Adapted from BMJ Sept 19 Promoting physical activity to patients by Christine Haseler et al.
The Academy of Medical Royal Colleges has described walking as a miracle cure. Despite this many of us are not as active as we should be and inactivity is thought to result in as many deaths as smoking. More than a quarter of UK adults do less than 30 minutes physical activity a week.
Quantified, these are the benefits of just plain walking:
30% lower all cause mortality, even 10 minutes a day is worthwhile.
20-30% lower risk of dementia.
Better relief from back pain than back exercises
30% lower risk of colon cancer
30% reduction in falls for older adults
22-83% reduction in osteoarthritis
even lower body fat than playing sports
20-35% lower risk of cardiovascular disease
20% lower risk of breast cancer
30-40% lower risk of metabolic syndrome or type two diabetes
The people who need to see their GP before undertaking exercise are few but include people with unstable angina, aortic stenosis or uncontrolled severe hypertension.
In pregnancy the sort of activities that need to stop are: impact activities, lying on the back for long periods, high altitude activities and underwater activities.
From Diabetes in Control: Getting and Staying Motivated to Be Physically Active Jan 4, 2020
Author: Sheri R. Colberg, PhD, FACSM
Every New Year all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?
Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.
Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:
Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
Get yourself an exercise buddy (or a dog that needs to be walked, you can borrow one!).
Use sticker charts or other motivational tools to track your progress.
Schedule structured exercise into your day on your calendar or to-do list.
Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
Reward yourself for meeting your goals with noncaloric treats or outings.
Plan to do physical activities that you enjoy as often as possible.
Wear a pedometer (at least occasionally) as a reminder to take more daily steps. You can get free pedometer apps that turn your mobile into a pedometer.
Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
Do not start out exercising too intensely, or you may become discouraged or injured.
If you get out of your normal routine, and are having trouble getting restarted, take small steps in that direction.
As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension.
Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.
From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).
Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.
Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.
The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.
The colleges want more active participation with patients in planning for their care.
The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent. Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections. Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.
This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.
It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.
The Public Health collaboration online conference 2020 was very successful. The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.
If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00. This is via the PHC site.
This year there were contributions from mainly the UK but also the USA.
Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity to the effects of coronavirus is a side effect of these healthy living practices.
Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.
A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!
My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.
There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format. We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.
I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post. The whole video is available from the PHC site which takes you to all the videos on You Tube.
Adapted from Military Medicine January 2019 by Richard Al LaFountain et al of Ohio State University.
This is the first study of a ketogenic diet in military personnel. Daily ketone monitoring was done to personalise the diet. 29 subjects from various branches of the military took part over the 12 week study.
15 self selected to go on the ketogenic diet (KD) monitored by blood ketones daily. 14 continued their mixed diet (MD). Various measurements were done at the start and end of the programme.
All of the KD group were in ketosis throughout the 12 weeks as assessed by beta-hydroxybutrate levels. The KD group lost 7.7kg more (range -3.5 to -13.6kg) despite no calorie restriction. They lost 5.1% body fat (range -0.5 to -9.6%). 43.7% was visceral fat (range – 3.0 to – 66.3%) and had a 48% improvement in insulin sensitivity. There were no changes in the MD group. There were no changes between the groups in aerobic capacity, maximal strength, power and a military specific obstacle course.
The authors conclude that this was a very well accepted intervention which showed remarkable improvements in body composition and weight without compromising physical performance in exercise training.
In the USA two thirds of active military personnel are overweight or obese which mirrors the general population. Nearly three out of four young people aged 17-24 fail to qualify for military service mainly due to obesity and failure to meet fitness standard thus posing an impending recruitment crisis.
The military usually follow the USDA’s dietary guidelines that advocates low fat, high carbohydrate foods. Americans have followed these recommendations for decades and have seen a marked rise in obesity at the same time. A diet that emphasises carbohydrate has the effect on suppressing fat oxidation and the production of ketones. Over half of active military personnel report drinking sugar and caffeine containing energy drinks in the past month.
Ketones produced while following a ketogenic diet have been shown to improve fat oxidation, enhance gene expression, inflammation, antioxidant defense and healthspan. Fat loss without the explicit need to restrict calories is a benefit. Reversal of metabolic syndrome and obesity occurs. Previous studies have shown no detrimental impact on endurance and resistance training performance. The study was done in the military to see if this was a feasible approach.
The success of a ketogenic diet depends on commitment so we did not randomise the subjects. Both groups took part in identical physical training that emphasised strength and power.
Participants were recruited from the Ohio State Reserve Officer Training Corps and other local groups with a military affiliation. We wanted people as similar as possible to the demographics of serving soldiers regarding age, sex, race and body mass. Participants were excluded if they had had previous experience of a ketogenic diet, were over 50, had certain illnesses, conditions, medications or allergies or who could not exercise safely.
