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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Keeping a Food Journal

A food journal (also called a food log or diary) is a record of everything that you eat and drink during a 24 hour period. A growing amount of research has shown that people who keep a food journal are the ones who lose the most weight and keep it off the longest. 

Record everything that you eat and drink. Not only do your main meals matter, but your drinks, snacks, and nibbles do too. The handful of crackers while packing the kids’ lunches, the cookie from the break room at work, and that glass of wine after dinner can all add up in a big way. When you keep track of every bite and sip, you become more aware of calories that sneak in throughout your day. Be as specific as possible. Include whether foods were part of a meal or snack, the time it was eaten, how it was cooked, and if anything was added (such as dressings, condiments, salt, etc). Record food and drinks right after consumption so that you don’t forget the details. Include amounts or serving sizes. Most of us overestimate serving sizes. Pay attention to how much food is actually in a serving and record how much you are eating. Pay attention to your hunger level. Record your hunger level before eating (0= not hungry at all, 10= starving). This can help you learn if you are eating because you are hungry or for other reasons such as boredom, happiness, or anger.Describe your mood or thoughts before eating or drinking. Pay attention to how you feel as you are eating. Are you rewarding or punishing yourself with food? Are you feeling shame or guilt? Write these thoughts down as you become aware of them. Make recording food intake a daily habit. If you can’t track your food intake every day, do it on most days of the week and especially on days that you are prone to over-eating or making less healthy food choices.Choose the format that fits your lifestyle. Your food journal can be kept in a notebook, a computer spreadsheet, on a website, or by using a phone “app.” Several of the internet programs have a large database of foods to choose from so that you may easily keep track of calories and other nutritional information. Find an accountability partner. It is helpful to find someone with whom you can “check-in” on a regular basis. Choose a supportive, non-judgmental friend, family member, co-worker, health coach, personal trainer, etc.Check out online resources and apps. Many online programs and apps are available to help make food journaling easier. For example, the USDA’s Supertracker offers one tool to try. Others include MyNetDiary Calorie Counter, MealLogger, and MyFitnessPal.Feeling overwhelmed? If the thought of keeping a food journal seems impossible to you, try breaking it up into small pieces. Start by recording your basic food intake for a few days. Once you have mastered this, start paying attention to how many servings you eat. Add more details to your journal as you become more comfortable with the process. 

Additional Resource

American Council on Exercise

American Council on Exercise—Fit Life 

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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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Too Much of a Good Thing

A little exercise is good for you, so more must be better, right? Well, sometimes. And sometimes more is just that—more. There comes a point of diminishing returns or, worse, a point where your body says “Enough!”

Everyone reaches this point at different times. Triathletes, for example, are able to withstand the rigors of three-sport training—running, cycling and swimming—at levels unthinkable to most. For others, an extra step class or hitting the weights too hard can put them over the top. In the quest for better health and fitness, it is sometimes difficult to quell one’s enthusiasm and take a break from exercise. But if exercise is leaving you more exhausted than energized, you could be suffering from an acute case of overtraining.

It’s important to be able to recognize the signs of overtraining before they become chronic. Physical signs of overtraining include:

Decreased performanceLoss of coordinationProlonged recoveryElevated morning heart rateElevated resting blood pressureHeadachesLoss of appetiteMuscle soreness/tendernessGastrointestinal disturbancesDecreased ability to ward off infectionIncreased incidence of musculoskeletal injuriesDisturbed sleep patterns

Keep in mind that not all of the signs of overtraining are physical. Much like regular exercise has a positive effect on mood and stress levels, too much exercise can do just the opposite, leaving the exerciser irritable and depressed, particularly as the quality of the workouts declines. Psychological and emotional signs of overtraining include depression, apathy, difficulty concentrating, emotional sensitivity and reduced self-esteem.

Once you recognize the symptoms of overtraining, it’s important to understand and honestly confront the cause. For some, overtraining occurs as a result of an upcoming competition. Increased training prior to an event is understandable, but if it’s interfering with your health and well-being, you have to question its worth. The solution may be as easy as reducing the rate at which you increase your training intensity. The body needs sufficient time to adjust to your increased demands. Triathletes don’t start out running 10 miles, cycling 100 miles and swimming 1000 meters all at once. They gradually increase their training to allow their bodies to adapt.
For others, the basis for overtraining may have more to do with emotional or psychological reasons than physical ones. Much like eating disorders, exercise addiction is now recognized as a legitimate problem. Exercising beyond the point of exhaustion, while injured, or to the exclusion of other aspects of one’s life are some of the signs of exercise addiction. It’s a difficult problem to recognize, particularly in a culture where discipline and control are lauded.
Individuals who exercise excessively are risking more than poor performance: They’re risking their health. Overuse syndrome, which may lead to more serious injuries, is common. And the emotional cost of isolating oneself to exercise can be devastating. If you recognize these symptoms in yourself or in a friend, it is essential that you seek professional help.

The key, it seems, to staying healthy is to do everything in moderation, which is best viewed as something relative to one’s own fitness level and goals. Don’t expect to exercise an hour every day simply because your very fit friend does. The body needs time to adjust, adapt and, yes, even recuperate. Exercising to the point of overtraining is simply taking one step forward, two steps back—not exactly good training tactics.

About.com: www.exercise.about.com/cs/exercisehealth/a/toomuchexercise.htm
WebMD: www.webmd.com/hw-popup/overtraining

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Step Training for Fitness and Fun

Within the last few years, step training’s popularity has climbed rapidly. An estimated 10 million people have tried step training.

Could 10 million steppers be wrong? On the contrary—vigorous stepping provides the cardiovascular benefits of running but stresses the joints little more than walking. Performed to invigorating music with creative choreography, this low-impact workout is also lots of fun.

