Th S d The Sedentary Athlete t Athl t Introducing Exercise for - - PDF document

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Th S d The Sedentary Athlete t Athl t Introducing Exercise for - - PDF document

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5/10/2010 Th S d The Sedentary Athlete t Athl t Introducing Exercise for the first time time again again 1 5/10/2010 Build on Build on successes Build on Build on successes successes successes. Everyone has to start somewhere 2

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Th S d t Athl t The Sedentary Athlete

Introducing Exercise for the first time again time… again

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Build on Build on successes successes Build on Build on successes successes.

Everyone has to start somewhere

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Put it in Put it in perspe perspectiv ctive Put it in Put it in perspe perspectiv ctive

Hit it home

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Wri Write it it down down Wri Write it it down down

Written directions are more readily followed. Exercise is a prescription! www.exerciseismedicine.org

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Begin at the beginning

  • Find out likes
  • Find out when
  • Find out with who
  • Find out how often
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When When to do a stress to do a stress test test

Have diabetes more than 10 years 35 y/o and DM with or without CVD risk factors Older than 30 y/o with BP > 140/90, smoker, dyslipidemia, d f il h f t CAD and family hx of premature CAD Any of the “opathies” or metabolic syndrome Diabetic Autonomic Neuropathy

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Activ Activity Vs ty Vs E xercise E xercise

Not the same May avoid stigma but Be sure you know the differenc Aerobic by definition is Aerobic by definition is sustained rhythmic activity longer than 2 minutes

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Why E xercise?

  • Increases strength to improve

function and quality of life function and quality of life

  • Decreases risks of major illnesses
  • Improves anxiety levels and overall

self image self image

  • Most effective than any other option in

the marketplace

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DPP

  • 150 Min of ex/week

30 min 5x/day

  • 30 min 5x/day
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Activity

  • Choose and activity of the person’s choice

and liking and liking

  • http://www.cdc.gov/physicalactivity
  • http://prevention.sph.sc.edu/tools/docs/do

cuments_compendium.pdf

  • http://riskfactor.cancer.gov/tools/atus-

met/met.php

  • http://www.cdc.gov/physicalactivity/downl
  • ads/PA Intensity table 2 1.pdf

_ y_ _ _ p

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ME T

  • http://www.brianmac.co.uk/mets.htm
  • Calculate METs into calories
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Pick a position

  • Standing
  • Seated
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Resistance

  • Weights
  • Exercise bands

Exercise bands

  • Gravity (Own Body

weight)

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Base of Support

  • Wide
  • Narrow
  • Feet turned out

Feet turned out

  • Feet turned in
  • Feet offset
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Direction of Movement

  • Forward
  • Backward
  • Laterally

Laterally

  • Rotation
  • Upward
  • Downward
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Speed

  • Fast
  • Slow
  • Somewhere in

Somewhere in between

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Range of Motion

  • Stay within painfree

ROM ROM

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Cardiac Concerns

  • Thorough history
  • Nueropathy
  • Do stress test if

necessary

  • Blood pressure
  • Medication

B t bl k – Beta blockers

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Before you get started

  • Submaximal Exercise test

6 i lk t t – 6 min walk test

  • End Point

70% 85% of age predicted HRmax – 70%-85% of age predicted HRmax – RPE of 4-5 – Carry a conversation without gasping for air.

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6 Minute Walk Test

  • Easy to administer
  • High degree of validity and reliability
  • Measures functional capacity
  • Person can stop whenever they want

d ti ithi th 6 i t and continue within the 6 minutes or stop altogether.

  • If stop early note time that stopped
  • http://www thoracic org/statements/re
  • http://www.thoracic.org/statements/re

sources/pfet/sixminute.pdf

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Prediction equations

  • > 68 y/o

W 6MWD 493 (2 2 h i ht) – Women: 6MWD = 493 + (2.2 x height) – (0.93 x weight) – (5.3 x age) – Men: add 17 to above equation – Use metric, meters and kilograms , g

  • 50 – 85 y/o

– 6 MWD = 218 + (5.14 x height – 5.32 x age) – (1.8 x weight + 51.31 x sex)

  • Male = 1; female = 0
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Prediction E quation – All ages

  • 6MWD = 868.8 – (age x 2.99) – (Gender

x 74 7) x 74.7)

  • Female = 1, Male = 0
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Conversions

  • Feet to meters

M t f t 0 3048 – Meters = feet x 0.3048 – Feet = Meter x 3.2808 – 5289 feet = 1 mile

  • Pounds to Kilogram

– Kilograms = pounds x 0.4536

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Intensity

  • MOST CRITICAL FACTOR

70 90% HR 55 75% VO2 – 70-90% HRmax or 55-75% VO2 max – Training sensitive zone

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Determine Heart Rate

  • Linear relationship between HR and

VO2max VO2max

  • Karvonen Method

– [(220-age) – HR rest] x 0.6, 0.7, 0.8 then add HR rest add HR rest – Tanaka – for older adults >65

  • [202 – (0.7 x age) – HR rest] x % HR max then

add rest HR

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HR and VO2 max correlations

  • 70% HRmax ~ 58-60 % VO2max
  • 80% HRmax ~ 70% VO2max
  • 90% HRmax ~ 85% VO2max
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HR Considerations

  • Beta Blockers
  • Autonomic neuropathy

– Look for the sensory/motor, if present assume autonomic assume autonomic – Use RPE scale

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E xercise and Insulin Resistance

  • Exercise recommendations

5 d / k – 5 days/week – Try for same time every day – Duration: optimal 40-60 minutes

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Use it or lose it!

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Potential Adverse E ffects

  • Hypoglycemia in patients using

insulin insulin

  • Complications for proliferative

retinopathy stay away from retinopathy – stay away from isometrics and valsalva

  • Musculoskeletal or soft tissue injuries
  • Musculoskeletal or soft tissue injuries
  • Foot injuries
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General precautions

  • Monitor blood glucose levels

B f i b i – Before exercise begins – Exercise only if between100mg/dl & 250- 300mg/dl – If at high end measure after 15 min ex. g – If BG < 70mg/dl – carbo snack and remeasure in 15 min

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General Precautions

  • Avoid use of muscles around injection

site site

  • Avoid exercise during peak insulin

activity activity

  • Light meal or carbohydrate snack

before exercise before exercise

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General Precautions

  • Inform others about signs and

symptoms of hypoglycemia and what symptoms of hypoglycemia and what to do.

  • Be alert several hours after exercise

– Depleted muscle and hepatic glycogen – Depleted muscle and hepatic glycogen stores are being replenished – May deplete blood glucose and cause symptoms 6 1 h f i – 6-15 hours after exercise

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Musculoskeletal implications

  • Feet

G d h – Good shoes – Check feet after exercise – Don’t overload – Neuropathy and balance safety Neuropathy and balance, safety

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Be a coach

  • Inspire
  • Encourage
  • Give guidelines

– “be careful” is not a guideline

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Conclusion

  • Exercise is a prescription and should

be handled with care be handled with care

  • When in doubt, refer out
  • The Physical Therapist is the most

qualified professional to prescribe exercise across the continuum of exercise across the continuum of care.

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Questions??