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.

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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.

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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.

Neck Pain and Stiffness

I recently did some corporate wellness testing and one of the most common complaints was that of neck and mid back pain and stiffness. The main complaint was a dull ache in the neck and mid back region with a sharp pain at the base of the skull, often resulting in headaches. One of my earlier blogs spoke of correct ergonomics when sitting at your desk, as poor seated posture is very closely related to back and neck pain. Besides correct seated posture, remember to get up from your desk and walk around the room at least every hour.

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Other factors also contribute to this very debilitating neck and mid back pain. An x-ray should be done to rule out the possibility of any disc disorder. Then one must look at muscle spasm and tightness. Weakness of the deep neck stabilizing muscles, mid back muscles, shoulder and arm muscles, and tightness of the chest and superficial neck muscles may contribute to neck and mid back pain. In other words, a muscle imbalance exists, which causes certain muscles to go into spasm, resulting in pain and stiffness in the neck and mid back region.

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Numerous deep muscles stabilize the neck, as can be seen in the image below. If these muscles are weak, the superficial muscles, predominantly the trapezius muscles, compensate, often causing them to be tight and possibly to go into spasm because they are permanently working.

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The muscles in the mid back region help to stabilize the scapulae (shoulder blades). If these muscles are weak, it creates a pulling sensation on the neck muscles, as the scapulae pull downwards with gravity and the muscles are not strong enough to hold them in place. This constant pulling puts enormous strain on the neck, resulting in pain.

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If the shoulder and arm muscles are weak, the neck muscles, predominantly the trapezius muscle (shown above) tends to take over, especially when lifting heavy objects, such as shopping bags in and out of the boot of your car. Again, this overworked portion of the trapezius muscle results in pain and stiffness of the neck and mid back region.

Tightness in a muscle results in limited range of motion (ROM) of the joint it surrounds. When the trapezius muscle is overworked, it becomes very tight and may even go into spasm, resulting in pain. The chest muscles are often tight because of sitting in front of a computer all day with a poor seated posture – shoulders forward and rounded back. Add a phone tucked in between your ear and shoulder and you’re headed for disaster! These tight muscles must be stretched regularly before any strengthening can begin, because full (ROM) needs to be achieved and then the muscles strengthened throughout that range. Stretching also generally provides immediate relief of symptoms. If the neck is in spasm, see a Physiotherapist to break down the spasm before starting a specialized stretching and strengthening programme with a Biokineticist.

Arthritis

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.

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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.

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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.

Osteoporosis

Tomorrow, October 20, is World Osteoporosis Day, so I decided that this would be an appropriate time to provide you with some insight into osteoporosis and the importance of exercise in managing and preventing this condition.

Osteoporosis refers to a decrease in bone mass and bone quality, mainly due to increasing age. After the age of 35 years, there is a reduction in the activity of the cells that contribute to bone formation. This results in reduced bone mass. This is a concern because it puts these weaker bones at an increased risk for fracture. A bone density scan is the most accurate way to diagnose osteoporosis.

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The American College of Sports Medicine (ACSM) found that every 1 in 2 women and 1 in 8 men over the age of 50 are likely to experience an osteoporotic fracture at some stage in their lives. Women are at a much higher risk for osteoporosis due to the reduction in estrogen levels following menopause, while men generally experience bone loss much later on in life (after age 70) and to a much lesser extent, as a result of reduced testosterone production.

ACSM identifies the following risk factors for osteoporosis:

·         Females are at a higher risk than males

·         Increasing age

·         Race – Caucasian/Asian

·         Family history of osteoporosis

·         Low body weight for height (individuals with small frames)

·         Early menopause

·         Prolonged premenopausal amenorrhea (missed periods over a long duration)

·         Low testosterone levels in men

·         Lack of physical activity

·         Smoking

·         Excessive alcohol consumption

·         Low dietary calcium intake

·         Chronic use of medications causing bone loss (e.g. steroids)

It is essential that adequate calcium is ingested as part of one’s diet, particularly during a child’s growth years, as this is when the bones are forming and developing. The Good Life Dietitians can provide more insight into dietary requirements for osteoporosis.

In terms of exercise, it is essential that individuals keep physically active throughout their lives in order to prevent osteoporosis. This means performing aerobic, weight-bearing activity at least 3 times per week for 30 to 45 minutes. If you already have osteoporosis, then the types of exercises you can perform depend on the degree of severity of osteoporosis, as one does not want to increase the risk for injury or fracture. Weight-bearing exercises are particularly important in building bone strength. These exercises include walking, squats and lunges. ACSM recommends aerobic, weight-bearing activities 4 days per week and resistance exercises 2 to 3 days per week. By strengthening the muscles around the bones, bone mass is conserved and the muscles can support the weaker bones. It is essential that balance exercises are performed on a regular basis in order to reduce the risk of falling and thus injury or fracture. Functional exercises that will assist an individual to perform the activities of daily living are also recommended.

The Science of Stiffness

Anyone who has done any form of strenuous activity will have felt that painful ache in the muscles for a few days after exercise. A lot of you may have decided that this pain couldn’t possibly be good for you and, therefore, have avoided any exercise since. Some of you might have decided you quite like that achy feeling, reminding you of what a good workout you had the day before. Basically, this mild discomfort is not bad for you and the good news is it won’t last forever.

Various myths regarding muscle soreness as a result of exercise exist. The most common is the idea that a build up of lactic acid in the muscle causes muscle soreness the next day. It is true that there is a build up of lactic acid in the muscle tissue with strenuous exercise; however, this lactic acid is removed within an hour of finishing exercise. Thus, it is not the cause for pain and stiffness that materializes the following day.

Muscle stiffness or pain after exercise is termed delayed onset muscle soreness (DOMS). There are two key models to explain this exercise effect. The first is known as the Local Ischemic Model. This model suggests that following either strenuous exercise, or even moderate, non-traumatic exercise, there is swelling in the soft tissue. This causes an increase in tissue pressure and a local reduction in blood and oxygen supply to the muscle (ischemia). This in turn causes muscle spasm and the pain known as DOMS.

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The second model is known as the Mechanical Trauma Model. Here, it is suggested that there is structural damage (microtears) to the muscle tissue as a result of increased mechanical forces during muscle contraction. This again leads to swelling and inflammation in the muscle tissue, resulting in pain.

Neither of these models suggests that there is permanent damage to the muscle tissue. In fact, it is recommended that one repeats the same exercise on a regular basis so that the muscle tissue can adapt to the increased force placed on it. This is called the “repeated-bout effect”. The more the exercise is performed, the quicker the muscle tissue adapts, reducing muscle soreness.

So, next time you wake up the morning after exercise, cursing your trainer, the gym, exercise and life in general because you can’t walk up stairs or stand up from the toilet, think of the positive changes taking place to the muscle. Take yourself off to the gym and do a light exercise session with a good cardiovascular warm-up and lots of stretching – even if it hurts a little. This will increase blood flow to the sore muscle tissue, improve flexibility and thus reduce pain and stiffness.