Module 3: Cardiovascular Exercise Principles
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Questions and Answers

What characterizes diabetes as a chronic metabolic disease?

Diabetes is characterized by hyperglycemia resulting from defects in insulin secretion and/or an inability to utilize insulin.

Identify two main physiological processes involved in regulating blood glucose levels in type 2 diabetics.

Insulin secretion from the pancreas and the utilization of insulin in peripheral tissues are the main processes.

What is the primary treatment goal for diabetes management?

The primary treatment goal is to achieve stable blood glucose levels and prevent complications.

List two complications that can arise with exercise in diabetics.

<p>Hypoglycemia and potential cardiovascular issues can arise during exercise for diabetics.</p> Signup and view all the answers

How can exercise aid in the management of type 2 diabetes?

<p>Exercise can enhance insulin sensitivity and promote glucose uptake into the muscles.</p> Signup and view all the answers

What role does the GLUT-4 vesicle play in glucose transport?

<p>GLUT-4 vesicles facilitate the transport of glucose from the blood into skeletal muscle cells.</p> Signup and view all the answers

What distinguishes type 1 diabetes from type 2 diabetes?

<p>Type 1 diabetes is an autoimmune condition leading to the destruction of insulin-producing beta cells, while type 2 is characterized by insulin resistance.</p> Signup and view all the answers

What is considered a significant challenge in managing type 2 diabetes during exercise?

<p>A significant challenge is the risk of hypoglycemia, which can lead to serious health issues.</p> Signup and view all the answers

What does an A1C blood test measure?

<p>The A1C blood test measures your average blood sugar level over the past 120 days.</p> Signup and view all the answers

What is the target blood pressure for individuals managing diabetes?

<p>The target blood pressure is less than 130/80 mmHg.</p> Signup and view all the answers

What dietary considerations should be made for diabetes management?

<p>Patients should focus on when and what to eat, aiming for balanced meals.</p> Signup and view all the answers

What effect does insulin have on glucose transport in skeletal muscle?

<p>Insulin stimulates the movement of GLUT-4 to the skeletal muscle membrane, enhancing glucose transport.</p> Signup and view all the answers

Name one common medication used to treat diabetes and its classification.

<p>Metformin is a common oral anti-hyperglycemic medication.</p> Signup and view all the answers

What is the initial condition of adipose tissue during the development of insulin resistance?

<p>Adipose tissue becomes insulin resistant before skeletal muscle.</p> Signup and view all the answers

How much exercise is recommended weekly for individuals with diabetes?

<p>At least 150 minutes of moderate-to-vigorous intensity activity weekly.</p> Signup and view all the answers

How does excess lipids affect insulin signaling in skeletal muscle?

<p>Excess lipids lead to the production of reactive lipids like diacylglycerols, which impair insulin signaling.</p> Signup and view all the answers

What happens to insulin levels during exercise and why is this significant?

<p>Insulin levels decrease during exercise to facilitate glucose uptake by muscles.</p> Signup and view all the answers

What is the LDL cholesterol target for diabetes management?

<p>The target for LDL cholesterol is less than 2.0 mmol/L.</p> Signup and view all the answers

List two common acute complications of hyperglycemia.

<p>Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome.</p> Signup and view all the answers

Identify one barrier to effective diabetes management mentioned.

<p>One barrier is stress management.</p> Signup and view all the answers

What is the suggested exercise frequency for individuals with diabetes to maximize cardiovascular benefits?

<p>More than 3 days per week.</p> Signup and view all the answers

What are two symptoms of hypoglycemia?

<p>Shakiness and weakness.</p> Signup and view all the answers

What are the chronic complications of diabetes related to neuropathy?

<p>Peripheral neuropathies, including somatic and autonomic neuropathy.</p> Signup and view all the answers

Why is weight management particularly important for those with Type 2 Diabetes Mellitus (T2DM)?

<p>Healthy weight loss and maintenance are crucial for preventing complications associated with T2DM.</p> Signup and view all the answers

Define diabetic retinopathy and mention one of its symptoms.

