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Rondanelli M, Gasparri C, Riva A, Petrangolini G, Barrile GC, Cavioni A, Razza C, Tartara A, Perna S. Diet and ideal food pyramid to prevent or support the treatment of diabetic retinopathy, age-related macular degeneration, and cataracts. Front Med (Lausanne) 2023; 10:1168560. [PMID: 37324128 PMCID: PMC10265999 DOI: 10.3389/fmed.2023.1168560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Many eye diseases, such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and cataracts are preventable and treatable with lifestyle. The objective of this review is to assess the most recent research on the ideal dietary approach to prevent or support the treatment of DR, AMD, and cataracts, as well as to construct a food pyramid that makes it simple for people who are at risk of developing these pathologies to decide what to eat. The food pyramid presented here proposes what should be consumed every day: 3 portions of low glycemic index (GI) grains (for fiber and zinc content), 5 portions (each portion: ≥200 g/day) of fruits and vegetables (spinach, broccoli, zucchini cooked, green leafy vegetables, orange, kiwi, grapefruit for folic acid, vitamin C, and lutein/zeaxanthin content, at least ≥42 μg/day, are to be preferred), extra virgin olive (EVO) oil (almost 20 mg/day for vitamin E and polyphenols content), nuts or oil seeds (20-30 g/day, for zinc content, at least ≥15.8 mg/day); weekly: fish (4 portions, for omega-3 content and eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) 0.35-1.4 g/day), white meat (3 portions for vitamin B12 content), legumes (2 portions for vegetal proteins), eggs (2 portions for lutein/zeaxanthin content), light cheeses (2 portions for vitamin B6 content), and almost 3-4 times/week microgreen and spices (saffron and curcumin). At the top of the pyramid, there are two pennants: one green, which indicates the need for personalized supplementation (if daily requirements cannot be met through diet, omega-3, and L-methylfolate supplementation), and one red, which indicates that certain foods are prohibited (salt and sugar). Finally, 3-4 times per week, 30-40 min of aerobic and resistance exercises are required.
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Affiliation(s)
- Mariangela Rondanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
- Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Pavia, Italy
| | | | | | - Gaetan Claude Barrile
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Pavia, Italy
| | - Alessandro Cavioni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Pavia, Italy
| | - Claudia Razza
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Pavia, Italy
| | - Alice Tartara
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona “Istituto Santa Margherita”, University of Pavia, Pavia, Italy
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
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The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature. Nutrients 2022; 14:nu14061252. [PMID: 35334909 PMCID: PMC8955064 DOI: 10.3390/nu14061252] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Diabetes is a major social problem. As shown by epidemiological studies, the world incidence of diabetes is increasing and so is the number of people suffering from its complications. Therefore, it is important to determine possible preventive tools. In the prevention of diabetic retinopathy, it is essential to control glycemia, lipid profile and blood pressure. This can be done not only by pharmacological treatment, but first of all by promoting a healthy lifestyle, changing dietary habits and increasing physical activity. In our work, we present a review of the literature to show that physical exercise and an adequate diet can significantly reduce the risk of diabetes and diabetic retinopathy.
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Ren C, Liu W, Li J, Cao Y, Xu J, Lu P. Physical activity and risk of diabetic retinopathy: a systematic review and meta-analysis. Acta Diabetol 2019; 56:823-837. [PMID: 30900027 DOI: 10.1007/s00592-019-01319-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/05/2019] [Indexed: 01/28/2023]
Abstract
AIMS Diabetic retinopathy (DR) is an important microvascular complication of diabetes mellitus (DM) and a leading cause of visual impairment and blindness among people of working age. Physical activity (PA) or exercise is critical and beneficial for DM patients, whereas studies evaluating the relationship between PA and DR have yielded inconsistent and inconclusive results. The American Diabetes Association's "Standards of Medical Care in Diabetes" has also pointed out the indeterminate roles of PA in DR prevention. The purpose of this systematic review and meta-analysis was to explore the association between PA and DR risk. METHODS Medline (accessed by PubMed), EmBase, and Cochrane Library were systematically searched for studies up to June 2018, and the reference lists of the published articles were searched manually. The association between PA and DR risk was assessed using random-effect meta-analysis. RESULTS Twenty-two studies were included in this meta-analysis. PA was found to have a protective association with DR [risk ratio (RR) = 0.94, 95% confidence interval (95% CI) 0.90-0.98, p = 0.005] in diabetic patients, and the impact was more pronounced on vision-threatening DR (RR = 0.89, 95% CI 0.80-0.98, p = 0.02). Sedentary behavior could increase the risk of DR (RR = 1.18, 95% CI 1.01-1.37, p = 0.04). Moderate-intensity PA was likely to have a slight protective effect (RR = 0.76, 95% CI 0.58-1.00, p = 0.05). CONCLUSION PA is associated with lower DR risk, and more studies should focus on the causality between them.