Before beginning a step-training class, be sure that your step—the platform—is secure and at the proper height for your fitness level. If you are new to step training, or just beginning a fitness program, start with a platform height of 4 to 6 inches. (Regardless of fitness level, the platform height should not require bending your knees more than 90 degrees.)

Keep the area around your platform dry and remove objects that could interfere with your workout.

Proper body alignment during step training helps prevent injuries. While stepping:

Relax your neck and keep it straight.Always keep your knees soft and don’t lock the knee joints.Maintain good posture with the shoulders back, chest lifted and pelvis tucked under.Lean from the ankles, not the waist, as you step onto the platform; do not bend from the hips.Don’t arch your back.Correct stepping technique also prevents injuries and improves your workout:Always place your entire foot on the platform; no part of the foot should hang over the edge.Step close to the platform, allowing the heels to contact the floor. Note: Only the ball of the foot, not the heel, should touch the floor during lunges or other rapidly repeated movements (called “repeaters”).Step quietly. Pounding can unduly stress the ankles and knees.Keep an eye on the platform at all times.Don’t use hand weights. They may increase the risk of injury and provide no significant benefit.

If you initially find step training difficult to follow, focus on learning the foot patterns and omit arm movements. You can add arm movements later.

Remember that raising your arms above shoulder level makes your heart work harder and can leave you breathless. So, if you have a hard time keeping up, lower your arms and catch your breath.

To avoid injuries caused by too much stepping, alternate step-training classes with a variety of aerobic workouts like bicycling, walking or other recreational activities.

Step-training workouts may seem difficult at first, but beware—they’re habit-forming! Just remember to maintain proper body alignment and stepping technique to keep you stepping injury-free for years to come.

American Council on Exercise—Step Training by Sabra Bonelli

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Exercising With Heart Disease

Coronary heart disease is the most common form of cardiovascular disease and the leading cause of death in the U.S. and worldwide. It results when fatty material in the coronary arteries blocks the flow of blood to the heart muscle. If the blood flow can’t meet the demands of the heart, a person often feels chest pressure or a dull ache, sometimes radiating up into the neck, jaw, left shoulder or arm. This type of pain is referred to as angina. Clots may form and completely close the vessel, resulting in a heart attack. More than 1 million Americans suffer a heart attack, or myocardial infarction (MI), each year.

A regular exercise program and a healthy diet after MI can save your life. Research suggests that exercise reduces death both from cardiovascular causes and in general. Further, the atherosclerotic process is slowed, and the risk of having another cardiovascular event (such as an MI) or hospitalization is decreased. But doctors often aren’t appropriately trained nor blessed with the extra time to provide extensive nutrition and exercise recommendations, which is why cardiac rehabilitation centers are available to provide nutritional advice, guidance about weight management and exercise prescription.

If you’ve recently had a heart attack, have chronic angina (persistent chest pain), had a stent placed, underwent coronary artery bypass graft (CABG) surgery, had a heart valve replaced, have chronic heart failure or received a heart transplant, your physician should refer you to a cardiac rehabilitation program; however, only 10 to 20% of appropriate candidates in the U.S. get this critically important referral. Part of the reason is due to geographic availability, or lack thereof. Part is due to physician failure to refer—particularly for women and the elderly. If you think that you should be eligible for cardiac rehabilitation, consult your physician for advice on the best type of program based on your medical history and present physical condition. Keep in mind that some people can safely start an exercise program at home or on their own.

Once your physician has cleared you to exercise on your own or with a qualified trainer, you should follow a program that will best help you to meet your health and fitness goals. Following are some guidelines to help you to optimize your exercise time as well as your health and safety:

Include at least a five-minute warm-up and five-minute cool-down in every exercise session to reduce the likelihood of oxygen deprivation to the heart in response to a sudden physical effort or abrupt cessation of exercise.Engage in moderate-intensity physical activity such as brisk walking for at least 30 minutes on most, preferably all, days of the week.Monitor your exercise intensity closely. Make sure to stay within your individual heart-rate zone (usually determined from a treadmill test under the supervision of a physician).Be cautious about engaging in vigorous physical activity. If you plan to begin a vigorous program, discuss it thoroughly with your physician. Also be sure to complete an exercise stress test first.Avoid strenuous activity in extreme environmental conditions. Vigorous exercise in the cold (such as snow shoveling) is associated with MI. Hot conditions require a dramatic increase in the heart’s workload. High altitude increases demands on the heart, particularly for individuals who are not acclimatized.Inform your trainer and physician if you have any abnormal signs or symptoms before, during or after exercise. These include chest pain, extreme fatigue, indigestion or heartburn, excessive breathlessness, ear or neck pain, upper respiratory tract infection, dizziness or racing heart and severe headache.If prescribed, always carry your nitroglycerin with you, especially during exercise.Never exercise to the point of chest pain or angina. If you develop chest pain during exercise, call 911 immediately.Make sure the facility where you exercise is well-equipped in case of an emergency. Ask the managers if the facility has an emergency response plan and an automated external defibrillator (AED) (with staff trained on how to use it) on the premises.

It’s never too late to start an exercise program or increase physical activity. In fact, combined with a healthy diet, it’s the best choice you can make for your heart health. Work closely with your physician and other healthcare providers to start slow and gradually increase your exercise frequency and duration. And know that if you ever need an extra hand, you can find an ACE-certified Advanced Health & Fitness Specialist in your area.

American Heart Association: www.americanheart.org/
Medline Plus—Heart Disease: http://www.nlm.nih.gov/medlineplus/heartdiseases.html/
WebMD—Heart Health Center: http://www.webmd.com/heart/

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