Margaret Coles: Invite this Physiotherapist into your home

At  www.movingtherapy.co.uk. you can find Margaret Cole’s free educational resource to help your health and well being.

home-physio

Margaret worked as a community physiotherapist and when she retired she decided to put her knowledge and experience to good use. She produced videos covering a lot of different situations that you can face regarding your physical and mental states and has put them on the site. She also gives advice on how to lose weight.   People from all over the world have visited the site since 2011.

NHSinform Scotland and her local authority also promote the site.

 

 

Most people need a minimum of one hour exercise a day

walking

How Much Exercise Compensates for Sitting at a Desk for eight Hours A Day?

Diabetes in Control August 27th 2016

At least an hour of physical activity needed to offset risk for several chronic conditions and mortality

Sedentary behavior has been associated with increased risk of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. A new study examined the associations of sedentary behavior and physical activity with all-cause mortality.

The meta-analysis of trials involving more than 1 million individuals was reported online July 27 in The Lancet. It is one of a special series of papers on physical activity.

The Lancet notes that its first series on physical activity in 2012 concluded that, “physical inactivity is as important a modifiable risk factor for chronic diseases as obesity and tobacco.” The meta-analysis found that 1 hour of moderate-intensity activity, such as brisk walking or riding a bicycle, can offset the health risks of sitting for 8 hours a day. Twenty-five percent of all individuals in the study reported this level of physical activity. The study also discovered that even shorter periods of 25 minutes a day can be beneficial.

For those of us who work by sitting at a desk, it can be very difficult not to sit while we do our jobs.  But, there are still many ways to get moving, like going for a walk during lunch, or even getting up and walking over to an associate to hand them a note instead of sending an email.  There are many ways to get in your physical activity.

According to the researchers, the data from more than a million people is the first meta-analysis to use a harmonized approach to directly compare mortality between people with different levels of sitting time and physical activity. They included 16 studies, with data on 1,005,791 individuals (aged >45 years) from the United States, Western Europe, and Australia.

Researchers divided the study participants into four groups based on their reported levels of physical activity: <5 min/day; 25-35 min/day; 50-60 min/day; and 60-75 min/day.

Researchers noted that, “Among the most active, there was no significant relation between the amount of sitting and mortality rates, suggesting that high physical activity eliminated the increased risk of prolonged sitting on mortality.” But as the amount of physical activity decreased, the risk for premature death increased.

Researchers found prolonged sitting associated with an increase in all-cause mortality, mainly due to cardiovascular disease and cancer (breast, colon, and colorectal), noting that, “A clear dose-response association was observed, with an almost curvilinear augmented risk for all-cause mortality with increased sitting time in combination with lower levels of activity.”

Compared with the referent group (i.e., those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12–59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08–1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52–1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99–1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22–1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05–1·28).

In conclusion, the researchers emphasized that high levels of moderate intensity physical activity (i.e., about 60–75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations.

In another study published online by JAMA Ophthalmology in August, they found that sedentary behavior may be associated with diabetic retinopathy.  The analysis included 282 participants with diabetes. The average age was 62 years, 29 percent had mild or worse DR, and participants engaged in an average of 522 min/d of SB. The author found that for a 60-min/d increase in SB, participants had 16 percent increased odds of having mild or worse DR; total PA was not associated with DR.  “The plausibility of this positive association between SB and DR may in part be a result of the increased cardiovascular disease risks associated with SB, which in turn may increase the risk of DR.  In order to prove a cause and effect of SB and worsening DR s larger study would be needed.”

Practice Pearls

  • Inactivity is linked to a decreased production of certain hormones.
  • We need to break up periods of sitting for prolonged periods with short bursts of activity.
  • Walking 5 minutes every hour can offset sitting for the other 55 minutes per hour.

Lancet. Published online July 27, 2016. Abstract Editorial How Much Exercise Compensates for Sitting at a Desk Eight Hours A Day?#848 (1)]–[www_diabetesincontrol_com_how_]-[MTExNjQyNDI1NTE1S0]–

Exercise Versus Activity: Walk About A Bit and Then Go Home

diabetes dietExercise. What does it mean? An interesting article in the Daily Telegraph* recently highlighted what exercise isn’t or what it shouldn’t be.

