Clinical Exercise Physiology Notes

Diabetes

• Summarize key physiology (pathophysiology) of diabetes.

• Discuss key exercise considerations for diabetics (Type 1 & 2).

• Increased prevalence of diabetes.

  • Roughly 1 in 20 Australians live with diabetes(2022).

  • 1 in 5 between 80-84 years old have diabetes.

  • Higher prevalence in men compared to women.

• Associated comorbidities are a concern.

  • Overweight, cardiovascular disease, hypertension.

• Metabolic syndrome: hypertension, diabetes, cardiovascular disease.

• Mortality trends related to type one diabetes have declined worldwide.

  • People with type one diabetes are still at a higher risk of mortality (2-5 times).

Pathophysiology of Diabetes

Type 1

• Early onset, hereditary/genetic (cause not fully understood).

• Autoimmune destruction of insulin-producing beta cells in the pancreas.

  • Results in absolute insulin deficiency.

• Increased risk of ketoacidosis.

• No known cure or prevention.

• 5-10% of all cases.

Type 2

• Adult onset.

• Muscle and liver become insulin resistant.

  • Results in elevated/uncontrolled blood glucose levels.

• Prevention possible through diet and lifestyle.

• 90-95% of all diabetes cases.

• In diabetes, there's an exaggerated insulin response.

• Managing diabetes = glycemic control.

Exercise and Diabetes

• Benefits: Insulin sensitivity.

  • Diet, exercise, and medication manage glycemic control.

• Recommendations:

  • 3-7 days a week, no more than 2 consecutive days without activity.

  • Benefits to aerobic and resistance training.

  • Improve muscle mass to improve utilization of glucose.

  • Improve aerobic capacity to generate more mitochondria.

• Enhanced GLUT4 transporters

• Increase in glycogen synthase and glycogen stores.

• Better glycemic control with both aerobic and resistance training (20% increase in insulin sensitivity).

• Combining aerobic and resistance training improves insulin sensitivity by up to 70%.

• Moderate intensity (50% VO2 max) improves insulin sensitivity by 50%.

• Intense exercise (80% VO2 max) improves insulin sensitivity by 80%.

• High intensity exercise helps facilitate glucose/glycogen breakdown.

• HIIT has most benefit postprandially. Low intensity training under a fasted condition also elicits similar glycemic improvement.

• Type one diabetes is associated with a marginal decrease in skeletal muscle health and cardiorespiratory fitness.

• Endurance exercise can help lower risk of glycemia.

• Explosive activities can increase the risk of glycemia.

• HIT training and resistance training moderate glucose relatively well.

• Performance and competition for type one diabetics:

  • Glucose monitoring and insulin dosing.

  • Strategic snacking and meal planning.

  • Ensure adequate hydration and minimize stresses.

• Diabetics (type 1 & 2) maintain skeletal muscle function/aerobic capacity up to 40-45 years of age.

Clinical Exercise Physiology and Respiratory Conditions

• Focus on asthma and COPD.

Asthma

• Chronic disease: bronchial airways narrow/swell, making it difficult to breathe.

  • Two point seven million Australians have asthma (2017-2018 stats).

  • Higher rates of fair to poor health and psychological distress.

  • 78% of people with asthma age 45+ had at least one other chronic condition.

  • Most people with asthma can exercise to their full potential if they have good control.

• Exercise-induced asthma: vigorous physical activity triggers acute airway narrowing in people with heightened airway reactivity.

  • Linked to changes in environment (heat, humidity, moisture levels).

    • Early phase onset (5-15 minutes of exercise) or late phase onset (4-6 hours after).

    • General population: 10-20% prevalence.

    • Winter athletes: 30-70% prevalence.

    • Persistent asthmatics: 70-90% prevalent.

• Diagnosing:

  • Asthmatics will have an issue getting the air out of their lungs.

  • Significantly reduced peak expiratory flow and FEV1.

  • Slight reduction in forced vital capacity.

• Exercise in asthma: extensively researched and well documented.

  • Training programs improve cardiorespiratory and functional fitness in adults with asthma.

  • Aerobic exercise with adults that have asthma can be benefical.

    • Resistance Exercise with adults that have asthma can be benefical.

    • Breathing and stretching exercises are benfical with adults that have asthma.

• Asthmatics typically have lower fitness levels.

  • Linked to activity, not condition severity.

  • Exercise outcomes are better than asthma medications.

    • Exercise improves cardiopulmonary fitness and quality of life.

