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The Warrior Zero Body Weight Challenge Summary


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Physical Activity And Fitness

Furthermore, low cardiorespiratory fitness is an independent predictor of cardiovascular disease in obese adult men. This is comparable with diabetes mel-litus, high blood pressure, and smoking (395). Myers et al. studied exercise capacity as a predictor of mortality in adults (396). He demonstrated that after adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 improvement in survival. Mayer et al. suggested that exercise capacity is a more powerful predictor of mortality among men than other established risk factors for...

Physical Fitness

Cardiorespiratory fitness defined by measurement of oxygen consumption at a submaximal or maximal workload on a graded treadmill or bicycle ergometry, has been used extensively to validate physical activity assessment tools (31-33). The rationale for using fitness as a validation method for physical activity extends from the consistent findings that aerobic activity improves cardiorespiratory fitness (34). When well-defined laboratory criteria are used, physical fitness testing can be highly reproducible and avoids some of the subjective pitfalls of questionnaires. Fitness provides an objective way of comparing individuals in the population and of evaluating progress in exercise interventions. Like physical activity, physical fitness has been shown to be protective against cardiovascular disease and all-cause mortality (35-37) and may be one mechanism whereby physical activity prevents disease (38). However, physical fitness has a strong genetic component (39). Because of the...

Management Strategies

Regular exercise improves bodyweight, plasma lipids, blood pressure, insulin sensitivity and glucose tolerance. It also maintains general fitness, balance, mobility and sense of well-being. Prior to starting regular exercise, the patient should be assessed with respect to cardiovascular, respiratory and musculo-skeletal systems by the physician. A stress electrocardiogram is indicated in those with suspected ischaemic heart disease. Ideally, moderate exercise should be done for at least 20 minutes each time, three or four times a week, but the actual duration, frequency and progression of exercise should be individualized. Avoidance of injury during exercise should be taught.

Ed Prestwood Bs Ma Founder and President Cyber Soft

Prestwood is the former director of Technical Public Relations for the P k Motorola Semiconductor Product Sector. Ed founded CyberSoft in 1986 and has published several books, most of which pertain to the nutritional contents of foods. The NutriBase Series of books are the top-selling books on the market for this genre. Ed managed the development of NutriBase for DOS, released in 1993. NutriBase has since evolved to become the most powerful and comprehensive software for nutrition and fitness professionals today. The NutriBase personal editions incorporate many of the functions in the professional versions of NutriBase.

Physical activity and obesity

Exercise is the most variable component of energy expenditure it is therefore clear to see why exercise has been adopted as a component to treat overweight and obesity. Indeed, exercise or physical activity is promoted within a range of guidelines for the prevention and treatment of overweight and obesity (WHO, 1997 NIH, 1998). Understanding the impact of physical activity and exercise on obesity and associated variables is important, as an increase in physical activity not only has significant positive effects on body mass and body fat mass, but also on a range of other variables associated with health (Blair and Brodney, 1999). Physical activity has been suggested to have favourable effects on weight loss, decreased fat percentage, decreased skinfold thickness, android disease, decreased risk of coronary heart disease (CHD), improved glucose metabolism, increased basal metabolic rate (BMR), prevention of loss of fat free mass (FFM), increased dietary thermogenesis, reduced blood...

Preoperative Assessment

Preoperative assessment of the elderly diabetic patient is aimed at checking general fitness for surgery, ensuring that diabetic management is appropriate, and confirming that glycaemic control is reasonable. By 'inappropriate' management is meant potentially hazardous drugs such as the potent and or long-acting sulphonylureas, glibenclamide and chlorpropamide. Regrettably a number of older diabetic patients remain on such preparations and treatment may need to be updated prior to surgery. There are theoretical reasons for avoiding metformin also if possible (because of lactic acidosis risk), though this is not strictly evidence-based (Gill and Alberti 1992).

Pathophysiology Of Macrosomia

Pathophysiology Undernutrition

Prepubertal healthy children with a family history of type 2 diabetes (n 9) matched for age, pubertal status, total body adiposity determined by dual energy X-ray absorptiometry, abdominal obesity determined by computed tomography scan, and physical fitness measured by VO2maxwith those without such history (n 13) had three hour hyperinsulinemic clamp studies to assess insulin sensitivity. Those with a family history of type 2 diabetes had lower insulin stimulated glucose disposal and nonoxidative glucose disposal there were no differences in glucose oxidation, fat oxidation, or FFA suppression (47). These data indicate that family history of type 2 diabetes is a risk factor for insulin resistance.

Intermittent claudication

The mainstay of treatment for intermittent claudication is smoking cessation and regular exercise. A meta-analysis of randomised controlled trials of physical exercise has shown that regular exercise improves walking distance, but the walking programme should be supervised and involve 30 min per session, at least three times per week for 6 months (Gardner and Poehlman, 1995). The mechanism for the benefit may be derived from improved cardiovascular fitness, increased production of nitric oxide and or modification of cardiovascular risk factors. In the exercise programme, patients should be told to 'walk through the pain' rather than to stop at the point when the pain begins since this helps to increase the collateral blood supply. Raising the heel of the shoe by 1 cm will also increase the walking distance by reducing the workload on calf muscles. Bicycle riding is probably less beneficial because it exercises the thigh muscles and not the calf muscles.

