Transcript GRx Healthy Lifestyle Support - bewell.org.nz

D
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B
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disease
insulin
annoying
blood sugars
exercise
types (pre-diabetes, 1,2 gestational)
eating
sedentary
DIABETES and EXERCISE
Presentation Overview
• Why Exercise is important in good diabetes management
• Exercise guidelines
– How much, how often, how intense?
– Resistance training
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Case Study 1
Patient Considerations/Precautions
GRx Healthy Lifestyle Support
Case Study 2
Recap
Why Exercise?
Physical Activity
Nearly everyone with diabetes can derive some benefit from an
appropriate physical activity programme.
Physical activity (PA) is a cornerstone of patient’s diabetes selfmanagement.
• Aerobic exercise increases insulin sensitivity and, together with
proper nutrition, helps restore normal glucose metabolism, by
decreasing body fat.
• Strength training (resistance or weight training) also decreases body fat
by raising metabolism.
• Its MAIN BENEFIT is increasing glucose uptake by muscles and
enhancing ability to store glucose.
How does exercise affect BSLs?
When exercising, the body needs extra energy/fuel (glucose) for the exercising muscles.
For short bursts (jogging to the car) muscles and the liver can release stores of glucose for
fuel.
With continued moderate exercising however, muscles uptake glucose at almost 20 times
normal rate.
This lowers blood sugar levels.
But intense exercise can have the opposite effect and actually decrease BSL.
The body recognises intense exercise as a stress and releases hormones that tell your body to
increase available BSL to fuel the muscles.
For a variety of reasons, after exercise, people with diabetes may have an increase or
decrease in BSL.
Specific health benefits for diabetics
 Helps control blood glucose
 Lowers triglycerides
 Assists with weight loss
 Lowers blood pressure
 Helps raise HDL
 Helps lower total cholesterol
and LDL (if there is weight loss)
 Increases cardiovascular fitness
 Increases muscle strength and balance
PA – yes, there’s more ..2
 Builds/maintains healthy bones / reduce risk of osteoporosis
 Promotes psychological wellbeing
 Reduces risk of colon cancer
 Improves sleep patterns
 Increases cardiovascular fitness
 Decreases pain
 Helps rehab after medical/surgical events
 Helps maintain independent living / reduce risk of fractures
Exercise can mean the difference between ‘medical management’
and ‘lifestyle management’ of Type 2 Diabetes
PA / Exercise Guidelines
How much? How often? How intense?
 Reduce sedentary (sitting) time From the Latin: sedere – to sit
Latest findings show that a combination of AEROBIC and STRENGTH training
has a profound impact on helping people manage diabetes.
 30 minutes per day on at least 5 days a week
(Pedometers 10,000 steps per day)
 10 minutes x 3 during the day preferable to 0
 Moderate intensity (Borg Scale Perceived Exertion of 6-7) (Talk Test)
-Examples include brisk walking, cycling, swimming, dancing, rowing, lawn mowing
- Preferred options include local pools, community classes, walking groups, gyms
PA / Exercise Guidelines
How much? How often? How intense? Cont..
 Weights/resistance training
- Twice a week
- 8 – 12 repetitions per set of 8 – 10 exercises
targeting major muscle groups
- Build up to 3 sets
- Light hand weights, Dyna bands (Fit Strips),
resistance balls cheap and effective
- Qualified Trainer can set personalised, reviewable programme
- Community options available i.e. ‘Shape-Up’
Case Study 1
• 58 yrs old
• 113 kg
• Working full time
• BP high, energy/mood low
• Non-restorative, broken sleep
• Diagnosed Type 2 early 2010
• Took nutritional advice to heart
• Green Prescription issued March
• Began walking 10 minutes to/from work 3 x week
• Persevered to 5 x week, walking faster
• Added weekend walks
• Began to ‘just feel better’
• Now lost 17kgs and still feels fantastic!
Patient Considerations
for PA
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Any additional risk factors for CVD
Peripheral arterial disease
Thermo regulation
Diabetic neuropathy
Retinopathy
Regular glucose monitoring
(self observation)
• Routine of exercise, eating and medication
• Foot care / eye care
• Medically stable for exercise (GRx)
GRx Healthy Lifestyle Support
Your first port of call when prescribing exercise for diabetes
12 or 24 weeks patient support
Use the 5 “A”s to assist patient to succeed
(A=Assess, A=Advise, A=Assist, A=Agree, A=Arrange)
Employ the 3 “E”s to achieve sustainability
(E = Enjoyment E = Exercise E = empowerment)
Monthly Face to face consultations
Monthly telephone top-ups
Smart Goal Setting
Hit The Target steps to the Smart Goal
Behaviour Change identification
GRx Healthy Lifestyle Support
Motivational text messages
Effective Encouraging Emails
Physical activity options – the right choice at the right time
Exercise Induction Process at venues
Personalised Physical Activity Plans
Nutritional advice
Using a Food Diary
Short-term pedometer hire
Links to other community support groups
Transport assistance (St. Johns bus)
Specific focus meetings
Volunteer opportunities
cont..
Case Study 2
•65+ years old
•Type 2 Diabetes
•Overweight
•No energy, too many medications
•High BP
•Mild Depression
•Painful arthritis / reduced mobility
•Nurse referred to GRx
•Planned to look at Sit and be Fit and ‘Water-Worx’
•Attended seated exercises with a friend
•Achieved success, no negative side-effects, lots of fun
•Warm water at pool fabulous, moving more freely
•No longer needs ‘nana naps’
•Lost 7 kgs
•Regularly active and feeling so much happier!
To Recap
• PA crucial to good diabetes management
• Refer to GRx team for Healthy Lifestyle Support
(patient doing less than 2.5hrs/exercise per week and 18+ yrs)
• Every little bit of exercise helps – 10mins x 3 x 5
• Contact GRx team anytime for extra motivational
tips / phrases / helpful conversation guides
Referrals Forms
• GRx desk pad or
• Your own MedTech
electronic practice referral
• No electronic referral on
your computer? Arrange
for installation.
Please Contact Us
• Leigh Dalzell, GRx Co-ordinator
Nelson Bays Primary Health
P.O. Box 1776
20 New Street, Nelson
Tel: 539 1772
DD 539 1662
Cell 021 547811