimmune disease, in which there is destruction of the beta cells in the pancreas – the cells responsible for producing insulin. The result of this is a complete insulin deficiency; therefore, these people immediately start insulin injections.

Type 2, or non-insulin dependent, diabetes usually presents itself later in life and occurs as a result of a combination of insulin resistance and decreased insulin secretion by the pancreas. Various factors increase the risk for developing type 2 diabetes. These include obesity (especially a large waist circumference), physical inactivity, family history, smoking, high blood pressure, high cholesterol, and stress. Individuals with type 2 diabetes usually start with oral medication to improve insulin sensitivity and will possibly start insulin injections later on if necessary, to accommodate for the decreased insulin secretion. Thus, it is possible to have type 2 diabetes and be insulin-dependent; this does not mean you have type 1 diabetes.

Why is exercise so important in managing diabetes?

There are many complications associated with diabetes, including cardiovascular (heart), renal (kidney), and neuropathies (nerve system damage). Physical activity is essential in managing these complications. Both type 1 and type 2 diabetes put individuals at increased risk for heart disease. Therefore, exercise is important to reduce the risk of heart disease, as has been discussed in previous blogs. Exercise also improves insulin sensitivity and glucose tolerance, thereby decreasing insulin requirements. Individuals with type 2 diabetes also often have high blood pressure and high cholesterol and are often overweight. Exercise is particularly important for these individuals to manage these conditions, as well as to reduce body fat percent.

Individuals who are on insulin therapy (injections) must be carefully monitored, especially when starting an exercise programme, as they tend to respond very quickly to exercise. During exercise, the body uses glucose as an energy source. Different types of insulin have different peak onset times. If the insulin peaks at the same time as the individual is exercising, then too much glucose may be used up, resulting in the individual experiencing a hypoglycaemic incident – the glucose dropping too low to keep the body functioning. The individual may faint and lose consciousness. Usually, one will have other symptoms first, such as sweating, shaking and nausea. Individuals will generally start to learn how their bodies react to hypoglycaemia.

On the other hand, individuals with type 1 diabetes are at risk of developing ketoacidosis if they exercise with very high sugar levels. If the blood glucose levels are not controlled and are too high, then there is no glucose in the cells, which means that fat must be broken down and used as an energy source. During this process, ketones, which are acids, are produced. This causes the body to become acidic and a coma may result if this state is prolonged.

An individual with diabetes will benefit from any exercise regimen. It is recommended that these individuals do at least 150 minutes of aerobic activity per week, to reap the cardiovascular benefits of exercise. They must also do light resistance training at least 2 to 3 times per week to improve muscle strength, decrease body fat percent and increase glucose metabolism. Stretching is also important to maintain flexibility and joint mobility and to reduce stress.

So, if you have diabetes, don’t pretend it is not there and that it can’t cause any harm because you don’t have any visible symptoms. It is crucial to check your blood glucose levels regularly, follow a healthy diet and exercise on a regular basis. When exercising, be aware of how you are feeling and check your blood glucose levels whenever necessary if you are not feeling quite right. Always have a snack or some fruit juice nearby in case your glucose levels drop too low.

Diabetes is not something to be afraid of. If it is carefully monitored and correctly managed, one can live a reasonably hassle-free, long and healthy life. Educate yourself on how it works, so that you can be proactive and look after your body.

Osteoarthritis and Biokinetics

Two common forms of arthritis exist, namely osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the cartilage of a specific joint degenerates, resulting in localized pain and inflammation within that joint. The most common joints affected by osteoarthritis are the hands, spine, hips and knees. Rheumatoid arthritis is an inflammatory, multi-joint disease in which numerous joints and organ systems may be affected as a result of an autoimmune response. The most commonly affected joints include the wrists, hands, knees, feet and neck.

