Type 2 diabetes is a lifestyle disease that has become more prevalent in the recent years. According to the Australian Bureau of Statistics and Diabetes Australia, around 1.7 million Australians have diabetes (either type 1 or 2), with 280 Australians developing it every day. It is also costing the Australian Health System an estimated $14.6 billion! I would go as far as to call this an epidemic of the 21st century! Unfortunately, there is no known “cure” for diabetes (however, there are reported cases of people going from Type 2 Diabetes to insulin resistance), and such requires long term management of one’s lifestyle.
What is Diabetes?
Diabetes is when the pancreas does not respond to the hormone known as insulin, which then inhibits the body’s ability to utilise sugar (glucose) into the cells to be use as energy. This causes a rise in the amount of glucose in the bloodstream (blood glucose levels). This can either be from a lack of production of insulin or an increased resistance from the body’s cells . Diabetes is divided into three categories (or types):
• Type 1 Diabetes: This is an autoimmune disease where the body’s own immune system destroys the insulin-producing cells in the pancreas. • Type 2 Diabetes: This is considered a ‘lifestyle’ disease and is characterised by a reduced production of insulin from the pancreas and an inability of the body’s cells to respond fully to the insulin. • Gestational Diabetes: Occurs during pregnancy, where the body cannot keep up with the extra demand for insulin production resulting in high blood glucose levels
How can exercise help?
A structured exercise program, consisting of both resistance and aerobic training, aids greatly in the management of diabetes, especially for type 2 diabetes. As we exercise, the body uses stored energy, as our energy depletes, it must be replenished (this is done via glycolysis). This response promotes the body’s cells to respond to insulin, which then allows the glucose to enter the cells, which then in turn, lowers blood glucose levels. This makes exercise an effective way of managing blood glucose levels, while both aerobic and resistance training will help manage blood glucose levels, the added benefit of resistance training is as the muscles grow and get stronger, there is a greater amount of glucose utilised by the muscle cells for energy.
Along with a structured diet from a dietitian, this is the ideal way to manage diabetes in the long term. As always, talk to your Doctor or Diabetes Educator before commencing an exercise program (there are programs for exercise and diabetes claimable under Medicare) and make sure you are properly assessed by and Exercise Physiologist or Physiotherapist to get the best exercise program for you!
Article by Nick Adkins Accredited Exercise Physiologist at MD Health Pilates
References Australian Bureau of Statistics. (2013). Australian Health Survey: Users’ Guide, 2011-13. Retrieved September 19, 2015, from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/E79DB0C3CA8FBA6FCA257B8D00229E8D?opendocument McGinley, S.K., Armstrong, M.J., Boulé, N.G., & Sigal, R.J. (2015). Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials. Acta Diabetologica, 52(2), pp 221-230. Yang, Z., Scott, C.A., Mao, C., Tang, J., & Farmer, A.J. (2014). Resistance Exercise Versus Aerobic Exercise for Type 2 Diabetes: A Systematic Review and Meta-Analysis. Sports Medicine, 4(4), pp 487-499.
“Accredited exercise physiologists (AEPs) hold a four-year university degree and are allied health professionals who specialise in the delivery of exercise for the prevention and management of chronic diseases and injuries.”
Exercise and Sports Science Australia (ESSA) has the above definition on their website www.essa.org.au. It is an adequate definition however it really doesn’t explain why the need for such confusing terminology. To be an Exercise Physiologist (EP) who can practice within Australia I must be accredited through ESSA otherwise I would not be eligible to register for a Medicare provider number. So that explains the “Accredited” part but what about the word “Exercise”. Well this just means that our primary method of rehabilitation will be exercise based unless we have further training in any specific areas. The final word “Physiologist” is essentially a term that means a person who studies physiology, specifically human in this case. As an AEP I essentially use the science of exercise and human physiology in order to help people with disease or injury.
What does this mean in terms of Pilates at MD Health I hear you ask? It essentially means that our EP’s and Physio’s are more highly trained than Pilates Instructors and Personal Trainers. It means that all our staff are Allied Health Professionals and their services may be claimable with your private health fund or Medicare. It also means that we are accountable, to you, but also to our employer and to our governing bodies. Standards and scopes of practice exist that we have to know and be on top of and it is much harder to become an AEP than many people would understand. All AEP’s have completed 500 hours minimum of clinical experience working directly with clients like you and all done before they got their first job.
On top of this the MD Health AEP’s have also completed the MD Health technical training program to ensure the highest possible quality of service before they ever set eyes on a client.
What you can be assured of by knowing that you are working with one of our AEP’s:
• We use evidence based treatment • We work closely with any other medical or allied health professionals you may be seeing • We are focused on long term improvement not just short term pain relief • We are required to stay up to date with current research • We are probably more excited about the exercises you are doing than you are • We understand what the exercises we are giving feel like (even if sometimes we can’t do them as well as you) • We can work you hard as well as make sure you are doing the exercises correctly
Finally, I will just say that the easiest thing you can be told if you are in pain is what not to do. Any doctor, trainer, friend or acquaintance can tell you if you have a sore knee “don’t bend it” “don’t stand on it” etc. and short term that may be part of your treatment. It just takes a much higher level of knowledge to be able to tell you which exercise you actually can do, not just to get a workout but also to manage injury and disease. This is what an Accredited Exercise Physiologist at MD Health can do by carefully selecting the right exercises based on your full body assessment and any relevant medical history.