A London gym – I won’t name them because I don’t want to give them the publicity – recently issued a press release, where they boasted of a class so extreme that they had defibrillators on hand.

Exercise is vital for type 2 diabetics – and type 1s too, though there is less research on exercise and type 1s, as there are fewer of us. The health benefits of exercise for type 2s include:

  • It helps your body use insulin more effectively, which will give you better control over your diabetes
  • It burns extra body fat
  • It strengthens your muscles and bones
  • It improves your blood flow
  • It lowers your blood pressure, cuts LDL cholesterol levels and raises HDL cholesterol
  • It boosts your energy and mood, and it de-stresses you.**

Exercise: The Definition

But what is exercise? Is it the kind of class where they need defibrillators on hand because it’s so hard? As the exercise expert in the Telegraph pointed out, don’t bother paying for that class. Just do 500 burpees in a row as fast as you can.

For all the people who post that irritating, “go hard, or go home” meme, nine out of ten of their readers will think, “I’m off home”. Not, “Yeah! I’m gonna exercise till I puke”. Who wants to do that and more importantly, who can keep doing that?

Think in terms of activity instead. Instead of “go hard, or go home”, try “walk about a bit and then go home”.

Low levels of activity performed regularly throughout the day count. What sounds more do-able to you? Getting changed into your gym gear, walking or driving to said gym and doing an insanity class you pay for featuring lots of burpees and lunge jumps, or going for a 15 minutes’ walk two or three times a day?

Body Weight Exercises

Other activity ideas include housework, standing instead of sitting in front of a computer, walking up and down your stairs frequently and doing short bouts of body weight exercises while watching TV.

There is a place for hard exercise. If you’re an athlete, you need hard exercise so you can compete. The rest of us? Not so much. The occasional high-intensity interval exercise session can be practised once or twice a week (the 4-minute Tabatha method, for example) if you like. Insanity classes are not HIIT. They are just hard, exhausting, stressful exercise sessions that people use to punish themselves.

As you might have guessed from the angle of this post, I love walking. I do about two hours a day, split between walks to the shop/library/train station and then all the steps I perform in general. I used an online tracker for a while to count it up and then stopped once I knew what I needed to complete 10,000 steps a day. (And it’s not as much as two hours, more like one hour 15 minutes.) I am fitter, happier and healthier than I’ve ever been in my exercising life.

If you can increase the amount of time you are walking, stretching and lifting so that you minimise the amount of time you are sitting, you provide your body with the benefits it needs. For further reading and information, I recommend you check out the work of Katy Bowman, who promotes movement and activity over exercise, and suggests various ways you can add activity to your daily life.

 

 

*I can’t find the original article unfortunately.

**So long as you don’t do insanity classes!

Diabetes: I’m Thankful For…

diabetes diet
Go to bed early with a good book and other advantages to diabetes.

How much does diabetes shape your personality? If you’ve ever experienced high blood sugars while at a party or surrounded by other people, you’ll know feeling tired and ill turns you into an introvert. Making conversation, especially with strangers, requires far too much effort.

Perhaps many of we introverted diabetics are extroverts dying to get out? Without the ups and downs of diabetes, we’d be flinging ourselves at strangers, auditioning for the X Factor, dominating meetings at work and organising sing-songs whenever we get together with friends and family?! Everyone would secretly dread us coming into a room. “Oh no, it’s XXXX. Now we’re going to be bullied into singing/dancing/playing some daft game.”

Just a thought…

When you experience on target blood sugars, the resultant energy gives you confidence – the kind of confidence that makes life’s more extroverted activities do-able and possible. I was diagnosed with type 1 diabetes at the age of nine and it’s been with me for all of my adult life.

There are plenty of positives diabetes has given me. One of the blogs we follow – Georgina M Llloyd – listed 30 ways diabetes has helped improve her life. I had a think about some of the ways it has shaped mine.

Here they are:

Organisational skills. You need tip-top organisational skills to stay on top of diabetes – ensuring you have enough medication, ordering and picking up repeat prescriptions, making sure you have carry enough medical gear with you, planning for exercise, keeping glucose tablets or jelly babies on hand, preparing for holidays etc.