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Affiliation(s)
- Chi Ren
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Weiming Liu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Jianqing Li
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Yihong Cao
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Jiayi Xu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, People's Republic of China.
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Kirk A, Mutrie N, MacIntyre P, Fisher M. Promoting physical activity in people with type 2 diabetes. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514020020031301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alison Kirk
- Centre for Exercise Science and Medicine, University of Glasgow, Glasgow, UK,
| | - Nanette Mutrie
- Centre for Exercise Science and Medicine, University of Glasgow, Glasgow, UK
| | - Paul MacIntyre
- Centre for Exercise Science and Medicine, University of Glasgow, Glasgow, UK
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Lubenova D, Titianova E, Vasileva D. Orthostatic Reactivity in Patients with Diabetic Neuropathy. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP).MATERIAL AND METHODS: The study was performed in 90 patients with DNP (34 male and 56 female, mean ages 60.8 ± 7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing.RESULTS: At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was not found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT.CONCLUSION: The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP.
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Stehno-Bittel L. Organ-based response to exercise in type 1 diabetes. ISRN ENDOCRINOLOGY 2012; 2012:318194. [PMID: 23251813 PMCID: PMC3518066 DOI: 10.5402/2012/318194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/14/2012] [Indexed: 12/16/2022]
Abstract
While significant research has clearly identified sedentary behavior as a risk factor for type 2 diabetes and its subsequent complications, the concept that inactivity could be linked to the complications associated with type 1 diabetes (T1D) remains underappreciated. This paper summarizes the known effects of exercise on T1D at the tissue level and focuses on the pancreas, bone, the cardiovascular system, the kidneys, skeletal muscle, and nerves. When possible, the molecular mechanisms underlying the benefits of exercise for T1D are elucidated. The general benefits of increased activity on health and the barriers to increased exercise specific to people with T1D are discussed.
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Affiliation(s)
- Lisa Stehno-Bittel
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Colberg SR, Albright AL, Blissmer BJ, Braun B, Chasan-Taber L, Fernhall B, Regensteiner JG, Rubin RR, Sigal RJ. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 2011; 42:2282-303. [PMID: 21084931 DOI: 10.1249/mss.0b013e3181eeb61c] [Citation(s) in RCA: 351] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.
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8
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Riddell MC, Burr J. Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process. Appl Physiol Nutr Metab 2011; 36 Suppl 1:S154-89. [DOI: 10.1139/h11-063] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Physical activity (PA) is one of the most powerful treatment options for persons with prediabetes or diabetes. However, some elevation in risk occurs with increased PA, at least initially, and certain precautions need to be made to lower these risks, particularly if these persons are unaccustomed to exercise. We conducted a standardized search of all adverse events associated with increased PA in persons with prediabetes or diabetes (type 1 or type 2) and provided evidence-based guidelines on PA screening in these apparently high-risk individuals. A systematic literature review was performed of all studies reporting on adverse events in persons with prediabetes or diabetes. Studies included were from all designs (retrospective and prospective including randomized controlled trials) and were assessed according to evaluation criteria adapted by a consensus panel. A total of 47 studies, involving >8000 individuals, were deemed eligible. A number of these studies identified a range of mild to severe acute risks with exercise (musculoskeletal injury, hypoglycemia, foot ulceration, proliferative retinopathy, hypotension, sudden death) but the overall prevalence was low. Based on several randomized controlled trials and prospective studies in which prescribed exercise was performed at a wide range of intensities, it appears that increased PA is a relatively safe procedure with no evidence of a loss of life. Based on our assessment of the available literature, we provide a new PA risk algorithm for persons with prediabetes and diabetes and comment on the role of the patient, the qualified exercise professional, and the patient’s physician in the risk screening process.