The KD group were coached and were provided with unlimited frozen, pre-cooked meals and grocery supplies. Carbohydrate was limited initially to 25g per day and protein to 90 g/d until ketosis occurred. Thereafter they could increase the amounts in their diet provided they stayed in ketosis. They were encouraged to use salt. Carbohydrate was targeted at less than 50g per day including non starchy vegetables, nuts, seeds, selected fruit and berries. Protein goals were 0.6 – 1.0g g/kg of lean body mass. Total energy intake was not restricted. Non starchy vegetables and fats were encouraged to reach satiety. Alcohol over 2 drinks a day was discouraged in both groups. Participants checked their blood ketones every morning and sent pictures of their readings to the research team.
The mixed diet group had a minimum consumption of 40% dietary calories from carbohydrate. All participants met with registered dieticians and were encouraged to eat to satiety with no specific caloric limit. Dietary supplements were not allowed.
All groups undertook a progressive resistance training programme two days a week for an hour at a time. They had one additional cardio training session a week consisting of running and body weight circuit training for at least 30 minutes. Each resistance training session ended with 15 minutes of whole body, high intensity circuit training.
Body mass and body composition was measured by DEXA. Fat was assessed by MRI. Indirect calorimetry was used to evaluate resting metabolic rate and the respiratory exchange ratio.
The most noteworthy result was a spontaneous reduction in energy intake resulting in a uniformly greater weight loss for the ketogenic group. The visceral fat was also markedly reduced which leads to a reduced risk for insulin resistance and cardiometabolic disease. Insulin sensitivity improved in the ketogenic group.
Normalisation of weight is important for soldiers because non combat musculoskeletal injury is 33% more common in this group.
Subjects in this study were overweight but not obese, so the weight loss effect could be expected to be even more in obese subjects. Release of fatty acids and ketones are likely the cause of the satiety effect leading to less hunger. The weight loss in the ketogenic group was 80% from body fat mass. 44% of the fat lost was from the viscera, largely in the middle of the body.
Because the subjects decided what diet they would follow, selection bias can’t be ruled out. The KD group was also slightly heavier at baseline than the MD group. The two women in the KD group responded similarly to the men.
Shin spots occur in 17-40% of people with type one and two diabetes. The spots can also be seen in the forearms. They tend to be irregularly shaped, brown and they don’t itch or bleed.
The older you are and the longer you have had diabetes, the more you are likely to have. They are thought to be due to small blood vessel changes similar to the kind that cause other complications like retinopathy and neuropathy.
Comment: Do any of you have them? I haven’t even noticed them before but I will keep an eye out for them now.
British Journal of General Practice December 18
Adapted from Tendinopathy in type 2 diabetes by Richard Baskerville et al
People with diabetes have three times the risk of all musculoskeletal conditions and particularly tendon problems. Tendon problems are also more resistant to treatment in diabetics.
Half of people with type two diabetes who are given exercise programmes for a variety of health conditions drop out due to musculoskeletal symptoms. Tendon problems can be for example, Achilles tendinopathy, rotator cuff problems in the shoulder, tennis elbow and trigger finger.
In a typical GP practice 18% of diabetic patients will be affected for around three months for each episode over a five year period.
Tendonitis means that the person has an acute condition with inflammation of the tendon. Tendinopathy is a degenerative process that lasts weeks or months.
Tendinopathy is due to too much wear and not enough repair of the tendons. Diabetics also have the added problem of sugar molecules binding onto collagen. Instead of the collagen fibres running over each other like silk sheets, they get stuck together like Velcro. Blood supply, collagen production and healing are impaired. Obesity, high blood pressure, ageing, alcohol and smoking are all independent factors that worsen tendon healing.
Tendinopathy is more likely in people who are on insulin or who have had the condition more than five years. Other conditions which are related such as bursitis, carpal tunnel syndrome, Dupuytren’s contracture, frozen shoulder and plantar fasciitis are also more common in diabetes.
The onset of tendinopathy tends to be gradual but a trivial event can bring it to light. The symptoms are of unusual pain and stiffness on certain activities. If the condition is not better by two months it is usually due to a tendinopathy.
The tendon is painful when pressed or moved. The area does not have increased warmth. There is often reduced muscle strength. Tendonitis on the other hand is usually an acute condition with redness, warmth and a crackling feeling under the examining finger.
Early physiotherapy is the mainstay of treatment. The aim is to improve general fitness, stretch the muscles and load the muscles in a controlled way. Recovery is often painful and slow.
