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Your search term(s) "Exercise and physical activity" returned 115 results.

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Diabetes And Exercise. Diabetes Educator. 34(1): 37-40. January 2008.

This article presents the position statement of the American Association of Diabetes Educators (AADE) on diabetes and exercise. The AADE is a multidisciplinary professional membership organization of health care professionals dedicated to integrating successful self-management as a key outcome in the care of people with diabetes and related conditions. The AADE asserts that diabetes educators play a unique and influential role in advising and motivating individuals with diabetes to integrate physical activity and exercise into a lifestyle that supports optimal diabetes management and health. The position statement covers the health benefits of exercise, the role of exercise in diabetes prevention, potential exercise risks, exercise recommendations and guidelines, and outcomes expectations. The statement concludes that, although exercise carries potential risks for individuals with diabetes, with careful planning, its numerous health benefits far outweigh these risks. By using established, sound exercise guidelines and tailoring exercise recommendations to thorough pre-exercise assessment, diabetes educators can suggest safe and effective physical activity interventions that will enhance the health and well-being of all individuals with diabetes. Physical activity remains an underused treatment modality in diabetes management. 25 references.

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Exercise, the Under-Prescribed Drug. Kidney Beginnings. 7(5): 16-18. February 2008.

This article encourages readers with kidney disease to think of exercise as a treatment for health, just as they might consider a drug therapy. Exercise is touted as providing a patient with more energy, improved moods, a way to fight depression, a way to lower blood pressure and reduce risk of heart attack, and a way to build stronger muscles and bones. The author cautions that physical fitness decreases continuously with chronic kidney disease (CKD), resulting in decreased flexibility, decreased muscle strength, coordination disturbances, and decreased endurance. Readers are advised to check with their physician before starting an exercise program and then incorporate exercise and physical activity into their daily plan. The author reviews the three types of exercise: endurance or aerobic, strength and balance, and flexibility. Exercising with a partner or buddy can help keep motivation levels up. Readers are referred to the American Association of Kidney Patients (AAKP) website for more information (www.aakp.org). 3 figures.

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Helping Your Patients Become Active. Diabetes Spectrum. 21(1): 59-62. Winter 2008.

This article reminds readers of the importance of exercise and physical activity in the prevention and management of diabetes. Exercise is prescribed to prevent diabetes, to improve diabetes control, and to promote weight loss. The author focuses on strategies that health care providers, counselors, and educators can use to help their patients become more active. The author reviews the basic physiology and glucose metabolism associated with exercise and summarizes the barriers to becoming physically active, solutions to those barriers, options for exercise with the presence of diabetes complications and/or orthopedic issues, and guidance for blood glucose management related to exercise. Recommendations to attain the maximum health benefit, improve diabetes control, and maximize caloric expenditure are to exercise daily at low to moderate intensity for 60 minutes or more. The activity can be accumulated throughout the day, with a minimum of 10 minutes or more for each exercise bout. Patients should engage in a combination of aerobic and resistance training. Health care professionals can help patients overcome barriers to exercise by providing them with an understanding of glucose management during exercise and helping them create an exercise routine that is unique to their health status, age, current exercise capacity, glycemic control, and personal goals. 2 tables. 20 references.

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Managing Preexisting Diabetes for Pregnancy: Summary of Evidence And Consensus Recommendations for Care. Diabetes Care. 31(5): 1060-1079. May 2008.

This article presents consensus panel recommendations for the medical care of pregnant women with preexisting diabetes, including type 1 and type 2 diabetes. The document is designed to help clinicians deal with the broad spectrum of problems that arise in the management of diabetes before and during pregnancy, and to prepare women with diabetes for treatment that may reduce complications in the years after pregnancy. Guidelines are presented in two sections. The first section addresses managing preexisting diabetes for pregnancy, including the organization of preconception and pregnancy care, initial evaluation, glycemic control, perinatal outcome and glycemic goals, assessment of metabolic control, medical nutrition therapy, insulin therapy, oral antihyperglycemic agents for type 2 diabetes, physical activity and exercise, and behavioral therapy. The second section covers the management of diabetes complications, including diabetic ketoacidosis (DKA), maternal hypoglycemia, thyroid disorders, management of cardiovascular risk factors, screening for cardiovascular disease (CVD), hypertension, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathies. Practical suggestions, including recommended laboratory values and goals, are highlighted. The recommendations for diagnostic and therapeutic actions are based on a grading system adapted by the American Diabetes Association that was used to clarify and codify the research evidence available.