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Affiliation(s)
- Michael C. Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, Physical Activity and Chronic Disease Unit, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jamie Burr
- School of Kinesiology and Health Science, Muscle Health Research Centre, Physical Activity and Chronic Disease Unit, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
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9
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Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33:e147-67. [PMID: 21115758 PMCID: PMC2992225 DOI: 10.2337/dc10-9990] [Citation(s) in RCA: 882] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, Virginia, USA.
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10
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Abstract
Musculoskeletal injuries and diseases are common in persons with obesity and diabetes mellitus. High body mass index is associated with an increased risk for musculoskeletal injuries, diseases, and disability. There is a significant positive correlation between the level of obesity and musculoskeletal injuries, and disability and health-related costs. The prevalence of obesity and diabetes is inversely proportional to health-related quality of life.
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Affiliation(s)
- Robert P Wilder
- Department of Physical Medicine and Rehabilitation, University of Virginia, 545 Ray C. Hunt Drive, Suite 310, Charlottesville, VA 22908, USA.
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11
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Loganathan R, Bilgen M, Al-Hafez B, Zhero SV, Alenezy MD, Smirnova IV. Exercise training improves cardiac performance in diabetes: in vivo demonstration with quantitative cine-MRI analyses. J Appl Physiol (1985) 2007; 102:665-72. [PMID: 17082374 DOI: 10.1152/japplphysiol.00521.2006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Diabetic cardiomyopathy is a distinct myocardial complication of the catabolic state of untreated insulin-dependent diabetes mellitus in the streptozotocin-induced diabetic rat. Exercise training has long been utilized as an effective adjunct to pharmacotherapy in the management of the diabetic heart. However, the in vivo functional benefit(s) of the training programs on cardiac cycle events in diabetes are poorly understood. In this study, we used three groups of Sprague-Dawley rats (sedentary control, sedentary diabetic, and exercised diabetic) to assess the effects of endurance training on the left ventricular (LV) cardiac cycle events in diabetes. At the end of 9 wk of exercise training, noninvasive cardiac functional evaluation was performed by using high-resolution magnetic resonance imaging (9.4 T). An ECG-gated cine imaging protocol was used to capture the LV cardiac cycle events through 10 equally incremented phases. The cardiac cycle phase volumetric profiles showed favorable functional changes in exercised diabetic group, including a prevention of decreased end-diastolic volume and attenuation of increased end-systolic volume that accompanies sedentary diabetes. The defects in LV systolic flow velocity, acceleration, and jerk associated with sedentary diabetes were restored toward control levels in the trained diabetic animals. This magnetic resonance imaging study confirms the prevailing evidence from earlier in vitro and in vivo invasive procedures that exercise training benefits cardiac function in this model of diabetic cardiomyopathy despite the extreme catabolic state of the animals.