Kyle Richardson Accredited Exercise Physiologist at MD Health Pilates
The Importance of Joint Mobility to Accompany Your Strength Training Program
by Beth Chiuchiarelli Accredited Exercise Physiologist at MD Health Pilates
To get the most out of your strength training or rehabilitation programs we not only need to strengthen the muscles that move and support the joint but we also need to maintain normal range of motion of your joints.
Joints have cartilage that provide articular surfaces for shock absorption so that bones are protected when there is a load placed on them. They have ligaments that provide passive support as well as a dense fibrous capsule made out of many collagen fibers that encase the joint and not only provides static support but also provide a type of torque (wind up action) of the joint to help provide a transfer of load to muscles during movement.
Our joints are made to move over a millions of times in a lifetime and so if there is anything in a joint that is compromised and you feel pain or there is swelling. The damage has probably already occurred. Mobility of a joint is important to allow better efficiency of these joints so that their movements are not compromised and joints need to be strong so that they move better and in the right position. They need to be mobile enough to allow the muscles to do their job properly. If a joint is stiff there is less ability for the muscle to move the joint through its normal range of motion. The better the joint moves the better the effect the muscles will have.
Unfortunately, when there is muscular weakness around a joint or you have an injury muscles become rigid and have poor contractile ability and the capsule can become thickened reducing its ability to provide the necessary movement the joint needs. This can cause the joint capsule as well as fascia and muscles to become stiff, this can reduce your ability to improve your strength and so you may notice that we usually prescribe some sort of treatment such as myofascial release in your sessions. What we also like to do is teach you how this can be done on your own.
There are many pieces of equipment in the market today to help you complete self guided myofascial release to improve your joint mobility. We recommend foam rollers, spikey balls, even a rubber bouncy ball is fine. Currently we have been trialling the way we can use the heavy power bands to help with improved joint range of motion as well as the Lacrosse ball – which is the size of a tennis ball however made out of rubber.
Once we have assessed your joints range of motion as well as its strengths/weaknesses we can prescribe a very specific exercise and mobility program for you. For more information contact us on 9857 0644 or email us at email@example.com
Nick Adkins, one of our Exercise Physiologists, recently attended a course on running technique and the importance of bio mechanics to improve running gait. Many people want to run and so they give running a go, however they usually will not have had proper training or technique focus and therefore injury usually occurs. The way in which we run is very important and this is dependent on a number of different factors for example strength, mobility, cardiovascular fitness and technique.
Overall, if you improve your bodies efficiency in running you will be able to run further and faster!
So how should we be running? E.g. forefoot vs. heel strike
Interestingly, the hype over barefoot running has caused much controversy over the last few years and according to Dr. Christian Barton the optimal foot strike is actually highly dependent on the patient’s injuries and current abilities. Forefoot running is technically more ideal (if done correctly) because there is less load through the joints due to better weight distribution when landing compared to heel striking. However, many people trial running in a way that their bodies are unable to cope with such as barefoot running which predominately will force you to run on your toes. This ‘fad’ is great if you have the right bio mechanics for barefoot running and have good strength, mobility and technique. If you don’t you will pull up sore or provoke an injury.
When teaching people to run it is best to assess their overall strength and current running gait and then put together an integrated exercise program that not only includes strength training but specifically breaks down the running technique and educates them for a long term change.
Overall there is no ‘one size fits all’ for running technique it’s actually best to prescribe a program that suits the particular person. For example forefoot strike is much better for knee pathologies as there is less load distributed through the knee but more work through the ankle, however heel strike is better for patients with Achilles pain or plantar fasciitis yet is harder on the knees. If you think about it no one is there to show us how to walk and run properly as toddlers and so we have all developed different ways in which we move. This is why an individual, structured program that includes strengthening as well as education on how our joints should specifically move is the best way to transition to running or improve current running. Even minor changes to technique can have a drastic effect on performance and injury prevention.
We will be going over some practical applications next week. If you have an interest in running we may be assessing your running gait during your sessions over the next few weeks!
Article by Beth Chiuchiarelli, Exercise Physiologist at MD Health
Work Out Tip – How Many Sets/Reps Should I Complete
The number of sets and reps that you do for each exercise is highly dependent on what you are wanting to achieve out of your training program.
Someone who plays a high intensity, power based team sport such as netball or basketball would ideally want to increase their strength and then progress to improve their power and speed. However, perhaps you enjoy hiking or running marathons where endurance based program is more suited to allow you to continue at a constant speed for longer.
Here is a description of each fitness goal to allow you to select the correct sets and reps for your gym program:
• Endurance- Ability to maintain a certain activity at a constant speed for longer • Hypertrophy – Increasing the size of a muscle • Strength – Ability to move a certain amount of weight • Power – Ability to more a certain amount of weight quickly
The following table demonstrates the required number of sets and reps needed to focus on each specific goal:
Fitness goal Sets Repetitions Rest between sets Endurance 3 15-20 30 sec Hypertrophy 3-4 8-12 1 min Strength 4-5 6-8 2 min Power/Speed 5-6 6-8 2-4 minutes
Make sure you read our previous article ‘What weight should I choose’ http://www.mdhealth.com.au/weight-using/ and you will be able to apply this general rule of weight selection:
“If the last 2 reps of each set are hard to complete without losing technique you have the correct weight however, if it was too easy to complete or you could not complete all of the repetitions your weight is too light or too heavy!”
Written by Beth Chiuchiarelli Exercise Physiologist at MD Health