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Chronic Disease Management and Exercise

Chronic Disease Management and Exercise . Miss Victoria Hyland & Mr David Webb COLEG Llandrillo CYMRU . Overview and Aims . Outline common Illnesses & Chronic Disease Management of Illnesses & Chronic Disease through the prescription and life style changes

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Chronic Disease Management and Exercise

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  1. Chronic Disease Management and Exercise Miss Victoria Hyland & Mr David Webb COLEG Llandrillo CYMRU

  2. Overview and Aims • Outline common Illnesses & Chronic Disease • Management of Illnesses & Chronic Disease through the prescription and life style changes • Pros and cons of Exercise prescription for these illnesses and health conditions • To be able to manipulate exercise to fit in with specific populations and life styles • Exercise Myths

  3. Determinants of Health Living and working conditions and access to facilities and services Support and influence within communities which can sustain or damage health Economic, cultural and environmental conditions such as standards of living Personal behaviour and lifestyle

  4. Lifestyle Factors Lifestyle factors are responsible for most of the illness and deaths- Smoking Stress Alcohol Improper diet Overeating Lack of exercise

  5. Obesity

  6. What is obesity? Excessive development of body fat. (Bailliere’s 2002) BMI – Body Mass Index BMI – Weight (Kg) Height 2 (m2) Densitometry - Provides measurements of body density -body pod -Hydrostatic weighing Duel energy x-ray absorptiometry -DXA scan Bioelectrical impedance Skin fold measurements

  7. Obesity & Physical activity facts • Average person gains 1lb (0.45kg) of fat/year after age 25 and loses 0.5 kg lean body weight/year resulting in a net gain of 0.7kg (1.5lb) of fat per year • Inactivity is a major cause of obesity, probably more important than overeating • Physical activity increases energy expenditure during the activity and for some time after when the metabolic rate remains high • Physical activity can cause a loss in fat weight/maintenance or a gain in fat free mass ACSM (2010)

  8. Weight Loss / Fat Reduction • To lose weight you have to create a calorie deficit. You can do this by decreasing your calorie intake and increasing your exercise work output.

  9. Coronary Artery Disease (CAD)

  10. CAD • Coronary arteries are the vessels that supply oxygen rich blood to the heart. • Plaque builds up in these arteries and cause restricted blood flow to the heart. • This build up can cause plaque reduces the oxygen to the working heart muscle • Angina • Increased BP • Arrhythmias • Myocardial Infraction (MI) • Heart Failure

  11. Reduce Risk of CAD. How? • Reduced blood pressure (Duncan et al, 1985, ACSM 2010 ) • Increases HDL (Goldberg & Elliot; 1987, ACSM 2010) • Decreases LDL (Sady et al 1986; Work; 1987, ACSM 2010 ) • Reduces obesity ( Bray; 1986, ACSM 2010)

  12. WHAT ARE THE BENEFITS OF EXERCISE? • Regular aerobic exercise protects against CAD; possibly with increasing benefits as the amount of exercise increases (ACSM 2010) • Even after an MI regular exercise reduces the risk of a subsequent MI by 25% (Dargie & Grant; 1991) • Decreased risk of diabetic complications (Boule et al; 2001) GP referral to exercise!

  13. DIABETES

  14. DIABETES WHAT IS DIABETES? • Insulin Dependant Diabetes Mellitus (IDDM) or Type I Diabetes • Non-Insulin Dependant Diabetes Mellitus (NIDDM) or Type II Diabetes

  15. IDDM • Characterised by a lack or absence of endogenous insulin production • Regular subcutaneous injections of insulin are required to prevent hyperglycaemia Fact: Prior to the discovery of insulin Type I patients usually died within 2 years, from ketoacidosis. (high blood glucose; often caused by illness or taking too little insulin, ketones accumulate in the blood ACSM(2010)

  16. NIDDM • Impairment of the pancreatic beta cells to secrete insulin in response to elevated plasma glucose concentrations • A reduced sensitivity to insulin in target organs (such as muscle, liver and adipose tissue) • Often goes undiagnosed!