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Affiliation(s)
- Rajprasad Loganathan
- Dept. of Physical Therapy and Rehabilitation Science, Univ. of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA
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12
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Loganathan R, Searls YM, Smirnova IV, Stehno-Bittel L. Exercise-induced benefits in individuals with type 1 diabetes. PHYSICAL THERAPY REVIEWS 2006. [DOI: 10.1179/108331906x99056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Guazzi M, Brambilla R, Pontone G, Agostoni P, Guazzi MD. Effect of non-insulin-dependent diabetes mellitus on pulmonary function and exercise tolerance in chronic congestive heart failure. Am J Cardiol 2002; 89:191-7. [PMID: 11792341 DOI: 10.1016/s0002-9149(01)02199-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In chronic congestive heart failure (CHF), backward effects of left ventricular dysfunction alter pulmonary volumes and gas diffusion. Some of these disorders are detected in some patients with diabetes mellitus, possibly due to a microangiopathic process and nonenzymatic glycosylation of lung tissue proteins. We explored the possibility that coexistence of non-insulin-dependent diabetes mellitus (NIDDM) may potentiate the deterioration of lung function in CHF. In 20 normoglycemic patients (group 1) and in 20 patients with NIDDM (group 2), with New York Heart Association class II to III CHF due to idiopathic or ischemic cardiac disease, and in 20 controls (groups were age- and gender-matched), we investigated cardiac function, pulmonary volumes, carbon monoxide diffusion (DL(CO)) and its alveolar-capillary membrane (D(M)) subcomponent, oxygen uptake and dead space-to-tidal volume ratio (pVD/VT) at peak exercise (individualized ramp test), and slope of ventilation-to-carbon dioxide production ratio (VE/VCO(2)) during exercise. Although, compared with reference subjects, both patient groups had similar variations in left ventricular diastolic volume, ejection fraction, and pulmonary wedge pressure; in group 2 lung volumes, DL(CO), D(M), and oxygen uptake were significantly more reduced; in this group there was no overlap of individual results of DL(CO) and D(M) with those in controls; VE/VCO(2) slope and pVD/VT also were significantly increased, and inversely correlated with D(M). Thus, coexistence of NIDDM makes pulmonary dysfunction worse in CHF, and significantly enhances exercise intolerance.
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Affiliation(s)
- Marco Guazzi
- Istituto di Cardiologia dell'Università degli Studi, Centro di Studio per le Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Centro Cardiologico, I.R.C.C.S., Milan, Italy.
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14
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Abstract
As rates of diabetes mellitus and obesity continue to increase, physical activity continues to be a fundamental form of therapy. Exercise influences several aspects of diabetes, including blood glucose concentrations, insulin action and cardiovascular risk factors. Blood glucose concentrations reflect the balance between skeletal muscle uptake and ambient concentrations of both insulin and counterinsulin hormones. Difficulties in predicting the relative impact of these factors can result in either hypoglycemia or hyperglycemia. Despite the variable impact of exercise on blood glucose, exercise consistently improves insulin action and several cardiovascular risk factors. Beyond the acute impact of physical activity, long-term exercise behaviors have been repeatedly associated with decreased rates of type 2 diabetes. While exercise produces many benefits, it is not without risks for patients with diabetes mellitus. In addition to hyperglycemia, from increased hepatic glucose production, insufficient insulin levels can foster ketogenesis from excess concentrations of fatty acids. At the opposite end of the glucose spectrum, hypoglycemia can result from excess glucose uptake due to either increased insulin concentrations, enhanced insulin action or impaired carbohydrate absorption. To decrease the risk for hypoglycemia, insulin doses should be reduced prior to exercise, although some insulin is typically still needed. Although precise risks of exercise on existing diabetic complications have not been well studied, it seems prudent to consider the potential to worsen nephropathy or retinopathy, or to precipitate musculoskeletal injuries. There is more substantive evidence that autonomic neuropathy may predispose patients to arrhythmias. Of clear concern, increased physical activity can precipitate a cardiac event in those with underlying CAD. Recognizing these risks can prompt actions to minimize their impact. Positive actions that are part of exercise programs for diabetic patients emphasize SMBG, foot care and cardiovascular functional assessment. SMBG provides critical information on the impact of exercise and is recommended for all patients before, during and after exercise. More frequent monitoring (and for longer periods following exercise) is recommended for those with hypoglycemia unawareness or those performing high-intensity exercise. Preventing the sequelae of an exercise-induced severe hypoglycemic reaction can be as simple as carrying glucose tablets or gel, a diabetic identification bracelet or card, or exercising with an individual who is aware of the circumstances. In addition to blood glucose concentrations, proper foot care is critical to people with diabetes who exercise and includes considering type of shoe, type of exercise, inspection of skin surfaces and appropriate evaluation and treatment of lesions (calluses and others). Those with severe neuropathy can consider alternatives to weight-bearing exercises. Precipitation of clinical CAD is of great concern for all diabetic patients participating in exercise activities. Although a sufficiently sensitive and specific screening test for coronary disease has not been identified, those planning an exercise program of moderate intensity or greater should be evaluated. Initial cardiac assessment should include exercise testing as well as identifying risk for autonomic neuropathy. In addition to noting maximal heart rate and blood pressure as well as ischemic changes, exercise tolerance testing can identify anginal thresholds and patients with asymptomatic ischemia. Those without symptoms should be counseled regarding target pulse rates to avoid inducing ischemia. Ischemic changes need to be evaluated for either further diagnostic testing or pharmacological intervention. For patients with diabetes mellitus, the overall benefits of exercise are clearly significant. Clinicians and patients must work together to maximize these benefits while minimizing risks for negative consequences. Identifying and preventing potential problems beforehand can reduce adverse outcomes and promote this important approach to healthy living.