Medical Complications

Cardiorespiratory fitness or physical fitness of the individual is an attribute that determines the alterations in glucose-mediated transport by the muscle, thus inactivity and inaction play an important role in the clinical expression and complications of the syndrome (56,57). However, genetic components also play an important role as there may be mitochondrial activity alterations (58) and alterations in the retinoid X receptor heterodimers (59).

Classification of Diabetes Mellitus

The most common associations with insulin resistance are obesity and lack of physical fitness. A wide range of other conditions is associated with insulin resistance (see Table 1.2) and many also increase the risk of developing diabetes. In prospective studies, obesity is the strongest modifiable risk factor that predicts future risk of diabetes in nondiabetic populations.37 Body fat distribution is important also visceral (abdominal) obesity, as measured by the waist hip ratio, is a stronger predictor than body mass index.38 It is thought that the increased fat mass in obese individuals augments insulin resistance by a number of different mechanisms, including increased release of free fatty acids and a number of adipocytokines including tumor necrosis factor-a, leptin, resistin, and interleukin-6. Some workers have also proposed, in the lipotoxicity theory that obesity not only affects insulin sensitivity, but also pancreatic function, with excess fatty acids...

Can Weight Loss andor Exercise Reverse Muscle Insulin Resistance

It is unquestionable that cardiorespiratory fitness reduces the risk of CVD and that low rates of physical activity are associated with a greater risk of developing insulin resistance, obesity, MS, and T2DM (51, 231-233). In the midst of an epidemic of obesity and diabetes, renewed interest has developed in understanding the molecular pathways by which exercise appears to reverse defects associated with insulin resistance reviewed in-depth under .234-236) . While the role of exercise will be reviewed in other chapters, a few points deserve attention. First, as discussed in the previous section, it is important to recognize that lipid accumulation in skeletal muscle and insulin resistance are not just the result of excessive fatty acid supply, but likely the combination of increased supply and a reduced capacity of muscle to use it as a fuel for energy needs. Because disruption in lipid metabolism FFA flux appears to be causal in the development of insulin resistance, it follows that...

Laser Treatment Of Diabetic Retinopathy

A further possible complication is loss of peripheral vision. This is a direct effect of the treatment itself, which is effectively ablation of healthy retinal tissue by placing spaced burns in the periphery of the retina (Figure 9.8). This results in loss of visual field (peripheral vision). After a full treatment the field is reduced by 40-50 . If the treatment involves both eyes this may affect the fitness to drive.

Central Visceral Obesity

Several studies have reported the advantage of combining weight-reduction and exercise programs on delaying the progression to diabetes in subjects with IGT. The Oslo Diet and Exercise Study (Toijesen et al 1977) demonstrated that a program combining total fat reduction with moderate increase in physical activity in 219 inactive, normoglycemic men and women with features of the insulin-resistance syndrome reduced fasting glucose levels and body mass index and improved insulin sensitivity and beta-cell function (as well as lipid profile and blood pressure). Insulin sensitivity, estimated using the homeostasis model, improved after one year of a low-fat diet alone as well as in the combined diet and exercise group, but not in the exercise-alone group. The Malmo study (Eriksson and Lindgarde 1991) evaluated the effects of a 5-year program of a low-fat, hypocaloric diet combined with increased physical activity in 41 recently diagnosed Type 2 diabetic subjects and in 181 individuals with...

The Finnish Diabetes Prevention Study DPS Eriksson et al Uusitupa et al Tuomilehto et al

They received individual advice about how to achieve the intervention goals reduction in weight of 5 per cent or more, total fat intake less than 30 per cent of energy consumed, saturated fat intake less than 10 per cent of energy consumed, fibre intake of at least 15 g 1000kcal, and moderate exercise for 30 min per day or more. Frequent ingestion of wholemeal products, vegetables, berries and fruit, low-fat milk and meat products, soft margarines, and vegetable oils rich in monounsaturated fatty acids were recommended. The dietary advice was based on 3-day food records completed four times per year. The subjects had seven sessions with a nutritionist during the first year of the study and every 3 months thereafter. They were also individually guided to increase their level of physical activity. Endurance exercise (walking, jogging, swimming, aerobic ball games, skiing) was recommended to increase aerobic capacity and cardiorespiratory fitness....

Physical activity in the treatment of type diabetes

Although relatively little research has been conducted on the impact of intensity of intervention on treatment outcomes, McAuley et al. (2002) compared a modest treatment (similar to current standard treatment programmes) and a more intensive treatment programme. The more intensive treatment programme produced a more significant improvement in insulin sensitivity (23 per cent, P 0.006 (intensive intervention group) versus 9 per cent P 0.23 (modest standard intervention group and for aerobic fitness (11 per cent increase in intensive group, P 0.02 versus 1 per cent in the modest group, P 0.94). The more intensive treatment included goals to achieve both greater dietary change than the modest treatment group and the 1990 ACSM guidelines for developing and maintaining cardiorespiratory and muscular fitness. The differences in response of these groups and the lack of improvement in insulin sensitivity for standard treatment shown in this study highlight the significant challenge ahead...

