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Concerned About Constipation?.
This fact sheet from the National Institute on Aging provides basic information about constipation. Readers are reassured that there is no correct number of daily or weekly bowel movements and being “regular” is different for each person. The fact sheet lists recommended questions to help readers determine whether they might have a constipation problem. These questions consider symptoms such as bowel movements fewer than three times per week, difficulty passing stools, lumpy or hard stools, and a feeling of being blocked or of not having fully emptied the bowels. The fact sheet discusses the causes of constipation, including diet; using too many laxatives or enemas; lack of exercise; holding back bowel movements; some medical conditions; some medications; treatment approaches such as adding fiber to the diet, drinking adequate fluids, and getting enough physical activity; and how to know when to consult a health care provider about constipation concerns. Readers are referred to three resource organizations for more information: the National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov or 1–800–891–5389), the National Library of Medicine Medline Plus (www.medlineplus.gov), and the National Institute on Aging Information Center (www.nia.nih.gov or 1–800–222–2225). Readers are encouraged to go online to NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website that has health information for older adults.
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Diabetes And Exercise. Diabetes Educator. 34(1): 37-40. January 2008.
This article presents the position statement of the American Association of Diabetes Educators (AADE) on diabetes and exercise. The AADE is a multidisciplinary professional membership organization of health care professionals dedicated to integrating successful self-management as a key outcome in the care of people with diabetes and related conditions. The AADE asserts that diabetes educators play a unique and influential role in advising and motivating individuals with diabetes to integrate physical activity and exercise into a lifestyle that supports optimal diabetes management and health. The position statement covers the health benefits of exercise, the role of exercise in diabetes prevention, potential exercise risks, exercise recommendations and guidelines, and outcomes expectations. The statement concludes that, although exercise carries potential risks for individuals with diabetes, with careful planning, its numerous health benefits far outweigh these risks. By using established, sound exercise guidelines and tailoring exercise recommendations to thorough pre-exercise assessment, diabetes educators can suggest safe and effective physical activity interventions that will enhance the health and well-being of all individuals with diabetes. Physical activity remains an underused treatment modality in diabetes management. 25 references.
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Exercise, the Under-Prescribed Drug. Kidney Beginnings. 7(5): 16-18. February 2008.
This article encourages readers with kidney disease to think of exercise as a treatment for health, just as they might consider a drug therapy. Exercise is touted as providing a patient with more energy, improved moods, a way to fight depression, a way to lower blood pressure and reduce risk of heart attack, and a way to build stronger muscles and bones. The author cautions that physical fitness decreases continuously with chronic kidney disease (CKD), resulting in decreased flexibility, decreased muscle strength, coordination disturbances, and decreased endurance. Readers are advised to check with their physician before starting an exercise program and then incorporate exercise and physical activity into their daily plan. The author reviews the three types of exercise: endurance or aerobic, strength and balance, and flexibility. Exercising with a partner or buddy can help keep motivation levels up. Readers are referred to the American Association of Kidney Patients (AAKP) website for more information (www.aakp.org). 3 figures.
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Helping Your Patients Become Active. Diabetes Spectrum. 21(1): 59-62. Winter 2008.
This article reminds readers of the importance of exercise and physical activity in the prevention and management of diabetes. Exercise is prescribed to prevent diabetes, to improve diabetes control, and to promote weight loss. The author focuses on strategies that health care providers, counselors, and educators can use to help their patients become more active. The author reviews the basic physiology and glucose metabolism associated with exercise and summarizes the barriers to becoming physically active, solutions to those barriers, options for exercise with the presence of diabetes complications and/or orthopedic issues, and guidance for blood glucose management related to exercise. Recommendations to attain the maximum health benefit, improve diabetes control, and maximize caloric expenditure are to exercise daily at low to moderate intensity for 60 minutes or more. The activity can be accumulated throughout the day, with a minimum of 10 minutes or more for each exercise bout. Patients should engage in a combination of aerobic and resistance training. Health care professionals can help patients overcome barriers to exercise by providing them with an understanding of glucose management during exercise and helping them create an exercise routine that is unique to their health status, age, current exercise capacity, glycemic control, and personal goals. 2 tables. 20 references.
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Importance of Being Active. Diabetes Wellness News. 14(3): 2-3, 5-6. March 2008.
This patient education newsletter article explores the health benefits of increasing one’s physical activity, including the impact of exercise on long-term health and the successful daily management of diabetes. The author defines increased activity and the benefits it can offer. The author briefly explains how activity can increase stamina, strength, and flexibility, including the physiology of increased activity in diabetes. The author points out some potential barriers and provides ideas to overcome those barriers. Topics include weight reduction; caloric intake versus caloric expenditure; adjusting insulin dosages for increased physical activity; balancing food, insulin, and exercise; risks of hypoglycemia; how to incorporate exercise into one’s daily life; and special suggestions for readers with reduced mobility. Some of the information presented is reiterated in sidebars and charts, including the exercises and calories burned during 20 minutes of different types of exercise. Readers are encouraged to work closely with their health care providers to safely add exercise and other activities to their program of diabetes management. 4 figures.
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Managing Preexisting Diabetes for Pregnancy: Summary of Evidence And Consensus Recommendations for Care. Diabetes Care. 31(5): 1060-1079. May 2008.
This article presents consensus panel recommendations for the medical care of pregnant women with preexisting diabetes, including type 1 and type 2 diabetes. The document is designed to help clinicians deal with the broad spectrum of problems that arise in the management of diabetes before and during pregnancy, and to prepare women with diabetes for treatment that may reduce complications in the years after pregnancy. Guidelines are presented in two sections. The first section addresses managing preexisting diabetes for pregnancy, including the organization of preconception and pregnancy care, initial evaluation, glycemic control, perinatal outcome and glycemic goals, assessment of metabolic control, medical nutrition therapy, insulin therapy, oral antihyperglycemic agents for type 2 diabetes, physical activity and exercise, and behavioral therapy. The second section covers the management of diabetes complications, including diabetic ketoacidosis (DKA), maternal hypoglycemia, thyroid disorders, management of cardiovascular risk factors, screening for cardiovascular disease (CVD), hypertension, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathies. Practical suggestions, including recommended laboratory values and goals, are highlighted. The recommendations for diagnostic and therapeutic actions are based on a grading system adapted by the American Diabetes Association that was used to clarify and codify the research evidence available.