<p>Diabetic retinopathy is damage to the retina caused by diabetes, with symptoms including blurred vision.</p> Signup and view all the answers

What combination of exercise types is recommended for better blood glucose control in T2DM patients?

<p>A combination of aerobic and resistance exercise.</p> Signup and view all the answers

What should individuals on hypoglycemic medication consider in relation to their food intake during exercise?

<p>They should consume additional carbohydrates after 1 hour of exercise, specifically 15 g of CHO.</p> Signup and view all the answers

What A1C level should most people aim for to manage blood sugars effectively?

<p>Most people should aim for an A1C of 7% or less.</p> Signup and view all the answers

What does it indicate when glucose utilization exceeds glucose production during exercise?

<p>It indicates hypoglycemia.</p> Signup and view all the answers

How do insulin and counterregulatory hormone concentrations in diabetics differ from those in non-diabetics during exercise?

<p>They do not respond to exercise in a normal manner.</p> Signup and view all the answers

What is the key problem faced by diabetics who engage in regular exercise?

<p>The imbalance between peripheral glucose utilization and hepatic glucose production.</p> Signup and view all the answers

What should be monitored to ensure normoglycemia during exercise?

<p>The rates of glucose utilization and glucose production.</p> Signup and view all the answers

How does acute exercise influence fatty acid partitioning compared to sedentary subjects?

<p>Acute exercise increases the partitioning of fatty acids to intramuscular triglycerides (IMTG) rather than muscle glycogen in comparison to sedentary subjects.</p> Signup and view all the answers

What role does GLUT-4 translocation play in diabetes during exercise?

<p>GLUT-4 translocation to the plasma membrane is stimulated by exercise and remains effective in individuals with diabetes.</p> Signup and view all the answers

What effect does acute exercise have on plasma glucose levels in diabetics?

<p>Acute exercise reduces plasma glucose levels for an extended time in diabetics.</p> Signup and view all the answers

Explain how acute exercise can prevent lipid-induced insulin resistance.

<p>Acute exercise helps prevent lipid-induced insulin resistance by reducing reactive lipid formation and enhancing proper lipid storage.</p> Signup and view all the answers

What are the long-term implications of increased IMTG storage from acute exercise?

<p>Increased IMTG storage from acute exercise may improve energy availability during endurance activities and enhance metabolic flexibility.</p> Signup and view all the answers

Describe the impact of exercise on insulin sensitivity in Type II diabetic individuals.

<p>Exercise enhances insulin sensitivity in Type II diabetic individuals, particularly after bouts of moderate to high-intensity activity.</p> Signup and view all the answers

What is the relationship between acute exercise and the action of fatty acid translocase (FAT/CD36)?

<p>Acute exercise stimulates the action of FAT/CD36, facilitating increased fatty acid uptake into muscle cells.</p> Signup and view all the answers

Why is the understanding of glycemic instability in Type II diabetes critical for treatment?

<p>Recognizing glycemic instability is critical because it aids in identifying risks for severe hyperglycemia and optimizing diabetes management strategies.</p> Signup and view all the answers

What effect does exercise have on glucose transport in relation to insulin resistance?

<p>Exercise stimulates glucose transport independent of insulin resistance.</p> Signup and view all the answers

List three substances that accumulate in muscle during exercise to stimulate glucose transport.

<p>Ca2+, ADP, and reactive oxygen species (ROS).</p> Signup and view all the answers

What is the 'athlete's paradox' in relation to IMTG and insulin sensitivity?

<p>The 'athlete's paradox' refers to the phenomenon where individuals with high intramuscular triglyceride (IMTG) concentrations remain insulin sensitive due to regular exercise.</p> Signup and view all the answers

How does a single session of exercise affect insulin sensitivity?

<p>A single session of exercise markedly improves insulin sensitivity.</p> Signup and view all the answers

What role do lipogenic enzymes play following a single session of exercise?

<p>Lipogenic enzymes, such as DGAT1 and mGPAT, may increase in expression after exercise to facilitate IMTG synthesis.</p> Signup and view all the answers

In what situation might the proposed mechanism of partitioning fatty acids toward IMTG synthesis be particularly important?

