Diabetes and Exercise

i think we'll get started i know that some people are still out in the foyer we're doing glucose testing out there and that will slow some people down but we will start now because we have some at-home viewers who are watching us live with our webcasting and we're welcoming them as well as everyone who's here tonight i'm nora kane i'm the director of the stanford health library and i'm happy to have you here this evening for our second great program on managing type 2 diabetes tonight the subject as you can see is diabetes and exercise and we have two speakers which will only enhance the experience for all of us our first speaker is dr baldeep singh he's a clinical professor of medicine at stanford and our second speaker is dr kathleen waczowski and she's a senior physical therapist in the department of orthopedics and rehabilitation at stanford as well so just so everybody understands how we run these programs if you haven't been here before our speakers will do their presentations and then we open it up to questions and answers afterwards so i'm going to just at this point welcome you and also welcome our speakers and let us get going thank you dr singh thank you very much so i'm an internist i'm a practicing physician at stanford so i deal a lot with patients with diabetes and so i thought we'd start because i know that there's varying levels of knowledge and give you a little primer on diabetes and move into some of the issues around exercise so what is diabetes diabetes is a disease where the body cannot make enough insulin and therefore the sugar goes up in the body so currently for those of you who've been to the doctor you'll get a report from your doctor typically i send these out to patients all the time that tell us tell you what your fasting blood sugar is and that's a normal blood sugars between 70 and 110 and so your physicians may give you some advice around that sugar because as the sugar starts to creep up they may tell you that i'm a little concerned your blood sugar is going up and that means that you're creeping towards potentially diabetes as that number rises so typically we like most patients below 100 fasting blood sugar so for those of you who've been to your physicians and see that that number is a nice number below 100. um that's usually makes us happy and brings a big smile to our face when you're between 101 and 125 that's considered borderline diabetes or pre-diabetes which means that your body is not able to regulate the sugar quite as well it's struggling a little bit more and then by definition the definition of diabetes is when the fasting blood structure is consistently above 126. and we'll talk about glycosylated hemoglobin in a minute but typically a glycosylated hemoglobin over seven is considered diabetes six and a half to seven um if you're uh so we try to use the fasting because it's the most consistent blood sugar after eating the blood sugar can vary and that's why the physicians usually don't like or don't rely on the sugars after eating and the glycosylated hemoglobin which i'll show you a picture of in just a moment is a average three month sugar so the problem with sugar is if i check your sugar right now for the next hour it will be vacillating a lot with with many kinds of things with food with exercise which we'll talk a little bit about and so it's very hard to get a good sense of what your real true blood sugar average is uh by just checking blood sugars so we a number of years ago someone discovered this thing called a glycosylated hemoglobin and we'll come back to the slide but essentially a red blood cell here carries a little bit of sugar on it the higher your sugar is in your body the more sugar is on that red blood cell and a blood blood cell is unique in that it lasts in the body three months and then your body sort of chews it up so it's a good reflection of where your sugar has been averaging over a three month period so the reason the physician are we as physicians like to measure it is it's a very good reflection of the average and going back a little bit the number you can see for your average sugar correlates with the a1c quite well and so we use that as a much better gauge of where someone's sugar lies on average than just the numbers that you check in one instance which are less accurate so you can see on the right the more glucose that runs in your body the more that sticks to those red blood cells the higher the glycosylated hemoglobin and so i tell people it looks like kind of a donut with a glazed sugar on it and we use that analogy for for many reasons here the more sugar on the red blood cell the more the higher the glycosylated hemoglobin and the poorer the control of the diabetes so just briefly uh there's a number of types of diabetes we always talk about type one and type two eighty percent of people uh that i said the vast majority of you who are diabetic would be type two diabetes and the pathophysiology of that's differently but but the bottom line is that the um body does not process the insulin as well we call that insulin resistance and it is correlated with weight and with exercise so the reason that you hear that there's an epidemic of diabetes in this country right now is because as your weight goes up your ability to process insulin is impaired we call that insulin resistance and your sugar goes up as you lose the weight your insulin is actually able to be processed better and your sugar comes down so as the population gains in weight we will see more diabetes type one which is the kind that we see in juveniles or kids juvenile that type of diabetes is the kind where your body attacks your pancreas typically and produces no insulin and those patients