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Preventing Long Term Complications of Diabetes. 4th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).
This DVD program explains the long-term complications of diabetes, including atherosclerosis and other cardiovascular diseases, kidney disease, eye disease, and neuropathy. Viewers are reminded of the importance of a self-management plan for keeping diabetes under control and preventing or minimizing these complications. The management plan outlined includes patient education, healthy eating, physical activity and exercise, medications, self-monitoring of blood glucose (SMBG), and the glycosylated hemoglobin (A1C) test used for longer term monitoring of blood glucose levels. The video depicts a variety of people who share their experiences with complications and diabetes management. Simple graphics are used to explain most of the topics covered. Viewers are referred to the American Association of Diabetes Educators website for more information and to find a local diabetes educator.
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Soup Can Plan: Getting Fit Without Leaving the House. Diabetes Forecast. 61(2): 37-38. February 2008.
This article encourages readers to incorporate exercise and physical activity into their daily lives, even when they do not think they have the time or inclination to do so. The author reviews the benefits that even moderate amounts of activity can confer on diabetes control, noting particularly the positive aspects of both aerobic activity and resistance training. The article includes an illustration of a simple set of resistance training exercises that can be done with light pounds or household items like soup cans or water bottles. Readers may find it easier to start a program of resistance training because it can feel less taxing on the body than aerobic activities like running, biking, or walking. Aerobic activity can use up some stored glycogen in the muscles, which can help increase insulin action for a period afterwards. Resistance training can result in more muscle mass, which means a greater storage deposit for carbohydrates and a higher metabolism, which can help with weight loss. Readers are reminded to check with their health care provider before starting any new program of exercise.
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What I Need to Know About Physical Activity and Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 15 p.
Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about the role of physical activity and exercise in a complete diabetes management program. Topics include the benefits of a physically active lifestyle, the kinds of physical activity that may be appropriate, cautions for some types of physical activity, the interrelationship between exercise and low blood glucose levels, how to get started on an exercise program, and how to stay motivated to maintain a physically active lifestyle. Suggestions are provided for incorporating exercise into everyday activities, for making sure that aerobic exercise is included, and for stretching and strength training. A sidebar lists tips for treating low blood glucose episodes. The booklet includes contact details for resource organizations where readers can get more information. A final section summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 6 figures.
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Diabetes Lifestyle Book: Facing Your Fears and Making Changes for a Long and Healthy Life. Oakland, CA: New Harbinger Publications, Inc. 2007. 230 p.
This book offers practical suggestions for people coping with diabetes and its complications. The authors focus on the barriers to comprehensive diabetes self-care, including barriers that may be self-inflicted, using a technique called acceptance and commitment therapy (ACT). The book includes a set of self-knowledge exercises that can help readers learn a set of skills and strategies to help them keep their health and their life going in positive directions. The book includes 13 chapters that cover basic diabetes information, acceptance of diabetes, motivation and persistence, the role of commitment, food and nutrition, exercise and physical activity, medications, preventing and treating complications, behavior change, and the role of communication. The authors use numerous case examples, the stories of real people, and practical suggestions to implement everyday activities that help readers connect with the information provided, set and achieve realistic goals, and feel empowered. Specific self-knowledge exercises are provided throughout the book. 29 references.
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Hypoglycaemia in Children With Diabetes. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 190-216.
This chapter on hypoglycemia in children with diabetes is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The author stresses that children are very susceptible to repeated and severe episodes of hypoglycemia, with long-term consequences. This chapter examines the etiology, physiology, consequences, and management of episodes of hypoglycemia during childhood. Specific topics include a definition of hypoglycemia in childhood diabetes; nocturnal hypoglycemia; risk factors for hypoglycemia; glycemic control; the varying insulin requirements at different ages; intensive insulin regimens; diet and nutrition; physical activity and exercise; genetics; counterregulation in childhood, glucagon; epinephrine response; the effect of sleep stage on counterregulation; and the consequences of hypoglycemia, including cognitive impairment, hypoglycemic hemiplegia, and fear of hypoglycemia. A final section of the chapter focuses on the management of hypoglycemia, including prevention, patient education, insulin use, diet therapy, and exercise. 3 figures. 3 tables. 109 references.
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Lifestyle Interventions For Patients With Diabetes. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 405-464.
Physicians who manage patients with diabetes should have a basic understanding of behavioral interventions as they relate to diabetes management. Successful long-term diabetes self-management requires the integration of pharmacotherapy, proper nutrition, home blood glucose monitoring, continuing patient education, an increase in physical activity, and surveillance for and prevention of complications. This chapter about lifestyle interventions for patients with diabetes is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author discusses how to improve adherence to diabetes self-management strategies, patient noncompliance versus nonadherence, ways to delegate patient care responsibilities, medical nutrition therapy (MNT) and how to discuss MNT with patients, the diabetes food pyramid, the exercise prescription for diabetes, travel tips for patients with diabetes, and the role of self blood glucose monitoring (SMBG). The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 5 figures. 14 tables. 59 references.
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Metabolic Syndrome and Obesity. Totowa, NJ: Humana Press. 2007. 303 p.
