Diabetes
Although physical activity is a key element in the prevention and management of type 2 diabetes mellitus, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes proves that participation in regular physical activity improves blood glucose control and can prevent or delay type 2 diabetes mellitus, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining physical activity and modest weight loss have been shown to lower type 2 diabetes mellitus risk by up to 58% in high-risk populations. Most benefits of physical activity on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, physical activity-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for physical activity with diabetes-related complications. Type 2 diabetes mellitus is a significant cause of premature mortality and morbidity related to cardiovascular disease (CVD), blindness, kidney and nerve disease, and amputation. Although regular physical activity may prevent or delay diabetes and its complications most people with type 2 diabetes mellitus are not active
Hypertension
Hypertension, one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of hypertension, with exercise being an integral component. Exercise programs that primarily involve endurance activity prevent the development of hypertension and lower blood pressure in adults with normal BP and those with hypertension. The blood pressure lowering effects of exercise are most pronounced in people with hypertension who engage in endurance exercise with blood pressure decreasing approximately 5–7 mm Hg after an isolated exercise session (acute) or following exercise training (chronic). Moreover, blood pressure is reduced for up to 22 h after an endurance exercise bout (e.g., post exercise hypotension), with the greatest decreases among those with the highest baseline blood pressure.
Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of hypertension. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the blood pressure lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. Based upon the current evidence, the following exercise prescription is recommended for those with high blood pressure.
Frequency : on most, preferably all, days of the week
Intensity : moderate-intensity (40–<60% of V̇O2R)
Time : ≥ 30 min of continuous or accumulated physical activity per day
Type : primarily endurance physical activity supplemented by resistance exercise
It is reasonable for the majority of patients to begin moderate intensity exercise training (40–<60% V̇O2R) such as walking.
Individuals with controlled hypertension and no cardio vascular disease or renal complications may participate in an exercise program or competitive athletics, but should be evaluated, treated, and monitored closely
ISCHEMIC HEART DISEASE / HYPERLIPEDEMIA
Patients with coronary artery disease are not a homogeneous group and must be considered individually. They vary greatly in their clinical status including: extent of coronary disease, left ventricular dysfunction, potential for myocardial ischemia and presence of cardiac arrhythmias. Some patients with coronary artery disease have had prior cardiac events (e.g. Myocardial infarction, cardiac arrest) or cardiac treatments (e.g. Coronary artery bypass) . Many patients have additional medical disorders including hypertension and diabetes mellitus.
Furthermore, although exercise improves functional capacity and reduces clinical symptoms in patients with coronary artery disease, such patients are at increased risk for cardio vascular complications during exercise: therefore appropriate safeguards should be employed to minimize these risks.
Maximal exercise performance in patients with angina pectoris is limited by discomfort. In patients with classic angina pectoris, such discomfort occurs at a highly reproducible rete pressure product (heart rate times systolic blood pressure) if factors such as time of the day, room temperature, and body positions are constant.
Exercise training reduces sub maximal heart rate at any given work load or activity and delays the onset of symptoms during exercise.
Regular physical activity causes
- Decreased blood pressure
- Decreased LDL Cholesterol
- Increased HDL Cholesterol
- Decreased triglycerides
- Improved glucose tolerance
ARTHRITIS
Water exercise is especially good for people with arthritis, because it allows exercise without putting excess strain on the joints and the muscles.
Exercise for arthritis often focuses on improving muscle strength, endurance and flexibility. In some cases, exercise may be designed to train balance.
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Exercise for special groups
ADOLASENCE AND CHILDREN
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ELDERLY
Advancing age is associated with physiologic changes that result in reductions in functional capacity and altered body composition. Therefore aging is associated with increased risk for chronic diseases and causes decline in physical activity volume and intensity. But physical activity significantly reduces these risks.
Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions
Exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises
The guidelines stress that if older adults cannot do 150 min of moderate-intensity aerobic activity per week because of chronic conditions, they should be as physically active as their abilities and conditions allow.
Aerobic exercise training
Refers to exercises in which the body's large muscles move in a rhythmic manner for sustained periods.
