Preparation for exercise in patients with Diabetes

Exercise is an important therapeutic tool in people with or at risk of diabetes. However, like any other the effects of exercise in patients with diabetes must be thoroughly understood by the patient. It has been shown that regular exercise (as simple as brisk walking), improves the control of blood sugar and reduces the demand of medication by approximately 20% over period of time. In this blog, let’s take a look at the most important phase of exercising in patients with diabetes – “the preparation phase”.

Young patients (below 35 years of age) in good blood glucose control can safely participate in most activities. The middle-aged (age 35 years to 50 years) individual with diabetes should be encouraged to be physically as active as possible. However, among patients aged more than 50 years, the aging process leads to degenerative changes in muscles and joints, disuse of muscles, commonly seen in patients with diabetes may exacerbate the problem. Therefore, before beginning any exercise program, among elderly the individual with diabetes should be screened thoroughly for any underlying complications.

It is highly recommended for diabetic individuals, that exercise should include a proper warm-up and cool-down period. A warm-up should consist of 5–10 min of low-impact aerobic activity (walking, cycling, etc.) and stretches. The warm-up session is to prepare the skeletal muscles, heart, and lungs for a progressive increase in exercise intensity. Primarily, the muscles used during the active exercise session should be stretched, but warming up all muscle groups is optimal.

After the core exercise session, a cool-down should be structured similarly to the warm-up. The cool-down should last about 5–10 min and gradually bring the heart rate down to its pre-exercise level.

There are several considerations that are particularly important and specific for the individual with diabetes, these include,
• Taking precautionary measures for exercise involving the feet is essential for many patients with diabetes and keep the feet dry is important for minimizing trauma to the feet.
• Proper footwear is essential and must be emphasized.
• Individuals must be taught to monitor closely for blisters and other potential damage to their feet, both before and after exercise.
• Proper hydration is also essential, as dehydration can affect blood glucose levels and heart function adversely.
• High-resistance exercise using weights may be acceptable for young individuals with diabetes, but not for older individuals or those with long-standing diabetes.
• Moderate weight training programs that utilize light weights and high repetitions can be used for maintaining or enhancing upper body strength in nearly all patients with diabetes.

Based on:
Exercise and NIDDM (Technical Review). Diabetes Care 13:785–789, 1990.
Exercise in individuals with IDDM (Technical Review). Diabetes Care 17:924–937, 1994.

Jump Start Mondays - We are not talking about "work" but "workout"

Starting an exercise program may the “best thing” you could do for your health at the beginning of the week! Most of you might have already been doing exercise, however, not very certain how to take it to the next level. Even if you are a starter or you exercise regular, the good news is that these 4 steps will help you improve your chances of a better performance and hence better results.

Plan a target:
Assess your current fitness level and determine your purpose of exercise (Ex. Loose weight, improve endurance, prepare for a marathon). Having clear goals will help you gauge your progress. Remember to set realistic targets and a written plan a may encourage you stay on track.

Warm Up and Cool down:

If you are a beginning to exercise, start cautiously and progress slowly. Design a exercise program that gradually improves endurance, strength. Incorporating warm up and cool down periods before and after the core training respectively will help decrease the chances of injury. Many people start exercising with frenzied zeal — working out too long or too intensely — and give up when their muscles and joints become sore or injured. Plan time between sessions for your body to rest and recover.

Work Hard:
Start slowly and build up gradually. Initially break up the sessions with breaks at regular intervals. As your stamina improves, gradually increase the duration of exercise first and then the intensity of the exercise. What ever you do give your best effort possible.

Achieve:
Be creative. Your workout routine should include various activities, such as walking, bicycling or aerobics. But don't stop there. Take a weekend cycling tour with your friends or spend an evening dancing. Retake your personal fitness assessment six weeks after you start your program. You may notice that you need to increase the amount of time you exercise in order to continue improving. Or you may be pleasantly surprised to find that you're exercising just the right amount to meet your fitness goals. If you lose motivation, set new goals or try a new activity. The poster in this blog (print and paste it at home/office) is an effort by us to keep you motivated! Exercising with a friend or taking a class at a fitness center may help, too.

Starting an exercise program is an important decision. But it doesn't have to be an overwhelming one. By planning carefully and pacing yourself, you can establish a healthy habit that lasts a lifetime.

Fitness @ Formula One – Train Like A Formula One Driver

When was the last time you saw a fat formula driver? Think about it! To drive a formula one car and reach top speeds of 370 kmph. For 2 hours at a stretch requires high levels of muscular endurance, core strengthening and cardiovascular fitness. A typical formula one driver exercise protocol involves a mix of core strengthening exercise, low impact endurance training and athletic strength training. Here is a sample summary of a speed demon’s (Formula one driver) work out routine.

F1™ Core Strengthening Work out:

Swiss Ball Push Ups: One of the best core strength exercises. Having your feet balanced on a

Swiss ball while doing push ups ensures that you engage all supporting muscles. Aim for 3 x 12-15 reps.

Seated Swiss Ball Balancing: Sit on a Swiss ball, lift one foot up and hold until fatigue. Repeat with the other foot. This exercise engages both hip and lower back muscle groups.

Additionally, while in this position, pushing your forehead against a training partner’s palm will help build neck muscles.

Hammer pull-ups: With arms extended and palms facing in, pull yourself up until your chin is over the bar and hold until fatigue. This is a classic back and forearm strength builder, the
main purpose of which is to build a strong grip. Without proper preparation, two hours clutching

an F1™ steering wheel rapidly starts to burn.