Physical activity and type diabetes

The specific benefits of physical activity to improved glucose tolerance and control are associated with regular bouts of exercise that repeatedly provoke the acute effects of a single bout. These and other improvements in metabolic control associated with physical activity are not only important to those with type 2 diabetes but also to the sedentary and overweight, and those who have the metabolic syndrome. Significant improvements in metabolic fitness have been associated with increased physical activity that may not be sufficient in intensity to increase the more traditional measures of fitness such as maximal oxygen uptake (Vo2 max, the maximum rate at which an individual can take up and utilize oxygen while breathing air at sea level (Astrand and Rodahl, 1986)). However, sustained changes in activity levels are required for the benefits of exercise or physical activity to positively affect insulin action (Ivy et al., 1999 Albright et al., 2000 ADA, 2002). According to the ACSM...

Prepregnancy counselling

The woman's fitness to withstand pregnancy and her prospects of healthy survival during the years in which her child needs her most must also be considered. Nowadays, women with severe tissue damage are surviving pregnancy with normal infants, but this requires nine months very intensive effort, and the harsh reality is that they may become severely disabled or die before their child grows up. Retinopathy can worsen in pregnancy and fundoscopy should be part of the pre-pregnancy screen as should assessment of renal function. Renal failure may also worsen considerably during pregnancy and such women should be managed jointly by obstetrician, renal physician, and diabetologist from pre-pregnancy onwards.

Encouraging exercise at all ages

I The National Association for Sport and Physical Education, made up of more than 25,000 professionals in the fitness and physical activity fields, offers excellent resources at naspe. Here you find National Standards for Physical Education, the Shape of the Nation Report on the status of physical education in the United States, and Tools for Observing Your Children's Physical Education. i The President's Council on Physical Fitness and Sports has a Web site at where you can find out about its work to improve physical fitness and connect to a large number of other resources on the Internet. The site also has a page of Physical Activity Facts. Among them are the following

Determining how hard to exercise

The Perceived Exertion Scale is very useful in determining whether an activity is making a difference in your fitness (or your child's). To use the scale, you rate the degree of your exertion while performing a certain activity from extremely light to extremely hard, according to your personal physical ability level. Here's the scale

Guidelines For Exercise

Studies have shown that better glycemic control results from the additive effect of repeated exercise sessions and is not related to overall physical fitness, consistently improving insulin sensitivity and carbohydrate metabolism. This was directly related to the duration and not the intensity of exercise 30-60 minutes per session three to four Other types of activity include biking and stationary cycling, aerobic water exercises, and swimming, in addition to walking at a moderate pace (3-5 mph). Diabetic patients should always be encouraged to carry identification and to monitor blood glucose levels before and after exercise. In addition to constantly being aware of the signs and symptoms of hypoglycemia during subsequent workouts, diabetic patients should carry appropriate, readily available carbohydrate sources to treat hypoglycemia. Clearly, low cardiorespiratory fitness increases mortality. A 2003 study in the Journal of the American Medical Association (21) from the Coronary...

Cardiovascular Risk Factors

The role of exercise and the prevention of coronary heart disease in the general population have been well documented, but there is less evidence of a similar effect in people with diabetes. Modification of risk factors for CHD, including decreased total and LDL (low-density lipoprotein) cholesterol and triglyceride concentrations, have been demonstrated in Type 1 diabetes (20). People with Type 2 diabetes have two to four times the cardiovascular risk of those without diabetes and low cardiorespiratory fitness has been shown to be a predictor of mortality in men with diabetes (21).

Type Diabetes Management

The accepted, tried-and-true treatment for type 2 diabetes is a balance of diet and exercise. Even if you need medications, healthy eating and exercise habits continue to be key in caring for your type 2 diabetes. Most people with type 2 diabetes are advised to lose weight and improve their physical fitness. This can help to lower the body's resistance to insulin. The severity of type 2 diabetes can be greatly reduced by maintaining a healthy body weight. Even a modest weight loss 10 pounds can have benefits. By building a healthy lifestyle around a low-fat, well-rounded diet and regular exercise, it is possible to decrease body weight and insulin resistance. Exercise helps by taking some glucose from the blood and using it for energy during a workout, an effect that lasts even beyond the workout. Healthy eating, especially watching the amount of food eaten, helps glucose levels stay lower. As your level of physical fitness improves with regular exercise, so does your body's...

Physical activity and exercise what is the difference

Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure, whereas exercise is planned, and repetitive bodily movement done to improve or maintain one or more of the components of fitness (Casperson et al., 1985 American College of Sports Medicine, 1998). Exercise may include training, sports participation or going to some form of regular exercise class. Physical activity is therefore the umbrella term with types of exercise, sport and physical recreation forming subsets of physical activity. Physical activity can therefore take many forms, as a means of transport, occupational requirements, daily living activity and leisure time activity. Although there are differences in definitions of exercise, sport and physical activity it is important to realize that most individuals do not discriminate between them in this way. If you ask people how active they are, evidence suggests that they will probably interpret the question as to...