This book presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. In the introduction, the author briefly considers the historical perspective of obesity and focuses on the potential role of cost and availability of different types of foods and their impact on obesity. The book then offers 11 chapters that cover: definitions and prevalence; epidemiology and metabolism; costs, pathology, and health risks of obesity and the metabolic syndrome; the natural history of obesity, including differential diagnosis, clinical types, and age-related changes; patient evaluation, prevention, and introduction to treatment; diet; behavior modification; physical activity and exercise in the obese; pharmacological treatment of the overweight patient; treatments for the whole metabolic syndrome or its components; and surgical treatment for the overweight patient. Each chapter includes an outline, figures and tables, and concludes with an extensive list of references. A subject index concludes the volume.
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Overcoming Lifelong Habits: Making Medical Nutrition Therapy and Physical Activity Work for all Patients. Diabetes Educator. 33(Suppl 4): S82-S86. April 2007.
This chapter on medical nutrition therapy (MNT) and physical activity in people with type 2 diabetes is from a special, continuing education supplement to Diabetes Educator that helps readers understand some of the barriers to insulin use among their clients. Nearly 60 percent of individuals diagnosed with type 2 diabetes maintain A1C levels higher than the recommended target of 7 percent. The author notes that MNT alone can reduce AIC levels by 1 to 2 percent—observable within 3 to 6 months of initiation—while ongoing, regular exercise lowers A1C levels, increases insulin sensitivity, and reduces cardiovascular disease risk and mortality. The author provides guidance regarding current lifestyle recommendations as well as a series of strategies to help overcome patient resistance. The author contends the present approach to patient care is a top-down, prescriptive approach that is ill-suited to an environment in which patients' language, literacy, and culture may differ from that of providers. When patients are invited to participate, ask questions, and express opinions, they perform more self-care activities and have improved outcomes. The collaborative approach also gives health care providers the opportunity to help patients identify faulty knowledge, clarify beliefs and attitudes, and develop realistic goals. 1 figure. 2 tables. 16 references.
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Physical Activity and Exercise in the Obese. IN: Bray, G.A. Metabolic Syndrome And Obesity. Totowa, NJ: Humana Press. 2007. pp 185-202.
This chapter about physical activity and exercise in the obese is from a book that presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. Topics covered in this chapter include measuring energy expenditure, physical activity and health, treatment of overweight using exercise, and exercise as a strategy to maintain weight loss. The author emphasizes that changes in physical activity are particularly important in the pathogenesis of overweight and in its treatment; this aspect especially true for the long-term maintenance of weight loss when it involves the use of one or more large muscle groups and raises the heart rate. The chapter concludes with a list of specific suggestions for physical activity. The chapter includes an outline, figures and tables; it concludes with an extensive list of references. 4 figures. 3 tables. 47 references.
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Use of Insulin Pump Therapy in the Pediatric Age-Group: Consensus Statement from the European Society for Pediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society and the International Society for Pediatric and Adolescent Diabetes, Endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 30(6): 1653-1662. June 2007.
This article presents a consensus statement on the use of insulin pump therapy in the pediatric age group, implemented primarily to avoid recurrent episodes of hypoglycemia in patients seeking to achieve near-normal blood glucose ranges. Continuous subcutaneous insulin infusion (CSII) is used to closely simulate the normal pattern of insulin secretion and offers more flexibility and more precise insulin delivery than multiple daily injections (MDI). The consensus panel was convened to clear up controversy as to whether CSII has advantages over MDI in terms of reduction in blood glucose levels, occurrence of severe hypoglycemic events, episodes of diabetic ketoacidosis (DKA), and frequency of hospitalizations in young patients. In addition, physicians need guidelines for choosing patients for whom CSII therapy might be appropriate. Recommendations are provided in the areas of glycosylated hemoglobin (A1C) levels, severe hypoglycemia, blood glucose variability, physical activity and exercise, weight gain, metabolic deterioration, infusion site reactions, psychosocial issues, pump features, selecting an insulin pump, catheter features, calculating and timing the prandial (bolus) insulin requirement, monitoring patients on CSII, cost-effectiveness, and terminating CSII. The authors conclude that CSII use in children and adolescents may be associated with improved glycemic control and improved quality of life and poses no greater, and possibly less, risk than MDI. Minimizing the risks of CSII entails the same interventions that promote safety in all patients with type 1 diabetes, including proper education, frequent blood glucose monitoring, attention to diet and exercise, and the ongoing of communication with a diabetes team. 1 table. 95 references.
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"I Hate to Exercise" Book for People With Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association. 2006. 155 p.
Sticking to an exercise plan is tough, but the key is simple: stay active by making the most of the activities you already do. This revised and expanded book includes many easy ways to build activity and exercise into a daily, low-impact fitness routine. Designed for readers with diabetes, the book includes eight chapters: why exercise is so important for people with diabetes, establishing reasonable goals, the building blocks for an activity program, incorporating activity into everyday events and chores, activity across the lifespan, walking as a core exercise strategy, exercising safely with diabetes, and sample exercises, with line drawings illustrating how to do the exercises. Much of the information is presented in charts or checklists. One appendix offers a list of physical activity, diabetes, and health resources. A subject index concludes the text.
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Being Active. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 670-688.
Diabetes educators have an important and challenging role in helping individuals with diabetes and prediabetes be more physically active. This chapter on exercise and being active is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author notes that effective behavior change strategies, coupled with a solid understanding of current recommendations for physical activity and exercise, can be powerful tools for helping individuals incorporate physical activity into their diabetes management program. The chapter covers the importance of pre-exercise medical evaluations, how to develop a physical activity program, aerobic exercise, resistance (strength) training, safety considerations, modifications for clients with diabetes complications, modifications for obesity, modifications for older adults, considerations with children and adolescents, the stages of change for exercise behavior change, promoting lifestyle physical activity, the use of the Activity Pyramid, and the use of motivational interviewing to enhance behavior change. The author concludes that the true art of exercise program planning lies in the effective use of behavior change strategies to tailor programs to each individual’s health status, personal preferences, abilities, goals, and stage of readiness. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 1 figure. 3 tables. 44 references.
