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T2DM EXERCISE PROGRAMMES ( Specific Needs )

Agustín Meléndez-Ortega Ph.D. T2DM EXERCISE PROGRAMMES ( Specific Needs ). INTRODUCTION. Definition and prevalence T1DM - T2DM Aims of the exercise programme Organizational preconditions Demands for qualification of instructors Evaluation measures Learning outcomes.

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T2DM EXERCISE PROGRAMMES ( Specific Needs )

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  1. Agustín Meléndez-Ortega Ph.D. T2DM EXERCISE PROGRAMMES (Specific Needs)

  2. INTRODUCTION Definition and prevalence T1DM - T2DM Aims of the exercise programme Organizational preconditions Demands for qualification of instructors Evaluation measures Learning outcomes

  3. DEFINITIONandPREVALENCE

  4. Diabetes Mellitus Chronic illness (hyperglycemia) Hyperglycemia: results from defects in insulin secretion, receptors, or both Associated to obesity, hypertension, high cholesterol & cv mortality Inactivity (sedentarism) illness Image: Medline Plus

  5. Glucose Transporter -Type 4 (GLUT4) - Rate limiting step in glucose utilization - Facilitated Diffusion - GLUT4 major transporter isoform - Exercise and insulin are powerful stimulators Glycogen Glycolysis Goodyear y Horton 2001

  6. Glucose transport in the presence of insulin

  7. GLUT4 translocation in the skeletal muscle Goodyear y Horton 2001

  8. Exercise and insulin action on the skeletal muscle Goodyear y Horton 2001

  9. Prevalence Source: International Diabetes Federation; MedMarket Diligence, LLC, report #D500, "Diabetes Management, Worldwide, 2005-2015: Products, Technologies and Markets in the U.S., Europe, Japan & Rest of World."

  10. European Prevalence of Diabetes There are about 50-60 million people with diabetes in the European region, or about 10.3% of men and 9.6% of women aged 25 years and over. Prevalence of diabetes is increasing among all ages in the European region (overweight and obesity, unhealthy diet and physical inactivity). Source: OECD (2012), “Diabetes prevalence and incidence”, in Health at a Glance: Europe 2012, OECD Publishing. http://dx.doi.org/10.1787/9789264183896-17-en

  11. AIMSof theEXERCISE PROGRAMME

  12. Exercise Programme (DM1) Positive effects of training on insuline resistance Modetare evidence Limited evidence Strong evidence No evidence A B C D Pathogenesis Symptoms specific to the diagnosis Physical fitness or strength Quality of life Source: Pedersen BK and Saltin B; Scand J Med Sci Sports; 2006:16 (Suppl:1)

  13. Exercise Programme (DM2) Positive effects of training on insulin resistance Moderate evidence Limited evidence Strong evidence No evidence A B C D Pathogenesis Symptoms specific to the diagnosis Physical fitness orstrength Quality of life Source: Pedersen BK and Saltin B; Scand J Med Sci Sports; 2006:16 (Suppl:1)

  14. Aims of the Exercise Programme • General for Health • Physical Fitness • Risk Factors • Specific • Body Composition • Short term Control • Medium term control CVD Mortality Risk* by Fitness and BMI Categories, 2316 Men Diabetes, 179 CVD Deaths *Adj. for age and examination year Church TS et al. Arch Int Med 2005; 165:2114

  15. ORGANIZATIONAL PRECONDITIONS • Scenarios (Time with the disease) • T2DM < 2 years • T2DM 2-5 years • T2DM > 5 years • Elderly (> 65) T2DM • CV Fitness • < pred. VO2 max • > pred. VO2 max • Body composition • > BMI 30 • < BMI 30 Source: Modified from Praet, SF y Van Loon, LJ.; J. Appl Phys 103: 1113-1120, 2007.

  16. Scenario 1:Obese patients recently diagnosed Intense to moderate aerobic exercise (Daily exercise preferable). Combined with a caloric restriction to produce a weekly weight loss of ½ to 1 kilo. At least 1 weekly session of strength training to avoid loss of muscle mass. Source: Modified from de Praet, SF y Van Loon, LJ. J. Appl Phys 103: 1113-1120, 2007. Image: Exercise Physiology: Wilmore y Costill

  17. Scenario 2:Patients who have had the condition for some time and have been treated with insulin Bear in mind comorbidities. Programme intermittent exercises, relatively intense strength training exercises and aerobic-type exercises Once an improvement in muscle strength and functional performance has been achieved, progress to a more generic intervention programme (with more intense aerobic exercise) Fuente: Praet, SF y Van Loon, LJ; J. Appl Phys 103: 1113-1120, 2007. Image: Robert Newton. Edith Cowan University

  18. Scenario 3:Elderly people recently diagnosed with T2DM Important: Strength training (To avoid or reverse the loss of muscle mass). Co-intervention with diet Source: Praet, SF y Van Loon, LJ.; J. Appl Phys 103: 1113-1120, 2007. Image: Robert Newton. Edith Cowan University

  19. Scenario 4:Insulin resistant state with no complications Glycemic control, cardiorespiratory fitness and microvascular function can be improved with a more vigorous programme [including strength training and flexibility] Source: Praet, SF y Van Loon, LJ. J.; Appl Phys 103: 1113-1120, 2007. Images: Left. Dr. Robert Newton. Edith Cowan University; Right. Human Kinetics Catalog

  20. DEMANDS for QUALIFICATION of theINSTRUCTORS

  21. Demands for Qualification of the Instructors • General Exercise Programmes (See Capacity Building-Active Age) • Diabetic specific and risk factors • Management of hyper and hypoglycemia • Avoidance of complication for comorbidities • Adaptation for contraindications

  22. Demands for Qualification of the Instructors • Programming • Complications (Comorbidities)

  23. Bear in mind that subjects are usually sedentary, with high blood pressure and cholesterol and overweight or obese, possible contraindications. Comorbidities Physical Fitness Body composition Treatment Orthopedic limitations (e.g. feet…), Programming

  24. Retinopathy Hypertension Autonomous neuropathy Peripheral Neuropathy Nephropathy Complications of Diabetes(Comorbidities) Source: B. N. Campaigne: Exercise and Diabetes Control. ACSM´s Resource Manual, 1998

  25. Complications

  26. Complications of Diabetes(Comorbidities) Bear in mind the absolute contraindications for exercise • Proliferative retinopathy • Microangiopathy • Severe neuropathy • Nephropathy • Evidence of underlying CV disease • Lack of glycemic control (T1, >250 mg/dL y KK) (T2 >300 mg/dL) Source: B. N. Campaigne: Exercise and Diabetes Control. ACSM´s Resource Manual, 1998

  27. Evaluation Measures • Pre and post stress test - (CV risk) & Classification • Subject evaluation • Glucose response to exercise (programme) • Fitness evaluation (Blair) • Diabetes evolution (A1C) • Controls and glucose response to exercise • Programme evaluation • Attendance • Satisfaction • Results

  28. Learning Outcomes • FOR THE SUBJECT • How to improve blood glucose control with exercise • Decrement achieved in risk factors • Short term response • Medium term response • How to act if complications arise • Possible mechanism for different types of exercise

  29. Questions ? Comments ?

  30. Thank you for ypur attention

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