The effect of yoga exercise therapy on metabolic activity and oxidative stress indicators in non-insulin dependent diabets mellitus (NIDDM) patients [abstract]

OBJECTIVE: To evaluate the effort of yoga traditional exercises on indicators of oxidative damage and on anti-oxidative enzyme system in patients with NIDDM. METHODS: Ninety-four NIDDM volunteers were divided randomly into two groups: traditional and yoga exercise (female to male 5:1, age 50 to 70 yeras, with 2-5 years of duration of diabetes and without clinical complications). Both groups twice weekly for six months with similar nutritional support. Blood samples were taken at the beginning, and six months following exercise treatments and the following were determined: glycaemia by glucose oxidase (automatic analyser), microalbuminuria by semiquantative methods, creatinine by kinetic method, malondialdehyde (MDA) by products of thiobarbituricacid, superoxide dismutase (SOD) by kinetic method - the inhibition of pyrogallol, phospholipase A2 by colorimetry, protein oxidation (POX) by the method of Reznicky and Pucker. RESULTS: There was a reduction of glycaemia in the yoga group after 6 months (8.84 vs 8.35 mmol/l), while there was an increase in the traditional group 8.74 vs 9.51 mmol/l). The concentration of creatinine and microalbumin decreased in both groups notably in the yoga group. (AU)

A 4-year evaluation of blood pressure management in Trinidad and Tobago

This paper reports a 4-year evaluation of government primary care services in Trinidad and Tobago. The sample included 16 primary care health centres in Trinidad and Tobago with cross-sectional surveys of adult attenders in 1994 and 1998. Data were obtained from clinic records including details of processes of care, drug utilisation and blood pressure (BP) control. Intervention following the initial survey was by means of reports to the Ministry of Health and annual training workshops for medical officers. Data were analyzed for 1759 adult attenders at study clinics (981 in 1994 and 778 in 1998). Most attenders had blood pressure recorded (96 percent in 1994 and 98 percent in 1998). Among 1176 subjects with hypertension (BP > or = 160/95 mm Hg or treated with drugs) the proportion with dietary advice ever recorded increased from .139/662 (21 percent) in 1994 to 185/514 (36 percent) in 1998, and recording of exercise advice increased from 36 (5 percent) in 1994 to 99 (19 percent) in 1998. Among subjects treated with drugs, use of Brinerdin decreased from 191/625 (31 percent) in 1994 to 29/486 (6 percent) in 1998, while use of diuretics, beta-blockers, calcium antagonists and ACE inhibitors increased. The proportion of patients with blood pressure adequately controlled (<160/95 mm Hg) was 338 (51 percent) in 1994 and 297 (58 percent) in 1998 (odds ratio 1.39, 95 percent confidence interval 0.96 to 2.00). An audit study used to inform health care policy, staff training and clinical practice may contribute to improving processes of hypertension management in a middle-income country like Trinidad and Tobago.(Au)

Yoga exercise versus traditional exercise in the control of non-insulin diabetes mellitus - Poster presentation

The sample population was selected from 3 municipals of Havana City. The population size was selected using the programme EP16 with the option statcalc. From a population size of 17,068 diabetics, a sample size of 100 diabetics was calculated as the minimum population size required to obtain a confidence level of 95 percent. Patients were divided into two groups (yoga and traditional group) and were matched according to the following criteria: Age +/- 5 years, Sex, Type of treatment, Evolution of NIDDM, BMI. The two groups of 63 diabetics were matched according to the criteria described above and were then grouped as "yoga exercise group" and "traditional exercise group". Biochemical analysis was done at the start of the investigation, and included: HDL - C Tryglyceride, LDL - C, Total cholesterol, Glycated haemoglobin, Insulinic receptors, Microalbuminuria, Blood glucose, quantification of T3, T4 Insulin, GH, and TSH, Oxidative stress enzymes serum, creatinine. The Second Stage: Both groups had similar diet and practised their respective physical exercise at the same duration and frequency for periods of 3 and 6 months. The biomedical analysis was done at these intervals. The biochemical analysis at the start showed: In most cases there were alterations in lipid metabolism, renal function as seen as hyperlipidaemia and hypercortisolaemia and a reduction in the union and internalization of insulin in the receptors of lymphocytes. There was a correlation between GH and T4. These findings show that it is necessary to deepen the investigation of these patients as there exists a difference in the laboratory results and the clinical manifestations of endocrine metabolc diseases.(AU)

