Diabetes Mellitus & Senaman

Diabetes Mellitus & Senaman

Mohamad Affeenddie bin Sulaiman Pegawai Pemulihan Perubatan Fisioterapi

Jabatan Kesihatan Negeri Johor

At the end of this session, you should be able to: ● Understand what happen to patients with DM

● Type of DM ● Prevalence

● Understand if left untreated, what could happen to patients with DM ● A little bit of information on strategies to manage DM

● Medication ● Nutrition ● Exercise and physical activities ● Foot care

● Understand the importance of exercise & physical activity in managing DM ● Exercise Intervention

● how to start ● General Exercise prescription (FITTS) ● Preparation ● when to stop

Introduction DM ialah penyakit dimana paras gula dalam

darah tinggi berpunca dari hormon insulin tiada dalam badan atau tidak cukup ataupun tidak berkesan untuk membawa gula ke dalam sel

Type of DM

Tubuh tidak mampu menghasilkan

insulin untuk badan dan perlukan suntikan.

Type 1 DM Insulin dalam badan yang ada tidak dapat berfungsi membawa

gula ke dalam sel

Type II DM

Prevalence

The low prevalence of exercise practice in this population may be explained by the insufficient awareness about the potential benefits of exercise and the lack of specific knowledge about current recommendations.9–11

However, the vast majority of patients with type 2 diabetes do not engage in regular exercise.5–7 For example, in Portugal, about 60% of these individuals reported not practising any type of exercise.

01

02

463,000,000 9.3% of adults aged 20–79 years (2019)

A further 1.1 million children and adolescents under the age of 20, live with type 1 diabetes. A decade ago, in 2010, the global

projection for diabetes in 2025 was 438 million.

IDF Diabetes Atlas 9th ,2019

Main concern

vast majority of patients with type 2 diabetes do not engage in regular exercise. For example, in Portugal, about 60% of these individuals reported not practising any type of exercise.

(Morrato et al, Herman G. et al)

The low prevalence of exercise practice in this population may be explained by the insufficient awareness about the potential

benefits of exercise and the lack of specific knowledge about current recommendations.

(O’Hagan C et al, Colberg SR et al)

However, it may also be explained by behavioural barriers—a gap between knowledge and action

01 02 03

Prevention

5-17 thn Kumpulan ini perlu melakukan aktiviti fizikal intensiti sederhana

hingga tinggi sekurang-kurangnya 60 minit setiap hari.

18-64 thn Kumpulan ini perlu melakukan aktiviti fizikal intensiti sederhana sekurang-kurangnya 150 minit seminggu atau 75 minit seminggu

bagi aktiviti berintensiti tinggi.

≥65 thn Kumpulan ini perlu melakukan aktiviti fizikal intensiti sederhana sekurang-kurangnya 150 minit seminggu atau 75 minit seminggu

bagi aktiviti berintensiti tinggi.

Complication

Kebutaan Katarak

Kegagalan buah pinggang

01

02

Mata

Kidney

Salur Darah Serangan jantung

Strok

03

Saraf Gangrene

Kebas Kaki Peripheral Neuropathy

Amputation

04

Some Point

Moderately active people, compared with those who are

sedentary, have a 30-40% lower risk of DM

physiopedia.com

Women who reported engaging in vigorous exercise at least once a week had a lower

incidence of self-reported type 2 diabetes during the 8 years of follow-up than did

women who did not exercise weekly

Manson JE et al, 1991

Strategy to manage DM

Insulin

Ubatan

Suku suku separuh

Pemakanan

Pengurusan berat badan Aerobic exercise Strength Training

Senaman & Aktiviti fizikal

Luka Deria sentuh

Penjagaan Kaki

Faedah Senaman

05 02

03

04 01

06

Meningkatkan pengaliran darah

Meningkatkan penyerapan insulin& Menstabilkan

paras gula dalam darah

Mengawal berat badan Mengekalkan deria sentuh

Meningkatkan kepadatan tulang

Meningkatkan fungsi paru-paru & kecergasan jantung

—Ryden L, et al. Colberg SR et. Al. Hansen D et. Al. Hordern MD et. al

“Combined aerobic and resistance exercise within the same exercise session has a more favourable impact on

glycaemic control than aerobic or resistance exercise alone.”