Resistance exercise training
Refers to exercise that causes muscles to work or hold against an applied force or weight
Flexibility exercise
Refers to activities designed to preserve or extend range of motion (ROM) around a joint
Balance training
Refers to a combination of activities designed to increase lower body strength and reduce the likelihood of falling.
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Physical activity and reproduction are normal parts of life, and for normal healthy women, combining regular exercise and pregnancy appears to benefit both mother and baby in many ways. Thus, a healthy woman with a normal pregnancy may either continue her regular exercise regimen, or begin a new exercise program
All mothers want the best possible health for themselves and their babies, but some women are concerned that regular maternal physical activity during pregnancy may cause miscarriage, premature delivery, poor fetal growth, or musculoskeletal injury. For normal pregnancies, these concerns have not been substantiated. Indeed, participation in regular weight-bearing exercise has been shown to improve maternal fitness, restrict weight gain without compromising fetal growth, and hasten postpartum recovery. In addition, the psychological benefits of exercise are undeniable, and should be nurtured by all who care for pregnant women.
During this time, the fetus is undergoing its most important growth, including development of organs and limbs. For this reason, a proper balance of nutrition, hydration, exercise and rest assume great importance
Thus, well hydrated, fit pregnant women regulate their core body temperatures more efficiently than sedentary people, and undergo less temperature variation during exercise
The second and third trimesters are accompanied by dramatic changes in a woman’s body. Normal weight gain is centered around the abdomen and pelvis, which alters both posture and the center of gravity. During this time, exercises requiring balance and agility may become more difficult due to the change in the pregnant woman’s weight distribution. The use of properly adjusted exercise equipment, a smooth floor surface, and/or aquatic (water) exercises are extremely helpful
For pregnant women who wish to exercise during pregnancy, the American College of Sports Medicine provides the following recommendations:
Safety: As changes in weight distribution occur, balance and coordination may be affected. Exercise programs should be modified if they pose a significant risk of abdominal injury or fatigue as opposed to relaxation and an enhanced sense of wellbeing. Until more information is available, exercising in the supine or prone positions should be avoided after the first trimester.
Environment: Temperature regulation is highly dependent on hydration and environmental conditions. Exercising pregnant women should ensure adequate fluid intake before, during and after exercise, wear loose-fitting clothing, and avoid high heat and humidity to protect against heat stress, especially during the first trimester.
Growth and Development: The pregnant woman should monitor her level of exercise and adjust her dietary intake to ensure proper weight gain. If pregnancy is not progressing normally or if vaginal bleeding, membrane rupture, persistent pain or chronic fatigues are noted, exercise should be stopped until a medical evaluation has been completed. Also, if regular contractions occur more than 30 minutes after exercise, medical evaluation should be sought. This may signify pre-term labor.
Mode: Weight-bearing and non-weight-bearing exercise are thought to be safe during pregnancy. Improved maternal fitness is a well-known benefit of non-weight-bearing exercise such as swimming and cycling. Weight-bearing exercises are similarly beneficial as long as they are comfortable. Swimming and stationary cycling are excellent non-weight-bearing exercises, and may be recommended. Walking, jogging and low-impact aerobics programs are good choices when weight-bearing exercise is to be considered.
Heavy weightlifting, or similar activities that require straining, are to be discouraged. Bicycle riding, especially during the second and third trimesters, should be avoided because of changes in balance and the risk of falling
Intensity: Pregnancy is probably not a time for serious competition. For women who are continuing their regular exercise regimen during pregnancy, exercise intensity should not exceed pre-pregnancy levels. The intensity of exercise should be regulated by how hard a woman believes she is working. Moderate to hard is quite safe for a woman who is accustomed to this level of exercise.
Exercise: A healthy woman with a normal pregnancy may either continue her regular exercise regimen or begin a new exercise program during pregnancy. For your particular exercise prescription and its duration, check with your physician.
Exercise for health
TO MAINTAIN WEIGHT
Prevention of weight gain may be the easiest way to prevent the development of undesirable changes in cardiovascular disease risk factors such as,
Increased LDL-Cholesterol
