Exercise testing prescription exam 3 TTU Day

Type 1 Diabetes

Autoimmune beta cell destruction and ABSOLUTE INSULIN DEFICIENCY

Type 2 Diabetes

Progressive loss of insulin secretion plus long standing INSULIN RESISTANCE

Gestational diabetes

Placental hormones block insulin effect, 20-24 weeks into pregnancy. VERY PRONE TO HAVE DIABETES AFTER GIVE BIRTH

Path of insulin

Stim by INC in blood glucose levels

Pancreas releases insulin

Insulin stims glycogen formation in liver and uptake by cells

Path of glucagon

Stim by DEC in blood glucose levels

Pancreas releases glucagon

Glucagon stims glycogen breakdown in the liver

Risk factors for T2DM (8)

Have prediabetes

Have high blood pressure

Overweight

45 years or older

Have parent, siblings with type 2 diabetes

Active less than 3x a week

Had gestational diabetes

Given birth to 9lb baby

What is the PRE diabetes stats

Fasting Plasma Glucose (100 - 125 mgdL)

HbA1C (5.7 - 6.4%)

2h Plasma Glucose (140 - 199 mgdL during oral glucose tolerance test)

ADA diagnostic criteria for Diabetes Mellitus

FPG = > 126 mgdL

2h PG = > 200 gdL during OGTT

lowF1C = > 6.5%

Random PG = > 200 mgdL PLUS symptoms of hyperglycemia

Fasting means how long of no calorie intake?

8 hours

Lifestyle modifications used for T2DM

Plate method

Sleep

Alcohol

Social

Plate method

Half of plate - fruit/veggies

Quarter - protein

Quarter - grains

Sulfonylureas suffix

Gl -

-ide

Physiologic changes of a sulfonylurea

Stim beta cells to release more insulin

Sulfonylureas exercise effects

INC risk of hypoglycemia

INC sensitivity to sunlight

Metformin physiologic change

DEC hepatic production of glucose

INC muscle tissue sensitivity to insulin

1st line of defense

Metformin exercise effects and what impact it has on measurements

INC HR

INC RPE
Hypoglycemia

HR AND RPE WONT BE ACCURATE

USE METS, TALK TEST, or OMNI SCALE

DPP-4 Inhibitors suffix

-gliptin

DPP-4 Inhibitors physiologic changes

Block action of DPP-4

MORE GLP-1 and GIP

DPP-4 Inhibitors exercise effect

NONE!

GLP-1 and Dual GLP-1/GIP RECEPTOR AGONISTS suffix

-glutide

Receptor agonists physiologic changes

activate the receptors for GLP-1 and GIP on tissues

Receptor agonists exercise effects

Tachycardia, hypotension

Hypoglycemia symptoms

shaking tremors

lips/tongue tingly

headache/confusion

dizziness/weakness

HYPERglycemia symptoms

excessive thirst

inc hunger

inc urination

fruity breath

Contraindication to exercise

BG LESS THAN 70

BG EQUAL OR ABOVE 250 in combo with KETONES IN URINE

BG EQUAL OR ABOVE 350

Hypoglycemia exercise and feeding BG values

Less than 70 NO EXERCISE

Less than 80 EAT 30 GRAMS OF CHO WAIT 15 MINS

80 - 100 EAT 15 - 30 G OF CHO

Hyperglycemia BG exercise values

ABOVE OR EQUAL 250 WITH KETONES NO EXERCISE

ABOVE OR EQUAL 350 NO EXERCISE

Diabetes aerobic exercise FITT for T2DM

F: 3-7 d/wk NO MORE THAN 2 DAYS CONSECUTIVE SKIPPED

I: mod to vig talk test, METS

T: 150 min/wk

Diabetes resistance prescription T2DM

F: NO MORE THAN 2 NON-CONSECUTIVE DAYS

I: as tolerated

T: sets and reps

T: multiplanar multijoint exercise, each major tendon muscle unit

Diabetes flexibility prescription T2DM

F: 2-3 d/wk

I: tight, slight discomfort NO PAIN

T: 10-30 s, 2-4 reps

T: static, dynamic

Diabetes balance prescription

F: 2-3 d/wk

I: RPE 10-14

T: any duration

T: lower body and core

How to progress Resistance training

Inc LOAD first

Inc reps

Inc sets

Inc frequency last

Benefits of resistance training

Improved lean muscle mass trickle down effect

INC fat oxidation

Greater capillary density

Optimal pre exercise BG

90-250

Best training?

COMBO

During combo training do which type first?

Resistance then aerobic!

Why should we stay hydrated during exercise?

Inc risk of overheating

How long after eating should they exercise?

WITHIN 2 HOURS

What should get eaten after exercise?

Complex carb snack

Retinopathy is what?

Carbs build up in iris and cause blindness

Avoid these with retinopathy in exercise

Vigorous aerobic or resistance

Jumping/jarring

Head down

Valsalva maneuver

Peripheral neuropathy what is it?