Treatment

Aerobic Exercise Strength Training Diabetes patients should engage in 150 min or more of moderate-to-vigorous intensity aerobic activity per week, spread over at least 3 days/week, with no more than two consecutive days without activity.

undertake resistance training at least 2–3 times/week.

Especially elderly

Get it measured

3 minute step test

Aerobic endurance test Push up test

1 minute squat test Standing long jump test

Strength test HbA1c/FBS

Lipid Profile/HDL/LDL BMI

Fat analysis Waist hip ratio

Body circumference

Other outcome measure

To measure cardiorespiratory fitness

3 Minute Step Test

To measure lower limb strength

1 minute Squat test

Norm for 1 min squat test (Man)

Norm for 1 min squat test (Woman)

Standing long jump Test

To measure explosive power of lower limb strength

Norm UKJK for long jump test

Kump Umur

Tahap Lakuan Wanita Lelaki

13- 19 Superior Above average Average/Normal Below average poor

191 181-190 171-180 161-170 160

251 241-250 231-240 221-230 220

20-29 Superior Above average Average/Normal Below average poor

181 171-180 161-170 151-160 150

241 231-240 221-230 211-220 210

30-39 Superior Above average Average/Normal Below average poor

171 161-170 151-160 141-150 140

231 221-230 211-220 201-210 200

40-49 Superior Above average Average/Normal Below average poor

161 151-160 141-150 131-140 130

221- 211-220 201-210 191-200 190

50 and above

Superior Above average Average/Normal Below average poor

151 141-150 131-140 121-130 120

211 201-210 191-200 181-190 180

To measure upper limb and core muscle strength

Push Up Test

Norm UKJK for 1 min push up test

Kump

Umur

Tahap Lakuan Wanita Lelaki

13- 19 Superior Above average Average/Normal Below average poor

30 20-29 10-19 5-9 4

40 30-39 20-29 10-19 9

20-29 Superior Above average Average/Normal Below average poor

26 17-25 8-16 4-7 3

36 26-35 16-25 8-15 7

30-39 Superior Above average Average/Normal Below average poor

21 15-20 6-14 3-5 2

30 20-29 13-19 6-12 5

40-49 Superior Above average Average/Normal Below average poor

17 11-16 5-10 2-4 1

26 16-25 9-15 5-8 4

50 and above

Superior Above average Average/Normal Below average poor

15 10-14 4-9 1-3 1

20 13-19 8-12 4-7 3

We always believe that every patient is unique.

Exercise is best when prescribed individually

Our Recommendation

HIGH LEVEL ( Diabetes Care , volume 29, number 6, June 2006) TEST Type of exs FIT

3 min step test

Good Excellent

Aerobic Running (10 min/mile) cycling fast/ up to hill Jump rope ( 15 min ) Dance fast ( 30 min) Hiking/ football / treadmill

F = 3 - 5 days/weeks I = 70-89% of Hr Max T = 75 min (25 min on 3 days) RPE 14-16

Strength

Push up Sit up Squat Plank Lunges Circuit training Theraband exs

F = 2-3 days/weeks I = 75-80% of 1RM T = 10 – 15 Repetitions (each exercise) = 3 – 4 sets

HIGH LEVEL ( Diabetes Care , volume 29, number 6, June 2006)

MEDIUM LEVEL ( Diabetes Care , volume 29, number 6, June 2006) TEST Type of exercise FIT

3 min step test

Average Above average Below average

Aerobic

Brisk walk Gardening Jogging cycling On treadmill Mop the floor Play with kids Football/badminton Swimming

F = 5 days / weeks I = 55 – 69 % of Hr Max T = 150 min (30 min per days) RPE 12 - 14

Strength Push up Weight lifting Squat Plank Lunges Climbing stair Theraband exs

F = 2-3 days/weeks I = 50% of 1RM T = 8 - 10 Repetitions (each exercise) = 3 – 4 sets

LOW LEVEL ( Diabetes Care , volume 29, number 6, June 2006) TEST Type of exs FIT

3 min step test

Very poor Poor

Aerobic

Walking Running Swimming Cycling Chairobic with resisted

exercise

F = 5 days / weeks ( Alternate with strength) I = < 55% of Hr Max T = 30 min continuously RPE: 12-14 (according to own ability)