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Preventing Long Term Complications of Diabetes. 4th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).

This DVD program explains the long-term complications of diabetes, including atherosclerosis and other cardiovascular diseases, kidney disease, eye disease, and neuropathy. Viewers are reminded of the importance of a self-management plan for keeping diabetes under control and preventing or minimizing these complications. The management plan outlined includes patient education, healthy eating, physical activity and exercise, medications, self-monitoring of blood glucose (SMBG), and the glycosylated hemoglobin (A1C) test used for longer term monitoring of blood glucose levels. The video depicts a variety of people who share their experiences with complications and diabetes management. Simple graphics are used to explain most of the topics covered. Viewers are referred to the American Association of Diabetes Educators website for more information and to find a local diabetes educator.

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Soup Can Plan: Getting Fit Without Leaving the House. Diabetes Forecast. 61(2): 37-38. February 2008.

This article encourages readers to incorporate exercise and physical activity into their daily lives, even when they do not think they have the time or inclination to do so. The author reviews the benefits that even moderate amounts of activity can confer on diabetes control, noting particularly the positive aspects of both aerobic activity and resistance training. The article includes an illustration of a simple set of resistance training exercises that can be done with light pounds or household items like soup cans or water bottles. Readers may find it easier to start a program of resistance training because it can feel less taxing on the body than aerobic activities like running, biking, or walking. Aerobic activity can use up some stored glycogen in the muscles, which can help increase insulin action for a period afterwards. Resistance training can result in more muscle mass, which means a greater storage deposit for carbohydrates and a higher metabolism, which can help with weight loss. Readers are reminded to check with their health care provider before starting any new program of exercise.

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What I Need to Know About Physical Activity and Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 15 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about the role of physical activity and exercise in a complete diabetes management program. Topics include the benefits of a physically active lifestyle, the kinds of physical activity that may be appropriate, cautions for some types of physical activity, the interrelationship between exercise and low blood glucose levels, how to get started on an exercise program, and how to stay motivated to maintain a physically active lifestyle. Suggestions are provided for incorporating exercise into everyday activities, for making sure that aerobic exercise is included, and for stretching and strength training. A sidebar lists tips for treating low blood glucose episodes. The booklet includes contact details for resource organizations where readers can get more information. A final section summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 6 figures.

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Diabetes Lifestyle Book: Facing Your Fears and Making Changes for a Long and Healthy Life. Oakland, CA: New Harbinger Publications, Inc. 2007. 230 p.

This book offers practical suggestions for people coping with diabetes and its complications. The authors focus on the barriers to comprehensive diabetes self-care, including barriers that may be self-inflicted, using a technique called acceptance and commitment therapy (ACT). The book includes a set of self-knowledge exercises that can help readers learn a set of skills and strategies to help them keep their health and their life going in positive directions. The book includes 13 chapters that cover basic diabetes information, acceptance of diabetes, motivation and persistence, the role of commitment, food and nutrition, exercise and physical activity, medications, preventing and treating complications, behavior change, and the role of communication. The authors use numerous case examples, the stories of real people, and practical suggestions to implement everyday activities that help readers connect with the information provided, set and achieve realistic goals, and feel empowered. Specific self-knowledge exercises are provided throughout the book. 29 references.

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Hypoglycaemia in Children With Diabetes. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 190-216.

This chapter on hypoglycemia in children with diabetes is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The author stresses that children are very susceptible to repeated and severe episodes of hypoglycemia, with long-term consequences. This chapter examines the etiology, physiology, consequences, and management of episodes of hypoglycemia during childhood. Specific topics include a definition of hypoglycemia in childhood diabetes; nocturnal hypoglycemia; risk factors for hypoglycemia; glycemic control; the varying insulin requirements at different ages; intensive insulin regimens; diet and nutrition; physical activity and exercise; genetics; counterregulation in childhood, glucagon; epinephrine response; the effect of sleep stage on counterregulation; and the consequences of hypoglycemia, including cognitive impairment, hypoglycemic hemiplegia, and fear of hypoglycemia. A final section of the chapter focuses on the management of hypoglycemia, including prevention, patient education, insulin use, diet therapy, and exercise. 3 figures. 3 tables. 109 references.