Fad Exercise Programs

The appeal of fad exercise programs is no less than that of fad diets. An entire exercise industry has developed that includes exercise tapes, books, workout programs, specialized centers to facilitate yoga (combat yoga, sweat yoga), strength training, weight training, jazz exercise, step aerobics, spinning, and almost every type of exercise equipment imaginable for home gyms, bedrooms, and traveling.

Conventional Risk Factors Insulin Excess

Relative or absolute therapeutic insulin excess occurs when (1) insulin doses are excessive, ill-timed, or of the wrong type, (2) the influx of exogenous glucose is decreased (such as during the overnight fast or following missed meals or snacks), (3) insulin-independent glucose utilization is increased (such as during exercise), (4) endogenous glucose production is decreased (such as following alcohol ingestion or administration of other drugs and with loss of renal parenchyma), (5) sensitivity to insulin is increased (such as following exercise, in the middle of the night, with glycemic control, with increased fitness, weight loss, or both, or with administration of certain drugs), and (6) insulin clearance is decreased (such as in renal failure).

Plan in Advance Continued

Suggest that the whole family participate. Play with your children or grandchildren, organize a game of tag or touch football, or go for a walk. Everyone will benefit from the activity, and it's nice to spend time together. Before booking your hotel, ask if it has a health club, swimming pool, or exercise room. Some hotels provide access to a nearby fitness center.

Sites for exercise programs

1 offers individualized fitness programs with individual advice and message boards for reading the experiences of others and offering your own. 1 offers personalized fitness programs. You get weekly email tips and unlimited email consultations. There are lots of member testimonials in case you want to read the experience of others. 1 is the address for Global Health and Fitness, a site that offers a large amount of information on fitness with lots of feedback from trainers. Judging by the successful clients they show on the site, they get some fairly good results.

Clinical studies nonrandomized

Intervention consisted of unspecified dietary advice and increased physical activity conducted either in groups or individually. There were improvements in VO2max , lowered body weight, BP and serum triglycerides, greatest at one year, but maintained over the six years. Among people in the IGT group without intervention, 21.4 met criteria for diabetes ( 6.7 mmol l fasting and or 11.1 mmol l at two hours), whereas only 10.6 had diabetes in the intervention group (RR 0.49 (CI 0.25-0.97)). Subjects who lost the most weight and improved oxygen uptake the most had the greatest improvements in glucose levels. These results were further explored in another report76 which showed that, in addition to forced vital capacity (as a correlate of fitness), insulin resistance (higher 2 h insulin level) and lower insulin secretion (40 minute insulin increment during the OGTT) predicted diabetes independently among people with normal glucose tolerance.

Exercise And Diabetes

Despite the widespread beliefs of the benefits of physical activity and the promotion of exercise by many health professionals, people with diabetes are reluctant to increase their physical activity (22). This is not restricted to those with diabetes as it applies to the British population as a whole. A UK study in 1990 showed that only 15-30 of British adults are taking sufficient exercise for optimum health and that there is a large discrepancy between people's perception of their fitness and the amount of exercise they actually take (23). A recent Canadian study has shown that while 84 of people with diabetes thought they should be exercising, only 45 were actually doing so (24). Against this background of reluctance to exercise there is also a lack of knowledge of the physiology of exercise. In order to maximise the advice given to people with diabetes who wish to increase their physical activity, it is essential to gain an understanding of the physiology of physical activity,...

Prevention Of Type Diabetes

There is now unequivocal evidence that physically fit people are less likely to develop Type 2 diabetes and some intervention trials have shown that encouraging people with impaired glucose tolerance (IGT) to increase their physical activity significantly reduces their risk of developing diabetes (14-16). This benefit is independent of body mass index (BMI) and there is some evidence that physical activity has a greater protective effect as BMI increases (17). It may be of more importance for people at risk of Type 2 diabetes to increase their physical fitness rather than concentrate on weight reduction.

Why is exercise important for peopLe with diabetes

It helps us to look good and feel better about ourselves it increases physical fitness it reduces the risk of heart disease it helps with weight control and it improves muscle tone. Besides improving the body, exercise can also promote a positive, healthy outlook on life.

Physical activity and obesity treatment in children

A review by Epstein and Goldfield (1999) has outlined the important elements of intervention programmes for overweight and obese children. The only area where there was a sufficient number of studies to make a quantitative analysis led to the conclusion that diet plus exercise programmes achieved greater weight loss. Two studies have shown that subjects involved in a diet only intervention were less successful than subjects involved in diet plus exercise (Epstein et al., 1985) (-3.8 kg diet only versus -6.8 kg diet and exercise) and Hills and Parker (1988) (-2.6kg diet only versus -5.5 kg diet and exercise)). Gutin et al. (1999) has shown that exercise only interventions can produce improvements in body composition (-2.2 kg), fitness (-3.8 bpm at 48 w during a cycle ergometer test) and biochemical profiles (TAG (1.15 0.01 mmol l pre 0.95 0.01 mmol-l-1 post intervention group compared to 0.98 0.01 mmol-l-1 pre 1.10 0.01 mmol-l-1 post control group) and fasting insulin (155.5...

