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
Acute injuries, which result from a sudden trauma, such as an awkward fall, collision or twist of the knee joint, and overuse injuries, which result from continuous activity or overload, such as running, jumping and cycling. These types of injuries start gradually and usually relate to a range of factors such as structural or bio mechanical problems, training methods, incorrect footwear, incorrect techniques in the workplace and incorrect exercise style.
The tips below are to help you move well, stay well and assist in reducing the risk and severity of knee injuries in the workplace.
With every step, shock is absorbed by the feet, knees, hips and spine to decrease the force of impact. Wearing the correct footwear will help to reduce these forces further whilst not affecting the normal function of the foot.
Wearing the right footwear for the job protects you from stress-related injury to the ankles, knees, hips and spine.
Avoid activities on slippery or uneven surfaces and in areas with poor lighting.
Remove all potential trip hazards before conducting activity in that area.
Simple exercise such as walking or swimming is the best.
Make sure you warm up before and cool down after exercise with gentle stretches.
Build up your exercise program gradually increasing the frequency, duration and intensity, but don’t work through pain (see your physio if you are experiencing pain).
Maintain good general fitness and lower body strength and flexibility (especially quadriceps muscles).
Practice standing on one leg to improve your balance and leg muscle strength.
Article by the Australian Physiotherapy Association as a part of Tradies National Health Month. For more information visit http://www.tradieshealth.com.au/
Late last year Jacinta attended a course on ‘Greater trochanteric pain syndrome’. This syndrome covers many dysfunctions and injuries around the hip. Greater trochanteric syndrome is caused by irritation of the bursa (fat pad) which is a shock absorber as well as a lubricant for the muscles around the hip that lie adjacent to it. The bursa cannot be irritated on its own, there are many injuries that pre-exist that eventually cause the bursa to become inflamed. Once the bursa is inflamed it can be hard to treat as it can become irritated easily. Exercise can help however it needs to be assessed appropriately and only then can a closely watched exercise program commence.
Completing a hip assessment is not an easy process, if you have had your hip assessed by us you may remember there are many objectives that we need to measure and test before we can derive exactly what is causing your hip pain. This is how we can prescribe the correct type of program. One exercise that Jacinta has introduced to MD Health is a seated hip abduction hold with a belt. This is a great way to strengthen the gluteal muscles without causing irritation to the bursa! Once the pain has relieved we can progress to isometric holds with added resistance. You may have seen some of these exercises around the clinic!
Core Stability – How It Will Be Even Better In The Future
Following Nicholas’ rehabilitation after his disc prolapse, we have been working hard to determine the best way to incorporate some of the additional core stability training, in particular, Multifidus training, as part of everyone’s Pilates program over the next few months. So why is this important?
What Does Multifidus Do?
The Multifidus are a small group of back muscles which make up some of the deepest layers of the back muscles. In particular, they make up the ‘Local Stabilizing system’ of the lumbar spine, which means their major role is to keep one vertebrae (eg the top vertebrae) ‘stable’ over the other vertebrae (eg the bottom vertebrae), so that the power muscles, such as the erector spinae muscles can move the spine safely. In other words, the multifidus control the amount of glide one vertebrae has over the other. If this is ‘uncontrolled’, it puts pressure on the support structures such as the discs and facet joints, causing injury.
How Does Multifidus Differ From The Abdominal (Transversus Abdominus) Muscles In Core Stability?
These muscles work together, but are not the same thing. The Transversus abdominus muscle wraps around the body and attaches onto the spine indirectly through a thick layer of connective tissue called the thoraco-lumbar fascia. The multifidus muscle attaches directly on the lumbar spine and has a more direct action in maintaining core stability. Multifidus also attaches onto the thoraco-lumbar fascia, so the muscles are linked and enhance each other’s actions
How Do We Train Multifidus?
We can now view multifidus directly on ultrasound. Viewing the activation of this muscle will now become a standard part of your re-assessment and we will work on teaching everyone how to contract this muscle during their Pilates sessions over the next couple of months
• Kneel onto your hands and knees • Make a small arch in the lower back • ‘Squeeze’ the muscle of the lower back ‘in towards each other’. You should feel the muscle in the lower back puff up. Hold for 3 second
Don’t worry, we will be practicing these exercises during your Pilates sessions
Written by Nicholas Charalambous Physiotherapist at MD Health