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Lifestyle Interventions For Patients With Diabetes. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 405-464.

Physicians who manage patients with diabetes should have a basic understanding of behavioral interventions as they relate to diabetes management. Successful long-term diabetes self-management requires the integration of pharmacotherapy, proper nutrition, home blood glucose monitoring, continuing patient education, an increase in physical activity, and surveillance for and prevention of complications. This chapter about lifestyle interventions for patients with diabetes is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author discusses how to improve adherence to diabetes self-management strategies, patient noncompliance versus nonadherence, ways to delegate patient care responsibilities, medical nutrition therapy (MNT) and how to discuss MNT with patients, the diabetes food pyramid, the exercise prescription for diabetes, travel tips for patients with diabetes, and the role of self blood glucose monitoring (SMBG). The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 5 figures. 14 tables. 59 references.

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Metabolic Syndrome and Obesity. Totowa, NJ: Humana Press. 2007. 303 p.

This book presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. In the introduction, the author briefly considers the historical perspective of obesity and focuses on the potential role of cost and availability of different types of foods and their impact on obesity. The book then offers 11 chapters that cover: definitions and prevalence; epidemiology and metabolism; costs, pathology, and health risks of obesity and the metabolic syndrome; the natural history of obesity, including differential diagnosis, clinical types, and age-related changes; patient evaluation, prevention, and introduction to treatment; diet; behavior modification; physical activity and exercise in the obese; pharmacological treatment of the overweight patient; treatments for the whole metabolic syndrome or its components; and surgical treatment for the overweight patient. Each chapter includes an outline, figures and tables, and concludes with an extensive list of references. A subject index concludes the volume.

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Overcoming Lifelong Habits: Making Medical Nutrition Therapy and Physical Activity Work for all Patients. Diabetes Educator. 33(Suppl 4): S82-S86. April 2007.

This chapter on medical nutrition therapy (MNT) and physical activity in people with type 2 diabetes is from a special, continuing education supplement to Diabetes Educator that helps readers understand some of the barriers to insulin use among their clients. Nearly 60 percent of individuals diagnosed with type 2 diabetes maintain A1C levels higher than the recommended target of 7 percent. The author notes that MNT alone can reduce AIC levels by 1 to 2 percent—observable within 3 to 6 months of initiation—while ongoing, regular exercise lowers A1C levels, increases insulin sensitivity, and reduces cardiovascular disease risk and mortality. The author provides guidance regarding current lifestyle recommendations as well as a series of strategies to help overcome patient resistance. The author contends the present approach to patient care is a top-down, prescriptive approach that is ill-suited to an environment in which patients' language, literacy, and culture may differ from that of providers. When patients are invited to participate, ask questions, and express opinions, they perform more self-care activities and have improved outcomes. The collaborative approach also gives health care providers the opportunity to help patients identify faulty knowledge, clarify beliefs and attitudes, and develop realistic goals. 1 figure. 2 tables. 16 references.

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Physical Activity and Exercise in the Obese. IN: Bray, G.A. Metabolic Syndrome And Obesity. Totowa, NJ: Humana Press. 2007. pp 185-202.

This chapter about physical activity and exercise in the obese is from a book that presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. Topics covered in this chapter include measuring energy expenditure, physical activity and health, treatment of overweight using exercise, and exercise as a strategy to maintain weight loss. The author emphasizes that changes in physical activity are particularly important in the pathogenesis of overweight and in its treatment; this aspect especially true for the long-term maintenance of weight loss when it involves the use of one or more large muscle groups and raises the heart rate. The chapter concludes with a list of specific suggestions for physical activity. The chapter includes an outline, figures and tables; it concludes with an extensive list of references. 4 figures. 3 tables. 47 references.

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Use of Insulin Pump Therapy in the Pediatric Age-Group: Consensus Statement from the European Society for Pediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society and the International Society for Pediatric and Adolescent Diabetes, Endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 30(6): 1653-1662. June 2007.