Glucose Levels and the Estrogen Cycle Menstruation

At first, you think you're just imagining it. You're going along and everything seems fine. You're in good spirits, eating well, getting regular workouts, and your blood glucose levels are on target most of the time. Then, for some unexplained reason, everything seems out of whack. Maybe your blood glucose levels are too high. Or maybe they're too low. Then you check the calendar. Oh, yeah it's that time of the month.

Padding in some areas

Walking can be especially invigorating if you move at a brisk pace and travel over hilly terrain. Walking is a lifelong activity, and it is a good way to have a more active lifestyle. It can also help you ease into a more vigorous exercise if you are newly diagnosed with diabetes or are not used to exercising. Maybe you are a little afraid that exercising too vigorously will throw your blood glucose levels out of whack, just when you thought you had things figured out. After walking for a while, you will develop the confidence, stamina, and fitness level to try other activities.

Other Complications in the Diabetic Patient

Diabetic patients with end-stage renal disease (ESRD) and who are dependent on renal dialysis are obliged to be physically inactive for long periods of time and tend to lose cardiorespiratory and neuromuscular fitness. Tiredness resulting from uraemia and chronic anaemia limits exercise capacity and leads to further loss of fitness. Renal osteodystrophy is an early complication of renal failure and the loss of bone mass is exacerbated by lack of exercise. Exercise programs can reduce disability and handicap in patients with ESRD (Painter 1988), and therefore qualify as valid rehabilitation activities. Sensory neuropathy sometimes limits the exercise options available to the elderly diabetic patient and loss of fitness can result. For those who do exercise, trauma to the foot can result in blistering and ulceration of the skin, muscular sprains and fractures. Muscles and tendons are at risk from overstretching. Neuropathic weight-bearing joints are easily damaged and a Charcot joint...

Exercise and Pregnancy

If you exercise regularly with type 1 or type 2 diabetes, pregnancy is no reason to stop working out, but you may need to lower your workout intensity. If you have gestational diabetes, exercise lowers your blood glucose level and so is considered an effective part of your treatment plan. Staying physically fit during your pregnancy will help you prepare for the work of labor and baby care that lies ahead. Exercise can also moderate your weight gain, increase your strength and stamina, and lower your anxiety level. In some cases, it may help you avoid or delay the start of using insulin.

You know I cant overdo it I have diabetes Exercise might make my complications worse

Benefits your heart, lungs, and muscles. It is the best way to burn calories and get rid of fat. Stretching increases your flexibility. To see improvement, you'll need to work out at least three to four times per week. You might want to alternate days of aerobic activity with days set aside for strengthening activities for muscle toning. For more intense workouts, you might want to alternate resting days and workout days. But some people find it easier to manage their blood glucose levels if they keep a similar exercise routine each day.

Current physical activity behaviour and guidelines

The results of the Allied Dunbar National Fitness Survey (Activity and Health Research, 1992) showed that in terms of physical activity 7 out of 10 men and 8 out of 10 women fell below their age-appropriate activity level necessary to achieve a health benefit. Increasing heart rate to between 60 and 90 per cent of its estimated maximum (220 beats per minute minus age in years) during regular sustained physical activity (three times per week for at least 30 min) will improve cardiorespiratory fitness and decrease the risk of heart disease, stroke and metabolic disorders (ACSM, 1995). There is also increasing evidence to support the health benefits of shorter periods of physical activity accumulated throughout the day, which is how sedentary obese and type 2 diabetics should start to engage in a more active lifestyle (ACSM, 1995). For most adults who are not regularly active but are able to walk comfortably, walking can become a good way to establish an active lifestyle. It is important...

Making moderate exercise your goal

How long can you stop exercise before you start to decondition It takes only about two to three weeks to lose some of the fitness your exercise has provided. Then it takes up to six weeks to get back to your current level, assuming that your holiday from exercise does not go on too long.

Easy Exercises for Beginners

Bending and stretching exercises are good for beginners because they are easier and less likely to cause injury than more strenuous aerobic exercises. Even after you advance to more strenuous activities, it's a good idea to prepare for each workout with a few minutes of bending and stretching. In addition to bending and stretching, there are safe beginner's exercises you can do lying down on your bed or a floor mat, or sitting in a chair.

Exercise And Primary Prevention

An interesting trial has been published under the name Harvard Alumni study (5) in 16,936 college alumni the amount of leisure time physical activity was estimated from questionnaires and structured interviews. After an observation time between 12 and 16 years participants in the most active group reduced their cardiovascular risk by 50 as compared to inactive persons. All of the above studies determined physical activity by questionnaire with an inherent degree of error. A recently published trial used the maximal work capacity on a treadmill to determine physical fitness as a hard parameter in more than 6000 patients referred for evaluation of various angina-like symptoms. Cardiovascular risk in the fittest quintile was only one-quarter of the risk in the quintile with the lowest fitness (6). In total there are more than 30 publications with nearly 250,000 enrolled patients, followed for an average of 10 years, documenting the efficacy of regular physical exercise to reduce...

