Exercise and Type 1 Diabetes

Type 1 diabetes is a disease that affects the body’s ability to use sugars, starches, fats and proteins. Because the body needs various fuels for energy, this disease disrupts normal energy metabolism both at rest and during physical exercise.

Following digestion, a hormone called insulin is released into the blood from the pancreas. Among insulin’s primary roles is its ability to allow carbohydrates (absorbed in the form of glucose) and proteins to enter muscle cells, where they are stored or used for energy. Individuals with type 1 diabetes are unable to produce enough—or even any—insulin to allow this process to occur. Consequently, glucose is unable to enter cells and builds up in the blood. Because people with type 1 diabetes have insufficient insulin production, daily insulin injections are required to maintain glucose levels as close to normal as possible. Thus, individuals with type 1 diabetes are considered insulin-dependent.

It is imperative for those with type 1 diabetes to regulate their blood glucose (blood sugar) levels to help reduce complications associated with this disease. If glucose levels remain unchecked for extended periods, people with type 1 diabetes run the risk of developing heart disease, kidney failure, blindness and nerve dysfunction.
Therefore, people with type 1 diabetes must always be careful about the amounts and types of foods they eat, as well as when they exercise and what types of physical activity they perform.

Because exercise uses glucose as a fuel, it is an effective way to control blood sugar levels. Exercise has an insulin-like effect on glucose, enhancing its uptake into cells and counteracting elevated blood glucose levels that frequently occur after eating. With exercise, the amount of insulin injected for controlling blood glucose can be lowered in those in type 1 diabetes.

Also, many health-related benefits of physical activity (e.g., lowering blood pressure, managing body weight, improving self-efficacy and confidence, and improving blood lipids) are part of the exercise therapy.

Under a doctor’s care, individuals with type 1 diabetes should exercise a minimum of three to four times per week at a low-to-moderate intensity, for about 20 to 60 minutes. Most aerobic activities are recommended for those with type 1 diabetes unless restricted due to medical complications.

In addition to aerobic exercise, it is important for individuals with type 1 diabetes to engage in flexibility and strength-training exercises. Resistance training should be performed at least two days per week, with a minimum of one set of 10 to 15 repetitions of each exercise at a low-to-moderate intensity.

People with type 1 diabetes should monitor their glucose before and after exercise to understand how it responds to certain types of exercise. Also, exercising with a partner and wearing an ID bracelet indicating one’s condition are very important.

Because individuals with type 1 diabetes take insulin medication, exercise may place them at risk for low glucose levels (referred to as hypoglycemia). Consequently, they should also carry a light snack that is high in carbohydrates in case energy is needed immediately.

Finally, those with type 1 diabetes should see their physicians regularly to minimize the potential for diabetic complications. If complications of the eye, kidney or heart are present, it is important that their physicians give clear boundaries regarding the intensity of any physical activity.

American Diabetes Association—Exercise: www.diabetes.org/weightloss-and-exercise/
exercise/overview.jsp
Centers for Disease Control—Exercise and Diabetes: www.cdc.gov/diabetes/faq/exercise.htm
Mayo Clinic—Diabetes and Exercise: www.mayo clinic.com/health/diabetes-and-exercise/DA00036

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Managing Cholesterol with Exercise

High cholesterol, known as hypercholesterolemia, is a major risk factor for cardiovascular disease. In the United States, more than 105 million people (that’s almost 50% of adults over age 20) suffer from elevated cholesterol. Individuals who are sedentary, overweight or obese, consume a diet high in saturated fat, have a family history of high cholesterol and/or are middle-aged or older are at particularly high risk of hypercholesterolemia and subsequent cardiovascular complications. The good news is that cholesterol levels can be improved with a little TLC; that is, therapeutic lifestyle changes.

In fact, the National Cholesterol Education Program (NCEP) recommends that all individuals with an LDL cholesterol (low-density lipoprotein—this is the “bad” cholesterol) >100 mg/dL implement TLC to reduce cholesterol levels. Some of these individuals also will begin cholesterol-lowering medications if target LDL is not met after six weeks of the lifestyle changes. Refer to the accompanying table for NCEP cholesterol guidelines.