An appreciation of the UK health system. A civilised country provides free healthcare to its citizens. As a type 1 diabetic, I’m so glad I live in the UK. All my medication, hospital appointments and eye checks are free. If I want extra help from a diabetic  nurse, that won’t cost anything either. I’ve got gum disease (it’s one of the side effects of diabetes, but it’s also common among the general population) and I’m receiving treatment at the dental hospital. That’s free too.

The ability to say no. Georgina mentioned this one too. When you’re a people pleaser as I am, it jars to say no to food people have lovingly prepared and placed in front of you. Practise it enough and it becomes automatic. And then you can use that ability elsewhere; being asked to do too much, for example.

A love of walking. I’ve tried lots of forms of exercise over the years. Walking is the best – it’s gentle, easy and it serves more than one purpose. It’s exercise, but it gets you from A to B. It’s exercise, but it helps lower your blood sugar levels. It’s exercise, but it calms the mind at the same time. It’s exercise and it gives you access to fresh air, beautiful views, chats with dog owners and more.

Health and fitness is my hobby. It might have become one of my interests anyway, but thanks to diabetes I’ve always found diet and activity fascinating. These days, we’re lucky enough to have access to lots of information. we can do our own research and work out the best ways to look after ourselves.

It gives you an excuse to go to bed early. A cosy bed and a good book? Just tell your other half that you want to read, sneak upstairs, put your pyjamas on and dive in. It’s legit because you need more sleep anyway, right?

How has diabetes improved or changed your life? What are you grateful for? 

 

 

When is the best time of day to exercise?

 

 

050529-N-4729H-109From Diabetes in Control 14th July 2016
Is there a best time to work out, based on circadian rhythms?

Circadian rhythms are estimated 24 –hour biological cycles that function to prepare the organism for daily environmental changes. There is a molecular clock mechanism found in most cell types including skeletal muscles.  Disturbances in the circadian rhythms have been shown to have harmful impacts on health, which may lead to metabolic syndrome.
Experiments in mice suggest that the timing of exercise may be critical for the maintenance of molecular rhythms.  Scheduled exercise functioned to enhance the stability of both activity and heart rate rhythms.
Another study determined the significant differences in circadian rhythms  in healthy non-diabetic young men. 59 subjects between the ages of 20-34 were recruited and studied for 60 days. They were grouped based on their BMI as healthy weight, overweight or obese and all were free from cardiovascular disease, diabetes, pulmonary disease and many diseases.

Resting heart rate and blood pressure were measured, so was their body composition and a maximal graded exercise test performed. Their circadian rhythm parameters were measured by noninvasive wrist temperature rhythm monitoring and recording devices.

Subjects recorded daily questions concerning sleep, frequency and timing of nutritional intake, alcohol use, and smoking, and removal times of wrist skin temperature monitor.

There was no association between body fat and peak wrist temperature during night time hours (r= -0.05; P= 0.79). The poor % fat group (109.10 ± 14.12) had significantly lower circadian temperature stability than the optimal % fat (166.52 ± 17.84) or fair % fat group (175.21 ± 23.96).
Another recent study was performed to determine the exact time one needs to work out, based on circadian rhythm, to obtain a better outcome. In this study it was found that the various times one exercises give different outcomes.

For instance, when one exercises from  7 to 9am, their pain tolerance is higher but they have poorer flexibility  since their body temperature is low and therefore more likely to sustain an injury. (My comment: so not great for yoga or running but maybe better for walking, meditiation or  weight training?)

Exercising from 10 am to 12 p.m. is good for any skill based sports that require alertness and short term memory peaks.  (Anyone for tennis?)

Meanwhile from 4 to 8 pm showed an overall performance peak since it coincides with the peak body temperature. Body temperature is normally high at that time since there is a higher lung capacity, blood flow to muscle and flexibility. (So good for a run and yoga and indeed most sports and activity)
In conclusion the best time for one to work out is whenever is appropriate for and suits that person since many things affect the circadian rhythms.
Practice Pearls:
Circadian rhythms is a molecular clock mechanism found in most cell types including skeletal muscles.
Presence of a molecular clock is argued to be a necessary timekeeping mechanism to prepare the cell for daily changes in environmental conditions
The best time to work out is when it is convenient for one since every time frame has its advantages and disadvantages.

