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Personal trainer and her client with dumbbells

Metabolic Syndrome: A New Focus for Lifestyle Modification

Personal trainers have the opportunity to do more than just help people they train become more active. We need to be prepared to also help our clients implement lifestyle behavior changes related to stress, family history of coronary heart disease, obesity, smoking, high blood pressure and high cholesterol.

A look at what is called metabolic syndrome will help you understand why, even though increasing physical activity levels is the overall best thing you can do for any client, there are additional ways to guide them to a healthier lifestyle. Sometimes you may be able to help them make the changes yourself; and, sometimes you will need to refer them to another health professional like a doctor or dietitian for guidance. Either way, knowing how to help them or when to direct them to someone who is more knowledgeable than you is important. So, first let’s become familiar with the syndrome and the clinical criteria that the doctor uses to diagnose it. Your goal is then to help your clients understand and make the necessary changes so that they don’t progress to cardiovascular disease and the almost certain heart attack heart that will be the end result.

Cardiovascular disease is still the number one cause of morbidity and mortality in the United States and much of this burden of disease can be linked to poor nutrition and a dramatic increase in sedentary lifestyles, leading to overweight and obesity. This increase in weight leads to an increase in the incidence of type 2 diabetes, and blood pressure and cholesterol problems, which are all well-established cardiovascular disease risk factors. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has updated the recommendations for the evaluation and management of adults dealing with high cholesterol, renewing its emphasis on the importance of lifestyle modifications for improving cardiovascular risk. The NCEP has coined the term “therapeutic lifestyle changes” (TLC) to reinforce both dietary intake and physical activity as crucial components of weight control and cardiovascular risk management.

As well as focusing attention on the LDL cholesterol (also called bad cholesterol) levels, the NCEP also identified metabolic syndrome as a secondary target of therapy. Metabolic syndrome (also called insulin resistance syndrome and syndrome X) is characterized by decreased tissue sensitivity to the action of insulin (pre-diabetes), resulting in a compensatory increase in insulin secretion. This metabolic disorder predisposes individuals to a cluster of abnormalities that can lead to such problems as type 2 diabetes, coronary heart disease and stroke. The prevalence of the syndrome has increased 61% in the last decade. It is crucial for medical professionals to identify patients at risk and follow these patients closely and counsel them about making lifestyle changes to lower the risk of type 2 diabetes and cardiovascular disease.

GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at least 3 of the following 5 clinical factors

Risk factor Defining level
Abdominal obesity
Men
Women
Waist circumference
>40 in (>102 cm)
>35 in (>88 cm)
Fasting triglyceride level >150 mg/dL
HDL cholesterol level
Men
Women
 
<40 mg/dL
<50 mg/dL
BP >130/>85 mm Hg
or taking antihypertensive medication
Fasting glucose level >100 mg/dL or diabetes

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health; 2001. NIH publication 01-3670.

Millions of Americans at risk for metabolic syndrome can sharply lower their chances of getting this disease by adopting a healthy lifestyle (stop smoking, low-fat diet, weight loss/maintenance and increased physical activity). Without diet and exercise modifications, most patients will eventually fail and progress to type 2 diabetes within a decade and experience a heart attack about 10 years later. Experts recommend a diet reduced in saturated fats (<7%), low in cholesterol (<200 mg/day), high in fiber (20-30gm/day) and reduced in simple sugars. Weight loss of only 5-7% (less than 15 pounds) can make a big difference in health markers like cholesterol and blood pressure. A program that includes daily exercise reaching 85% of heart rate for age is reported to be of benefit too. However, any exercise is better than none, and a target of 30 minutes every other day is a reasonable level for most people.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. The medical community is good at diagnosing this syndrome, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases, you have more knowledge in this area than the physician who has been trained in tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise since this is not a focus in medical school) medicine.  Often times all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. A personal visit to your primary care doctor and others in your area is even better. But, be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.


Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

References

  1. Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: cdc.gov/nchs/about/major/nhis/released200312.htm.
  2. Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 https://www.cdc.gov/nchs/nhis/SHS/tables.htm 16 Apr. 2018.
  3. Centers for Disease Control and Prevention. Prevalence of health care providers asking older adults about their physical activity levels—United States, 1998. Morbidity and Mortality Weekly Report. 51(19):412-4, 2002.
  4. Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms5-6 (2009): 231–237. PMC. Web. 16 Apr. 2018.
running-beach

Proven and Tested Tips to Run Safely with Diabetes

According to statistics, in 2014, 8.5% of adults above 18 years old had diabetes. Sadly, the disease is also affecting the youths below the age of 20. Basically, what this means is the chances of getting the disease are becoming higher for everyone. Eating healthy and maintaining a good exercise routine are often thought of as preventive measures but the truth is they can work wonders even if you have been diagnosed.