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Affiliation(s)
- S R Chipkin
- Department of Medicine, Tufts University School of Medicine, USA.
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EXERCISE AND PHYSICAL ACTIVITY IN THE TREATMENT OF TYPE 2 DIABETES. Nurs Clin North Am 2001. [DOI: 10.1016/s0029-6465(22)02547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Orsini M, De Freitas MRG, Presto B, Mello MP, Reis CHM, Silveira V, Silva JG, Nascimento OJM, Leite MAA, Pulier S, Sohler MP. Guideline for Neuromuscular Rehabilitation in Guillain-Barré Syndrome. ACTA ACUST UNITED AC 2001. [DOI: 10.34024/rnc.2010.v18.8443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction. Originally described by Landry in 1859 and Guillain, Barré and Strohl in 1916, Guillain-Barré Syndrome (GBS) is the most common cause of acute neuromuscular paralysis selflimited in developed countries. The annual incidence of GBS is 1.5 per 100,000. Although it had a favorable prognosis (“maladie bénigne et spontanément curable”) it’s mortality rate is about 5% and 10% of patients remaining severely disabled one year after neurological onset. Specialist teams, intensive care and rehabilitation are essential for patient management and should be provided in appropriate hospital units. Objective. To guide the health professionals about the utilization of the physical and respiratory techniques in patients with GBS, as well as it’s indication. Method. Update of articles about GBS and Rehabilitation, on the last years of the data bases Bireme, ScienceDirect, PubMed and SciELO. Conclusion. There is currently no consensus on the management of these patients in the acute, sub-acute and chronic settings. Many of them are being discharged without access to rehabilitation services. Our results suggest that the rehabilitation makes a measurable and significant difference and should be available to all patients with GBS.
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Albright A, Franz M, Hornsby G, Kriska A, Marrero D, Ullrich I, Verity LS. American College of Sports Medicine position stand. Exercise and type 2 diabetes. Med Sci Sports Exerc 2000; 32:1345-60. [PMID: 10912903 DOI: 10.1097/00005768-200007000-00024] [Citation(s) in RCA: 344] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Physical activity, including appropriate endurance and resistance training, is a major therapeutic modality for type 2 diabetes. Unfortunately, too often physical activity is an underutilized therapy. Favorable changes in glucose tolerance and insulin sensitivity usually deteriorate within 72 h of the last exercise session: consequently, regular physical activity is imperative to sustain glucose-lowering effects and improved insulin sensitivity. Individuals with type 2 diabetes should strive to achieve a minimum cumulative total of 1,000 kcal x wk(-1) from physical activities. Those with type 2 diabetes generally have a lower level of fitness (VO2max) than nondiabetic individuals. and therefore exercise intensity should be at a comfortable level (RPE 10-12) in the initial periods of training and should progress cautiously as tolerance for activity improves. Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2 diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result, ratings of perceived exertion rather than heart rate may need to be used for moderating intensity of physical activity. Although walking may be the most convenient low-impact mode, some persons, because of peripheral neuropathy and/or foot problems, may need to do non-weight-bearing activities. Outcome expectations may contribute significantly to motivation to begin and maintain an exercise program. Interventions designed to encourage adoption of an exercise regimen must be responsive to the individual's current stage of readiness and focus efforts on moving the individual through the various "stages of change."