Devoting an hour a day

You need to warm up and cool down for about five minutes before and after you exercise. Stretching is one possibility for both warm-up and cool-down. I am not going to discuss stretching in detail because the place of stretching for the healthy exerciser is not clear. One study showed that a group of runners who did not stretch did better than a group who did. Most doctors agree that stretching after an injury is appropriate, but whether all the advice about stretching before exercise for an uninjured person is much ado about nothing is yet to be determined. If you do stretch, do not stretch to the point that it hurts. This is where muscle tears occur. See the excellent book Fitness For Dummies, 3rd Edition, by Suzanne Schlosberg and Liz Neporent, M.A. (Wiley), for more about stretching.

Training with Weights

In addition to exercises for cardiovascular fitness, encourage your child to lift weights. Have him select lighter weights that he can lift repetitively. This is called weight training. (He should avoid very heavy weight lifting, which is anaerobic refer to the earlier section Developing (And Sticking to) an Exercise Plan for an explanation of aerobic versus anaerobic exercise.) To try some other weight-training exercises, see the book Weight Training For Dummies, 3rd Edition, by Liz Neporent, Suzanne Schlossberg, and Shirley Archer (Wiley). You also can consult an exercise trainer in a fitness club to find out how to do these exercises and others safely.

Delicious Diabetic Recipes

Applicability, fitness, or completeness of the contents of this e-book. This e-book doesn't come with any warranties (express or implied), or fitness for any particular purpose. We shall in no event be held liable to any party for any direct, indirect, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is , and without warranties.

The Patient with Myocardial Infarction

An alternative approach is a low-intensity group approach such as that which is often used in Australian cardiac rehabilitation programs. This does not require initial exercise testing for risk stratification or monitoring. Patients are taught to monitor their own exercise levels based on perceived exertion. They are advised to exert themselves to the level at which they breathe more deeply but still talk comfortably while exercising. Low-intensity group programs achieve similar improvements in quality of life and physical fitness as high-intensity exercise programs (Worcester et al 1993). Assuming that medications (e.g. beta-blockers) which control heart rate are not being prescribed, individual patients should aim to maintain heart rate within a predetermined range when exercising. To this end, the pulse rate should be monitored regularly, and the degree of exercise modified accordingly. An adequate warm-up and cool-down period should begin and end every exercise session. Running,...

Looking after the body

Any person starting an exercise programme needs to consider whether they are fit enough for their chosen activity, or whether it is safe for them to work towards attaining an appropriate standard of fitness for that activity. Also, remember that people with diabetes are more likely to have coronary heart disease than the general population (women as well as men) and that they may have diabetic tissue damage which could be further damaged by exercise.

Exercising to Improve Control of Type Diabetes

The fact that your child has type 1 diabetes (also known as T1DM) just makes it more important that he develops a fitness program that's part of his everyday activities, like eating and sleeping. Chapter 6 draws your attention to world-class athletes who have T1DM, and although the average child with T1DM isn't likely to become a world-class athlete, he can certainly use physical activity not only to help to control diabetes but also to help to live a long and full life.


If you are used to exercising and you have just been diagnosed with diabetes, you might be wondering whether you will be able to continue your workouts. (Of course you will ) If you are not yet in the swing of things, it's time to think about beginning an exercise program. Everyone needs to be physically active it's good for your overall health. It can help prevent heart disease and other health problems. Regardless of your type of diabetes, exercise can have many positive benefits. Not only does exercise make you feel and look good, it improves blood flow and muscle tone. It can even help you handle stress. Aerobic exercise gives your heart and lungs an especially good workout. It makes your heart pump harder and gets the blood flowing through even your smallest blood vessels. This helps prevent the circulation and foot problems that people with diabetes can get. Walking is something that almost everyone can do and is very effective as an all-around exercise. You need to take special...


Many health service financial cycles are annual. Diabetic complications take years to become obvious, so the immediate benefits of intensive management can rarely be demonstrated to a financial manager planning the following year's budget. Both DCCT and UKPDS studied the long-term cost-effectiveness of intensive diabetes care. In UKPDS, intensive management of Type 2 diabetic patients 'significantly increased treatment costs but substantially reduced the cost of complications and increased the time free from complications'. They calculated that with intensive care the patient would gain 1.14 years (confidence interval 0.69-1.61) of event-free time (an event being a diabetic complication, including death). They did not include the nonmedical and social benefits such as fitness to work. In DCCT, they concluded that intensive rather than conventional therapy for the 120 000 people with Type 1 diabetes in the

Lifting Weights

Lift Dumbbells Over Your Head

Weight training, which uses lighter weights, can be a form of aerobic exercise. Because the weights are light, they can be moved for prolonged periods of time. The result is improved cardiovascular fitness along with strengthening of muscles, tendons, ligaments, and bones. Weight training is an excellent way to protect and strengthen a joint that is beginning to develop some discomfort.

Relapse prevention

The most commonly identified problem in obesity treatment is long-term maintenance of weight loss (DePue et al., 1995 Foreyt and Goodrick, 1991 Perri, 1998). A primary factor known to contribute to adherence with behaviour change strategies and maintenance of weight loss is maintaining episodic long-term contact with treatment providers and or peers (Perri et al., 1984, 1986, 1987). These follow-up contacts can be accomplished with face-to-face meetings, by telephone (Lindstrom et al., 1976), or via electronic e-mail. The optimal frequency of maintenance contacts is largely unknown, but should be devised in response to attendance and weight maintenance data. Restart programmes which give patients the opportunity to re-engage in an active intervention strategy for a short period of time (e.g. exercise groups or meal replacements for 6 weeks) may be offered to re-establish the benefits and behavioural patterns of the active intervention. It should be noted however that Smith and Wing...