  17. PHYSIOLOGICAL IMPLICATIONS • HYPERGLYCAEMIA - elevated concentration of glucose in the blood • CAN BE CONTROLLED WITH EXERCISE • Occurs if the liver releases glycogen (glucose) into the blood stream without the presence of insulin • HYPOGLYCAEMIA - Low blood sugar levels, often causing confusion, light headedness and irritability • CAN BE MADE WORSE BY EXERCISE • Occurs if the individual has used too much insulin or not consumed enough CHO

  18. RISKS ASSOCIATED WITH EXERCISE • Hypoglycaemia • Cardiac implications • Retinal bleeding • Protein excreted in the urine • Changes to BP • Increased risk of foot ulcers • Possible problems with thermo-regulation • GP referral to exercise!

  19. BENEFITS OF EXERCISE • Increase insulin sensitivity • Improved functional capacity • Enhanced sense of well-being • Reduced risk of CAD • Reduced risk of MI • Decreased ‘stickiness’ of blood platelets • Reduced risk of High BP • Can reduce high BP • Decreased triglyceride levels • Increased HDL levels • Decreased LDL levels • Improved HDL / LDL ratio • Decreased Body Fat • Decreased risk of Osteoporosis • Decreased risk of Diabetic associated complications

  20. Older Population

  21. What do you think is meant by the term “older adult” ?

  22. ACMS (2010) The term “Older Adult” is defined as a person >65 years and people 50-64 years with clinically significant conditions or physical limitations that affect movement, physical fitness, or physical activity.

  23. Benefits of physical activity • Slow physiologic changes of ageing that impair exercise capacity • Optimizing age related changes in body composition • Promoting psychological & cognitive well-being • Managing chronic diseases • Reducing the risk of physical disability • Increasing longevity (ACSM 2010)

  24. However………………… • Older adults are the least physically active of all age groups. • Exception…….. • http://www.youtube.com/watch?v=iUvjXQHt6QQ&feature=fvw

  25. Exercise Recommendations

  26. WHAT ARE THE BENEFITS OF EXERCISE? • Reduce the risk of Health Complications • Reduces risk of osteoporosis • Reduced Body Fat • Increase cross sectional muscle • Decreases risk of injury • Improves confidence and self esteem • Improves body image ACSM (2010)

  27. Exercise Prescription • Recommended by the ACSM (2010): • Frequency: at least 3-4 days a week / preferably daily. • Intensity: Moderate (physical activity that noticeably increase breathing, sweating, and HR) to vigorous (physical activity that substantially increase breathing sweating, and HR) intensity. • Time: 30 minutes a day of moderate exercise build to an hour. • Type: A variety of actives that are enjoyable and developmentally appropriate for the INDIVIDEAL.

  28. Strength • Recommended by the ACSM (2010): • Frequency = at least 2 days a week • Intensity = Moderate and vigorous • Type = Progressive weight training - Major Muscles groups

  29. Flexibility Recommended by the ACSM (2010): • Min 2 days a weeks • Intensity = 5-6 intensity scale • Type: Any activities that maintains or increases flexibility • Major muscle groups • Hold for minimum 15-30 sec

  30. SMART Goals Applied to Exercise • S - specific, significant, stretching • M - measurable, meaningful, motivational • A - attainable, agreed upon, achievable, acceptable, action-oriented • R - realistic, relevant, reasonable, rewarding, results-oriented • T - time-based, timely, tangible, trackable

  31. What exercise do you do in a day? In small group discuss your daily activities. Make a list of activities. Make a note of these activities duration. Do they fit in with the recommendations?

  32. Exercise Myths

  33. Performing exercise for a specific area in an attempt reduce body fat in that area alone. • But does this work? What do you think?

  34. Resistance training is any type of exercise using additional resistance • The main aim is to improve muscle strength and endurance, usually by weight training • Will it make females look masculine?

  35. FACTS on RT Resistance training increases Basal Metabolic rate (Mc Cartney 1993) Alexander (2002) RT/circuits – improve body composition and weight loss. Also has a higher energy expenditure post exercise then walking and jogging.

  36. Summary • Life style factors contribute to illness and chronic disease. • Manipulation of life style can help to maintain a health life style and prevent/manage illness and chronic disease. • Exercise provides benefits to reduce and prevention of illness and chronic disease. • Make exercise enjoyable and specific i.e. SMART Goal setting

  37. Be happy! Video Clip Be Happy with What You Have.WMV

  38. Any Questions

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