<p>This mechanism may be particularly relevant when fatty acid availability is high.</p> Signup and view all the answers

What happens to fatty acids in muscle cells during exercise regarding storage?

<p>Exercise promotes the storage of fatty acids as intramuscular triglycerides (IMTG) instead of directing them towards harmful metabolites.</p> Signup and view all the answers

How does exercise facilitate the movement of GLUT-4 within the cell?

<p>Muscle contraction during exercise triggers a signaling cascade that mobilizes GLUT-4 vesicles to the cell membrane.</p> Signup and view all the answers

Flashcards

Type 2 Diabetes

A metabolic disease resulting from insulin resistance and defective insulin secretion in peripheral tissues.

Insulin Resistance

Inability of cells to respond effectively to insulin, leading to elevated blood glucose.

Blood Glucose Regulation

The process of maintaining optimal blood sugar levels.

Hyperglycemia

High blood sugar levels.

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Exercise-Stimulated Glucose Transport

Exercise can directly transport glucose into muscle cells, independently of insulin.

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Type 1 Diabetes

An autoimmune disease causing the pancreas to stop producing insulin.

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GLUT-4 Vesicles

Transport glucose into muscle cells stimulated by insulin or exercise.

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Treatment Goal for Diabetes

Maintaining stable blood glucose levels and preventing complications.

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Insulin-stimulated glucose transport

Insulin signals the movement of GLUT-4 to the cell membrane, which facilitates glucose uptake.

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Insulin resistance in adipose tissue

Adipose tissue becomes resistant to insulin, leading to increased release of fatty acids.

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Excess lipids in skeletal muscle

High levels of lipids (e.g., DAGs and ceramides) in muscle impair insulin signaling.

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Diabetic ketoacidosis

A serious complication of diabetes involving high blood sugar, ketosis, and metabolic acidosis.

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Peripheral neuropathy

Damage to nerves, common in diabetes, affecting sensation and function.

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Diabetic retinopathy

Eye damage due to diabetes, often leading to vision problems.

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Diabetic nephropathy

Kidney damage in diabetes, impacting kidney function.

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A1C Test

A blood test measuring average blood sugar levels over the past 120 days.

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Blood Pressure Target

Keep blood pressure below 130/80 mmHg.

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LDL Cholesterol Target

Maintain LDL cholesterol below 2.0 mmol/L.

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Diabetes Medication Management

Talk to your healthcare team about medications to protect your heart for diabetes.

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Exercise for Type 2 Diabetes

Aim for at least 150 minutes of moderate-to-vigorous exercise per week, spread over 3 or more days.

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Diabetes Exercise Blood Glucose

Exercise causes insulin to decrease to maintain blood sugar during activity.

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Hyperglycemia in Diabetics

High blood sugar, often present at some considerable portion of the 24-hour day, even in well-controlled diabetics.

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Type 2 Diabetes Exercise Recommendations Weekly

At least 150 minutes of moderate-to-vigorous intensity exercise spread across 3 days. Can be reduced (minimum 75 minutes) for high fitness level individuals.

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Exercise's Impact on Insulin Sensitivity

Regular exercise makes individuals more sensitive to insulin, despite high levels of intramuscular triglycerides (IMTG). This phenomenon is known as the 'athlete's paradox'.

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Exercise and IMTG Storage

One session of exercise boosts IMTG synthesis and storage within muscle cells, particularly when fat availability is high.

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IMTG and Insulin Resistance

Research suggests that IMTG alone might not directly cause insulin resistance. This is because exercise, despite increasing IMTG, improves insulin sensitivity.

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Exercise and Fatty Acid Partitioning

Exercise preferentially directs fatty acids into IMTG storage, reducing the formation of harmful metabolites that can hinder insulin sensitivity.

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Exercise's Potential Mechanism for Improved Insulin Sensitivity

Exercise may enhance the expression of lipogenic enzymes (DGAT1, mGPAT), leading to increased IMTG synthesis and reduced formation of harmful fatty acid metabolites.