When exercising a person with osteoarthritis, one needs to consider the degree of articular cartilage degeneration in the specific joint, the level of pain and discomfort in that joint, the range of motion of the joint, the strength of the surrounding muscles of the affected joint, and finally, whether or not the individual is having a flare up. Osteoarthritis will periodically flare up and then may almost go into remission. During a flare up, pain will be much more severe. Common features associated with exercise include joint pain and stiffness, osteophytes (small bony formations) and cartilage destruction. It is important to strengthen the muscles surrounding the affected joints so that they can support those joints. However, these exercises must be performed carefully, placing minimal stress and impact on those joints. It is also essential to stretch the muscles surrounding the affected joints in order to maintain their range of motion and reduce joint stiffness.

When selecting exercises for individuals with rheumatoid arthritis, you need to know if the individual is having a flare up – increased pain will be the primary symptom. Common features associated with rheumatoid arthritis include morning stiffness that lasts longer than 30 minutes, acute and chronic inflammation, chronic pain and reduced joint integrity. Low-intensity and low-impact exercises, with lots of stretching, are recommended for these individuals. 

For any form of arthritis, it is important that individuals do regular low-impact, aerobic exercise, such as swimming or cycling, and lots of stretching. Any exercises that place heavy stress on the affected joints should be avoided. During flare ups, vigorous exercise must be avoided. Water therapy and water aerobics are highly recommended for individuals who suffer from arthritis.

Arthritis is a common condition, which often leaves people afraid to do any form of physical activity. However, exercise is important in managing the condition and maintaining mobility. So, if you suffer from arthritis, see a biokineticist to have a comprehensive assessment and be given an appropriate exercise programme. This will allow you to function more normally and improve your quality of life.

Post-Pregnancy Exercise

Having recently had my second baby, I thought I’d remind you of what types of exercise, as well as when one can start exercising following giving birth. Of course, post-pregnancy exercise depends on whether you have had a natural birth or a Caesarean section, and also the level of fitness you managed to maintain during your pregnancy. These are only guidelines – always check with your doctor before starting any exercise programme following giving birth, especially if you had any complications during pregnancy or birth.

Regardless of whether you had a natural birth or a Caesar, the body takes about six weeks to heal from the labour and/or surgery and so one must use this time to rest and recover and focus on your new born baby. Your body has undergone many changes over a period of nine months, so it will take time to get back to what it was before. However, one can start very gentle pelvic floor exercises the day after delivery, and light walking within your pain limits can begin one week later and is good for both your body and mind. Use pain as a guide – if you experience any discomfort, stop whatever you are doing immediately.

About six weeks post-delivery, your body should start to feel a little more normal again. You can increase your pelvic floor exercises and walking as you feel comfortable. Provided your surgical wound has healed without any complications and your doctor gives you the go-ahead, you can start swimming. After 12 weeks, gentle cardio, as well as light resistance exercises can be started, again provided your doctor has cleared you for this. Again, use pain as your guide and stop immediately if you experience any discomfort. Start slowly with whatever it is you are doing and increase gradually within your pain-free limits. Remember: even if you kept fit during pregnancy, your body has undergone a huge amount of trauma, whether it be from labour or surgery or both. If you laboured and still had a Caesar, the trauma to the body is even greater and so you will take a little longer to recover. Always listen to your body!

If you feel like you need some company or a little guidance, consider joining group classes, such as a Pilates class, or consult a biokineticist who will provide you with an appropriate exercise programme.

Exercise is like medicine for your body and mind and will help you to feel like yourself again after a long process of many changes. Embrace your new body and work within its limits. Take your baby for walks with you and enjoy the special time together.

References

The Pregnancy and Baby Book; DK Publishers

Pregnancy and Exercise

As I am about to go on maternity leave, I have chosen to remind my readers about the importance of exercise during pregnancy. Please also see the newsflash below.

Although you may feel very tired and uncomfortable during pregnancy, exercise – believe it or not – can help you to feel better, keeping you fit and strong and helping to manage your weight. By exercising during your pregnancy, you will also find it easier to regain your pre-pregnancy physical fitness. There are, however, some important points to be considered to ensure safe exercise for both you and your baby.