Strength

Bend side sh press Arm curl Biceps curl Weight lifting Theraband exs Climbing stair Push up

F = 2-3 days/weeks I = 50% of 1RM T = 5 - 10 Repetitions (each exercise) = 1 – 2 sets

LOW LEVEL ( Diabetes Care , volume 29, number 6, June 2006)

Senario pesakit DM :

1) Jika Kurang 5 tahun ON DM dan CONTROL

2) Pernah bersenam 2-3x seminggu Mon Tue Wed Thur Fri Sat

Aerobic Aerobic

+ strength Aerobic

Aerobic + strength

strength Aerobic

Brisk walk at lunch

Brisk walk +

squat

Brisk walk at

home

Briskwalk +

squat

Plank/ lunges

Walk to grocery store

30min 30min

+ 3-4 sets

30min 30min

+ 3-4 sets

3 – 4 sets 30 min

Senario pesakit DM : 1) Jika Tidak pernah bersenam 2) Kencing manis lebih dari 5 tahun dan uncontrol Mon Tue Wed Thu Fri Sat

Aerobic Strength Aerobic Strength Aerobic

Aerobic

Walk at lunch

Arm curl Walk home

Biceps curl Walk in park

Walk to

Grocery store

30min 1-2 sets 30min 1-2 sets 30min

>30 min

Sebelum Senaman

Demam Periksa tahap gula

Semak status kesihatan

01 Tiada luka

Pemeriksaan kaki

02 Kasut

Pakaian yang selesa

03 Air Kosong 1-2 gelas Standby fast glucose

Hidrasi dan nutrisi

04

Suntikan Insulin

Suntikan insulin adalah 1 jam sebelum senaman untuk mengelakkan hipoglisemia

Suntikan di otot peha dan perut , bukan di lengan

When to stop?

● Sekiranya berlarutan perlu segera dapatkan pemeriksaan daripada doktor

● Sesak Nafas

● Peluh Berlebihan

● Pening

● Kekejangan otot

● Gementar/berdebar didada

● Penglihatan kabur

Borg Scale/RPE

Penutup Senaman

Senaman pernafasan

Regangan otot secara statik

Menyejukkan badan

Conclusions Senaman perlu difahami dan dilakukan

Setiap senaman ada faedah tetapi perlu dilakukan mengikut

keperluan dan kemampuan khas individu

Start slow and then progress

Setiap rawatan perlu ada pengukuran supaya improvement

dapat dipantau

Our Team PKD BP PKD

Kluang PKD JB PKD

Pontian PKD

Segamat

PKD Muar PKD Kulai PKD

Mersing

PKD Kota Tinggi

PKD Tangkak

References ● 1 International Diabetes Federation. IDF diabetes atlas. 6th edn. Brussels International

Diabetes Federation, 2013. ● 2 International Diabetes Federation. Global guideline for type 2 diabetes. Brussels:

International Diabetes Federation, 2012. ● 3 Ryden L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and

cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013;34:3035–87.

● 5 Morrato E, Hill J, Wyatt H, et al. Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care 2007;30:203–9.

● 7 Hermann G, Herbst A, Schutt M, et al. Association of physical activity with glycaemic control and cardiovascular risk profile in 65 666 people with Type 2 diabetes from Germany and Austria. Diabet Med 2014;31:905–12.

References ● 9 O’Hagan C, De Vito G, Boreham CA. Exercise prescription in the treatment of type 2

diabetes mellitus: current practices, existing guidelines and future directions. Sports Med 2013;43:39–49.

● 11 Colberg SR. Physical activity: the forgotten tool for type 2 diabetes management. Front Endocrinol (Lausanne) 2012;3:70.

● 15 Hordern MD, Dunstan DW, Prins JB, et al. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. J Sci Med Sport 2012;15:25–31.

● 16 American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl 1):S14–80.

● 17 Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364–79.

CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics &

images by Freepik and illustrations by Stories

Thanks! Does anyone have any

questions?

Fisioterapikkjohor@gmail.com +60183232449

Unit Fisioterapi JKNJ