High BG levels damage sensory neurons and blood vessels

Peripheral neuropathy exercise precautions

FALL RISK

Nonweight bearing activities

Mental health

General feeling of well being, manage stress, contribute to community, work productively

Mental illness

Health condition that impacts thinking, behavior, mood, relatability, ADLs

Mental health indicators

Optimism

Clear thinking

Stable relationships

Flexibility

Productive behavior

Mental illness indicators

Withdrawal, numb, helpless, mood swings, harming yourself, cant do ADLS

Depress DSM5 Definition

Mood disorder involving a persistent low mood or loss of interest in actvities

Depression cognitive effects

negative self talk, pessimistic,hopelessness and helplessness

Depression somatice effects

Extreme fatigue, altered sleep, fluctuation in weight

Types of depression

Major depressive disorder

Perinatal

Premenstrual dysphoric disorder

Persistent depressive disorder

Seasonal affective disorder

Atypical

MDD

depressed mood, no pleasure

Perinatal

before or after childbirth

premenstrual dysphoric childbirth

mood swings, irritable, depressed mood or anxiety before menstruation

Persistent depressive disorder

MORE THAN 2 YEARS

Seasonal affective disorder

seasonal

Atypical

Has MDD with mood reactivity, INCREASED appetite, sleep, heavy limbs, and rejection sensitive

Anxiety DSM5 definition

excessive worry and apprehension that occurs more days than not for at least 6 months

Anxiety cognitive effects

cant concentrate, on edge, going down rabbit hole, irritable, restlessness

Anxiety somatic effects

trembling muslce tension, tachycardia, tachypnea, GI upset, dry mouth and easily fatigue

Generalized anxiety disorder

excessive worry about events

OCD

unwanted reoccuring repetitive behaviors

PTSD

distress due to being exposed to traumatic event

Panic disorder

intense recurrent panic attacks

social anxiety disorder

extreme anxiety in social situations

General causes of these illlness’

Autonomic dysfunction

Imbalance in brain systems

Impaired neurotransmitter release (GABA, serotonin, epi/norepi)

Inflammatory dysregulation

Regions of brain linked to anxiety and depression

Prefrontal cortex - Logical response and reasoning shut down by anxiety

Anterior cingulate cortex - AMPLIFY fear signals from amygdala

Amygdala - Response to fear, INC in size in anxiety

Depression anxiety stress scales 10

overall level of distress that is sensitive to and can be used to track effectiveness of treatment

Hospital anxiety and depression scale

identify hospital pts who need more psych evaluation and assistance

GAD 7 for anxiety and PQH 9

screening tools used to assess severity of symptoms

What mode is recommended in depressed pts

Submaximal exercise test

Recommended CRF tests

6 min walk WITH SUPPORT

Frenz ergocycle test

What needs to be discussed before testing a person with anxiety

INC HR and Respiratory rate with sweating may seem like an anxiety symptom

Antidepressents classes and their effect

SSRI - dizzy

SNRI - dizzy

Misc - dizzy and rapid heart beat

DIZZY =

FALL RISK

3 classes of antianxiety meds

Benzodiazepines - dizzy, memory loss, confusion, amnesia, breathing bad

Azapirone - dizzy drowsy, tachycardia, GI UPSET, headaches, nervousness, numb, tingling insomnia

Beta Blockers - -olol bradycardia, hypotension, fatigue, dizziness, sleepy

How exercise helps depression

Monoamine boost - INC serotonin, dopamine, norepi

BDNF brain plasticity - form new hippocampal neurons and synapses

Lower inflammation - releases antiinflammatory myokines

Kynurenine sink - protects blood brain barrier and prevents brain toxicity

How exercise helps anxiety

Stress axis tuning - cortisol responses become smaller and smaller

Endocannaboids/endorphins - calms and reduces tension after working out

anxiety senstivity retraining - exercise is a like a panic attack, trains body to react appropriately

sleep and rumination break - interupts worry loop

Aerobic FITT for anxiety/depression

F: 5 days mod 3 days vig

I: Mod 40-59% HRR RPE 12-13 Vig 60-89% HRR RPE 14-17

T: Mod 75 m/wk Vig 75 m/wk

T: Rhythmic, large muscle groups, walk bike swim

Resistance FITT for anxiety/depression

F: 2/3 d/wk 48 hours apart

I: 60-70 1RM 7 - 6 RIR 40-50% 1RM 5-4 RIR for 65 over and deconditioned

T: 8-12 reps, 2-4 sets, 2-3 min rest

T: multijoint/multiplanar for all muscle tendons

Behavioral strategies for anxiety and depression

Focus on rapport, empathy

NONADHERENCE SHOULD BE EXPECTED
Start with open ended goal

Enhance self efficacy

Remind of benefits

Positive rewards

Buddy or support system