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Exercise and Insulin Resistance Protection

A single bout of exercise may protect against the negative effects of fatty acid-induced insulin resistance the next day.

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Exercise-Stimulated Glucose Transport Signal

Muscle contraction triggers the release of Ca2+, ADP, and Reactive Oxygen Species (ROS), initiating a signaling cascade to increase glucose uptake.

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How GLUT-4 Translocates

In response to the exercise signal, GLUT-4, a glucose transporter, moves from inside muscle cells to the plasma membrane, facilitating increased glucose absorption.

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Exercise and Blood Sugar

During exercise, glucose utilization (how much glucose is being used) and glucose production (how much glucose is being made) are carefully balanced to maintain normal blood sugar levels.

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Diabetes and Exercise Response

In individuals with diabetes, the normal hormonal and metabolic response to exercise is altered, leading to an imbalance between glucose utilization and production.

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Hypoglycemia Risk

During moderate exercise, people with diabetes may experience hypoglycemia (low blood sugar) because their bodies might use more glucose than they produce.

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Why Does Hypoglycemia Occur?

In diabetes, insulin and counter-regulatory hormones don't respond normally to exercise, leading to a mismatch between how much glucose is being used and how much is being made.

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Exercise Prescription for Diabetics

Exercise programs for individuals with diabetes should be individualized based on medication schedule, complications, and goals.

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Carbohydrate Intake and Exercise

For diabetes, additional carbohydrates should be consumed before or after exercise to compensate for glucose utilization.

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Resistance Training and Diabetes

Resistance exercise provides similar metabolic benefits to aerobic exercise for individuals with type 2 diabetes.

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Combined Exercise for Diabetes

Combining aerobic and resistance exercise may lead to even better blood glucose control compared to solely using one type.

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Hyperglycemia in Type 2 Diabetes

People with type 2 diabetes may have abnormally high blood sugar levels even when considered "well-controlled" due to rapid fluctuations and frequent spikes throughout the day.

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Acute Exercise and Blood Glucose

Short bursts of physical activity can lead to a significant reduction in blood sugar levels in individuals with diabetes, lasting for an extended period.

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GLUT-4 Translocation

During exercise, GLUT-4, a protein responsible for glucose transport into muscle cells, moves from the inside of the cell to the cell membrane, even in individuals with diabetes.

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Exercise and Lipid-Induced Insulin Resistance

Exercise can overcome the negative effects of excess lipids in muscle cells, improving insulin sensitivity and glucose uptake.

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Exercise and Reactive Lipid Formation

Exercise helps reduce the production of harmful reactive lipids that contribute to insulin resistance, promoting healthy lipid storage.

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Exercise's Impact on Glucose and Lipid Metabolism

Exercise improves both insulin-stimulated and exercise-stimulated glucose transport by increasing the movement of GLUT-4 to the cell membrane, reducing the negative effects of excess lipids, and promoting efficient energy use.

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Acute Exercise and Insulin Sensitivity

Even short bursts of moderate-to-high intensity exercise, including intervals, can improve insulin sensitivity in people with type 2 diabetes.

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Exercise's Role in Diabetes Management

Regular physical activity plays a crucial role in managing type 2 diabetes by improving blood glucose control, increasing insulin sensitivity, and promoting overall health.

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Study Notes

Module 3: Cardiovascular Exercise Principles

  • Module: Cardiovascular
  • Week: 3
  • Instructor: Dr. Tanya Holloway, PhD, ACSM-RCEP

Exercise Prescription for Common Chronic Conditions: Diabetes

  • Topic: Exercise prescription for diabetes
  • Learning Objectives:
    • Define diabetes
    • Identify physiological processes in regulating blood glucose and factors contributing to high blood glucose levels in type 2 diabetes
    • Identify treatment goals for diabetes and the role of exercise in management
    • Describe complications of exercise in diabetics
    • Design effective exercise strategies for managing type 2 diabetes

Types of Diabetes

  • Diabetes: A chronic metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion and/or an inability to utilize insulin.
  • Type 1 Diabetes: An autoimmune disease affecting children and adults, caused by the destruction of beta cells in the pancreas, resulting in decreased insulin production.
  • Type 2 Diabetes: A metabolic disease characterized by insulin resistance in peripheral tissues and defective insulin secretion.
  • Gestational Diabetes: Glucose intolerance developing during pregnancy due to contra-insulin effects during pregnancy.