have no insulin from the very beginning and they require insulin whereas 75 percent of type 2s can get by with pills so only a small percentage of our patients with type 2 diabetes actually require insulin there's a few types of rare diabetes due to medication that i won't go into and then pre-diabetes is that range that i was telling you well you're not fully diabetic and there's not strong evidence that we need to put you on medication but that's the phase that we're really going to push patients hard about changing lifestyle which is the focus of today's talk really getting that diet intervention and that exercise intervention in place because if you change the trajectory of your diet and exercise you can reverse the course of that and your blood sugars will come down and you can get out of pre-diabetes and potentially diabetes so what are the signs of diabetes well typically we hope none of these things ever happen to you we're not trying to make you diabetic or rather we're trying to catch you before you actually get these symptoms right i should say so in the old days when we didn't have good blood sugar blood sugar checks like we do now on this on the blood test and we didn't have a1c testing people would come into our office with these types of symptoms extreme thirst extreme urination blurred vision drowsiness nausea hunger and i also work in one of the free clinics at stanford runs and we'll typically see these patients show up in our underserved population because they don't have access to good health care and they'll preserve present much later in the disease typically when they're overtly diabetic typically their sugars will be to over 200 whereas most of the time when we're watching our patients closely in the clinic we'll pick patients up long before they become get to sugars that high why do we care about blood sugar control well it helps maintain body health and nutrition it lowers your risk of infection poorly controlled diabetics have higher risk of infection it increases your energy level it increases the body patient's the rather the the the body's ability to heal and most importantly and the reason we care about this most in medicine is that uh diabetes leads to four serious complications kidney problems vision problems heart blood pressure problems so it increases your risk of cardiovascular disease heart attack and stroke and nerve disease so um as we as physicians try and and our healthcare teams try to impart on you the approach that we take to diabetes early on we try to get people to we call the abc approach which is um a for attitude that's you wanna have a good attitude towards trying to improve your lifestyle b blood sugar glucose measurement with your physician or at home see controlling the glucose of medications if necessary d diet and uh we could spend a lot of time on diet but suffice it to say there's a lot of we could say about diet and low carbohydrate intake and then e of course is exercise and we'll talk a little bit about exercise today and finally f is fortitudes that is the strength because this is not easy what we are asking you to do as physicians we're really asking you to really change in many cases a lifestyle that you've led for a long time and that and behavioral change is by far the hardest thing we as physicians need to tackle so why is exercise good exercise lowers blood sugars during and after exercise it helps insulin work better it improves blood sugars and fat profiles it supports muscle maintenance and conditioning it improves the sense of well-being and quality of life and decreases fat weight so for for for many of physicians we would say that one of the most important things you can do as you get older in life is to exercise because it really has almost all plus and no minus side so how does exercise help in preventing type 2 diabetes so i tried to sort of just pull a few studies to look at this and so i met analysis of 10 studies looking at physical therapy now this is in pre-diabetics i'm sorry yeah so we're trying to delay diabetes shows that regular exercise can can can decrease the onset of diabetes and in a prospective cohort of study of men either weight training or aerobic exercise for at least 150 minutes per week was associated with a lower risk of developing type 2 diabetes than no physical activity so by doing when you're in that intermediate phases i was telling you that pre-diabetic phase a lot of times we as physicians and our staff will be telling you to start these interventions because you can reverse the course of your um trajectory because if you continue to gain weight and you continue to remain sedentary the sugar will go up and up and up then you'll start on medication and they'll go up and up and up and then you might need something like insulin and then those effects that we mentioned earlier on the eyes and the heart and the kidneys will start to take place and tackling that early will really often prevent diabetes from coming on and so we really try to push people early on in that intermediate phase because that at that point you can really make a difference once you're a full blind diabetic it will typically help as i'll show you in a minute but uh and we can decrease the amount of medication we maybe may not be able to get you off medication so engaging in physical therapy is when you actually have type type dubies type 2 diabetes again we see that there's both a decrease in blood sugar based on a number of studies and your overall a1c that measure that we use actually goes down so we see an improvement in the control and what does that mean for the diabetic it means less medication means potentially delaying insulin it means better control and so people are able to then