In this article, we will discuss some simple tips on how you can run safely with diabetes.  There is no reason for you to quit running just because you have the condition. In fact, being able to lose weight with running can contribute to your general health.

You simply have to take a few more things into consideration before you hit the road. First off, you need to understand the needs of your body depending on the type of diabetes you have.

Running With Type 1 Diabetes

Type 1 diabetes is basically when the pancreas does not produce enough insulin and the sufferer requires daily insulin injections. The condition is not curable and symptoms include excessive urine, constant hunger, thirst, weight loss, and fatigue.

Those suffering from type 1 diabetes face the risk of getting fatigued after extended periods of running. You will need to constantly monitor your sugar levels during the run and make sure they stay normal. This is one of the most important steps you ought to take: understand how your body reacts to exercise and fueling.

Once you understand your body’s reaction, you may opt to use a GU energy gel after every 15 minutes to fuel their runs. However, before making any decisions, consult your physician and get their advice first. When it comes to fueling, runners generally require 30-60 grams of carbohydrates every hour but this depends on your insulin levels.

Preventing Low Insulin Levels

Type 1 diabetes sufferers need to always remember that the blood glucose response to exercise will vary depending on these factors:

  • The level of your blood sugar before the run
  • The intensity or duration of the run
  • The changes in your insulin intake

Basically, through trial and error, you will be able to come up with a system of insulin intake and fueling that works for you.

Running With Type 2 Diabetes

Type 2 diabetes is the most common type of diabetes and happens when your body does not properly use insulin-making your body “insulin resistant”.  Initially, your pancreas produces extra insulin but in time it isn’t enough to keep your sugar levels normal.

The symptoms are very similar to Type 1 diabetes and include weight loss, increased thirst, and frequent urination, fatigue, blurred vision and slow healing sores.

The benefit of running even with diabetes Type 2 is that, your muscles use glucose during exercise which means your glucose levels go down. There are also many long-term benefits of running with Type 2 diabetes such as lowered risk of heart problems.

Like Type 1 diabetes, you will need to constantly monitor your blood glucose levels during exercise and fuel accordingly. The same suggestions provided for Type 1 Diabetes can be applied to Type 2 diabetes.

General Tips for Running with Diabetes

Whichever Type of diabetes you are diagnosed with, there are some general rules you can follow to make sure you are safe during your runs. Of course, consulting your physician should always be on top of the list, after you do this, remember these five tips:

1.  Ease into running

This is true even if you have been running for a long time in the past. Remember that your body is different now and you need to understand it all over again. Instead of running a sprint immediately, gradually ease into it. Try walking for an hour, then upgrade to a brisk walk, then combine walking and jogging and finally try a short run.

2. Engage in Strength Training Exercises

According to one study, increased muscle mass attained as a result of strength training can contribute to blood glucose absorption thereby lowering the levels in the blood. This, in turn, can increase insulin sensitivity. You don’t have to go to the gym to lift weights but even workouts such as squats, push-ups, and lunges that use your own body weight can be done at home.

3. Have a Running Buddy

This is another great aid to running with diabetes safely. Find a running buddy who knows your condition and knows what to do if your blood sugar gets too low. Another option is to carry an identification tag with you that says that you have diabetes.

4. Wear the right footwear

Although this applies to everyone who runs, it is more serious if you have diabetes. Wearing the wrong kind of footwear could lead to getting foot ulcers. With diabetes, even the slightest blister could take a long time to heal and lead to many more complications such as gangrene.

When purchasing footwear, take into consideration the shape of your foot and whether you have foot deformities such as bunions. If you do have any kind of foot deformity, you might need special inserts or specially made therapeutic shoes.

5.  Keep yourself hydrated

A lack of water can greatly affect blood sugar levels so before you run, make sure you are fully hydrated and continue to hydrate during your run.

Conclusion

Running with diabetes is possible. You just have a checklist that is a little longer and a body that has different needs. Don’t let diabetes be the end of your running career! Remember that there are thousands of runners who continue to run marathons with the condition and you can do the same.


Amber Irwin is a running and sports writer; she loves to share her passion with fellow outdoor lovers. Amber believes running is an amazing sport for everyone and hopes to inspire others. Visit her website, everyfirststep.com

References

http://www.who.int/mediacentre/factsheets/fs312/en/

http://www.diabetes.org/diabetes-basics/statistics/

https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011

http://www.diabetes.org/diabetes-basics/type-2/

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-exercise

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/

Electronic bathroom scale and glucometer with result of measurem

How You Can Fight Diabetes At Home

Unfortunately, diabetes is becoming a common disease in the United States and elsewhere. Some of that is genetic since you are at a higher risk if your parents had the disease, but an unhealthy lifestyle can contribute to it as well.