    • Outdoor play for children lowers their risk of getting asthma.

• FIT recommendations: no real significant changes in our FIT principles for asthmatics.

COPD (chronic obstructive pulmonary disease)

• Common lung disease that restricts airflow and causes breathing problems.

  • Includes chronic bronchitis, bronchial asthma, and emphysema.

• Roughly 2.5% of Australians reported having COPD (2022).

  • There are much higher rates of fair to poor health. There are also high rates of moderate to very severe bodily pain as well.

  • Four times more likely to have COPD if you are a smoker.

  • Potential to become the third leading cause of death worldwide by 2030.

• COPD and asthma present very similarly.

  • Issues getting air out of lungs. *Significant reduction in forced expiratory volume in one second.

• Exercise plays a vital role alongside pulmonary rehabilitation.

  • Limitations: respiratory characteristics will limit exercise capacity.

  • Decreased work of breathing improves exercise performance and energy supply to locomotor muscles.

  • Oxygen cost of breathing/perfusion of respiratory muscles significantly higher.

  • Not all patients with COPD have detectable anaerobic threshold.

    • May exhibit true ventilatory limit to exercise.

  • Ischemia is greater than hypoxemia.

• Downward spiral of inactivity in patients.

  • Reduce and replace. The strongest predictor of mortality was having greater than eight and a half hours of sedentary time a day.

  • If you replace thirty of sitting with thirty minutes of moderate to vigorous physical activity, you would significantly improve your FEV1

  • High intensity exercise may have more benefit, but it may be less tolerable, something is more than nothing.

  • Active females with COPD had a life expectancy similar to females without COPD; regular exercise nearly eliminated the life expectancy gap in inactive male COPD patients as well.

  • Resistance training improves aerobic capacity, muscular economy, and walking economy.

• FIT recommendations:
  *Relatively straightforward just reduce and replace.

Exercise Physiology and Cardiovascular Conditions

• Focus on hypertension.
  *key physiological considerations, benefits, and exercise recommendations.

Hypertension

• Resting blood pressure of >140/>90, confirmed by a minimum of two measures taken on two separate days.

  • Or use on hypertensive medication

• Roughly 2.6 million Australians reported being hypertensive.

  • 74% of all adults with measured high blood pressure did not report having hypertension.

• older you are the more at risk you are.

• FIT recommendations:

  • Hypertensive individuals, it might be beneficial to use some form of RPE or exertion scale.

  • It might be beneficial to progress to up to eighty percent if it's tolerated.

• Physical activity reduces risk associated with hypertension.

Mechanisms by which we can reduce our blood pressure

• Improved endothelial function.

• Greater microvascular function.

• Arterial stiffness decreases.

• Reduction in systemic inflammation.

• Less atherosclerosis.

• Decrease in chronic stress.

  • feel good hormone increases.

• Either aerobic exercise or resistance exercise have similar effects on improving arterial stiffness, arterial function, endothelial function, and in very similar ways can reduce blood pressure.

• Resistance exercise for those with hypertension (Isometric resistance training) Results again substantial reduction in blood pressure.

Exercise Considerations

• Blood pressure medications can influence cardiac measures.

• Monitor exercise intensity appropriately (use RPE).

• Incorporate resistance training early.

Some key pointers:

• Prioritize frequency and duration over intensity as tolerated.

• Want to make sure that we are conscious of breathing throughout/we dont want to see any sort of Valsalva maneuvers to generate more force or things like that if were resistance training/we want to steer clear of those exaggerated blood pressure responses Recognizing.

Exercise physiology and cancer

• We will largely focus on Breast Cancer and Lung Cancer
  *Breast Cancer is the top 5 most common cancers diagnosed across the world
  *Lung Cancer is the top 5 most common cancers diagnosed across the world

*1 out of 50 people had cancer in 2022
*Men were slightly more likely to be diagnosed with cancer
*3 out of every 10 deaths are from cancer
*There are over 100 types of diagnosable cancer

4 common types are

• Carcinomas: lining of organs

• Sarcomas: bone/connective tissue cancers

• Lymphomas:localized lymphatic system

• Leukemia: Blood cancer

Cancer has controllable factors and uncontrollable factors such as sedentary lifestyle and geneticsControllable in a sense: Alcohol/lifestyle/Smoking/Diet/Obesity*Uncontrollable in a sense: Genetics