get by with better control of their diabetes without having to take more medication or potentially insulin what's the best kind of exercise i'm not going to spend too much on this i know my next speaker here is going to kathleen is going to talk a lot about that but in general actually all exercise is good um and the more exercise is probably better and i think one of the keys would be consistency you want to be consistent in your in your regimen particularly if you're on medication we even like it better at the same time of day because you're able to regulate your blood sugar a little bit better if you're taking medication if you try to do the exercise at the same time of day because then you can be a little more consistent in in your eating patterns and your exercise patterns so a reasonable regimen might be 10 minutes and then building up from them until we hit that 100 to 150 minutes that we were talking about earlier as an ideal goal for most patients so one of the things i like to we like to do as physicians is try to make what's called smart goals so i want you to think as kathleen talks a little bit about specific things that you might do specific changes something that's measurable something you can time something that's attainable don't try to shoot for the moon but make an intervention that you actually think you can do tomorrow and stick with that's reasonable and timely so it's much better to make small incremental changes and be consistent with them then make a huge change run a marathon tomorrow and then do nothing for the next rest of the year and i'm going to reserve the questions till after kathleen's comments so we're going to do a quick computer switch here i apologize for the audio visual issues here and then we'll take questions at the end so i'm kathy wasowski and a lot of people hear all the time about exercise and most of the time when people say oh you need to exercise more this is what a lot of folks think or something a little more along those lines how many people here exercise regularly wow very exciting all right how many want to be able to exercise regularly but somehow life just sort of interferes okay a few more honest people and how many people know they should exercise and just really don't want to do it no one who's willing to admit it but if you were to talk to physicians about exercise they would say this would and you're able to put it in pill form this would be the number one prescribed pill simply because it helps your body to run more effectively more efficiently just like getting that car engine turned tuned up one of the interesting things dr singh was talking about a number of different studies if you do seven hours of activity a week you can reduce your risk of dying early by 40 percent those are some pretty good numbers compared to the folks that are just sitting and growing roots onto their sofa so there's a lot of different improvements that you can do in your health you can improve your energy levels there's wonderful research showing that people with all kinds of diagnoses of different chronic diseases do much better activity wise and feel better improve sleep quality obviously muscle strength that's why people go and work out at a gym and with that increased muscular strength it will allow you to do a whole lot more activity helps you recover from injury better helps with relaxation as well as making you feel more energetic wonderful studies showing that exercising on a regular basis can help improve depression almost as much as medication helps improve cognitive function especially if you're older we all want to be more smart upstairs if you have cancer it helps to improve your general fitness level helps to improve energy and helps improve mood and quality of life so those are all some really good things there there's a few more things that it helps to reduce risk of and dr singh spent some time talking about heart disease hypertension and diabetes risk all are dramatically less it definitely helps with insulin resistance so as a diabetic that's what you're more interested in most of us for the aesthetic benefits we're interested in reduced fat as especially in the abdomen but it also will reduce your risk of osteoporosis helps to slow down your weight of bone loss which will help prevent hip fractures and because your muscles are stronger you've got better balance helps to reduce falls helps to reduce chronic pain helps to reduce stress this is the one i'm really interested in is it reduces your risk of alzheimer's by up to 50 percent even if you start exercising in middle age since i'm in my later 50s this is a very important thing it reduces your risk of breast and colon cancer prostate endometrial lung cancer not quite as great research but by 20 to 50 percent cancer recurrence and early death so you're going okay maybe it's not just all about diabetes but how much exercise can i get away with you know what is the minimum i have to do well the cdc says you have to engage in moderate intensity physical activity for 30 minutes five or more days a week okay or you can choose to engage in a more vigorous activity level for just three days a week for 20 minutes well how hard is vigorous how hard is moderate well if you are doing a moderate level of activity you can talk you're a little bit out of breath you should be a little out of breath because you're moving you're actually working it's not like just someone ambling along but you're not able to sing during the activity sounds sort of silly but it's a good way to let you know are you working hard enough vigorous activity you're not going to really be able to do more than just a few words simply because you are working hard these are the folks that are