When you received your diagnosis of diabetes, you had to make some immediate changes to keep your blood sugar in check. Taking prescriptions and insulin will help, but there are some things you can do right at home to stay healthy and keep your glucose levels in the right zone. But do you know exactly why that’s so important?

What Uncontrolled Diabetes Can Do

How do you know if your diabetes isn’t under control? The best way is through your testing kit. That’s why you need to regularly test your blood glucose level. But Everyday Health lists some other signs of uncontrolled diabetes you should be on the lookout for:

  • Increased thirst.
  • Frequent urination.
  • Blurred vision.
  • Extreme fatigue.
  • Sores or cuts that heal slowly.
  • Unexplained weight loss.

Is having such high blood sugar that bad? You know that the long-term effects include vision loss and losing sensation in your feet, but those are so drastic that it can be hard to accept them as real. Here are some other problems that come from uncontrolled diabetes:

  • Difficulty using your bladder and bowels.
  • Hearing loss.
  • Bleeding gums and gum disease.
  • Blurry vision or seeing dark spots.
  • Dry, itchy, or cracked skin.
  • Pain in your extremities.
  • Muscle aches and pain.

Simple Changes To Your Diet

With all that can go wrong with uncontrolled diabetes, it’s not hard to see why you need to work on keeping your blood sugar in check. Besides taking prescriptions as ordered, you can do this by making some changes to your diet.

One of the most obvious is lowering the number of carbs you eat. That can be hard, especially since sugar and carbohydrates are addictive. Healthline.com has a great list of ways you can reduce your carbohydrates at home:

  • Stop drinking regular soda and other sweetened drinks. These are a major source of sugar, so eliminating these can really help your diabetes.
  • Cut back on the amount of bread, pasta and rice that you eat.
  • Give up fruit juices like orange juice or apple juice. Although they have good vitamins, they’re also full of sugar.
  • When you snack, focus on protein and fiber.

But eating well means more than cutting back on carbs. Here are some other tips for a diabetic-friendly diet:

  • Eat more non-starchy vegetables like broccoli or salad greens.
  • Make alcohol a rare treat, as beer and wine have a lot of carbs in them.
  • Add more lean protein on your plate, especially fish rich in Omega-3 fatty acids.

Exercising With A Home Gym

Besides eating better, you need to get some exercise. Not only will this help reduce your blood sugar levels, it can keep your body healthy — and diabetics need that more than others. But you don’t have to buy an expensive gym membership. In fact, you can create a gym in your own home. Redfin explains there are a few home gym essentials to focus on, including:

  • Dumbbells and kettlebells: easy to use and very versatile
  • Yoga or pilates mat: makes exercising more comfortable
  • Resistance bands: inexpensive and provide a lot of exercise benefits

In addition, look into apps and devices like Fitbits to help keep you motivated by seeing the results of your efforts.

Get Diabetes Under Control

Having diabetes is annoying, but there are many ways you can keep your blood sugar under control. Know the signs of high blood sugar, and make some smart choices with your diet. Then start exercising at home. This way, you can stay healthy for many years to come even with diabetes.


Henry Moore is the co-creator of FitWellTraveler. The site blends two of his favorite subjects (travel and health) to provide readers with information about how to get the most out of both. He believes travel can change you, and good health preserves you. He combines both in his work on FitWellTraveler.
yoga-lake

Stress Management and Diabetes

Diabetes, is left uncontrolled, can cause a whole host of health complications such as vision impairment and neuropathy. It is important to adhere to any instructions your doctor has given you to keep blood sugars controlled. Your physician may also educate you on exercise, diet and stress management to keep a balanced and healthy lifestyle.

Anyone who suffers from chronic stress may have many health issues later in life. One condition that may arise is diabetes.  Prolonged stress can either cause diabetes or make it tough to obtain normal blood sugars. Blood sugar numbers usually go up and down depending on what you do throughout the day. If you are fasting your numbers should be less than 100 but could be 180 two hours after eating a meal. Most diabetics must monitor their glucose levels on a regular basis.

People who have diabetes may also feel stressed because of their treatment plan. This is also called, “Diabetic Distress”.  Individuals with diabetes have many things they must do to take care of themselves such as: check glucose levels, exercise, cook and eat healthy meals, maintain a certain diet and take medications as prescribed. This new lifestyle can be very stressful for many people who have diabetes.