Acute tendonitis can be managed with non steroidal anti inflammatory drugs and gels. Renal, gut, cardiac disease and hypertension can limit treatment. Steroid injections can help in the short term.
Tendinopathy is often recurrent. It is best to keep HbA1c and blood glucose variability low. If an episode has not settled in six weeks physio is recommended.
Adapted from Sheri Colberg’s article in Diabetes in Control July 6 2019
Exercise does NOT make you more tired.
Most people feel more invigorated after a workout. Regular exercise helps you cope better physically and mentally with your work and personal life. During periods of acute stress, at work for instance, a short brisk walk can help clear your mind and bump up your energy levels. Exercise helps reduce insomnia too.
You do NOT have to work out in a “fat burning range” to lose weight.
Just exercise as long and intensely as is reasonable for you if you want to lose weight. You do use up a little more fat at lower intensity exercise but this mainly happens during the recovery phase.
Your muscles will NOT turn into fat if you stop weight training.
Keep your muscles strong and noticeable by physical activity and exercise and aim to avoid fat gain.
Weight training will NOT bulk you up if you are a woman.
It takes a great deal of effort for men to bulk up doing weight training and this effort is magnified in women because they have very little testosterone. Your total weight may increase if you weight train as muscle is heavier than fat. Pay attention to how you look and feel and how your clothes fit rather than have a fixed idea of the optimum number on a scale.
No pain does NOT mean no gain.
You need to distinguish the feeling of lactic acid in the muscle from a well executed exercise set and delayed muscle soreness a day or two afterward with acute muscle tears and overtraining. The time it takes to recover is a good guide. Also adjust your timing and intensity gradually.
Lifting weights slowly does NOT necessarily mean you will build more muscle.
Lifting slowly can increase the total time that your muscle is under tension. This can increase muscle endurance. Lifting the heaviest weight quickly helps you recruit more muscle fibres and will result in bigger muscles. So if you are lifting a weight slowly during a particular exercise but could lift it faster, to build muscle you either need to move that weight faster or use a heavier weight.
Working on your abdominal muscles WON’T give you a flat belly.
You can’t spot reduce. You can tone up your belly and back muscles but what really helps is getting rid of excess fat covering the muscle. You can do harder workouts to increase your muscle mass and this will help you burn more calories including at rest.
More exercise does NOT mean more fitness
Overuse injuries are more common if you are working out for more than 60-90 minutes of aerobic exercise a day. Cross fit and high intensity interval training are likely to be more beneficial than very long workouts.
You DO NOT have to eat huge amounts of protein.
If you do weight train you do need more protein but only up to twice that for a sedentary person. That is 1.6 to 1.7 grams of protein per kilogram body weight. Most people, especially those on a low carb diet will naturally be eating enough protein. Some protein after exercise may be beneficial especially whey protein. You can eat natural foods eg egg whites or drink chocolate milk (careful about sugar) instead.
You DO NOT need to sweat profusely to do good.
Sweating varies a lot between men and women and individuals. If you are physically trained you may sweat sooner and more. The exercise intensity will affect it. So does the ambient temperature and humidity. Sometimes not sweating enough can be a sign of dehydration so it doesn’t always reflect your effort.
Sheri’s book The Athlete’s Guide to Diabetes: Expert advice for 165 Sports and Activities is available on Amazon and at Barnes and Noble stores.
She has websites to help you:Sheri Colberg.com and DiabetesMotion.com
Exercise, as we folks with diabetes are often told, is essential for good management of diabetes. ‘Good’ doesn’t mean easy. The usual disclaimer applies; my experiences are unique to me, but this week’s blog post is inspired by last week’s climb of Ben Lomond.
Ben Lomond is a munro—i.e. a mountain this is higher than 3,000 feet or 914.4 metres. Munro-bagging is the activity where you climb them, stand on the top for a while taking pictures (if it’s not on social media, it never happened, right?) and then telling everyone you know for weeks afterwards.
As Ben Lomond is the munro nearest to where I live, it’s been on my bucket list for ages. My sister in law is a keen walker/hill climber so the two of us set off to tackle the mountain last Monday.
I am fitter than average. My FitBit tells me I’m in the top percentage of people my age and gender when it comes to the VO2 measurement. (If you can explain exactly what this is to me, I’d be grateful.) But climbing a munro? Boy, a different kettle of fish entirely. I didn’t prepare properly and I suffered.
So, here are the lessons I learned…
Prepare, prepare, prepare
Endurance exercise needs far more before-hand and after preparation than short spurts of exercise. I can do half an hour to an hour’s exercise without needing to take extra carbs or adjust my insulin. A mountain is something else entirely.