running these are the folks that are playing singles tennis one thing that helps those of us who are not particularly athletically inclined is physical activity and exercise are perceived as the same thing by your body so you can go ahead and you can mop the floor vigorously you can be out there raking the leaves and your body still feels that that counts as exercise so a moderate level of exercise your heart rate should be 50 to 70 percent of your maximum and vigorous is 75 to 85 percent of your maximum now how do you find what your max heart rate is that's 220 minus your age so for a 50 year old person you would be if you're in the 50 to 70 percent you'd be at about 85 to about 119 for your heart rate and in the vigorous activity it'd be 120 up to about 140 five for that another way for those who are not a lot of times people have a hard time finding on your wrist really easy is find your adam's apple everyone can try that and you just slide your fingers backward into the side a bit and usually you can feel your heart rate bumping along and especially when you're doing some types of activity that's a much easier way than trying to find it somewhere on your wrist but the rate of perceived exertion is another way now researchers use a 1 to 10 scale or even a slightly different numbered scale but a lot of times people have a hard time saying well am i a six i'm a seven this is a very cool one one i can exercise all day this is easy two this is a little bit hard i can keep doing this for quite a while three this is moderately hard i'm gonna have to stop eventually but i can i'm feeling out of breath i'm feeling like i'm really doing some good work for very hard i'm not going to be able to keep doing this forever that's for sure five i have to stop right away so that's a really easy way for people to sort of check in on themselves and say well how hard are my exercise if you think okay i'm going to be sweeping the backyard and i'm just sort of moving at a leisurely pace that would be more about it too if i'm moving much more briskly i'm finding i'm getting a little more out of breath that would be moderately too very hard depending on how heavy and wet the leaves are so moderate intensity activities a lot of day to day stuff washing your car vacuuming ballroom dancing general gardening all of these your body thinks count just like going out for the walk going on the bike which is going for the more vigorous intensity things so heavy gardening that's if you're continuously digging one cool thing the cdc has also found is 10 minutes of moderate exercise is exactly perceived the same as doing 30 consecutive minutes so you can do three groups of 10 minute exercise first thing in the morning before you go to work you can go out do your vigorous brisk walk it's cold so you're definitely going to be walking a little faster you can go for a walk during lunch and then you can go ahead and um play a little ball with your kids and you know soccer with your kids in the afternoon after you get home so it's very nice for people that either have issues with pain my knee really won't let me go for that 30 minute walk but you can do three 10-minute walks spread out over the day or issues with endurance or just time a lot of us have very busy lives it's harder to fit in 30 consecutive minutes or we think it's harder but this is certainly a way to get going and still get those same benefits there's four main types of exercise the first one and this is the one that really makes the biggest difference in your health and diabetes in general is aerobic exercise and these are the things that keep your heart rate up for sustained amounts of time and that's the important thing it's sustained time that makes your body instead of just burning sugars only it will start burning fats and that's why most people are really very interested in that for the way it helps us look and that's one of the reasons why this is much better for losing weight strength and resistance training this is going out to the gym lifting weights using elastic bands like i've got some elastic bands over here doing sit-ups doing squats all of those things another nice way to take your aerobic workout you've done 20 minutes on the treadmill you want to get a little bit more activity in you can go ahead and do exercising with weights for an additional 10-15 minutes and as long as you're doing them at a slightly brisker pace you're staying at that yeah i'm breathing a little bit faster okay my heart rate is still staying up in order to keep that going this also helps your body to become more sensitive to insulin it helps to really build much stronger muscle and that's what most of us perceive of as okay i'm going to go and build muscle bulk but the great thing is when you have bigger muscles they help to burn more calories so if you have someone who if you measure their muscle mass in their leg even if you have two people who both weigh 140 pounds one person may have a lot more fat and another person has more lean muscle the person who has more lean muscle will end up burning more calories at rest which again will help with your long-term sugar control flexibility and stretching we all know that if you watch your typical cat or dog after they've been sitting down for a while they get up and they stretch and this is the kind of thing that usually helps us to continue to feel better we don't get so stiff most of us our lifestyle tends to be fairly sedentary we sit a lot so stretching can be very helpful classes like yoga tai chi and pilates involve a lot of stretching one great advantage of going to classes either at a gym or the y or the local community center is it helps you to get into the habit of exercising you join a