Along with Diabetic Distress there are the usual stressors that are a part of life. It is important to find ways to control stress throughout your lifespan. If you are newly diagnosed, the first step to reducing stress is to talk to your physician. Your medical team is on your side and can help you find a Diabetes Educator. These individuals host classes to go over any new information and questions you may have.

When controlling stress, you need to find out what works for you personally. Some individuals like to take a walk in the park, others choose to practice meditation or use a combination of many techniques. When you start to try new practices remember that you may have to try each a few times. The body has to get used to approaches. A qualified stress management consultant can help you to create a stress management plan specifically for you.

A great way to incorporate stress management into your daily routine is through meditation. Choose a certain time of day that you know will work for you. Some individuals find it helpful to meditate before getting out of bed in the morning. Others find it works best at the end of the day when they have finished working. Taking a break at work during lunch can be helpful as well. Once you find the time of day that works best choose your space. You want to find a room in your house that is free from distraction. It will also help to turn off all electronics and the television.

When practicing meditation, remember that there is no right or wrong way to meditate. Some individuals choose to meditate laying on a mat while others sit or stand. Choose a position that is comfortable for you. When sitting for meditation your knees should be lower than your hips to help sustain the position.

Guided meditation is also a great choice for meditation. A trained instructor will guide you through the meditation to help you reduce stress. Please check out this free guided meditation that you can try at home. Our Soothing Garden meditation may be shared with friends and family as well.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

Glucometer, sport shoes, fresh apple and accessories for fitness

What You Need to Know about Exercise and Diabetes

Do you have type 1 diabetes, type 2 diabetes, or prediabetes? Then you need to know that exercise is a cornerstone in the management of all of these conditions, and it can benefit your health in so many ways.

diabetes oldSometimes, being active can actually make it more challenging for you to manage your blood glucose (“blood sugar”) levels, unless you learn more about its effects. I have always known at some level that exercise generally did good things for my blood glucose, even before I had my first blood glucose meter (after going 18 years without access to one).  How could I tell without a blood glucose meter?

Being active always made me feel better, physically and emotionally, so much so that I earned a PhD in Exercise Physiology to understand why. You don’t need to go that far with your education, but there are some basics about being physically active with diabetes or prediabetes that you really need to know.

Here are some things that I know about exercise now that I wish someone had told me years ago.

#1: Exercise can help erase your blood glucose “mistakes”

  • Exercise acts kind of like an extra dose of insulin.
  • At rest, insulin is the main mechanism your body has to get glucose into muscle cells.
  • During exercise, glucose goes your muscles without needing any insulin (via muscle contractions)
  • Being regularly active makes your muscles more sensitive to insulin, so it takes less to have the same effect when you eat during or after exercise.
  • What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?

#2: Exercise doesn’t always make your blood glucose go down

  • It doesn’t always make your blood glucose come down, at least not right away.
  • During intense exercise, the excess glucose-raising hormones your body releases can raise your blood glucose.
  • Glucometer, sport shoes, fresh apple and accessories for fitnessOver a longer period of time (2-3 hours), it usually comes back down, but who wants to wait that long?
  • If you take insulin, you’ll need to take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
  • A cool-down of less intense exercise (like walking) can help bring it back to normal, so do an easy, active cool-down after intense workouts or activities.

#3: Your muscles are critical to managing your blood glucose levels

  • Exercise also helps you build and retain your muscle mass.
  • Muscles are the main place you store carbs after you eat them—like a gas tank.
  • Exercising helps use up stored carbs, but can also increase the size of the tank.
  • When you eat carbs post-exercise, they can easily go into storage with a little insulin.
  • Being sedentary keeps the tank full and makes you resistant to insulin.
  • Aging alone can cause you to lose muscle mass over time, but you can combat it to a certain extent by recruiting all of your muscle fibers regularly.
  • Resistance training and/or high-intensity intervals build muscle more because they recruit the faster fibers that you don’t use when walking or doing easier activities.

#4: Exercise is the best medicine there is

  • Use exercise to control stress and to stave off depression—with no bad side-effects!
  • It’s a natural antioxidant—more effective and better than supplements!
  • Being regularly active prevents all sorts of cancers.
  • If you’re active, you’ll likely feel better and look younger than you are (as long as you don’t exercise too much).
  • You’ll be even less likely to catch a cold if you exercise moderately and regularly.
  • Standing more, taking extra steps, and fidgeting even help—be active all day long, and don’t forget your daily dose of the best medicine there is!

For other tips on exercise and more, visit www.diabetesmotion.com or www.shericolberg.com. You can also find some exercise programs geared towards people with diabetes by visiting Diabetes Motion Academy (www.DMAcademy.com).


Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise.

man-counselor

Health & Wellness Coaching for Diabetes

Managing Diabetes can be very complex. How can the diabetes patient be successful at creating a solid lifestyle plan involving healthy nutrition, increased activity and effective medical management? A study published by American Diabetes Association, Clinical Diabetes, state’s “Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease. Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.”

Diabetes managementAccording to the New England Journal of Medicine, “Type 2 diabetes is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. It was concluded that the reduction in the incidence of diabetes was directly associated with changes in lifestyle and that Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.”

Diabetes self-management can be very overwhelming for the diabetic patient often leading to a sense of failure but there is help. A Health & Wellness Plan created together with a coach has proven to increase success in achieving healthier lifestyle behaviors and a greater quality of life.

While diabetes management can be overwhelming the Clinical Diabetes study results “revealed broad agreement among participants that their coach helped them figure out what to do to better control diabetes, that their coach’s encouragement was important in controlling diabetes, and that coaching was an important part of the overall program.”

Studies performed by Duke University, published by the New England Journal of Medicine, and the American Journal of Lifestyle Medicine suggest that working with a Health Coach improves medical management, patient engagement, social support, physical activity, diet, decreases stress, and reduces A1C scores. In addition, patient perception indicated positive improvements in overall personal health status, as well as, accomplishment of their goals when working with a health coach.

The Affordable Care Act recognizes that focusing on wellness and prevention is key to improving the health of Americans. The National Prevention Strategy is moving us from a system of sick care to one based on wellness and prevention. Many of the programs and initiatives now being funded include coaching. An example is the YMCA Diabetes Prevention Program that now includes Health Coaches within their team. We are now also finding coaches within insurance companies, such as UnitedHealth Group, Optima Health and Aetna due to success in improving diabetes control for the patient.

health-coaching-wordglobeWhat Can Health & Wellness Coaches Do for You?

Coaches work with diabetes patients in a variety of ways. In one example of coaching in a healthcare setting Dr. Heather Bennett and her team (in an American Academy of Family Physicians publication) described Health Coaching for patients as encompassing five principal roles:

  1. Providing self-management support
  2. Bridging the gap between clinician and patient
  3. Helping patients navigate the health care system
  4. Offering emotional support and support resources
  5. Serving as a continuity figure.

In Bennett’s model the role of health educator and the role of health and wellness coach was combined.

Providing self-management support
Self-management support is essential for patients to extend their health care outside the clinic walls and into their real lives. Coaches assist patients in seven domains of self-management support: providing information, teaching disease-specific skills, promoting healthy behaviors, imparting problem-solving skills, assisting with the emotional impact of chronic illness, providing regular follow-up and encouraging people to be active participants in their care. Patients have better health outcomes when provided with disease-specific knowledge and skills.

Bridging the gap between clinician and patient
Throughout the care process, there are plenty of opportunities for disconnects between the clinician and the patient. Prescribing medications is one example. It is a two-part endeavor: 1) writing prescriptions and 2) making sure patients obtain, understand and actually take the medications as prescribed. Physicians perform part one but lack time to address the critical second part. Health coaches can bridge these gaps by following up with patients, asking about needs and obstacles, and addressing health literacy, cultural issues and social-class barriers. Health Coaches help patients navigate the health care system. Many patients, particularly the elderly, disabled and marginalized, need a navigator to help locate, negotiate and engage in services. Coaches can help coordinate care and advocate with patients when their voices are not heard.

Offering emotional support
Coping with illness is emotionally challenging. Well-intentioned but rushed clinicians may fail to address patients’ emotional needs. As trust and familiarity grow, coaches can offer emotional support and help patients cope with their illnesses. They also assist patients in seeking out additional emotional support that will help them achieve and maintain success.

Woman Doing Stretching Exercises In Gym With Trainer

Serving as a continuity figure
Coaches connect with patients not only for office visits but also between visits, creating familiarity and continuity. This is particularly helpful in practices where clinicians work part-time or see one another’s patient. Coaches travel with the patient as an ally and assist them with staying the course while implementing their wellness plan.

Health & Wellness Coaches Can Help

Coaches facilitate a patient-directed process of evaluation and assessment, exploration, tracking and accountability to and assist in co-creating a plan that is tailored to the patient Health & Wellness Coaches work with a patient individually or in small groups. They help create a whole-life integrated wellness plan toward managing diabetes and bringing about the lifestyle changes needed for a healthier life. Coaches serve as an ally to help those challenged with diabetes follow through with their health & wellness plan so they can achieve their goals toward their best life possible.


References

Affordable Care Act – Department of Health & Human Services: www.hhs.gov

Bennett et al, Health Coaching for Patients With Chronic Illness. Fam Pract Manag. 2010 Sep-Oct;17(5):24-29.