Tumour Development

• Stage 1: Cancer is localised in small area

• Stage 2: size of cancer increases

• Stage 3: Cancer spreads to various other parts of the body

• Stage 4: Cancer has grown and has spread to the majority of the body
  *Strong evidence for breast cancer + the risk reduction of breast cancer associated with exercise
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  There is moderate strength of evidence associated with the risk reduction of contracting the disease of lung cancer associated with being active consistently from a relatively active state
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  There is a moderate strength of evidence based around the notion of potentially having the capabilities to reduce the likelihood of the diagnosis of lung cancer across the globe by on average 25% just by increasing ur respective lifestyle activities levels to engage and participate in the activities of exercise at the most respective current activity levels for your self
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  There is dose related response associated with the notion of being active is a great way and mechanism to continue to reduce your overall body respective risk associated with breast cancer and lung cancer from an activity participation levels
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  This is to gear your understanding behind the benefits and considerations of exercise as its related to helping support individual to improve different factors associated with each of the respective Cancer diagnostic conditions*There is a good foundation to the fact there is no significant decrease of your cardiovascular based function and respective factors relative to all the other cardiovascular factors out thier with breast cancer patients when engaging and participating in exercise *The overall outcome associated with participating is to allow the capability to preserve all the functions and cardiovascular functions following individual participants who have been previously diagnosed when adhering to exercise parameters based upon any treatments that you potentially have to endure with your body,
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  Following the diagnosis of breast cancer from a duration participation timeline over 3 months you can significantly reduce risks if you engage in leisure activities as recommended over a long term process following this diagnostic period
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  Exercise can help and significantly improve breast cancer prognosis and survival rates throughout those who engage an exercise routine over time (12 months - 5 years) as opposed to those who do not (Non exercises
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  Having depression/Low mood/Lowered quality of life can impact ur survivals rates and what we want to focus on improving for survival patients
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  Aerobic exercise can significantly help and decrease CRF better than typical and or other conventional care treatment styles
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  Resistance exercis prescription can help/significantly reduce and potentially lower or not increase fatigue than more so than if ur following conventional care *The main limiting factors associated with working around with post operations for those with patients who have or have been diagnosed with lung cancer or had a procedure done is dependent usually given that what factors surrounding there respective case may indicate and relate best too
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  Pre Lung Resection: Whether it be pre aerobic or resistance: Can improve exercise capacity, reduce pot operative complications, reduce over all stay at the hospital, reduce catheter duration
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  Post Lung Resection: We see post aerobic plus resistance training: Results in Improvement in quality overall health, improve muscular endurance, Improves or significantly helps and lowers breath rates and/or awarenesses of those who feel uncomfortable with certain respiratory metrics
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  In operable Exercise is a measure for pre treating such things can help improve a patient to allow treatment or treatment options or the chance to have an operation following exercise which helps and is beneficial for such patient outcomes as it relates to having potential improvements as well as in a comparable exercise fitness capacities and/or an almost more improve or almost more overall relative qualitative value and quantity associated with improvements for individuals quality of life (QOL)

A couple of important factors to remember when working with those after such post treatments such as

Biological Mechanisms can result in

• Reduction in fatigue/No exacerbations of fatigue levels. The act of exercise helps you feel less tired instead of exacerbating the feeling of being lethargic and fatigued

• Significant lung function improvements + Improvement to Diaphragm Strength-Diaphragm muscle can help promote lung capacities such as Force Vital Capacities

• Increased Natural Murderer Cells/Significant Improvement In Immune System Function + Natural Killer Cells count is indicative you have significant levels or higher levels due to treatments may hinder or cause this cell count to go down

• Reduction in cell population, slower population,slower turn over, slower cancer spreading cells
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  After procedures such as LOBECTOMY is when doctors go and target such a cancerous cell area where there is removal specifically of the lobe ( cancerous section ) of the infected cell.POST LUNGE SURGERY AFTER A LOBECTOMY: Doctors can see there is a disportionationalal Early Loss of that section and or sections or cells as it were to have an exaggerated loss relatively at the current moment but over a periods of such post surgery procedures such as a lobectomy there is potential to actually improve functional capacities over a longer period and respective time in a time respective factor to those with certain respective lobectomies and procedures

PNEUMONECTOMY-Doctors fully Remove a Lung following procedure's : can cause larger long term lasting issue and or cause issues regarding sustainable or sustained loss for said respective lunges with out many potential improvements and or capacities
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For all treatment capacities relating to specific cancer and treatments, be sure to factor in each and almost always individual patients respective backgrounds history or pre status will dictate most of what will factor there specific case and or there outcome when undergoing specific treatment