community you see your friends there which will help you to continue with this whole exercise habit balance is absolutely critical for safety especially if you have peripheral neuropathy as dr singh was mentioning the long-term effects involve sort of marinating your nerves in high levels of sugar over time they you have a hard time feeling your feet you have a hard time with controlling your balance with these muscles in your feet but you can do a lot of very simple things you can do like the drunk test you can walk sideways you can go ahead and just stand on one foot if you have difficulty with your balance you want to make sure that you are standing near something stable as you first begin practicing these things so how do you get started with all of this you've convinced me i gotta gotta get you going you have to ask yourself honestly where are you these days as far as fitness levels none of us is 20 anymore you may have rode crew in college but not recently so i'm mostly sedentary i don't really get a whole lot of exercise except for things like housework and yard work you know when i'm off the floor i get a little bit warm and sweaty but this gives you an idea of where exactly you should start finding an activity you like to do or something that you dislike less than some of the other things and finding a buddy someone that you create a contract with each other okay eight o'clock tuesday morning we're going to be there and that way you both feel sort of a commitment to each other and that will allow you to keep going when you get started exercising you want to make sure that you are not increasing your activity level a whole lot at one time a lot of times people say well gee i went for a 15-minute walk that felt great i'll go for an hour the next time and then as dr singh was mentioning we get the big crash and burn so 10 every few workouts so that you can gradually keep building on it we want you to be successful and to feel like this is something that really works well for you if you're having pain try modifying how long you do it how much resistance you do try changing a little bit what you're doing what time of the day but if you have continued pain do let your doctor know and of course physical therapy can be very helpful to help you modify exactly how you're doing those exercises maybe find something that works better for you or give you customized exercises to help with those particular aches and pains dr singh was talking about the smart goals that's a great way to do it so the more specific you want to be the easier it is to maintain staying on track with those goals so what activity are you going to do and for how long are you going to do it how often and when are you going to do it so if you can plan out for all of these variables it's a lot easier to get rid of some of those excuses that are floating around in the back of your head going oh i'm too tired okay i will walk briskly for 10 minutes during my lunch hour three times a week that sounds like something that's pretty attainable and sustainable you get a walking buddy you might end up going for a half hour during your hour lunch break so is it realistic and again as dr singh mentioned starting small always works a whole lot better starting in failing exercise programs if you go to a gym oh about january 5th gym's packed with people by about march you know it's just no one's going because people go there they work out for an hour everything hurts nah this exercise stuff isn't for me so we are much more interested in starting with a level that you know you can do it may even seem really stupid and easy but i would much rather that people did stuff five minutes a day every day five minutes isn't much but being very consistent and getting into that whole habit of exercising um so that pretty soon your body goes you know this moving around stuff is really feels good all right i've got a really hard time with fatigue you've got other medical issues and this is something that i deal with a lot most of the patients that i see have a lot of chronic pain and a lot of very major medical issues so check with your doctor first make sure that this is really something that he wants you doing like i said playing tennis may not work well for you but i have a gentleman who just had a kidney transplant who was playing doubles tennis up until the week before surgery you know wasn't able to do a lot of running around but found that if he paced himself and went nice and slow made it much easier brief walking in the neighborhood if you're having a lot of pain a lot of fatigue this is what i tell my patients it's called drive your neighbors crazy so you start out in front of your house and you walk two houses down piece of cake come back walk two houses back this way okay i'm getting tired i'm gonna go in now but you've now walked past two and two walking past your house a couple times and then two more you've walked past 10 houses but you've only been two houses away from your home so for people that are afraid of gee my back pain really bothers me what if i get on the other side of the block and i can't get back this is a really nice way to start improving your exercise activity your neighbors really won't think you're that nuts but um if you're just too exhausted exercise i'm a firm believer in the something is better than nothing if you are having a difficult time doing stuff doing exercises in your chair doing exercises in your bed there is a wonderful series of exercises called sit and be fit on pbs programs been going on for over 20 years you can get dvds you can go to kqed or kcsm and they have wonderful stuff for exercises for people who have a harder time doing stuff stronger muscles actually help to