MacLean et al, Telephone Coaching to Improve Diabetes Self-Management for Rural Residents. Clinical Diabetes. January 2012 vol. 30 no. 1 13-16.

Melko et al, American Journal of Lifestyle Medicine, March/April 2010; vol. 4, 2: pp. 187-194.

National Prevention Strategy, Clinical and Community Preventive Services, National Prevention Council 2010. www.surgeongeneral.gov/initiatives/prevention/strategy/preventive-services.pdf

National Prevention Council Action Plan: Implementing the National Prevention Strategy
www.surgeongeneral.gov/initiatives/prevention/2012-npc-action-plan.pdf

National Prevention Council, National Prevention, Health promotion, and Public Health Council, 2013 Annual Status Report. June 25, 2012. http://www.cdc.gov/features/PreventionCouncil

Sacco et al, Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. Journal of Behavorial Medicine. August 2009, Volume 32, Issue 4, 349-359.

Tuomilehto et al, Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance .N Engl J Med 2001; 344:1343-1350.

Wolever et al, Integrative Health Coaching for Patients With Type 2 Diabetes A Randomized Clinical Trial. The Diabetes Educator July/August 2010 vol. 36 no. 4 629-639.

sitting-sedentary

Is Sitting Really the New Smoking?

Make no mistake: sitting less time overall is a good idea for myriad health reasons, but is sitting as bad for you as some would suggest? Is it really the new smoking? In 2017 alone, a slew of new research studies has looked at various health detriments associated with prolonged sitting, even in adults who exercise regularly.

For adults with type 2 diabetes, bouts of either light walking or simple resistance activities benefit not only their glycemic responses to meals (4; 5), but also markers of cardiovascular risk. Both types of interrupting activities are associated with reductions in inflammatory lipids, increases in antioxidant capacity of other lipids, and changes in platelet activation (6).

What is good for one may not be as beneficial for all, though. For example, in adults with low levels of frailty, sedentary time is not predictive of mortality, regardless of physical activity level (1). Sitting more if you are already frail likely just increases frailty and mortality risk, which is not surprising. Along the same lines, being less fit matters in how you respond to breaking up sedentary time. Middle-aged adults with low levels of cardiorespiratory fitness gained the most metabolic benefit from breaking prolonged sitting with regular bouts of light walking, which included five minutes of light walking every 30 minutes over a 7-hour research period (2). If you’re already very fit, adding in some light walking breaks during the day is not going to have as much of an effect—again not surprising.

For in adolescents in school, reducing their sitting time (both in total time and length of bouts) has been shown to improve their blood lipid profiles and cognitive function. A “typical” day (65% of the time spent sitting with two sitting bouts >20 minutes) was compared with a simulated “reduced sitting” day (sitting 50% less with no bouts >20 minutes (3). Can teens stand to improve their health this week? Again, it cannot hurt to break up sedentary time, so why not do it? More recess breaks for teens would be good—and for everyone else for that matter.

All is not lost for people with limited mobility or no ability to engage in weight-bearing activities. Including short bouts of arm ergometry (five minutes of upper body work only every 30 minutes) during prolonged sitting attenuates postprandial glycemia (following two separate meals) when done by obese individuals at high risk of developing type 2 diabetes, even though they remain seated (7). People who cannot walk or stand can, therefore, break up their sedentary time in other ways that can also be metabolically beneficial.

As for other health benefits, breaking up sedentary time is associated with a lower risk of certain types of cancer. In a recent meta-analysis, prolonged television viewing, occupational sitting time, and total sitting time were all associated with increased risks of colorectal cancer in adults (8), which is the most common type after breast/prostate and lung cancers. That study reported a dose-response effect as well, suggesting that both prolonged total sitting time and greater total daily sitting time (2 hours) were associated with a significantly higher risk of colorectal cancer.

In summary, even just the most recent evidence is convincing enough that prolonged sitting is bad for you, and many more studies published similar results in prior years. Is sitting as bad as smoking, though? That remains to be proven. However, you really cannot argue with a recent international consensus statement on sedentary time in older people (9). It states, “Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle.” In fact, the best advice may simply be to consider the whole spectrum of physical activity, from sedentary behavior through to structured exercise (10). Putting yourself anywhere onto that spectrum is definitely better than sitting through the rest of your (shortened) life.

Reprinted with permission from Sheri Colberg.


Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise. As a leading expert on diabetes and exercise, Sheri has put her extensive knowledge to use in founding Diabetes Motion (diabetesmotion.com), a website providing practical guidance about being active with diabetes. She also founded Diabetes Motion Academy (dmacademy.com), offering training and continuing education to fitness professionals.