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Diet, Exercise, and Behavioral Treatment of Obesity. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 445-456.
This chapter on diet, exercise, and behavioral treatment of obesity is from a comprehensive textbook about diabetes and obesity. The author stresses that lifestyle interventions that change eating behavior, increase physical activity, and result in modest weight loss are known to prevent or delay diabetes in persons at high risk for the disease. Modest weight loss (5 to 10 percent of body weight), often achievable by a combination of reduced caloric intake and increased physical activity, lowers the risk of diabetes and insulin resistance and improves measures of glycemia and dyslipidemia in those with diabetes. The author includes a section that discusses strategies that promote behavior change. Behavior modification is a goal-oriented therapy that helps patients identify and change behaviors that prevent them from achieving their objectives for weight loss and increased physical activity. The author concludes that in order to successfully attack the interrelated diseases of obesity and diabetes, health-care providers and medical organizations need to transform the present model into a system that provides preventive care and early detection as an integral part of standard medical practice. 3 tables. 97 references.
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Epidemiology of Obesity and Diabetes: Prevalence and Trends. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 15-38.
Overweight and obesity have reached epidemic proportions globally along with an adoption of a Westernized lifestyle characterized by a combination of excessive food intake and inadequate physical activity. This chapter on epidemiology is from a comprehensive textbook on obesity and diabetes. In this chapter, the authors present the prevalence, secular trends, and geographic distribution of overweight, obesity, and diabetes in adults, children, and adolescents in the United States and in other developed countries, as well as in developing countries. The authors briefly summarize the epidemiological literature on obesity, weight gain, weight loss, and physical activity in relation to the risk of developing diabetes. The authors conclude that besides genetic predisposition, there is ample evidence that modifiable lifestyle factors such as obesity and physical inactivity are important determinants of the development of type 2 diabetes. In addition, lifestyle modifications, such as changes in exercise and dietary practices, can effectively delay or prevent the development of diabetes in high-risk groups. The authors stress that prevention of these two diseases in adults, and especially in children and adolescents, should be an essential component of future public health intervention programs. 12 figures. 6 tables. 70 references.
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Exercise, Nutrition, and Diabetes. IN: Mechanick, J.; Brett, E., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 297-312.
This chapter on exercise, nutrition, and diabetes is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors note that in diabetes management there is a complex interplay among physical activity, nutrition, pharmacological intervention, and genomics. In prediabetes and type 2 diabetes, physical activity is an essential component of treatment because it lowers blood glucose and reduces obesity. In type 1 diabetes, exercise can result in a complex set of metabolic derangements if careful monitoring and adjustments are not in place. Exercise plays an important role in preventing cardiovascular disease and cerebrovascular disease, both of which are major causes of morbidity and mortality in the diabetes population. The chapter discusses metabolic changes with exercise, and exercise in each of four types of diabetes: type 1, prediabetes, type 2, and gestational. 1 figure. 6 tables. 129 references.
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Obesity and Type 2 Diabetes Mellitus in Childhood and Adolescence. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 277-290.
Since the mid-1990s, an ever-increasing prevalence of obesity and diabetes in children has been observed. Childhood obesity is associated with substantial comorbidities and late complications, including cardiovascular, orthopedic, and psychosocial problems, whether or not obesity persists into adulthood. This chapter on obesity and type 2 diabetes mellitus in childhood and adolescence is from a comprehensive textbook on obesity and diabetes. The authors discuss epidemiology, genetic and environmental factors, clinical presentations (symptoms), screening procedures, a multidisciplinary treatment approach that includes the family, lifestyle and behavior modifications, counseling (individual, group, and family), exercise and physical activity, nutritional interventions, and drug therapy. The authors note that whereas diagnostic methods are clear and straightforward, treatment often remains difficult and frustrating for the patient, the family, and the multidisciplinary team providing health care. The authors caution that because of this reality, more attention must be paid to prevention and health promotion strategies. 2 figures. 3 tables. 77 references.
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Osteopenia. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Special Management Problems. Malden, MA: Blackwell Publishing Inc. pp. 340-359.
Osteopenia, or low bone mineral density (BMD), is a recognized complication of inflammatory bowel disease (IBD). This chapter on osteopenia is from a textbook that addresses some of the challenges in the understanding of ulcerative colitis (UC) and Crohn’s disease (CD), collectively known as IBD. After a section on bone physiology, including the role of corticosteroids and physical activity on bone mass, the author discusses the effect of cytokines on bone metabolism, the measurement of BMD, biochemical markers of bone metabolism, the multifactorial pathogenesis of osteopenia in IBD, the differences between CD and UC and how those differences impact the development of osteopenia, osteopenia in children with IBD, and the management of osteopenia in IBD. The author concludes that osteopenia in IBD is multifactorial, with corticosteroid use being the most relevant determinant in UC and inflammatory activity being the most important determinant in CD. The rate of bone loss is variable and quite small in the majority of patients; universal treatment with agents that improve BMD may be unnecessary. All patients should be encouraged to take adequate calcium and vitamin D, exercise regularly, and stop smoking. 6 figures. 5 tables. 99 references.
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Physical Activity, Exercise and Type 2 Diabetes: A Consensus Statement from the American Diabetes Association. Diabetes Care. 29(6): 1433-1438. June 2006.
This consensus statement from the American Diabetes Association summarizes the most clinically relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these advances. Topics include physical activity and the prevention of type 2 diabetes; the effects of structured exercise interventions on glycemic control and body weight in type 2 diabetes; physical activity, aerobic fitness, and risk of cardiovascular and overall mortality; recommended frequency of exercise; exercise for weight loss and weight maintenance; the role of resistance training; flexibility exercises (stretching); evaluation of the diabetic patient before recommending an exercise program; exercise in the presence of nonoptimal glycemic control, including managing hyperglycemia and hypoglycemia; and exercise in the presence of specific long-term complications of diabetes, notably retinopathy, peripheral neuropathy, autonomic neuropathy, and microalbuminuria and nephropathy. A final section offers specific recommendations in the areas of lifestyle measures for the prevention of type 2 diabetes, aerobic exercise, resistance exercise, and prevention of hypoglycemia. 70 references.