Comment from Dr. Sheri Colberg, Ph.D., FACSM, Advisory Board Member:
It has been suggested that many different things affect circadian oscillations, and in people with diabetes and in aging, some of these normal controls fail to work effectively.  For example, alterations in the release of melatonin, a critical hormone that regulates sleep and central nervous system balance, occur in both states (diabetes and aging) that lead to more imbalances.  Exercise of any type helps reset autonomic function, or the balance between sympathetic and parasympathetic branches of the autonomic nervous system.  For management of diabetes and successful aging both, being physically active on a regular basis is likely more important than the time of day that activity is undertaken.

References:
Colino Stacey “What is the best time of the day to exercise? The answer is complicated”. US News 6 July 2016. Web. 14 July 2016.
Schroder, Elizabeth A., and Karyn A. Esser. “Circadian Rhythms, Skeletal Muscle Molecular Clocks and Exercise.” Exercise and sport sciences reviews 41.4 (2013): 10.1097/JES.0b013e3182a58a70. PMC. Web. 14 July 2016.
Tranel, Hannah R. et al. “Physical Activity, and Not Fat Mass Is a Primary Predictor of Circadian Parameters in Young Men.” Chronobiology international 32.6 (2015): 832–841. PMC. Web. 14 July 2016.

Sheri Colberg: Statins and exercise

exercise bike
You’ll need to pedal harder than this if you want intensity…

I recently received an email from a person with type 1 diabetes living in Denmark (Guido) whose physician believes in prescribing many medications to manage cholesterol and high blood pressure in anyone with diabetes, regardless of need. Guido has been taking a statin (Atorvastatin, brand name Lipitor), along with at least four others for blood pressure control. He used to take Simvastitin (Zocor), but a year prior had been changed to Atorvastatin (and his dose doubled). That’s when his problems with exercise began.

Many prescribed medications can directly affect people’s ability to exercise or their responses to it, but most healthcare providers focus on the ones that affect blood glucose, particularly if they increase the risk of activity-related hypoglycemia. Another type really needs to be considered, though, because of the sheer number of patients who are being put on them and their potentially negative impact on the ability to exercise: statins. Statins are medications taken to treat high cholesterol levels or abnormal levels of blood fats, in an attempt to lower the risk of heart attack and stroke. Brand name examples include Altoprev, Crestor, Lescol, Lipitor, Livalo, Mevacor, Pravachol, and Zocor.

The cholesterol guidelines were recently updated, the result being that even more adults with diabetes and prediabetes are being prescribed various medications from this class. In individuals who are unwilling or unable to change their diet and lifestyles sufficiently or have genetically high levels of blood lipids, the benefits of statins for lowering cardiovascular risk likely greatly exceed the risks, or so the experts claim (1). If a person has a low risk for developing cardiovascular problems and does not already have type 2 diabetes, taking them is not advised (2), particularly because many statins increase the risk of developing type 2 diabetes (3).

Since one month after he started taking Atorvastatin, Guido confided that has been suffering from extreme stiffness and pain in his legs that occurs after running any distance (3 km or 20 km). The pain is in his lower leg/ankle (the right one hurts more, but the left leg is also very stiff) and occurs typically after his runs and decreases after 3 to 4 days, during which time he is unable to run at all. His legs have been scanned and are negative for any signs of fractures or inflammation, and they have ruled out compartment syndrome.

In his email to me, Guido stated: “I suspect it is the Atorvastitin. What do you think?”

My answer was, “I completely agree that your problems are probably coming from the Atorvastatin. As a group of medications, the statins are WELL known for causing muscle and joint issues. I would suggest considering going off of it completely and see if your symptoms resolve in a few weeks.”

Guess what? It worked! He emailed me a week later, stating “I have stopped using the Statins now for 5 days and after a 12 km run my legs feel completely different and back to normal.” That was great news to hear!

It’s not talked about enough, but undesirable muscular effects from statin use are commonplace, such as unexplained muscle pain and weakness with physical activity that Guido has been having, which may be related to statins compromising the ability of the muscles to generate energy. The occurrence of muscular conditions like myalgia, mild myositis, severe myositis, and rhabdomyolysis, although relatively rare, is doubled in people with diabetes (4). Others have reported an increased susceptibility to exercise-induced muscle injury when taking statins, particularly active, older individuals (5). Other symptoms, such as muscle cramps during or after exercise, nocturnal cramping, and general fatigue, generally resolve when people stop taking them. If people experience any of these symptoms, they need to talk with their healthcare provider about switching to another cholesterol-lowering drug that may not cause them.