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Regensteiner JG, Bauer TA, Reusch JE, Brandenburg SL, Sippel JM, Vogelsong AM, Smith S, Wolfel EE, Eckel RH, Hiatt WR. Abnormal oxygen uptake kinetic responses in women with type II diabetes mellitus. J Appl Physiol (1985) 1998; 85:310-7. [PMID: 9655791 DOI: 10.1152/jappl.1998.85.1.310] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Persons with type II diabetes mellitus (DM), even without cardiovascular complications have a decreased maximal oxygen consumption (VO2 max) and submaximal oxygen consumption (VO2) during graded exercise compared with healthy controls. We evaluated the hypothesis that change in the rate of VO2 in response to the onset of constant-load exercise (measured by VO2-uptake kinetics) was slowed in persons with type II DM. Ten premenopausal women with uncomplicated type II DM, 10 overweight, nondiabetic women, and 10 lean, nondiabetic women had a VO2 max test. On two separate occasions, subjects performed 7-min bouts of constant-load bicycle exercise at workloads below and above the lactate threshold to enable measurements of VO2 kinetics and heart rate kinetics (measuring rate of heart rate rise). VO2 max was reduced in subjects with type II DM compared with both lean and overweight controls (P < 0.05). Subjects with type II DM had slower VO2 and heart rate kinetics than did controls at constant workloads below the lactate threshold. The data suggest a notable abnormality in the cardiopulmonary response at the onset of exercise in people with type II DM. The findings may reflect impaired cardiac responses to exercise, although an additional defect in skeletal muscle oxygen diffusion or mitochondrial oxygen utilization is also possible.
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Affiliation(s)
- J G Regensteiner
- Section of Vascular Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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Affiliation(s)
- B L Feuerstein
- Department of Medicine, SUNY Health Science Center, Syracuse, USA
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Abstract
This study investigated the physical activity and beliefs about exercise of 30 adolescents with diabetes. The Seven-Day Physical Activity Recall was used to determine the physical activity for two different recall periods that were 2-weeks apart. Forty percent of the youths engaged in 30 minutes of moderate activity 5 times per week while only 10% engaged in 20 minutes of vigorous activity 3 times per week. Forty-seven percent of the teens consistently achieved or surpassed the time equivalent of activity for one of the Healthy People 2000 Objectives for moderate or vigorous physical activity. This group had significantly higher scores on the Exercise Belief Instrument for Adolescents that was developed for this study. Strategies to encourage regular physical activity are discussed.
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Abstract
Regular exercise has been recognised as an important component in the management of patients with diabetes mellitus. In addition to acutely lowering blood glucose, exercise training improves glucose tolerance and peripheral insulin sensitivity, contributes to weight loss and reduces several risk factors for cardiovascular disease. When proper precautions are taken to prevent hypoglycaemia, individuals with diabetes can enjoy the same benefits from exercise as nondiabetic healthy individuals. As a guideline, moderate intensity, aerobic endurance activities should be performed for 20 to 40 minutes at least 3 times a week. Blood glucose should be monitored, and insulin dose and carbohydrate intake adjusted based on the blood glucose response to the type and duration of exercise. This review will summarise current understanding of the therapeutic role of exercise in the treatment of diabetes and will present guidelines for prescribing exercise in diabetic patients.
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Affiliation(s)
- J C Young
- Department of Kinesiology, University of Nevada, Las Vegas, USA
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Soukup JT, Maynard TS, Kovaleski JE. Resistance training guidelines for individuals with diabetes mellitus. DIABETES EDUCATOR 1994; 20:129-37. [PMID: 7851226 DOI: 10.1177/014572179402000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Resistance/strength training is added to an exercise regimen to create a well-rounded program that enhances muscular conditioning and improves health, physical fitness, and/or athletic performance. This article presents resistance training guidelines for individuals with diabetes mellitus, with and without vascular complications. The existing literature concerning exercise prescription and the acute and chronic physiological responses to resistive-type exercise is discussed. The educator is provided with principles that govern resistance training so that safe and effective programs can be prescribed for individuals with diabetes.