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Physical Activity. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 298-319.
A lifestyle the incorporates sufficient physical activity aids in diabetes prevention and is extremely beneficial to general health. This chapter on physical activity is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author reviews current physical fitness terminology, including health-related physical fitness; the role of physical activity in diabetes prevention and treatment; the effect of physical activity on diabetes management, including cardiovascular exercise, resistance exercises, and flexibility exercises; the physiological responses to physical activity, notably changes associated with blood glucose levels; hypoglycemia and physical activity; self-management strategies for safe physical activity, including adding carbohydrates, medication adjustments, and problem-solving; the four components of the exercise prescription, including intensity, mode, frequency, and duration; physical activity in special populations, including children and teens, and elderly adults; and medical considerations, including the need for preactivity medical exam and assessment, cardiovascular disease, neuropathy, nephropathy, and retinopathy. The author stresses that learning to overcome barriers that interfere with a more physically active lifestyle is a large part of diabetes self-management education. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 13 tables. 45 references.
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Physical Activity: Important for Fall Prevention. Quality Care. 24(3): 4, 9. 2006.
Many older adults fall each year and fall-related injuries may result in disability. This article, from a newsletter of the National Association for Continence, explains the role of physical activity in preventing falls. The author outlines the environmental hazards that can contribute to falls, as well as risk factors such as poor muscle strength, arthritis, poor vision, stroke, decreased judgment, taking more than four medications, and a fear of falling. The author also considers the interrelationship between urge incontinence and falls; individuals may be rushing to the bathroom and may not take precautions to get there safely. Physical activities can help prevent some falls and should include a stretching component for flexibility. Even low-intensity exercise improves balance and muscle strength. The article concludes by reiterating that staying active and healthy is the best way to improve continence outcomes, reduce falls, and maintain a good quality of life.
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Why Exercise Can Make a Difference. Nephrology News & Issues. 20(9): 50-52. August 2006.
Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article reminds readers of the benefits that can be attained from an intradialytic exercise program. The author notes that the recently published Kidney Disease Outcome Quality Initiative clinical practice guidelines on management of cardiovascular disease mandate that all dialysis patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their levels of physical activity. This article also serves as an introduction to another article in this same journal that describes an ongoing dialysis exercise program at the University of Virginia. The author calls for more research to demonstrate exactly how to assess functioning and encourage physical activity within the routine care of end-stage renal disease (ESRD) patients. 1 figure. 8 references.
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Adventure Travel and Type 1 Diabetes: The Complicating Effects of High Altitude. Diabetes Care. 28(10): 2563-2572. October 2005.
In keeping with recommendations to stay physically fit, increasing numbers of people with type 1 diabetes now participate in extreme forms of physical activity, including high-altitude trekking and mountain climbing. However, exercise at altitude imposes a number of unique challenges for people with type 1 diabetes, including impairment in glycemic control and additional problems for patients with complications. This article reviews what is known about the impact of altitude on individuals with type 1 diabetes, then offers strategies for dealing with these challenges. High altitude is defined as 3,000 to 5,000 meters (10,000 to 16,000 feet) and extreme altitude as that greater than 5,000 meters. The author reviews three studies in this area, then discusses acute altitude sickness (also called acute mountain sickness or AMS), the effects of altitude on glycemic control and on glucose meter performance, altitude-induced anorexia, altitude and temperature, and other concerns including the impact of long-distance travel, poor hygiene, gastrointestinal disturbances, food supplies, and isolation. The author concludes that there are no absolute contraindications to travel at high or extreme altitudes for the knowledgeable individual with type 1 diabetes who is free of complications. However, there is some risk, including the possible consequences of hypoglycemia, illness, or injury. Specific recommendations for individuals with type 1 diabetes traveling at altitude are summarized in a table. 1 figure. 3 tables. 78 references.
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Diabetes Educators and the Exercise Prescription. Diabetes Spectrum. 18(2): 108-113. Spring 2005.
Physical activity and the exercise prescription is an integral component of the diabetes self-management training (DSMT) plan for any patient with diabetes or anyone at risk for developing type 2 diabetes. This article provides guidance for diabetes educators (regardless of health care background) by defining the assessment process and the information required to develop the exercise prescription. Topics include managing diabetes complications such as retinopathy and nephropathy, orthopedic problems, cardiovascular considerations, problems with motivation and psychosocial factors, areas of responsibility for diabetes educators, and the role of physical therapists. The author cautions that the potential risks of beginning an exercise program often have to be balanced with the presence of other diseases, diabetes complications, and medication regimens. The author also examines the contributions of clinical exercise professionals to the diabetes team, specifically within the scope of practice for reimbursement potential. Professional resources are discussed and recommended. The author concludes that diabetes educators from a variety of health care professions are responsible for the successful inclusion of this component into lifestyle behaviors; the multidisciplinary team approach is the preferred delivery system for DSMT. 24 references.
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Finding Your Way to a Healthier You: Based on the Dietary Guidelines for Americans. Department of Health and Human Services. 2005. 12 p.
This brochure, based on the 'Dietary Guidelines for Americans 2005,' offers basic advice on how good dietary habits can promote health and reduce risk for major chronic diseases, such as heart disease, diabetes, osteoporosis, and certain cancers. The brochure has three sections: how to make smart choices from every food group; how to balance food and physical activity; and how to get the most nutrition out of the calories ingested. Specific topics include making good decisions at restaurants, incorporating fruits and vegetables into a daily meal plan, the role of exercise and daily activity, the different types of fats, the role of sodium and potassium, the information on the nutrition facts label and how to use it, safe food handling and storage, and the use of alcohol. The brochure is illustrated with simple line graphics.