If you were participating in a regular exercise programme before falling pregnant, then you can generally continue with a similar programme for the first trimester. If you were not physically active on a regular basis before you became pregnant, then you need to start off very slowly and some guidance may be necessary. Either way, you must check with your doctor before starting an exercise programme, as each person is different and every pregnancy is unique!

During the first trimester, one can generally continue at a similar exercise level to what you were previously doing, although the intensity level may need to drop. Keep your heart rate below 140 beats per minute! Abdominal exercises can be done as usual. Because you will probably feel more tired when you are pregnant, adjust your cardiovascular and weight training to a comfortable level.

During the second trimester, light weight exercises can still be done, although you should avoid lifting weights above your head, as this increases your already elevated blood pressure. Avoid abdominal crunches and exercises performed lying flat on your back. Prolonged time on your back causes your heavier uterus to put pressure on the vena cava, the vein that returns blood from your lower body back to your heart. This interference with blood flow can make you feel dizzy. Cardiovascular exercise should continue, although the intensity must be decreased according to how you feel. Don’t do any running, jogging or other activities that will impact on your joints. Walking, swimming and cycling are best. It is important to always remember to keep your heart rate below 140 beats per minute. Stretching and breathing exercises can also be done. Always remember, depending on how quickly you’ve grown, do what is comfortable for you.

During the third trimester, you will start to feel much more uncomfortable and tired as the baby grows. Do what you can manage comfortably during this final stage. Cardiovascular exercises – walking, cycling, and swimming – can be continued, still keeping the heart rate below 140 beats per minute. Keep exercise sessions to a maximum of 30 minutes, as the increased blood flow associated with exercise can induce contractions if prolonged. Avoid heavy weights and movements that involve changing direction quickly. During pregnancy, your body releases a hormone called relaxin, which causes the ligaments around your pelvic joint to become lax, allowing for more space for the baby to be born. Because all the joints become more lax, the risk of spraining a joint, such as the ankle, increases. Therefore, it is important to wear comfortable shoes at all times and avoid uneven surfaces that could cause falls.

Kegel exercises can be done to strengthen the pelvic floor muscles, which help to minimize bladder leaks, a common problem during and after pregnancy. These exercises are easy to perform and can be done anywhere and anytime.

Lower back pain is a common symptom experienced during pregnancy. Due to the development of your stomach in front, your centre of gravity shifts and it puts a lot of strain on the lower back. If your lower back muscles aren’t strong enough, you will struggle as your baby grows. A Biokineticist can provide appropriate exercises to strengthen these muscles and, therefore, manage this condition.

Tips to remember:

·         Keep your heart rate below 140bpm at all times.

·         If you feel out of breath, slow down.

·         Wear comfortable, loose clothing with proper shoes to support your ankles.

·         Exercise in the morning or evening when it is not too hot.

·         Avoid jerking movements.

·         Avoid lying on your back for too long.

·         Exercises sitting on a big ball are usually very comfortable, but avoid bouncing.

·         Listen to your body – it will tell you if you are doing too much!

Stop exercising if you experience any of the following:

·         Vaginal bleeding

·         Dizziness

·         Faintness

·         Shortness of breath

·         Contractions

·         Nausea

Speak to your doctor before exercising again.

As I have already said, each person is different and every pregnancy is unique, so it is important to consult your doctor before starting any exercise programme! If you are struggling to start or maintain an exercise programme during pregnancy, consult a Biokineticist to assist you with safe and appropriate exercises for you and your baby.

References

http://www.virginactive.co.za/wellness/view/category/38

http://americanpregnancy.org/pregnancyhealth/toprecommendedexercises.html

http://pregnancy.about.com/od/symptoms/qt/backsleeping.htm

Newsflash!!

I would like to welcome Tandy Fourie to my practice.

Tandy is a registered biokineticist and she will be practicing at:

44 First Avenue
Dunvegan, Edenvale

Tel: 011 454 5800