Insulin-mediated glucose disposal varies widely in the population at large, with approximately 50 of the variability in insulin action resulting from differences in lifestyle variables with degree of adiposity and physical fitness each accounting for approximately (25 ). The remaining 50 is familial, likely to be of genetic origin, with powerful ethnic differences. Type 2 diabetes develops when insulin-resistant individuals cannot secrete the increased amounts of insulin needed to overcome the insulin resistance. However, the majority of insulin-resistant individuals are able to maintain the degree of hyperinsulinemia required to prevent manifest decompensation of glucose homeostasis. Although compensatory hyperinsulinemia prevents the development of frank hyperglycemia in insulin-resistant persons, insulin-resistant hyperinsuline-mic individuals are at greatly increased risk of being somewhat glucose intolerant, with a dyslipi-demia characterized by a high plasma TG and low HDL-C...


The rate of hypoglycaemia-induced accidents is extremely difficult to evaluate and is, of necessity, anecdotal. Most road accidents have several contributory factors, and it may be difficult to isolate hypoglycaemia as being the principal cause. Studies in the UK have suggested that the accident rate of diabetic drivers is very similar to non-diabetic drivers (Stevens et al., 1989 Eadington and Frier, 1989), and this premise is supported by studies from Germany (Chantelau et al., 1990) and the USA (Songer et al., 1988) (Table 14.1). In an assessment of medical factors causing road traffic accidents, a study in Iceland showed that disorders such as diabetes were not over-represented (Gislason et al., 1997). However, one American study has observed a 'slight increase' in the risk of motor vehicle accidents in diabetic drivers (Hansotia and Broste, 1991), but considered this increase to be insufficient to 'warrant further restrictions on driving privileges'. These studies have been...


There is no therapy currently available for the treatment of CAN. Therefore, treatment mostly focuses upon management of a number of modifiable risk factors, which can significantly reduce the risk of developing CAN. In the European Diabetes Prospective Complications Study (EURODIAB), which enrolled 1172 patients with type 1 diabetes, the incidence of neuropathy was associated with a poor glycemic control, elevated triglyceride levels, increased body-mass index, smoking, and hypertension (141). Initially, treatment should focus upon improving overall cardiovascular fitness. Indeed, an exercise program has been shown to be able to improve early CAN (142). However, because CAN might impair exercise tolerance (51,57) and mask myocardial ischemia (25,90-92), subjects with CAN should be considered for a cardiac stress study before undertaking an exercise program.


If you want to see how your child stacks up against many others, have him perform the President's Challenge Physical Fitness Test, which you can find online at details physical_fitness events.aspx. For the test, your child performs five exercises, and you compare his results with the results accomplished by a large school population (last measured, unfortunately, in 1985). Your child receives a Presidential Physical Fitness Award if he scores in the 85th percentile compared to the national standard. Perform the test every six months to best track your child's physical fitness progress.

Diabetes Management

Live a healthy lifestyle, with regular school or job attendance and fun social activities avoid extremely high blood glucose levels avoid severe low blood glucose or unconsciousness keep up normal growth, if you're young maintain a healthy body weight and physical fitness enjoy normal sexual function


The way that exercise affects blood glucose levels in people with type 1 diabetes can be a little complicated. Not only do you have to think about blood glucose levels getting too low, you also have to make sure they aren't too high. Having the right amount of insulin on board will help you get the most benefit from your workout or leisure activity. So, take the time to learn how to predict your insulin and food needs by monitoring in all types of situations. This will help you enjoy all manner of aerobic and strengthening exercises open to you. During mild to moderate exercise that doesn't last too long, your blood glucose levels are likely to fall during and after exercise. This is because the glucose in your blood is being used up faster than your liver can produce more glucose. This is one of the positive benefits of exercise. But if you exercise for longer periods, or if you didn't have much glucose in your blood to begin with, you could experience hypoglycemia. If you exercise...

Before You Begin

You may be an old hand at fitness like Charlotte who's just been diagnosed with diabetes. Or perhaps you have been living with diabetes for a while like Larry and want to start an exercise program or make changes in your existing program. The first step is to choose the type of exercise you will do. Be sure to pick something you will enjoy and can do regularly. Think creatively for example, maybe you find walking boring but love to dance. Don't try to force yourself to walk. Plan a time each day to put on some music that gets you moving and dance. Exercise physiologists people trained to study the effects of physical activity on the body do a variety of tests to determine your fitness level. In addition to a treadmill stress test to find out how much exercise you can safely do, they'll measure your strength, flexibility, and endurance and the percent body fat. Together with your provider, you and the exercise physiologist can create an exercise plan. Is it more effective to stick to...

