diabetes mellitus & senaman
TRANSCRIPT
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?
[email protected] +60183232449
Unit Fisioterapi JKNJ