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Soukup JT, Kovaleski JE. A review of the effects of resistance training for individuals with diabetes mellitus. DIABETES EDUCATOR 1993; 19:307-12. [PMID: 8370334 DOI: 10.1177/014572179301900410] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although the effectiveness of exercise as a treatment modality for the management of diabetes mellitus has long been recognized, a vital component of the exercise prescription has been overlooked. In addition to endurance training, resistance training may provide physiologic benefits to the individual with diabetes that, in some cases, may equal or exceed those gained through aerobic training. These benefits may include improved blood lipid profiles, increased absolute left ventricular wall contractility, decreased resting blood pressure, improved insulin sensitivity and glucose tolerance, improved glycemic control, improved muscular strength and endurance, and increased bone and connective tissue strength. By utilizing a combination of aerobic and resistance training, the individual with diabetes experiences a more comprehensive exercise program that can improve most areas of health and physical fitness. In addition, having a greater number of exercise modality options may enhance exercise compliance.
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Ruby KL, Blainey CA, Haas LB, Patrick M. The knowledge and practices of registered nurse, certified diabetes educators: teaching elderly clients about exercise. DIABETES EDUCATOR 1993; 19:299-306. [PMID: 8370333 DOI: 10.1177/014572179301900409] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study identified the knowledge base and practices of Registered Nurse, Certified Diabetes Educators (RN, CDEs) regarding their exercise teaching programs for elderly clients who have non-insulin-dependent diabetes mellitus (NIDDM). The random sample of 197 AADE members surveyed by questionnaire was a highly educated and experienced group. RN, CDEs who worked 30 or more hours per week in diabetes education or attended four or more continuing education (CE) programs per year had significantly more comprehensive exercise teaching program designs and instructional techniques to enhance elderly NIDDM clients' learning (P < .05). However, many CDEs do not teach their elderly clients about exercise due to lack of resources, lack of specific knowledge to prescribe exercise,and negative stereotypes of elderly clients' ability to exercise. Greater availability of educational programs for CDEs to explore curriculum development, program planning, evaluation, and exercise prescription for elderly clients with multisystem disease is recommended.
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Abstract
Exercise comes in many forms and uses different substrates (fuels) for adenosine triphosphate (energy) production. The greater the intensity of exercise, the greater the relative contribution of carbohydrate as a fuel source. However, as intensity exceeds the anaerobic threshold, anaerobic glycolysis is inhibited, forcing a decrease in exercise intensity. Proper manipulation of the exercise prescription components can create the desired health and fitness benefits, provide a high level of carbohydrate utilization, and control exercise risks while maintaining exercise intensity at aerobic levels. The calculation of target heart rate zones and proper monitoring of exercise heart rates allows for greater compliance to exercise prescriptions. Individual responses to various exercise intensities and modalities require regular assessments. Monitoring blood glucose levels before and after exercise assists in prescribing exercise duration and exercise times in relation to the medication and dietary regimen.
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Maynard T. Exercise: Part I. Physiological response to exercise in diabetes mellitus. DIABETES EDUCATOR 1991; 17:196-206. [PMID: 2019228 DOI: 10.1177/014572179101700316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Exercise is a valuable and effective tool for assisting with diabetes management. The benefits of exercise are significant. Metabolic responses to various workloads vary greatly and depend on many factors, including type of diabetes; time, dosage, and type of diabetes medication; time and content of last meal; fitness level; and intensity and duration of activity performed. Exercise-induced hypo- and hyperglycemia can occur in diabetes, and strategies to avoid this should be taught. Weight loss is a common goal in NIDDM, although often difficult to attain. Exercise plays a critical role in weight loss and should be considered part of the treatment plan when fat loss is a goal.
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Abstract
Physiological systems decline with age. Such declines may be the result of aging itself or physical deconditioning. Evidence suggests that the degree to which decrements occur with aging may be modifiable with physical activity. The elderly adapt to exercise programs at a generally reduced rate. Thus reduced activity, coupled with diabetes, may present unique clinical needs. In the design of exercise programs for the elderly person with diabetes, special attention needs to be given to medical screenings, potential risks, exercise goals, and implementation.
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