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Fishes, Whales, and Fishing Tips: Hooking an Active Lifestyle. Diabetes Spectrum. 18(2): 114-118. Spring 2005.
Given that a physically active lifestyle is important to health and quality of life, health care professionals are faced with the challenge of guiding individuals as they attempt to increase their level of physical activity. This article shares the suggestions of several lifestyle interventionists (many of whom were part of the Diabetes Prevention Program) gleaned from their experiences with participants and patients whom they have encountered through the years. The authors first review the benefits of an active lifestyle for people with diabetes, then discuss the problem of many people who continue to choose a sedentary lifestyle. Other topics covered include public health recommendations, the Diabetes Prevention Program (DPP) and its findings, the importance of maintaining any exercise or activity program, the fun of exercising with friends, creative ways to incorporate exercise and activity into everyday life, and how to handle and overcome barriers to exercise. 13 references.
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Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial. Annals of Internal Medicine. 142(5): 313-322. March 2005.
Weight loss and increase physical exercise reduce the risk for diabetes in people with impaired glucose tolerance (IGT), however evidence on the effects of these interventions on people without IGT is lacking. This article reports on a study undertaken to examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without IGT and in a post hoc subgroup analysis by baseline cigarette smoking status. The study included 12,866 men aged 35 to 57 years, at risk for cardiovascular disease, who were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years. This article reports on 11,827 men from this group who were without diabetes or IGT at entry and for whom follow-up glucose measurements were available. Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group. Results showed that 11.5 percent of the special intervention group and 10.8 percent of the usual care group developed diabetes over 6 years of follow-up. The authors conclude that weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers. 1 figure. 5 tables. 52 references.
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Keeping Off Lost Weight. Diabetes Forecast. 58(2): 58-61. February 2005.
This article considers the difficulties of losing weight and keeping it off, and investigates some of the strategies that successful weight loss requires. The author shares some information from the National Weight Control Registry (NWCR) which includes people who have lost at least 30 pounds and kept it off for at least one year. Every year, the researchers at the NWCR ask the registrants questions about their weight, eating habits, and physical activity. The people who are most successful in maintaining weight loss have four factors in common: eat a reduced-calorie, low-fat, moderately high-carbohydrate diet, try to eat breakfast every day, check weight regularly, and exercise regularly. The author concludes by encouraging readers to continue with needed efforts to lose weight and to maintain weight loss. Changing eating habits and increasing physical activity can help people lose weight and keep it off. 3 figures.
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Management of Competitive Athletes with Diabetes. Diabetes Spectrum. 18(2): 102-107. Spring 2005.
This article describes an effective management plan for an athlete with type 1 diabetes. Such a plan must consider the energy demands of intense competition and training, the athlete's goals, factors related to competitive sports that may affect glucose homeostasis, and strategies that may be employed to allow safe, effective sports participation. One section addresses how to minimize risky behaviors, including omission of insulin for weight loss. The authors focus on nutrition, diet therapy and energy needs. They caution that the most common acute risks for competitive athletes with diabetes are exercise-induced hypoglycemia and deterioration of hyperglycemia and ketosis brought on by physical activity during periods of hypoinsulinemia. The authors conclude that athletes should be appropriately screened, counseled to avoid risky behaviors, and provided with specific recommendations for glucose monitoring and insulin and diet adjustments so that they may anticipate and compensate for glucose responses during sports competition. 1 figure. 38 references.
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Patient Information: Planning for Physical Activity. Clinical Diabetes. 23(4): 160 p. Fall 2005.
Despite the many demonstrated benefits of exercise for diabetes control, many patients with diabetes do not include regular exercise as an integral part of their diabetes management plan. This patient education fact sheet outlines ways to incorporate physical activity and exercise into daily life activities. The fact sheet first lists the benefits associated with regular exercise, including improved blood glucose control, reduced need for insulin and pills for diabetes management, improved body weight management, improved cholesterol, lowered blood pressure, maintenance of bone health, reduction of heart disease risks, and relief of depression and anxiety. The fact guided readers through an assessment of their typical day, physical activities that they enjoy, physical activities they are interested in trying, and any potential obstacles to exercising. Readers are encouraged to then discuss the answers with their health care provider and find physical activities they will enjoy.
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Physical Activity: The Magic of Movement. Diabetes Self-Management. 22(1): 7-12. January-February 2005.
This article explores the benefits of physical activity for people with diabetes. These benefits can include lower blood glucose readings, reduced stress, and decreased body fat. The authors explain how exercise can lower blood glucose by both burning glucose and by improving the body's ability to use insulin. This improvement in insulin sensitivity may even allow some people with Type 2 diabetes to reduce or discontinue blood-glucose-lowering medications. The cardiovascular benefits are also particularly important in a patient population at high risk for cardiovascular complications. Other topics covered include steps to take before undergoing an exercise program, how diabetes complications can affect one's choice of physical activities, the significant health benefits that can be obtained by a moderate amount of physical activity, the importance of warm-up and cool-down periods, foot care, use of medical identification tags, the need to have a carbohydrate source available during and after exercise, and hypoglycemia concerns. The authors conclude by recommending that patients make a commitment to physical activity and work with their doctor to plan a individualized exercise prescription.
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Postpartum Physical Activity and Related Psychosocial Factors Among Women with Recent Gestational Diabetes Mellitus. Diabetes Care. 28(11): 2650-2654. November 2005.