This article presents a consensus statement on the use of insulin pump therapy in the pediatric age group, implemented primarily to avoid recurrent episodes of hypoglycemia in patients seeking to achieve near-normal blood glucose ranges. Continuous subcutaneous insulin infusion (CSII) is used to closely simulate the normal pattern of insulin secretion and offers more flexibility and more precise insulin delivery than multiple daily injections (MDI). The consensus panel was convened to clear up controversy as to whether CSII has advantages over MDI in terms of reduction in blood glucose levels, occurrence of severe hypoglycemic events, episodes of diabetic ketoacidosis (DKA), and frequency of hospitalizations in young patients. In addition, physicians need guidelines for choosing patients for whom CSII therapy might be appropriate. Recommendations are provided in the areas of glycosylated hemoglobin (A1C) levels, severe hypoglycemia, blood glucose variability, physical activity and exercise, weight gain, metabolic deterioration, infusion site reactions, psychosocial issues, pump features, selecting an insulin pump, catheter features, calculating and timing the prandial (bolus) insulin requirement, monitoring patients on CSII, cost-effectiveness, and terminating CSII. The authors conclude that CSII use in children and adolescents may be associated with improved glycemic control and improved quality of life and poses no greater, and possibly less, risk than MDI. Minimizing the risks of CSII entails the same interventions that promote safety in all patients with type 1 diabetes, including proper education, frequent blood glucose monitoring, attention to diet and exercise, and the ongoing of communication with a diabetes team. 1 table. 95 references.

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"I Hate to Exercise" Book for People With Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association. 2006. 155 p.

Sticking to an exercise plan is tough, but the key is simple: stay active by making the most of the activities you already do. This revised and expanded book includes many easy ways to build activity and exercise into a daily, low-impact fitness routine. Designed for readers with diabetes, the book includes eight chapters: why exercise is so important for people with diabetes, establishing reasonable goals, the building blocks for an activity program, incorporating activity into everyday events and chores, activity across the lifespan, walking as a core exercise strategy, exercising safely with diabetes, and sample exercises, with line drawings illustrating how to do the exercises. Much of the information is presented in charts or checklists. One appendix offers a list of physical activity, diabetes, and health resources. A subject index concludes the text.

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Being Active. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 670-688.

Diabetes educators have an important and challenging role in helping individuals with diabetes and prediabetes be more physically active. This chapter on exercise and being active is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author notes that effective behavior change strategies, coupled with a solid understanding of current recommendations for physical activity and exercise, can be powerful tools for helping individuals incorporate physical activity into their diabetes management program. The chapter covers the importance of pre-exercise medical evaluations, how to develop a physical activity program, aerobic exercise, resistance (strength) training, safety considerations, modifications for clients with diabetes complications, modifications for obesity, modifications for older adults, considerations with children and adolescents, the stages of change for exercise behavior change, promoting lifestyle physical activity, the use of the Activity Pyramid, and the use of motivational interviewing to enhance behavior change. The author concludes that the true art of exercise program planning lies in the effective use of behavior change strategies to tailor programs to each individual’s health status, personal preferences, abilities, goals, and stage of readiness. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 1 figure. 3 tables. 44 references.

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Diet, Exercise, and Behavioral Treatment of Obesity. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 445-456.

This chapter on diet, exercise, and behavioral treatment of obesity is from a comprehensive textbook about diabetes and obesity. The author stresses that lifestyle interventions that change eating behavior, increase physical activity, and result in modest weight loss are known to prevent or delay diabetes in persons at high risk for the disease. Modest weight loss (5 to 10 percent of body weight), often achievable by a combination of reduced caloric intake and increased physical activity, lowers the risk of diabetes and insulin resistance and improves measures of glycemia and dyslipidemia in those with diabetes. The author includes a section that discusses strategies that promote behavior change. Behavior modification is a goal-oriented therapy that helps patients identify and change behaviors that prevent them from achieving their objectives for weight loss and increased physical activity. The author concludes that in order to successfully attack the interrelated diseases of obesity and diabetes, health-care providers and medical organizations need to transform the present model into a system that provides preventive care and early detection as an integral part of standard medical practice. 3 tables. 97 references.