TLC consists of heart-healthy nutritional choices, weight reduction and increased physical activity. Specifically, the TLC diet is low in saturated fat (<7% of total calories) and cholesterol (<200 mg). It contains up to 10% of total calories from polyunsaturated fats and up to 20% from monounsaturated fats. Together, the fat comprises 25 to 35% of total calories. Carbohydrates comprise 50 to 60% of total calories, and protein is 15% of total calories. Fiber recommendation is 20 to 30 grams per day. And importantly, the TLC diet emphasizes weight management or weight reduction when necessary through caloric balance such that calories in (from food) equals (or is less than) calories out (from exercise plus basic functions of living, such as energy required to digest food, etc.). This nutritional plan leads to decreased LDL cholesterol and increased HDL (high-density lipoprotein—the “good” cholesterol). Regular physical activity helps to increase HDL cholesterol, reduce VLDL (very-low density lipoproteins—a form of “bad” cholesterol), and in some cases decrease LDL cholesterol. Furthermore, physical activity reduces blood pressure, improves insulin sensitivity, and favorably influences cardiovascular function.

When beginning an exercise program to improve your cholesterol levels:

Make an appointment with your physician to establish your overall cardiovascular health status. Your physician may want to perform more blood tests and/or a graded exercise test with an ECG (treadmill stress test) to determine your risk for cardiovascular disease.Aim to be physically active for at least 30 minutes on most, if not all, days of the week. Better yet, once you have integrated physical activity into your daily life, try to increase activity to at least one hour per day. Many research studies have shown that it is the duration of exercise—and not the intensity of exercise or the amount of improvement in fitness level—that is important for the improvement of cholesterol levels.Choose moderate-intensity exercises such as walking, swimming, walk-jogging or cycling. When exercising at a “moderate” intensity, you should break a sweat and feel slightly winded but still be able to talk. High-intensity exercise does not offer any increased benefit in improving cholesterol levels. Engage in weight-lifting or resistance-training exercises at least two days per week to maintain muscle mass. Adults ages 50+ who do not perform regular resistance-training exercises lose about 1/4 pound of muscle mass per year. Less muscle mass means decreased metabolism. And decreased metabolism leads to weight gain.

Remember that a regular physical-activity program, healthful nutritional choices and weight reduction for those who are overweight or obese all are critical for achieving optimal cholesterol levels. When these lifestyle changes are adopted, the risk of life-long dependence on cholesterol-lowering medications decreases dramatically. The risk of cardiovascular disease also decreases dramatically. And the opportunity for improved fitness and overall health, increased psychological well-being and a high quality of life rises exponentially. If you would like help getting your cholesterol levels in check, seek out the nearest ACE-certified Fitness Professional.

Program Adult Treatment

Panel III Guidelines*

Total Cholesterol

<200 Desirable
200–239 Borderline high
>240 High

LDL Cholesterol

<100 Optimal†
100–129 Near Optimal
130–159 Borderline High
160–189 High
>190 Very High

HDL Cholesterol

<40 Low (major heart disease risk factor)
>60 High (gives some protection against heart disease)

Triglycerides

<150 Normal
150–199 Borderline High
200–499 High
>500 Very High

*All values are expressed in milligrams per deciliter (mg/dL).
†<70 mg/dL is a therapeutic option for very high-risk patients (i.e., those with established CHD plus diabetes or multiple risk factors such as the metabolic syndrome)

American Heart Association: http://www.americanheart.org
Medline Plus—Cholesterol: http://www.nlm.nih.gov/medlineplus/cholesterol.html
NHLBI NCEP ATPIII Cholesterol Counts for Everyone Page: http://www.nhlbi.nih.gov/chd/
WebMD Cholesterol Health Center: http://www.webmd.com/cholesterol-management/
National Health and Nutrition Examination Survey (NHANES), 1999–04, Centers for Disease Control/National Center for Health Statistics: http://www.americanheart.org/presenter.jhtml?identifier=536

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Exercise for Individuals with Eye Impairments

While starting an exercise program poses unique challenges if you are visually impaired or legally blind, a few precautions and modifications can open your world to the many benefits and joys of regular physical activity. Following are some tips to help you get started.

Before you walk through the doors of a health club or purchase your first piece of equipment, talk to your ophthalmologist. This step is especially critical if you have recently had an eye operation or are at risk for intraocular bleeding from conditions such as diabetes or age-related macular degeneration. (In such cases, strenuous activity should be avoided.) Ask for a referral to a fitness professional who can help you begin a safe, effective and enjoyable exercise program. If your doctor doesn’t have a recommendation, check out www.acefitness.org/profreg/ to find an ACE-certified Advanced Health & Fitness Specialist near you.

If you will be exercising at a gym, ask for a facility orientation. Determine if doors are completely closed or open versus dangerously half open. Are exercise areas well-lit with as much glare control as possible? Is the facility large enough to assure ample space between equipment and minimal clutter?

Once you commit to a program, think of exercise as part of your daily routine. Set short-term, achievable exercise goals. This will help you to experience good results and the benefits of being active. Plus, modest, realistic goals also build confidence and enthusiasm, making exercise more fun.