This article reports on a study undertaken to examine patterns of postpartum physical activity among women with recent gestational diabetes mellitus (GDM). The authors focused on psychosocial factors related to this physical activity that could be addressed in diabetes prevention interventions. The telephone survey included on a random sample of women who had attended diabetes clinics in Sydney, Australia, for treatment of GDM in the past 6 to 24 months. Of the 226 women (mean age 33.4 years) who completed the survey, 26.5 percent were classified as sedentary and only 33.6 percent reported sufficient physical activity as recommended by health authorities. Walking was the most popular physical activity and most women reported no other moderate- or vigorous-intensity activity. The most common barriers to physical activity noted were lack of assistance with child care (49.1 percent) and insufficient time (37.6 percent). The type of social support for physical activity most often reported was verbal encouragement (39.1 percent), with more than half of the women reporting they never receive assistance with housework or have others exercise with them. The authors conclude that the prevalence of sufficient physical activity was found to be low and strongly related to social support and self-efficacy. They suggest that emphasis should be given in patient educational interventions to the legitimacy of women taking time away from their day-to-day responsibilities to participate in physical activity. 3 tables. 32 references.
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Racial/Ethnic Differences in Leisure-Time Physical Activity Levels Among Individuals With Diabetes. Diabetes Care. 27(10): 2493-2494. October 2004.
Diabetes affects 18.2 million people or 6.3% of the U.S. population and is associated with significant morbidity, mortality, and health care costs. Regular physical activity is beneficial for the prevention and management of diabetes and established benefits include improvement in blood glucose control, reduction of cardiovascular risk factors, weight loss, and improvement in well-being. This article reports on a study undertaken to determine racial and ethnic variations in 23 leisure-time physical activities (LTPAs) among adults with diabetes and to assess the independent effects of activity limitations and comorbidity on racial and ethnic differences in this population. The LTPAs included walking, gardening or yard work, stretching exercise, weight lifting, jogging or running, aerobics, riding a bicycle, stair climbing, swimming, playing tennis, playing golf, bowling, playing baseball or softball, playing basketball, skiing, playing volleyball, playing soccer, and playing football. The study included 1,850 adults with diabetes who were interviewed in 1998. Overall, only 25 percent engaged in moderate or vigorous LTPA daily. This varied from 16 percent in blacks to 23 percent in Hispanics to 27 percent in whites. The major findings of this study are that levels of leisure-time physical activity are generally low across all racial/ethnic groups with diabetes, that blacks are less physically active than whites, and low levels of physical activity in black women account for essentially all of the observed racial differences between whites and blacks. 1 table. 11 references.
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Say Yes to Physical Activity. Diabetes Wellness News. 11(6): 4. June 2005.
This brief article lists the ten most common excuses for not being physically active and offers ways to address each of the barriers to exercise. The excuses are: not enough time; exercise hurts; exercise is boring; too tired to exercise; exercise is not safe; exercise may cause injury; too old to exercise; there is no benefit to exercise; walking causes shortness of breath or is uncomfortable; and joining a gym is too expensive. Readers are encouraged to incorporate physical activity into their everyday lives and to begin with small goals and changes. Any form of physical activity offers health benefits. 3 figures.
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Sneaking in Fitness: Put the 'Active' Into Your Family's Everyday Activities. Diabetes Forecast. 58(3): 54-58. March 2005.
This article helps readers increase their family's activities level through every day habits and practices. The author stresses that even modest amounts of physical activity can improve everyone's health. A combination of structured and daily activities that add up to at least 30 minutes of physical activity a day is recommended. Overall fitness includes strengthening exercises and flexibility, as well as cardiovascular exercise. Specific suggestions for family-friendly activities are provided. One section offers five healthy nutrition tips that can tailor into a busy family's quest for health. A final section addresses the problem of sedentary screen-based activities, such as watching television, surfing the net, or playing video games. 3 figures.
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Socioeconomic Correlates of Global Complication Prevalence in Type 1 Diabetes (T1D): A Multinational Comparison. Diabetes Research and Clinical Practice. 70(2): 143-150. November 2005.
This article reports on a study that investigated the extent to which the geographic variation in the complications of type 1 diabetes (T1D) may reflect the socioeconomic status (SES) conditions and health care performance (HCP) of countries around the world. The World Health Organization (WHO) DiaMond complications study (DiaComp) is a multinational, cross-sectional study of complications in T1D. Information on complications was identified for 892 subjects from 14 clinical centers in 12 countries. All participants were diagnosed with diabetes in childhood (less than 15 years of age) and had disease duration of 5 to 24 years. Complications data were linked to center-specific information on the local social and economic landscape, health care access and diabetes management practices and health care costs. Country-specific indicators of social and economic development were also linked to the complications data. Results show that both diabetes complications and economic and health care factors vary widely across the DiaComp centers. Health system performance, as measured by disability adjusted life expectancy (DALE), gross national investment (GNI) per capita and purchasing power all showed strong consistent correlations with complications, and significant independent associations with complication prevalence after controlling for HbA1c and hypertension. The authors hypothesize that economic factors might be directly associated with complication prevalence given that the cost of treating diabetes is quite high. Higher treatment costs might preclude developing economies from having the ability to provide recommended levels of diabetes care. Physical activity may also be influenced by economics, with access to exercise and recreational facilities largely determined by the availability of individual and community resources. The authors conclude that health system performance, social distribution of wealth, and purchasing power may play important roles in explaining the geographic variation of diabetes complications. 1 appendix. 4 tables. 12 references.
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Walk, Cycle and Enjoy the Outdoors This Fall. Diabetes Vital. 1(3): 14. Fall 2005.
This brief article encourages readers to use the Fall weather as an impetus to get outside and exercise. Walking and cycling are both enjoyable in the Fall and provide benefits for patients with diabetes. These exercises can help readers lose weight, lower their blood glucose, respond better to insulin, reduce cholesterol levels and blood pressure, improve circulation, reduce stress, and lower their risks for heart disease. The author provides specific suggestions for strategies to safely incorporate walking and cycling into any regular program of exercise and physical activity.
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All About Physical Activity for People with Diabetes. Alexandria, VA: American Diabetes Association. 2004. 2 p.
Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on physical activity for people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet first reviews the importance of physical activity for people with diabetes, then suggests ways to begin incorporating physical activity into one's regular habits. The fact sheet defines a comprehensive physical activity routine as including four kinds of activities: being active throughout the day, aerobic exercise, strength training, and flexibility exercises (such as stretching). The fact sheet then offers practical suggestions in each of these four areas. Blank space is available for readers to record their plan for each area. 1 figure.
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Benefits and Risks of Exercise: From Heart-Healthy to Heartburn. Digestive Health and Nutrition. p. 12-14. March/April 2004.
The overall benefits of exercise are outstanding, however physical activity may be responsible for flare-ups of some gastrointestinal diseases. This article explores the benefits and risks of exercise, focusing on gastroesophageal reflux disease (GERD), gastrointestinal bleeding, ulcers, inflammatory bowel disease (IBD), and colorectal cancer. For each condition, the author outlines symptoms to watch for, strategies to prevent complications, and risk factors. The author encourages readers to incorporate physical activity into their everyday lifestyle, perhaps with preventive medicine or less vigorous workouts, if necessary. 1 figure. 3 references.
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Diabetes and Cardiovascular Disease Toolkit. Alexandria, VA: American Diabetes Association. 2004. (Instructional Packet).
Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. Physicians are encouraged to talk with diabetes patients about their increased risk for heart disease and stroke. This CD-ROM offers a set of 26 reproducible patient education handouts on topics related to diabetes CVD. Topics include pre-diabetes, getting the best care for diabetes, taking care of type 2 diabetes, blood glucose levels in people with type 2 diabetes, insulin resistance, making wise food choices, choosing dietary fats wisely, cooking with heart healthy foods, how to read food labels, carbohydrate counting, weight loss, physical activity, how to begin a program of exercise, behavior change, recognizing and handling depression, treating high blood pressure (hypertension), treating high cholesterol (hypercholesterolemia), the signs of a heart attack, prevention strategies, taking aspirin, stroke, peripheral arterial disease, medical tests and procedures for finding and treating heart and blood vessel disease, managing medicines, and recordkeeping strategies. The CD-ROM requires Acrobat Reader to view each document.
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Getting Started with Physical Activity. Alexandria, VA: American Diabetes Association. 2004. 2 p.
Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on getting started with physical activity for people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet first reviews the importance of physical activity for people with diabetes, then suggests ways to begin incorporating physical activity into one's regular habits. The fact sheet recommends a visit to the health care provider before starting a program of physical activity. The fact sheet defines a comprehensive physical activity routine as including four kinds of activities: being active throughout the day, aerobic exercise, strength training, and flexibility exercises (such as stretching). Additional sections discuss how activity affects blood glucose levels, the symptoms of low blood glucose (hypoglycemia), planning for exercise, and the importance of medical identification tags. A checklist of suggestions for getting started with physical activity is also provided. 2 figures.
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It's Not Too Late to Prevent Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2004. 4 p.
This brochure, from the National Diabetes Education Program (NDEP), is part of a program urging adults age 60 and over who are at risk for type 2 diabetes to increase their physical activity to prevent the disease. The brochure offers three easy steps for readers to follow, incorporating strategies for warming up, walking, stretching, adding exercise to every day activities, and dancing. One of the steps focuses on the importance of making healthy food choices and cutting down on the amount of food eaten to help manage body weight and prevent type 2 diabetes. A final section of the brochure encourages readers to work closely with their health care providers, to make small changes in their lifestyle, and to persist because even small changes can make a big change in health and diabetes prevention. The brochure is illustrated with full-color photographs of seniors engaged in a wide variety of activities. The contact information for two resources is also provided: the NDEP (800-438-5383) and the Weight Control Information Network (WIN; 877-946-4627 or www.niddk.nih.gov).
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Nutrition and Physical Activity in Diabetes. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 49-69.
Medical nutrition therapy (MNT) and physical activity have been considered the cornerstones of metabolic control in both type 1 and type 2 diabetes for decades. More recently, these lifestyle components have proven valuable in preventing type 2 diabetes. This chapter on nutrition and physical activity in diabetes mellitus is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. The author notes that the challenge for health professionals in implementing MNT and exercise guidelines is recognizing that the person with diabetes is responsible for 99 percent of the day-to-day management of diabetes, and ultimately makes the choice of what, when, and how much to eat and exercise. Helping patients prioritize strategies and develop critical thinking to problem solve around day-to-day hassles of diabetes is crucial to achieving metabolic control. Topics include healthy eating, glycemic control, body weight, minimizing weight gain, calorie restriction and weight, nutrient composition and weight, exercise and weight, carbohydrates, quantity of carbohydrate, type of carbohydrate and glycemic index, carbohydrate counting, physical activity and glycemic control, protein and renal (kidney) function, fat and cardiovascular risk, and alcohol. 1 figure. 3 tables. 106 references.
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Physical Activity-Exercise and Type 2 Diabetes. Diabetes Care. 27(10): 2518-2539. October 2004.
Exercise has been a cornerstone of diabetes management, along with diet and medication. This review article examines areas of major advances that have occurred since the last American Diabetes Association technical review of exercise and Type 2 diabetes in 1990. Advances in basic science have increased the understanding of the effects of exercise on glucoregulation. Large clinical trials demonstrating that lifestyle interventions (diet and exercise) reduce incidence of Type 2 diabetes in people with impaired glucose tolerance (IGT). Studies of structured exercise interventions in Type 2 diabetes have shown the effectiveness of exercise in reducing HbA1c (glycosylated hemoglobin, a measure of blood glucose over time), independent of body weight and the association between exercise training intensity and change in HbA1c. Large cohort studies have shown that low aerobic fitness and low physical activity level predict increased risk of overall and cardiovascular disease (CVD) mortality in people with diabetes. Clinical trials have shown the effectiveness and safety of resistance training (such as weight lifting) for improving glycemic control in Type 2 diabetes. 2 figures. 2 tables. 190 references.
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