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Epidemiology of Obesity and Diabetes: Prevalence and Trends. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 15-38.

Overweight and obesity have reached epidemic proportions globally along with an adoption of a Westernized lifestyle characterized by a combination of excessive food intake and inadequate physical activity. This chapter on epidemiology is from a comprehensive textbook on obesity and diabetes. In this chapter, the authors present the prevalence, secular trends, and geographic distribution of overweight, obesity, and diabetes in adults, children, and adolescents in the United States and in other developed countries, as well as in developing countries. The authors briefly summarize the epidemiological literature on obesity, weight gain, weight loss, and physical activity in relation to the risk of developing diabetes. The authors conclude that besides genetic predisposition, there is ample evidence that modifiable lifestyle factors such as obesity and physical inactivity are important determinants of the development of type 2 diabetes. In addition, lifestyle modifications, such as changes in exercise and dietary practices, can effectively delay or prevent the development of diabetes in high-risk groups. The authors stress that prevention of these two diseases in adults, and especially in children and adolescents, should be an essential component of future public health intervention programs. 12 figures. 6 tables. 70 references.

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Exercise, Nutrition, and Diabetes. IN: Mechanick, J.; Brett, E., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 297-312.

This chapter on exercise, nutrition, and diabetes is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors note that in diabetes management there is a complex interplay among physical activity, nutrition, pharmacological intervention, and genomics. In prediabetes and type 2 diabetes, physical activity is an essential component of treatment because it lowers blood glucose and reduces obesity. In type 1 diabetes, exercise can result in a complex set of metabolic derangements if careful monitoring and adjustments are not in place. Exercise plays an important role in preventing cardiovascular disease and cerebrovascular disease, both of which are major causes of morbidity and mortality in the diabetes population. The chapter discusses metabolic changes with exercise, and exercise in each of four types of diabetes: type 1, prediabetes, type 2, and gestational. 1 figure. 6 tables. 129 references.

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Obesity and Type 2 Diabetes Mellitus in Childhood and Adolescence. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 277-290.

Since the mid-1990s, an ever-increasing prevalence of obesity and diabetes in children has been observed. Childhood obesity is associated with substantial comorbidities and late complications, including cardiovascular, orthopedic, and psychosocial problems, whether or not obesity persists into adulthood. This chapter on obesity and type 2 diabetes mellitus in childhood and adolescence is from a comprehensive textbook on obesity and diabetes. The authors discuss epidemiology, genetic and environmental factors, clinical presentations (symptoms), screening procedures, a multidisciplinary treatment approach that includes the family, lifestyle and behavior modifications, counseling (individual, group, and family), exercise and physical activity, nutritional interventions, and drug therapy. The authors note that whereas diagnostic methods are clear and straightforward, treatment often remains difficult and frustrating for the patient, the family, and the multidisciplinary team providing health care. The authors caution that because of this reality, more attention must be paid to prevention and health promotion strategies. 2 figures. 3 tables. 77 references.

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Osteopenia. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Special Management Problems. Malden, MA: Blackwell Publishing Inc. pp. 340-359.

Osteopenia, or low bone mineral density (BMD), is a recognized complication of inflammatory bowel disease (IBD). This chapter on osteopenia is from a textbook that addresses some of the challenges in the understanding of ulcerative colitis (UC) and Crohn’s disease (CD), collectively known as IBD. After a section on bone physiology, including the role of corticosteroids and physical activity on bone mass, the author discusses the effect of cytokines on bone metabolism, the measurement of BMD, biochemical markers of bone metabolism, the multifactorial pathogenesis of osteopenia in IBD, the differences between CD and UC and how those differences impact the development of osteopenia, osteopenia in children with IBD, and the management of osteopenia in IBD. The author concludes that osteopenia in IBD is multifactorial, with corticosteroid use being the most relevant determinant in UC and inflammatory activity being the most important determinant in CD. The rate of bone loss is variable and quite small in the majority of patients; universal treatment with agents that improve BMD may be unnecessary. All patients should be encouraged to take adequate calcium and vitamin D, exercise regularly, and stop smoking. 6 figures. 5 tables. 99 references.