Blood Glucose Control and Type 2 Diabetes

  • Blood Glucose Control: Impaired in Type 2 Diabetes

Glucose Transport in Skeletal Muscle

  • Overview of glucose transport steps: glucose in blood, insulin, exercise, cytosol, GLUT-4 vesicle.
  • Key Point: Glucose transport into skeletal muscle can be insulin-stimulated or exercise-stimulated.

Pathophysiology of Insulin Resistance

  • Adipose Tissue (AT): Becomes insulin resistant before skeletal muscle.
  • Healthy AT: Adipocyte hypertrophy, inflammation, ROS emission
  • Lipolysis: Increased release of fatty acids from adipose tissue, accumulation in skeletal muscle
  • Effect of Excess Lipids: Lipid transport accumulation on skeletal muscle membrane, production of reactive lipids (DAGs, ceramides).
  • Important Point: High lipid environment leads to insulin resistance and hyperglycemia.

Diabetic Complications

  • Acute Complications: Hyperglycemia (manifestations), hypoglycemia (potential causes), diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic syndrome, common symptoms such as headache, weakness fatigue, too much insulin/oral agents, insufficient carbs, excessive or poorly planned exercise)
  • Chronic Complications: Peripheral, somatic, and autonomic neuropathies, nephropathies, retinopathies, macro/microvascular complications, diabetic foot ulcers, and infections.

Exercise Prescription in Diabetes

  • Treatment Goals: Diet, medication, regular exercise.
  • Follow the ABCDEs: A1C, blood pressure, cholesterol, drugs to protect your heart, exercise & eating, screening for complications, self-management, stress, and other barriers
  • Exercise Intensity: Moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), 150 min or more of moderate-to-vigorous intensity activity weekly.
  • Glucose Control Goals: Glucose control, prevention of diabetes-related complications, CVD risk factor reduction
  • Diabetes Mellitus: Exercise Testing: ECG stress testing, annual CVD risk factor assessments, mode of exercise testing based on the presence of complications.
  • Diabetes Mellitus: Exercise Prescription: Aim to maximize cardiovascular benefits with exercise frequency of greater than 3 d per week, promote healthy weight loss, resistance exercise confers similar metabolic benefits to aerobic exercise in individuals, combination of aerobic and resistance exercise improves glucose control more than exercise alone.
  • Individualized Exercise Programming: Based on medical history, medication schedule, presence and severity of diabetic complications, exercise program goals. Endurance and resistance exercise are included for improving cardiorespiratory fitness, body composition, and muscular strength/endurance. Food intake is important for those on hypoglycemic medications, and increasing carbohydrate intake may be necessary during exercise.

Insulin Sensitivity and Exercise

  • Acute exercise: Improves insulin sensitivity
  • Exercise and glucose transport: Glucose transport is independent of insulin.
  • Chronic Exercise training: Improves insulin action and blood glucose control, improves cardiovascular and metabolic fitness, reduces risk factors for development and progression of type 2 diabetes (obesity, hypertension, high blood cholesterol)

Contraindications

  • Blood glucose levels should be checked to avoid complications
  • Postpone if blood glucose is > 14 mmol/L and ketones are present.
  • Individuals with complications (retinopathy, peripheral neuropathy, autonomic neuropathy, nephropathy, or hypertension), or undergoing special conditions (high-intensity training/Valsalva maneuvers) should modify exercise accordingly. 

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Exercise Prescription for Diabetes PDF

Description

Explore the principles of cardiovascular exercise in this comprehensive module. Focusing on exercise prescription for diabetes, it covers physiological aspects of glucose regulation, treatment goals, and effective exercise strategies. Learn how to manage type 2 diabetes through practical exercise approaches.

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