F1™ Endurance Workout

An average F1™ race lasts for almost 2 hours and requires a great deal of concentration. Tiring leads to mistakes, which in the racing business can be deadly. This is why being extremely fit is an essential part of Formula One™, and why drivers undergo a variety of endurance training --

running, swimming, cycling or rowing -- depending on their preference.
The cardio workouts are designed to prepare the body for 120 minutes of torturous driving, hence the runners will typically cover about 16kms per day and the cyclists will cover up to 50kms. Rowing is also a popular form of cardio for F1™ drivers, as it involves training in a seated position and also works the arms and shoulders, which receive most of the strain while driving.

The F1™ Strength Workout

For F1™, overall athletic strength is the most important thing, so driver strength workouts involve big compound lifts. The following is what a typical driver strength session might look

like:

Squats – 3 x 12-15 reps

Deadlifts – 3 x 12-15 reps

Bench press – 3 x 12-15 reps

Rows – 3 x 12-15 reps

Pull ups – 3 x 12-15 reps

Shoulder press – 3 x 12-15 reps


Note: Drivers taking to the grid at the Indian Grand Prix this weekend will subscribe to some variation on the above 3-part workout in addition to appropriate nutritional intake. The Drivers are thoroughly assessed and monitored by an expert team of doctors, exercise physiologists and other para medical staff before designing a tailor made regime. So, do not try the above regime at home if you have a diagnosed medical ailment.

Robotic Assisted Surgery-A Revolution for Gynaecological Surgeries now at KIMS Hospital, Secunderabad.

With the DA Vinci Robotic Surgical System, surgeons and hospitals are re-writing accepted standards for surgical care. Da Vinci Robotic Surgery is changing experience of surgery .Robotic

Surgery, formerly a mere dream for doctors, has now become a reality. Doctors today can raise standards of efficiency, accuracy, ease, and comfort associated with the performance of Laparoscopic operations, using Robotic surgery. Robotic Surgery translates into instrument articulation, downscaling of movements, absence of tremor, 3-D image, and comfort of surgeon.
Since the late 1990s, the use of computer assisted or robotic technology in minimal invasive gynecological surgery has increased. Robotic technology is preferable to conventional Laparoscopic instrumentation for surgical treatment of gynecologic malignancies and most operations of benign diseases of certain complexity, such as hysterectomy, myomectomy, and invasive pelvic endometriosis.

Department of Gynaecology........ because every woman needs a gentler touch.

Note: Video of Robotic assisted Sacrocolpopexy (Surgery for uterine or vaginal vault prolapse) performed at KIMS Hospitals will be uploaded soon.

Exercise and Hydration: How much water is needed for proper hydration during exercise?

People perform physical activity throughout a range of environmental conditions such as, temperature, humidity, sun exposure and wind conditions. Depending upon the metabolic rate,

environmental conditions and clothing worn, exercise can induce significant elevations in body (core and skin) temperatures. Body temperature elevations elicit heat loss responses of increased skin blood flow and increased sweat secretion .Sweat evaporation provides the primary avenue of heat loss during vigorous exercise in warm hot weather; therefore sweat losses can be substantial.

Hydration or water balance during exercise depends on the difference between water gain and water loss. Water gain occurs from consumption of fluids during exercise while water loss during exercise predominantly occurs as sweat loss, urine, respiration.

Body weight measurement; provide a simple and effective tool to assess hydration. The before-exercise body weight measures are used with the post exercise body weight corrected for urine losses and drink volume. When possible, nude weights should be used to avoid corrections for sweat trapped in the clothing.

It is assumed that 1mL of sweat loss represents a 1-g loss in bodyweight (i.e., specific gravity of sweat is 1.0g ml/1). Fewer than 2% decrease in post exercise body weight in comparison to pre-exercise weight is widely acceptable. Anything above 2% difference indicates dehydration.

Dehydration increases physiologic strain and perceived effort to perform the same exercise task, and this is accentuated in warm-hot weather. The National Athletic Trainers' Association recommends the following hydration guidelines for exercise:

1. Two to three hours pre-exercise: 500 ml to 600 ml fluid of water or sports drink.
2. Ten to 20 minutes pre-exercise: 200 ml to 300ml of water or sports drink.
3. During exercise: Fluid replacement should approximate sweat and urine losses and at least maintain hydration at less than 2% body weight reduction. This generally requires 200 ml to 300 ml of water or sports drink every 10 to 20 minutes. Include carbohydrates in the beverage if the exercise is intense or lasts more then 45-50 minutes. Water alone will suffice, and save calories, if the exercise is moderate or less than 45-50 minutes.
4. Post-exercise: Ingest fluid equal to 150% of the weight loss (difference between pre and post exercise weight), ideally within two hours, and no more than four to six hours after the event. Carbohydrate in the drink will improve the rate of intestinal absorption of the fluid as well as replenish glycogen stores in the muscles and liver.

The goal of prehydrating is to start of physical activity euhydrated and with normal body electrolyte status. Prehydrating with beverages should be initiated at least several hours before exercise to enable fluid absorption and allow urine output to return to normal levels. The goal of drinking during exercise is to prevent excessive (92%body weight loss from water deficit) dehydration and excessive changes in electrolyte balance from compromising performance and health. Because there is considerable variability in sweating rates and composition between individuals, individualized fluid replacement programs are recommended.

Note: This content is based on ACSM Position stand on Exercise and Fluid Replacement, 2007. The content of this blog should not be considered as a medical advice. The content is developed keeping in mind, the reader as a middle aged, other wise healthy individual. If you have a diagnosed medical condition, ensure to consult your health care provider.