Exercising Safely

If you decide to do an aerobic activity program, plan your workout sessions to include 5 to 10 minutes of warm-up exercises and gentle stretching. Follow this with at least 20 to 30 minutes of aerobic activity. The aerobic activity should rev you up and get your heart pumping and blood flowing but should not be so intense as to cause shortness of breath, weakness, or intense pain. One easy guideline to remember is that, during your workout, you should still be able to carry on a conversation with your workout partner. Follow the aerobic activity with 5 to 10 minutes of cool-down exercises and stretching. Regular aerobic exercise, which keeps your body moving,

For Exercisers

For information about health and fitness. For people with diabetes and for health care professionals interested in exercise and fitness at all levels. Newsletter. President's Council on Physical Fitness and Sports Washington, DC 20201-0004 202-690-9000 202-690-5211 (fax) e-mail pcpfs Web site For information about physical activity, exercise, and fitness.

The Best of the Rest

Try yoga to increase your flexibility. Try aerobics classes, especially if you like to dance. Community and senior centers may have equipment available or offer classes that are free or reasonably priced. Try a trial membership at a health club convenient to your home. You could try out their machines to see if there are any you would use at home. You could rekindle your love of tennis, squash, or volleyball. Make an aerobic challenge out of washing the windows or sweeping the deck. When it comes to your fitness, the old saying use it or lose it is true

Physical activity

Intensity exercise each day can be shown to reduce blood pressure, improve lipid profile, decrease cardiovascular risk, improve energy levels and self esteem, all in addition to aiding weight loss and hence improved diabetic care (Sarvis, 1998). It is recognized that not only does increased activity help produce weight loss, but individuals who exercise regularly are also more likely to maintain their weight loss. Advice on physical activity has not traditionally been seen as the responsibility of the general practitioner, and yet so much can be achieved by a patient motivated to become more active. Before embarking on an exercise campaign, it may be helpful for the health professional to discuss with the individual which type, and what intensity of activity would be appropriate (see Box 14.1). Patients are often resistant to increasing their activity levels for a variety of reasons. They often, wrongly, perceive that to be beneficial exercise must be intense, and involve frequent gym...

Benefits Of Activity

Physical activity has a positive effect on insulin action, thus improving glucose control and insulin sensitivity (68). In addition, exercise improves lipid profiles by reducing serum TG and VLDL and raising HDL concentrations. Improvements in blood pressure have also been observed, independent of weight loss. Cardiac fitness is improved, with the risk of myocardial infarction reduced by 35-50 (69). Evidence suggests that these benefits are not uniform and that, in general, younger (40-54 years) individuals with Type 2 diabetes, in the early stage of disease, are more likely to benefit from the effects of exercise (70). In addition, the greatest benefits from physical activity may be in the weight maintenance phase of obesity management (71).

Jogging Running

Some people would rather jog or run than walk. You get a more intense workout in less time than walking. But jogging is tougher on your joints and feet because each step pounds the foot with three to five times your body's weight. Make sure that you discuss your running or jogging program with your provider before you start to make sure it is safe for you. Counting the calories you're burning is one way to keep track of your fitness efforts. The numbers of calories burned shown here are for a 150-pound person working out at an average intensity. If you weigh more or work out harder, you'll burn a few more calories. But remember, exercise has more benefits than just burning calories.

Prevention of TDM

Community-based efforts to prevent T2DM, however, have been less successful than the more intensive clinical trials. A program among elementary school children in the Mohawk community in Canada that encouraged healthy eating and more physical activity reported no effect of intervention on body mass index, physical activity, fitness, or diet. The investigators concluded that although early results showed some successes in reducing risk factors for T2DM, these benefits were not maintained long-term (104,105).

Human studies

Based on observational studies, decreases in abdominal fat appear to improve glucose tolerance in overweight individuals with IGT, although this has not been shown to be independent of the total amount of weight loss. In addition, increased cardiorespiratory fitness improves glucose tolerance in overweight individuals, but there is no evidence that shows this relationship to be independent of weight loss, even though several studies have shown short-term improvements in hyperinsulinemia.

John Alan Farmer

The concept that overweight or obese individuals who are physically fit and do not have associated metabolic conditions may not demonstrate increased cardiovascular risk has been proposed although considerable controversy exists due to methodological problems and the lack of large-scale prospective controlled clinical trials.6 However, it is clear that a lean physically fit individual has the lowest overall risk of developing cardiovascular disease. The presence and quantitative contributions of lifestyle, diet, exercise patterns, and degrees of physical fitness are difficult to determine in epidemiologic studies and may potentially confound the interpretation of observational data. The duration and intensity of physical activity are also significant determinants of body weight, glucose tolerance, and blood pressure but the quantitation of physical fitness is frequently problematic in large scale observational studies. The relationship of cardiovascular fitness, mortality, and obesity...


Good communication is essential for good diabetes care. The patient must learn what diabetes is, how to care for himself, and how to stay fit. Communication can be difficult if the patient and the health care team have different ethnic and cultural backgrounds. Some barriers to communication include


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101 Fitness Tips

101 Fitness Tips

100 Fitness Tips EVERY Fitness Buff Should Know. This Report 100 Fitness Tips will help you Utilize These Tips to Get Fit amp Healthy Starting Today.

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