improve your fatigue though so if you have a six-year-old kid and you ask them to carry a gallon of milk around the block that's going to be pretty hard for a six-year-old kid okay because the six-year-old kid doesn't have a lot of muscle if you ask his 16 year old big brother to carry the gallon of milk he could probably carry a gallon probably too around the block simply because he has bigger stronger muscles to allow him to do those activities so people that have a hard time getting up off of low toilets and off of low sofas we need to give to help you to grow stronger muscles so that you can do stuff small bites of time and activity great for helping you to get in the habit i happen to have a little pedometer i've walked just since i walked out to my car to come here i've already walked over 950 steps so it adds up fairly quickly on my normal workday because our department is huge on a really slow day where i'm doing a lot of sitting i walk five thousand and on a busy day i walk up to 8 000 and that's just at work so you can do a lot aerobic housework as i mentioned doing the same things you have to do just doing it a little bit faster getting your heart rate going walking a little bit further than needed not parking quite so close parking further on out the elastic resistant bands or standing exercises during a commercial break i had one patient who had severe heart and lung issues that said you're not going to be able to get me to exercise at home i know i just won't we convinced her to take the elastic band and she would microwave her frozen meal at lunch and at dinner and while it was on the microwave she would sit down and she would do things like here you're getting some cardio an arm bike and she could work on these exercises in these very small bites of time and actually she ended up doing a whole lot more than she expected because it was easy to get going bicycle peddlers those also work very nicely because you can put it in front of the sofa do some exercises you don't have to have a big bulky machine so we're going to all do some exercises everyone stand up please you didn't know about that did you so these i call touch and goes what you're going to do is you stand in front of your chair and if you are getting up to go to the bathroom get a drink of water you get up you do that but before you sit down you go and let's have everyone sit down and if you can just touch down and back up or as close as you can get and we'll do that three times and then the last time you can collapse in the chair but by doing that you have given yourself the opportunity to work in dozens of squats during the day just slipping it in another exercise everyone take your left foot and lift your toes up and then straighten your knee out in front of you and let's see if you can hold it for 15 seconds so this is stretching your hamstrings and your calf muscles working on your thigh muscles again those are ones that you need to help you get upstairs and get up off of that low sofa so you hold it on that one side for 15 seconds then go ahead and do the same thing on the other side easy to do while you're watching tv little things to just start getting your body moving a little bit more okay balance exercises standing in front of the kitchen sink on one foot you can do it while you're washing your hands if your balance is pretty good if you are having more difficulty with your balance you do want to have something that you can hang on to if your balance is pretty good you can do all kinds of exercises high stepping side stepping while you're watching tv waiting for the show to come back on you can progress to standing on a folded towel something as simple as this if your balance is already pretty good this gives you a somewhat unstable surface and you can do things like arm exercises standing on the towel to make it a little bit harder okay now the american diabetes association has some very specific guidelines for diabetics and exercises so sustained moderate exercise helps to lower blood sugar levels as we know but when you intensely exercise sometimes paradoxically your sugars go up so when you first start exercising it's really important that you check your sugars both before and after you want to always make sure that you're carrying some type of easily absorbed carbohydrate with you because since you are burning off these sugars we want you to be able to avoid the crashing so as dr singh was also mentioning taking your medications taking your exercise taking your meals at similar times allows you to have less problems with the crashing be careful if you do take insulin exercising right when you're peaking because you're more likely to have a lower sugar having a medical alert bracelet can be very helpful and make sure you hydrate well adjusting your dose of insulin or your medications may be necessary if you find that you still keep having problems but you and your doctor can work on that if your sugar does go down you may find that you and after you take your carbohydrate you should wait at least 15 to 20 minutes before you try exercising again so he was mentioning some of the high blood sugar symptoms low blood sugar symptoms my husband who's also diabetic he said this is like the seven dwarfs you have hungry sleepy shaky sweaty grumpy headachy and then dopey because you sometimes feel a little bit spacey so these are some right helps you to remember them okay so if your sugar's too high you check your sugar and it's 190 before you get going you and your doctor can help to formulate a plan at what point do you need to not exercise and actually maybe adjust your insulin levels but if you are producing ketones you know which you can check with your urine test don't exercise