Another major issue related to statins is that their long-term use negatively impacts the organization of collagen and decreases the biomechanical strength of the tendons, making them more predisposed to ruptures. Statin users experience more spontaneous ruptures of both their biceps and Achilles tendons (6-8); I personally know a physically active person with type 1 diabetes that simultaneously ruptured both of his Achilles tendons during a routine workout due to long-term statin use. Again, people should talk with their doctors about whether it may be possible to manage their cardiovascular risk and lipid levels without taking statins long-term for this reason and the aforementioned ones.

In my opinion, there’s nothing worse than a medication that is supposed to help lower your cardiovascular risk, but then likely ends up removing all of the potential benefits by taking away your ability to be physically active! Likely the greatest risk factor for heart disease is physical inactivity, so don’t prescribe statins that make people sit on the couch. At least have them try another medication to see if it a lesser negative impact on being active.

References:
1.Kones R: Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease–a perspective. Drug Des Devel Ther 2010;4:383-413
2.Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP, Ebrahim S: Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2011:CD004816
3.Mayor S: Statins associated with 46% rise in type 2 diabetes risk, study shows. BMJ 2015;350:h1222
4.Nichols GA, Koro CE: Does statin therapy initiation increase the risk for myopathy? An observational study of 32,225 diabetic and nondiabetic patients. Clin Ther 2007;29:1761-1770
5.Parker BA, Augeri AL, Capizzi JA, Ballard KD, Troyanos C, Baggish AL, D’Hemecourt PA, Thompson PD: Effect of statins on creatine kinase levels before and after a marathon run. Am J Cardiol 2012;109:282-287
6.de Oliveira LP, Vieira CP, Da Re Guerra F, de Almeida Mdos S, Pimentel ER: Statins induce biochemical changes in the Achilles tendon after chronic treatment. Toxicology 2013;311:162-168
7.de Oliveira LP, Vieira CP, Guerra FD, Almeida MS, Pimentel ER: Structural and biomechanical changes in the Achilles tendon after chronic treatment with statins. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association 2015;77:50-57
8.Savvidou C, Moreno R: Spontaneous distal biceps tendon ruptures: are they related to statin administration? Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2012;17:167-171

As a leading expert on diabetes and exercise, I recently put my extensive knowledge to use in founding a new information web site called Diabetes Motion (www.diabetesmotion.com), the mission of which is to provide practical guidance about blood glucose management to anyone who wants or needs to be active with diabetes as an added variable. Please visit that site and my own (www.shericolberg.com) for more useful information about being active with diabetes.
by Dr. Sheri Colberg, Ph.D., FACSM Diabetes in Control April 2 2016

 

Seven Free Online Work-Outs for You To Try

From bootcamps to ballet, there's a work-out for everyone on YouTube.
From bootcamps to ballet, there’s a work-out for everyone on YouTube.

When I first got into fitness some 25 years ago, there were nothing like as many options as there are now. I do remember doing one of Cindy Crawford’s original exercise videos (it was awful) and cycling everywhere.

Nowadays though, there are so many choices if you want to get more active but you don’t want to, or can’t afford to, join a gym or attend classes.

Step forward YouTube! If you know where to look, you can access thousands of online exercise DVDs so you never need to pay for anything (apart from your broadband connection of course) or leave the comfort of your own home.

The videos vary greatly in quality of course – from really slick, professionally produced clips to the rather more amateur, and length varies too. Some of the moves and programmes will be demonstrated very well, others will be downright dangerous – but intelligent adults need to work this out by themselves, recognising that free stuff doesn’t come with the same checks and balances you can expect if you pay for gym memberships, classes or personal training.

It’s important to exercise whether you have type 1 or type 2 diabetes because exercise increases your sensitivity to insulin, and it reduces the risk of cardio vascular disease (people with diabetes have an increased risk of CV disease). Continue reading “Seven Free Online Work-Outs for You To Try”