Aim to be physically active doing something that you enjoy for at least 30 minutes on most, preferably all, days of the week. Once you’ve developed an exercise routine, gradually increase intensity, duration, or frequency to maximize your fitness improvements. Also be sure that your trainer develops a program for you that includes cardiovascular exercise (walking, swimming, biking, running), resistance training (free weights or machines, push-ups, core-strengthening exercises), and flexibility training (stretching, yoga). As you become more comfortable with your exercise program, you may choose to complete some of your workouts without a personal trainer. In those cases, make sure to work out with a sighted partner to assure your safety.

Just as it is important to challenge yourself physically to achieve your goals, it is also important to know when to limit physical activity. If you’ve recently had an eye operation, a serious illness, or a change in your vision, modify your exercise program to reduce the risk of complications. Decrease your intensity with exercises such as walking, swimming or water aerobics. When weight training, use lighter weights and increase your repetitions instead of increasing the amount of weight. Avoid exercises that stress isometric muscle contractions (e.g., pushing against an immovable object). Also make sure that you are exercising at an intensity that is comfortable for you and not overly strenuous.

Terminate exercise if you experience loss or dimming of vision, new floaters (spots or shapes floating through vision) or light flashes or other symptoms.

A positive attitude will help with motivation and adherence to your program. Here are some tips for making your exercise routine enjoyable:

Keep routines interesting and fun. Choose activities you enjoy and feel comfortable with.Vary the types of exercise you do so you can avoid falling into a rut. Exercise variables must be changed not only for the sake of interest, but also to foster progress.Make your exercise routine fit your personality and daily lifestyle with respect to time, location, expense and degree of social interaction. The more comfortable the routine, the more likely you will be able to maintain it.Even when you are feeling tired or stressed, try to maintain your program. You will feel better after your workout. Focus on your successes, no matter how small. Remember, persistence pays off.

Lesley Teitelbaum, a research assistant professor at the department of psychology, Syracuse University, and Mitch Lemelbaum, a faculty member in the department of exercise science, Syracuse University, provided exercise tips and recommendations for this educational handout.

National Federation for the Blind: www.nfb.org
Medline Plus—Visual Impairment and Blindness: www.nlm.nih.gov/medlineplus/visionimpairmentandblindness.html
National Eye Institute: www.nei.nih.gov

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Don’t Deprive Yourself of the Rewards of Exercise

Talking to committed exercisers about the benefits of physical activity is like introducing a dedicated shopper to the joys of an anniversary sale at Nordstrom™. After all, those who exercise are no strangers to the freedom elicited by movement or to the sense of accomplishment felt at the end of a long walk or strength workout.

Those uninitiated in the pleasurable rewards of regular physical activity, however, remain skeptical. After all, how can something as basic as exercise not only improve one’s life today, but perhaps even also save one’s life tomorrow?

Researchers have sought to answer this question for years. In 1996, the Surgeon General’s Report on Physical Activity was released, detailing the research behind the benefits associated with exercise. This report goes beyond the anecdotal “it-just-feels-good” reason for exercising.

What follows are the conclusions of years of research on the health benefits of physical activity.

While not all types of exercise are appropriate for everyone, everyone can benefit from some type of exercise. After all, exercise is not limited to running or aerobics.

You can try water workouts or seated-chair classes. You can play softball or squash, go in-line skating or even take a turn or two around the mall, provided you don’t spend all your time lingering in front of shop windows. And if you think activities such as ballroom dancing or tending the garden don’t qualify as exercise, think again.

The primary factor in choosing an activity should be whether or not you enjoy it. Of course, an okay from your doctor also is advisable, particularly for men over 45 and women over 55, or those with special medical conditions or risk factors for heart disease.

How much one exercises is an individual decision, but numerous research studies indicate that hours of intense exercise are not necessary to reap the benefits detailed in the box above. In fact, health specialists now recommend that most adults accumulate 30 minutes or more of moderate physical activity on most days of the week.

Moderate activity is any activity that raises your heart rate and gets the blood pumping without leaving you out of breath or exhausted. So, rather than blocking off a large portion of one’s day, 10 minutes of walking at lunch and another 20 minutes after dinner, for example, is all it takes.

For those who are so inclined, exercising at slightly higher intensities for longer periods of time can bring about even greater health benefits. Less important than the intensity or duration of each exercise session is making the commitment to perform some type of physical activity every day, whether you focus on aerobic, strength or flexibility training. Soon, the exhilaration of movement and the empowerment that comes with greater fitness and health will have you hooked on exercise.

It won’t happen overnight, and there may be some aspects you find less enjoyable (some people just can’t get over the sweating part of it), but the sense of feeling better, of feeling healthier, will overpower any negative attitudes toward exercise that you may still be harboring.