then but find out you know keep track of this so you can see how your body reacts peripheral neuropathy as i was mentioning can be a huge problem generally low impact exercises work great if you're doing anything that's very high impact very sustained exercise especially if it's very hot or very cold if you can't feel your heat your feet and it's a hundred degrees outside and you're walking with something with a thin told shoe you can have some problems so we want you to keep the exercise habit going we want you to find a way to start to be motivated and to get motivated as i said something is better than nothing don't yell at yourself i'm a failure i blew it again please don't do that just skip the guilt restart exercising as dr singh was mentioning this is a long haul type thing attitude matters keep reminding yourself of why you're doing this you're doing it so that you can feel good not just because the doctor is nagging you you want to do it because you feel good and if you weren't successful don't give up so everyone stand up we're going to do a couple very quick exercises and then we'll be opening up for questions these exercises you everyone got that little slip of paper so that you can access these exercises in a good general exercise routine so everyone if you have balance problems please hang on to the chair in front of you but otherwise just lift up your knees straight in front of you if you don't have balance problems practicing this will also help to improve your balance okay hang on to the chair and without kicking your neighbor you can alternate kicking your feet side to side try not to do too much wobbling pull if you pull in your tummy muscles that will also also help your hips to move better again be kind and polite to your neighbor i can use elastic band or i can just use my hands and if i pinch my shoulder blades together oops sorry so this is good for strengthening your posture muscles and stretching out your chest since our eyes and hands and are in front of our bodies we're always doing stuff bent over so that's very helpful for that and then opposite arm raises where you raise one arm up and the opposite back again for stretching out the chest muscles and strengthening our shoulder blade muscles so we want to make all of this important to you we want to make it enjoyable please keep moving thank you questions yes sir is there a connection between exercise and cramps muscle cramps um there are exercises that you can do for muscle cramps especially if you do i just yes okay no problem you can go ahead and do the typical runner's stretch and that oftentimes is very helpful if you have cramps at night time doing it right before bed can be very useful yes does it make a difference in your blood sugar if you eat breakfast before or after you walk in the morning okay so i'm going to repeat all the questions yeah sorry for being taped so uh is your blood sugar does it make a difference to your blood sugar if you walk before taking it or no if you eat breakfast before you walk yes so i think what you're asking is when's the best time to exercise in relation to food in the morning right in the morning we would probably say that in general we like food in the system because typically what's happening is that you're going to wake up a little bit on the low side and if you don't put a little something into your system you might get hypoglycemic and so it doesn't mean that you have to eat a lot but if eating just getting up and going straight to the exercise may cause some hypoglycemia so in general we don't necessarily want you to fill up with a ton of food because then you'll cramp or get uh get a belly ache but putting a little something in your system before you exercise is probably the safest bet yes sir what exactly is the mechanism that glycose damages blood vessels and nerves is it is it similar to the glycolation of the hemoglobin so that's an extra question the question is how does the glucose actually damage the cells and so what happens is that we know a lot of things i'm not sure i can tell you the exact mechanism but it's the high blood sugar it's the really that at high levels of glucose that high level glucose is toxic to both blood vessels and and nerves over time and causes inflammation i can't tell you the back exact mechanism maybe my colleague dr kenny back there could tell us but i'm not sure i know exactly but it's the high blood sugar that causes the toxicity you mentioned a paradoxical increase in blood sugar after heavy exercise or very strenuous exercise is that problematic should that strenuous exercise be avoided not necessarily what sometimes okay she asked what happens um when someone does heavy exercise and the blood sugar goes up does that mean you should avoid the heavy exercise what happens is your liver will has a store of short chains of sugars that it is easily available and will break those down however when you are exercising heavily your body perceives this as stress it produces a hormone called cortisol which causes your blood body to okay there's a problem let's get more sugar in the system and so your sugar may go up ultimately your body will get used to it you may need to just ramp up your activity level so that you get accustomed to so maybe not going out and jogging even if you feel like you can physically if your sugars are going bonkers going so fast you may find that alternating walking and jogging and then gradually increasing the percentage of jogging is what will allow you to tolerate that and have sugar levels that stay at a more normal level does that make sense okay yes sir drag like friendly song steroid how would that just impact the diabetes so that's a question was about prednisone so uh