The practical experience of excerise and diabetes

Most patients with diabetes can safely engage in recreational and work related physical activity. Sedentary patients with a long duration of diabetes probably should have an exercise stress electrocardiogram prior to initiating an exercise programme. Pre-exercise evaluation should also include a careful eye, neurological, and peripheral vascular examination. The usual recommendation for a monitoring programme in patients with diabetes are given in the following table (table in journal). These recommendations are not dissimilar to those for other patient populations at high risk for vascular disease. The duration and intensity of exercise should be adequate to induce some degree of glycogen depletion. Exercise at intensities below 30 - 40 percent VO2max has little effect on subsequent glucose disposal. Aerobic exercise are generally preferred although resistance exercise can result in significant improvement in glucose, lipid and blood pressure levels. In addition, the increase muscle mass resulting from resistance training may be particularly beneficial for older patients and as an aid to weight maintenance. Potential problems with intense resistance exercise include an increase risk of musculoskeletal injuries an large swings in systolic blood pressure with possible cardiac and/or microvascular damage. A rough guidelines would be to utilize a resistance such that the patient can comfortably perform 15 repetitions in a given exercise. During training three set of 8 - 12 receptions of each exercise can be done. This level of training results in only modest elevation of blood pressure, has been shown to be safe exercise for older patients, and results in a significant increase in muscle mass. Many sedentary patients with type 2 diabetes have an unusually low VO2max. Initiating exercise regimens at too high an intensity is a common error in these patients. Estimate based on submaximal exercise testing using standard nomograms are often used to estimate maximal heart rate and oxygent comsumption and to prescribe exercise regimens. Prescriptions based on such data may overestimate the fitness of diabetic subjects and should be used with caution. The metabolic effects of exercise on subsequent glucose disposal are not negated by brief rest periods (<90 seconds) during the training sessions. These rest periods may make exercise more acceptable, particularly for older or unconditioned populations.(AU)

How frequently do patient comply? - Poster Presentation

Diet and exercise are important in the management of diabetes mellitus. Of 31 diabetic patients seen at the dietary department for counselling, 27 had type 2 diabetes and 4 type 1. Only 20 percent were hypertensive and only 6.6 percent smokers. The mean age was 62 years. The female:male ratio was 2.9:1 and the mean duration of diabetes 8.1 years. The commonest drug regime was twice daily insulin therapy (32.3 percent) followed by sulphonyl urea (25.8 percent) and biguanide therapy (12.9 percent). 66.6 percent had received counselling in the past but 45 percent did not comply. 45 percent exercised regularly. The commonest exercise was walking which was done for an average of 37 minutes for 3.6 days per week. The BMI was 38.12 (range 17-38.4) and the mean calories prescribed were 1536 kcal per day. Conclusion: Despite generalised obesity in this population, the proportion of patients offered previous dietary counselling was suboptimal. Exercise was practised by a minority, but those who exercised did so at the present recommended rate. The importance of diet and exercise needs to be emphasised to patients.(AU)

Exercise in the elderly and in patients with complications

Both physical activity in general and exercise for recreation or fitness decline progressively with age. Many people regard this as a normal and inevitable consquence of ageing, and make little attempt to overcome it. This is unfortunate since exercise has demonstrable benefits on cardiovascular fitness, reduction of muscle wasting, glucose tolerance, depression, quality of life, etc., and on morbidity and mortality. A number of recent studies have domnstrated the marked improvement of glucose tolerance in diabetes with exercise. The effects are synergistic with diet and proportional to the level and duration of exercise training, yet there appears to be far too little awareness of these benefits among both physicians and patients, On the National Health Interview Survey of th USA (1990) neither diabetics nor non-diabetics were meeting national goals. Only a minority of the population was exercising regularly. Slightly more diabetics walked than non-diabetics (49 percent versus 44 percent, P<0.05) but far fewer did any other exercise. In the Honolulu Heart Program (1995), a prospective follow-up s tudy in almost 7000 men, it was clearly shown that physical activity confers protection against diabetes, independent of other risk factors. In the Barbados Diabetes Intervention Study (BDIS), adults at high risk of diabetes (siblings or adult children of diabetics) were invited to take part in a three-month multifaceted intervention programme, with a prominent exercise component and culturally sensitive education and motivation components. Those subjects with abnormal glucose tolerance at the onset showed improvements while overweight patients showed significant reduction of weight and body mass index. Such programmes have major implications for the preventions of diabetes. Exercise has also been shown to have significant benefits on patients with disabilities. By preventing muscle wasting and even building muscles in elderly subjects exercise has multiple benefits. Aerobic training will improve cardiorespiratory fitness, improve activity levels and prevent secondary disabilities, improve depression and quality of life. Resistance training increases muscle mass, but older individuals vary in their attitude towards participation. For those who respond clear benefits can be shown. Programmes for exercise should be tailored specific age groups, social settings and disability levels.(AU)