 

References cited:

  1. Theou O, Blodgett JM, Godin J, Rockwood K: Association between sedentary time and mortality across levels of frailty. CMAJ 2017;189:E1056-E1064. doi: 1010.1503/cmaj.161034.
  2. McCarthy M, Edwardson CL, Davies MJ, Henson J, Bodicoat DH, Khunti K, Dunstan DW, King JA, Yates T: Fitness Moderates Glycemic Responses to Sitting and Light Activity Breaks. Med Sci Sports Exerc 2017;8:0000000000001338
  3. Penning A, Okely AD, Trost SG, Salmon J, Cliff DP, Batterham M, Howard S, Parrish AM: Acute effects of reducing sitting time in adolescents: a randomized cross-over study. BMC Public Health 2017;17:657. doi: 610.1186/s12889-12017-14660-12886.
  4. Larsen RN, Dempsey PC, Dillon F, Grace M, Kingwell BA, Owen N, Dunstan DW: Does the type of activity “break” from prolonged sitting differentially impact on postprandial blood glucose reductions? An exploratory analysis. Appl Physiol Nutr Metab 2017;42:897-900. doi: 810.1139/apnm-2016-0642. Epub 2017 Mar 1124.
  5. Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW: Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care 2016;39:964-972
  6. Grace MS, Dempsey PC, Sethi P, Mundra PA, Mellett NA, Weir JM, Owen N, Dunstan DW, Meikle PJ, Kingwell BA: Breaking Up Prolonged Sitting Alters the Postprandial Plasma Lipidomic Profile of Adults With Type 2 Diabetes. J Clin Endocrinol Metab 2017;102:1991-1999. doi: 1910.1210/jc.2016-3926.
  7. McCarthy M, Edwardson CL, Davies MJ, Henson J, Rowlands A, King JA, Bodicoat DH, Khunti K, Yates T: Breaking up sedentary time with seated upper body activity can regulate metabolic health in obese high-risk adults: A randomized crossover trial. Diabetes Obes Metab 2017;23:13016
  8. Ma P, Yao Y, Sun W, Dai S, Zhou C: Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017;96:e7049. doi: 7010.1097/MD.0000000000007049.
  9. Dogra S, Ashe MC, Biddle SJH, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Copeland JL: Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med 2017;19:2016-097209
  10. Dempsey PC, Grace MS, Dunstan DW: Adding exercise or subtracting sitting time for glycaemic control: where do we stand? Diabetologia 2017;60:390-394. doi: 310.1007/s00125-00016-04180-00124. Epub 02016 Dec 00112.
Electronic bathroom scale and glucometer with result of measurem

Going Beyond Diabetes Treatment: Exercise!

There are many treatments for Type II Diabetes (which will be referred to simply as diabetes in this article) but none come with the level of benefits seen by the implementation of a proper exercise program. This is a tall order but exercise is effective for the treatment of insulin resistance and diabetes in three areas. These areas are inflammation, the cell mitochondria (where the cell generates power), and hyperinsulinemia (high blood insulin).2 Treating these areas with exercise goes beyond the benefits of treating just diabetes. In turn, you will be helping prevent other health issues associated with diabetes such as heart disease, stroke, and circulation issues. The questions is how does exercise do this and what kind of exercise is necessary?1

To understand how exercise treats diabetes, it is important to understand that diabetes is the end result of insulin resistance. Insulin resistance can be illustrated in that: when we eat something with carbohydrates or sugar, our body breaks it down into blood sugar known as glucose. This glucose triggers a response from our pancreas to produce the hormone insulin. Insulin in turn shuttles the blood sugar into the cells to be used as energy. However, when someone becomes insulin resistant the cells do not respond to the insulin’s attempt to shuttle the blood sugar into the cell, so the pancreas produces more insulin to get the same job done. In essence, the cells are developing a tolerance to the insulin and in order to get the blood sugar absorbed the cells begin to require more and more insulin to do the same job. This leads to the blood retaining the blood sugar for prolonged periods of time as well as an elevated presence of insulin. When someone has prolonged high blood sugar, we call this hyperglycemia and the person is said to be diabetic. Having high blood sugar is dangerous due to the stress it places on cells. It can cause many problems up to and including death.

In the area of inflammation, it is known that not all inflammation is the same. Inflammation can be acute — meaning it is brought on for a short period of time — which happens with activities such as exercise or when tissue undergoes some sort of trauma. Inflammation can also be chronic, meaning it is persistent and recurrent.

Acute inflammation is necessary, and healthy, because it begins the healing and repair process by bringing in white blood cells, and ridding the tissue of damaged cells. Inflammation is required otherwise the body would be unable to heal.