i kind of briefly alluded to the fact that there was a third category of diabetes where some people take certain kinds of medications of which steroids are the most notorious and prednisone can make either a diabetic much worse or take someone who's non-diabetic and make them transiently diabetic um and so the the diabetes during the time that you aren't prednisone so people take prednisone for umpteen diseases um but wouldn't you would need to be treated during that period of time uh on the prednisone a little bit differently so often we'll have to intensify treatments when patients take steroids yes sir is there any significance to always having the only episodes of beginning exercise episodes of yeah that may um this gentleman asks finding he yawns a lot when he exercises that may be that sort of sleepy your blood sugars if you were to check them may be starting to get a little bit lower especially if you notice some of the other symptoms associated with that it may be simply that your sugar levels are going down a little bit more quickly and that's one of the reactions to that any other questions yes so where will the videos excuse me um the question was where this video is going to be posted perhaps one of our organizers uh mark can tell us and you'll be able to find them uh there or you can come to the health library website which is health library.stanford.edu and we have them there as well okay nora was saying that they can be post they will be posted on the stanford hospital website on youtube and also will be available at the stanford health library sorry one more year is there a spanish like kind of a form of this class that's offered anywhere locally um in east san jose because i'm bilingual in spanish there used to be something this was a number of years ago i can certainly see if i can translate this into spanish so um and i believe someone over on this site had one other question oh yes it wasn't a question my husband and i take a class through stanford medical health called strong for life at the avenida senior center in palo alto and a lot of the exercises you showed here they do in that class as basically strength and stretching so you don't fall correct and it's free and i don't know if people know that they can take it and it's free i don't know all the places it's offered all right she was mentioning that stanford does have a free exercise program called strong for life that goes through many of the similar exercises where the focus is improving functional strength and balance and that is currently offered over at the avenidas i would say just one thing about that and that is exercise is more fun when you're doing it with other people and also it reinforces the behavior if you're doing it with someone else because that person will reinforce you to get out of your chair and go do the exercise with them so um trying to find an exercise that is with other people in the form of a class or with a buddy is a good way to reinforce the behavior okay so everyone's got that um any other questions there's one or two other things i mentioned sit and be fit a lot of libraries have many different videos available bottles of water elastic bands like this very inexpensive easy for exercise adjustable cuff weights can also be used if people are interested instead of going out and buying a lot of different weights you can see in here that you can adjust them by a half pound each these are the ones that i stole from my husband and i mentioned these petal exercisers unfortunately the cheap ones tend to be very cheap and very flimsy but i use this on a daily basis on my kitchen counter for arm exercises so just something that's convenient to use oh the pedometer um yeah you can get just walking around in here i just did another 50 steps um you can get those very easily this is a very simple one this is a stanford one and each time i take a step it clicks and so that way it will tell you how many steps you take during a day and that way it will sort of give you oh i didn't walk that much i'll just walk down to the corner and back so that i get my you know 10 000 steps in today but it's just a nice way to help you remind you to stay active nope you can get these at any sporting goods store they're very inexpensive this is under 10 bucks i believe that's true yeah this one mary gave to me so i don't have a whole lot else to say sorry so the questions were a little bit about the pedometer and one nice thing about the pedometer would be that um it quantitates the amount of exercise so there's this uh thing that this mantra that we're using which is the ten thousand steps that we're trying to get people to do each day and so by doing by having a pedometer at least you can quantitate a little bit of the exercise and your change in exercise over time so it is a useful device for those who are trying to track their exercise over the course of a period of time one i think we'll make it one last question is that okay and and then uh we can we'll stay after for a few minutes for anybody who has questions at the end go ahead ma'am where can you get the therabands the thera-bands you um they have them for ten to fifteen dollars at sports authority big five does not carry them but sports authority does you can also get them at online as well all right thank you very much

Channel: Stanford Health Care

Views: 406,486

Rating: 4.7315636 out of 5

Keywords: Stanford, Stanford Hospital, Bay Area Healthcare, Medicine, Medical Science, Diabetic, glucose, insulin, sugar, blood, metabolism, RPE, aerobic, balance, pancreas, stroke, cholesterol, neuropathy, weight, overweight, hemoglobin, activity, T2D

Id: _FHye3nEUWA

Length: 54min 43sec (3283 seconds)

Published: Mon Nov 17 2014