The practical experience of exercise and diabetes: position statement

Diabetes health care professionals are often frustrated with results of their efforts to increase physical activity in patients with type 2 diabetes. Motivation is difficult and drop out rate are high. It is especially disappointing when the diabetes management team is successful in getting patients to exercise and find that improvements in physical fitness, weight management and glucose control are not as expected. Although our results often tempt us to throw up our hand and claim our patients are just "too fat and lazy" for an exercise program to do them any good, we should know better. Patients with type 2 diabetes are different and their prescriptions for exercise must account for these differences. Most type 2 patients do have very low initial VO2max values and typically do not improve much with physical training. We must be carefully planned to meet their specific needs and abilities. Fifteen years of practical experience have shown me that successful exercise programs are possible if the initial exercise experiences are well tolerated. Appropriate intensities and durations for aerobic activity should be based on tests of functional capacity. For most patients, resistance exercise should be slowly added to improve total fitness. Many patients take as long as 6 to 12 months before they are able to perform enough total exercise to see even modest changes in functional capacity and weight loss. Reasonable goals and appropriate feedback can enhance compliance.(AU)

Exercise in the treatment of type 1 diabetes

REVIEW OF FUEL METABOLISM DURING AND AFTER EXERCISE: Increased skeletal muscle glucose uptake induced by exercise *regional effects (exercised vs nonexercise muscle) *type of exercise (concentric vs eccentric). Importance of skeletal muscle glycogen depletion and replention in glucose homeostatis. Role of the liver in glucose production *hormonal control. Ketone body metabolism *importance of ambient insulin and counterregulatory *hormone concentrations at the onset of exercise. Amino metabolism *acute catabolic effects of exercise *post-exercise anabolic effects of exercise. METABOLIC RESPONSE TO EXERCISE IN TYPE 1 DIABETES: Glycaemic response to acute exercise *dependence on ambient insulin concentratios *effects of intensity and duration of exercise *accelerated ketogenesis in the insulin-deprived state *intact net protein anabolic effect following exercise *altered mechanisms in the insulin-deprived state. CLINICAL EFFECTS OF PHYSICAL EXERCISE IN TYPE 1 DIABETIC SUBJECTS: Risks of hypoglycaemia *during exercise *following exercise, long-term benefits of increased physical activity *glycaemic control * cardiovascular risk factor reduction, Risk of worsening diabetic complications due to exercise *retinopathy *proteina *neuropathy *peripheral *autonomic *cardiovascular disease. CLINICAL STRATEGIES TO PREVENT METABOLIC DECOMPENSATION BY EXERCISE: Carbohydrate intake *before and during exercise *following evening exercise. MULTIPLE DOSING OF INSULIN (MDI) REGIMENS: adjustments of short-acting insulin preparations for exercise, regular vs humalog (lispro) insulin, insulin pump (CSII) therapy, regular vs humalog insulin. RESOURCES FOR THE PATIENT AND THE HEALTH CARE PROFESSIONAL: published materials, International Diabetes Athletes' Association (IDAA).(AU)

Exercise in the treatment of the elderly and of diabetic complications

The elderly can reap similar benefits as the young from regular exercise. Of particular benefit are cardiovascular fitness and reduction in muscle wasting. The ability to cope with disabilities is aggravated by muscle wasting but this can be slowed by doing resistance training. Additional challenges include working with the disabled who may have had amputations, but these issues are similar to that of all other disabled without diabetes. Probably the greatest hindrance is the perception that the elderly can not exercise. Even health professionals such as physiotherapists are guilty of giving less than 100 percent care and advice for discharge patients. A family and community approach to providing exercise for the elderly and including church programmes will be the most cost effective. The Barbados Diabetes Intervention Study (BDIS) provides an example of an integrated programme, which can be modeled by other Caribbean countries.(AU)

Resistance training and the elderly: an effective alternative for the osteoarthritic patient - abstract

The aim of this prospective study of 20 patients with moderate or severe osteoarthritis was to determine the effectiveness of a one-year regime of aerobics and strength training. In all patients mobility and social life were significantly limited due to pain and stiffness in the joints. Bedridden patients with contractures of the hips and knees were excluded from the study. Muscle strength, flexibility, balance, level of pain and quality of life were measured before, and after 6 weeks, 3 months, 6 months and 1 year of the regime. Each patient served as his/her own control and for the group as a whole. The results showed that with progressive training there were significant gains in strength, flexibility and aerobic capacity (not highlighted in this study). These gains correlated with the decrease in pain and stiffness and the improvement in the quality of life for these patients. This study clearly illustrated that resistance training is a necessary adjunct in the management of patients with osteoarthritis. In many Caribbean countries, this form of treatment may be a cost-effective alternative to the expensive joint replacement programme in the management of patients with disabling osteoarthritis (AU)

Exercise and health

In this article the author discusses the positive benefits of exercise on health. The effects of exercise on coronary heart disease, lipids, hypertension, diabetes, mental well being, the elderly, obesity, osteoporosis and prescribed exercise are examined