Stretch, stretch, stretch
Stretch out your calves, quads and glutes thoroughly afterwards. No, do. Mine ached for five days afterwards, particularly my calves which I put down to going up on the balls of my feet as I clambered over the rocks. When I got out of bed on Sunday morning and limped downstairs to the toilet, I went so slowly my FitBit didn’t register the steps.
Eat, you diddy
Eat beforehand. I know, duh. I had food with me but my sister-in-law and I did it first thing so I hadn’t bothered with breakfast.
Test, test, test
Blood sugar at the start – 9.8. One hour in, 13.4. I took half a unit of rapid acting insulin—3.2 half an hour later. In a panic, I shoved in too many jelly babies. At the top I ate a banana and took no insulin. By the time I got to the bottom, my blood sugar had hit the heady heights (appropriate analogy, huh?) of 19. I took too much insulin and by the time I got home, I’d crashed once more.
Oh for the Abbot Free Style Libre, which would have made testing blood sugar levels so much easier and adjustments more likely to be accurate. Some day my star will come and the good people of Greater Glasgow and Clyde NHS health board will see fit to prescribe it.
Enjoy the views
Except, this being Scotland, count on getting to the top and seeing nothing thanks to the thick layer of grey cloud that hovers there. Still, twenty metres down and the views were glorious.
Afterwards, we realised we’d climbed Ben Lomond on World Naked Hiking Day… sadly, everyone else who climbed it on that day hadn’t got the memo either.
All of which brings me neatly to—can you do endurance exercise when you have type 1 diabetes to deal with? People do. There’s the Novo Nordisk team of cyclists for a start. On the other hand, they’ve got a team of dedicated professionals behind them to help with diet and working out what they take insulin-wise. I’m willing to bet too, that they have access to all the latest gear—the continuous glucose monitoring, the pumps and sophisticated feedback they can interpret to work out how to cope with long bike rides.
Our ascent of Ben Lomond took just over two hours and ten minutes (844 calories on the FitBit), and the descent about an hour and forty minutes. It counts as the hardest fitness challenge I’ve ever undertaken, far more difficult than running a half-marathon.
[Talking of running, we were overtaken by two trail runners at one point. Lordy. In awe.]
I don’t know if I would do it again. I’d rather do short bursts of exercise interspersed throughout the day as I know what I’m doing and how it will affect me. I’m a mesomorph body type too. My body favours that kind of exercise as opposed to the endurance stuff. I can walk long distances and often do, but most of the time that’s on flat ground or its hills do not last more than 45 minutes. Hauling yourself up mountains is hard as heck.
With exercise it is easy to forget that there is a level above which there is no point in doing extra unless you are training for a big event or you’re a professional sports man or woman or athlete. I do Pilates for the flexibility benefits, I walk or run for cardio and otherwise I try to move a little throughout the day. That, I think, is enough for me.
What do you prefer—endurance exercise or doing short, intense bursts of it?
From: BeTravelFit blog:
While I was traveling I saw myself faced with situations in which I didn’t have access to any sort of gym, not even a bar to do Pull-Ups with, hell, not even a damn park bench to do Tricep-Dips on because every single bench in the park was used by loved up couples and other people who don’t work out because they actually do have a social life and other things do to then lifting (what a bunch of losers).
So here’s a workout that you can perform anytime, anywhere, with absolutely no equipment needed – just as promised.
The workout consists of three different circuits with three different exercises in each circuit. The exercises in each circuit are to be performed directly one after another with no rest in between. That way the heart-rate stays elevated over an extended period of time and more calories are burned as a result.
Circuit 1: Upper Body (Chest, Shoulders and Triceps) – To be performed 5 times, 60 secs rest
Hindu Push* up x 5
Diamond Push-Up x 5
Push-Up x amrap (as many repetitions as possible) Circuit 2: Lower Body (Quads, Glutes, Hamstrings and Calves) – To be performed 5 times, 30 secs rest
Single Leg Box Squat x 10
Single Leg Romanian Deadlift x 10
Single Leg Calf-Raise x 15 Circuit 3: Core (Abs And Lower Back) – To be performed 5 times, 30 secs rest
Oblique Crunch x 10
Crunch x 20
Plank for 60 secs
And there you go, here’s your first full body, zero equipment, bodyweight only workout!
It burns a ton of calories, engages all major muscle groups and keeps you occupied for at least an hour to an hour and a half. Feel free to add extra repetitions or sets to make the workout more challenging as you progress and don’t feel intimidated if you can’t perform as many repetitions as suggested in the routine. Just give it your best shot and you’ll be fine!
Assume the downward dog position. Move your upper body backwards, into child’s pose, and then move your head and trunk forwards taking your weight in your arms till you then extend your head up with your trunk in the upward dog position.