Chronic inflammation can be found in many conditions, such as autoimmune diseases, prolonged injury/infection, obesity, diabetes and other chronic diseases. When inflammation remains present, even at a low level, it begins to damage the body’s cells. Science now knows that:2

  • Obesity creates a level of chronic inflammation.
  • Inflammation is the precursor to every chronic disease including heart disease, arthritis, and cancer.
  • Inflammation suppresses the insulin signaling pathway (how insulin and your cells communicate) which is believed to be related to a reduction of a heat shock protein, this protein however, can be increased through exercise.
    • Increases of the protein begin after the first session of exercise.3

You may remember from science class the power generator of the cell is the mitochondria. This is where the energy is created from fatty acids and glucose. It is now believed that when the mitochondria of the cell becomes dysfunctional, less fatty acids are taken in, elevating fat (lipids) in the blood, and increasing fat storage. It is also believed that the cell becomes dysfunctional as a result of insulin resistance. This relationship may then further feed into the increased body fat and increased inflammation. Further scientific studies in this area have determined that:

  • Proper exercise increases mitochondrial efficiency, proper exercise being summarized as:
    • No less than 150 minutes of moderate activity per week but ideally more than 250 (start light and increase intensity).
    • Incorporate a combination of resistance exercise (i.e. calisthenics and weights) and cardiovascular exercise.
    • Supervision by a registered clinical exercise physiologist if two or more chronic conditions are present is recommended.4
    • Exercising following an interval training protocol ranging from 70-90% of maximal heart rate may provide superior results if tolerable by participant.5
  • It is well known that aerobic training increases the number of mitochondria in muscle fibers in order to increase the delivery of oxygen to the muscle. More mitochondria means more energy that can be generated within the cell.

Hyperinsulinemia is best described as an elevated level of insulin relative to the amount of glucose (blood sugar) present in the blood. This may be the truest indicator of someone who is insulin resistant and about to become diabetic.6 In the beginning, it was illustrated how insulin resistance develops, and it being characterized as requiring more insulin to do the same job. This additional insulin is the definition of hyperinsulinemia. When someone has hyperinsulinemia it can be expected that in a matter of time, even higher levels of insulin will be required as the cell increases its tolerance to the insulin. Eventually the pancreas will not be able to produce the level of insulin required to lower blood sugar and the person will be said to have hyperglycemia, and will be classified as diabetic. When someone is experiencing hyperinsulinemia, they are already experiencing inflammation, and a weakening of the insulin signaling pathway (ways the cells communication for glucose uptake), and likely a dysfunction of the mitochondria, which in turn may magnify the issue further.

What is known is:

  • Exercise lowers glucose in the presence of insulin, and thus exercise will lower both glucose and insulin levels.
  • If you’re currently diabetic and taking insulin, the amount may likely need reduced prior to exercise.
  • Consistent proper exercise may lead to the need to have a physician re-evaluate dosage or usage of insulin and/or pills (i.e. metformin). Never discontinue use of a medicine without consulting with your physician.

Proper exercise not only goes beyond the treatment of diabetes to the treatment of the cause (insulin resistance), it helps prevent other health issues that stem from diabetes. Health issues such as cardiovascular disease, stroke, and issues with circulation dramatically decrease with exercise. Also, remember diabetes aside exercise reduces risk of nearly every chronic disease.1


Jeremy Kring holds a Master’s degree in Exercise Science from the California University of Pennsylvania, and a Bachelor’s degree from Duquesne University. He is a college instructor where he teaches the science of exercise and personal training. He is a certified and practicing personal/fitness trainer, and got his start in the field of fitness training in the United States Marine Corps in 1998. You can visit his website at jumping-jacs.com

References

  1. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. http://doi.org/10.1002/cphy.c110025
  2. Ye, J. (2013). Mechanisms of insulin resistance in obesity. Frontiers of Medicine, 7(1), 14–24. http://doi.org/10.1007/s11684-013-0262-6
  3. Matos, M. A. de, Ottone, V. de O., Duarte, T. C., Sampaio, P. F. da M., Costa, K. B., Fonseca, C. A., … Amorim, F. T. (2014). Exercise reduces cellular stress related to skeletal muscle insulin resistance. Cell Stress & Chaperones, 19(2), 263–270. http://doi.org/10.1007/s12192-013-0453-8
  4. Moore, G. E., Durstine, J.L., & Painter, P. (2016). ACSM’s exercise management for personals with chronic diseases and disabilities. Champaign, IL: Human Kinetics.
  5. Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training. Comprehensive Physiology, 3(1), 1–58. http://doi.org/10.1002/cphy.c110062
  6. Paniagua, J. A. (2016). Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World Journal of Diabetes, 7(19), 483–514. http://doi.org/10.4239/wjd.v7.i19.483