Don’t worry. These, too, will pass. So, isn’t it about time you got started?

Individuals who exercise regularly are less likely to develop:

Heart diseaseDiabetesHigh blood pressureHigh cholesterolCertain forms of cancerOsteoporosis

Individuals who exercise regularly are more likely to:

Maintain a healthy body weightEffectively control the pain and joint swelling that accompany arthritisMaintain lean muscle, which is often lost with increasing ageHave higher levels of self-esteem and self-confidenceContinue to perform activities of daily living as they grow olderExperience overall feelings of well-being and good health

National Institutes of Health Weight Control Information Network—Active at Any Size: www.win.niddk.nih.gov/publications/active.htm

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Exercise to Boost Your Job Performance

How would you like to feel more energized at work — to sharpen your brain and enhance your ability to concentrate, learn, and think creatively? Not only would you feel better physically, but you’d be more motivated — and at the top of your game, career-wise. Sound good?

Exciting new research shows the remarkable effect of moderate-to-vigorous exercise on brain structure and function. A brisk walk during a morning break or a cardio class at lunchtime balances neurotransmitters and other chemicals in the brain — substances responsible for influencing brain activity related to mood, attention, learning, motivation, and arousal. That’s why you’re likely to feel calmer, yet more alert — and better able to focus — after exercise.

Exercise also helps the brain — and body — cope better with stress. That’s good news for people who work in high-pressure environments.

According to author and Harvard psychiatry professor Dr. John Ratey, another influence on the way the brain works is brain-derived neurotrophic factor, or BDNF. This substance boosts brain cell (neuron) growth and strengthens cell-to-cell connections, essentially changing brain structure. It even protects neurons against age-related changes that can lead to cell death and dementia.

Stronger, healthier, better-connected, bigger brain cells equals increased learning capacity. And here’s the big discovery — exercise floods the brain with BDNF, providing the infrastructure it needs to absorb information, process, remember, and use it.

Ratey points out that even though exercise boosts BDNF, more is needed to optimize brain function. Ideally, exercise should be paired with or precede  complex motor or cognitive tasks — to build neurons and give them something to do. So activities like figure skating, rock-climbing, or soccer fit the bill — as do running, brisk walking, or swimming followed by reviewing data reports, participating in a Web conference, or repairing a vehicle. The key is to keep finding ways to challenge your body and your brain.

Trying to learn difficult material while on the stair climber is futile — because blood flow shifts away from the part of the brain responsible for critical thinking. But when you’re done working out, brain blood flow — enriched with higher levels of BDNF — returns to normal. According to Ratey, this is the optimal time for focusing on tasks that require serious brain power.

Many modern workplaces are increasingly sedentary, increasing worker risk of inactivity-related injuries and illness. While excessive sitting has been shown to impart risks that are independent of exercise level, an active lifestyle clearly cuts down on sitting time and results in both physical and mental benefits:

One study showed that a supervised, pre-planting season exercise program among reforestation workers reduced injury rates from 22% to less than 5% — and increased productivity.

A daily supervised 10-minute stretching program among assembly-line workers showed significant improvement in joint flexibility, fatigue, anger, depression, and overall mood.

A nine--month study of 80 executives showed that exercisers experienced a 22% increase in fitness and a 70% improvement in ability to make complex decisions compared to sedentary peers.

A study of railroad workers showed that 75% of employees reported improvement in on-the-job concentration and overall productivity.

In addition to increasing the ability to focus, think clearly, and learn more effectively, regular exercise improves mood, relieves anxiety and depression, enhances energy, and promotes self-efficacy. When you feel great and believe in yourself, your mindset at work is bound to be optimistic, and that bodes well for job performance — and career growth. When you stay physically active, you’re taking care of your body and your brain — reducing health risks and increasing your capacity for learning, motivation, and sharp thinking.

The nature of work in today’s marketplace often involves juggling multiple roles, heavy workloads, and the ability to think on one’s feet. Athletes train for peak performance — and research points to plenty of good reasons for workers in other fields to follow suit.

Exercise Fuels the Brain’s Stress Buffers – American Psychological Association http://www.apa.org/helpcenter/exercise-stress.aspx
Exercise on the Brain – New York Times http://www.nytimes.com/2007/11/08/opinion/08aamodt.html
Physical Training for Improved Occupational Performance – ACSM http://www.acsm.org/AM/Template.cfm?Section=current_comments1&Template=/CM/ContentDisplay.cfm&ContentID=8651  
Train Your Brain with Exercise – WebMD http://www.webmd.com/fitness-exercise/guide/train-your-brain-with-exercise

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