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Physical Activity, Exercise and Type 2 Diabetes: A Consensus Statement from the American Diabetes Association. Diabetes Care. 29(6): 1433-1438. June 2006.

This consensus statement from the American Diabetes Association summarizes the most clinically relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these advances. Topics include physical activity and the prevention of type 2 diabetes; the effects of structured exercise interventions on glycemic control and body weight in type 2 diabetes; physical activity, aerobic fitness, and risk of cardiovascular and overall mortality; recommended frequency of exercise; exercise for weight loss and weight maintenance; the role of resistance training; flexibility exercises (stretching); evaluation of the diabetic patient before recommending an exercise program; exercise in the presence of nonoptimal glycemic control, including managing hyperglycemia and hypoglycemia; and exercise in the presence of specific long-term complications of diabetes, notably retinopathy, peripheral neuropathy, autonomic neuropathy, and microalbuminuria and nephropathy. A final section offers specific recommendations in the areas of lifestyle measures for the prevention of type 2 diabetes, aerobic exercise, resistance exercise, and prevention of hypoglycemia. 70 references.

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Physical Activity. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 298-319.

A lifestyle the incorporates sufficient physical activity aids in diabetes prevention and is extremely beneficial to general health. This chapter on physical activity is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author reviews current physical fitness terminology, including health-related physical fitness; the role of physical activity in diabetes prevention and treatment; the effect of physical activity on diabetes management, including cardiovascular exercise, resistance exercises, and flexibility exercises; the physiological responses to physical activity, notably changes associated with blood glucose levels; hypoglycemia and physical activity; self-management strategies for safe physical activity, including adding carbohydrates, medication adjustments, and problem-solving; the four components of the exercise prescription, including intensity, mode, frequency, and duration; physical activity in special populations, including children and teens, and elderly adults; and medical considerations, including the need for preactivity medical exam and assessment, cardiovascular disease, neuropathy, nephropathy, and retinopathy. The author stresses that learning to overcome barriers that interfere with a more physically active lifestyle is a large part of diabetes self-management education. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 13 tables. 45 references.

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Physical Activity: Important for Fall Prevention. Quality Care. 24(3): 4, 9. 2006.

Many older adults fall each year and fall-related injuries may result in disability. This article, from a newsletter of the National Association for Continence, explains the role of physical activity in preventing falls. The author outlines the environmental hazards that can contribute to falls, as well as risk factors such as poor muscle strength, arthritis, poor vision, stroke, decreased judgment, taking more than four medications, and a fear of falling. The author also considers the interrelationship between urge incontinence and falls; individuals may be rushing to the bathroom and may not take precautions to get there safely. Physical activities can help prevent some falls and should include a stretching component for flexibility. Even low-intensity exercise improves balance and muscle strength. The article concludes by reiterating that staying active and healthy is the best way to improve continence outcomes, reduce falls, and maintain a good quality of life.

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Why Exercise Can Make a Difference. Nephrology News & Issues. 20(9): 50-52. August 2006.

Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article reminds readers of the benefits that can be attained from an intradialytic exercise program. The author notes that the recently published Kidney Disease Outcome Quality Initiative clinical practice guidelines on management of cardiovascular disease mandate that all dialysis patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their levels of physical activity. This article also serves as an introduction to another article in this same journal that describes an ongoing dialysis exercise program at the University of Virginia. The author calls for more research to demonstrate exactly how to assess functioning and encourage physical activity within the routine care of end-stage renal disease (ESRD) patients. 1 figure. 8 references.

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Adventure Travel and Type 1 Diabetes: The Complicating Effects of High Altitude. Diabetes Care. 28(10): 2563-2572. October 2005.

In keeping with recommendations to stay physically fit, increasing numbers of people with type 1 diabetes now participate in extreme forms of physical activity, including high-altitude trekking and mountain climbing. However, exercise at altitude imposes a number of unique challenges for people with type 1 diabetes, including impairment in glycemic control and additional problems for patients with complications. This article reviews what is known about the impact of altitude on individuals with type 1 diabetes, then offers strategies for dealing with these challenges. High altitude is defined as 3,000 to 5,000 meters (10,000 to 16,000 feet) and extreme altitude as that greater than 5,000 meters. The author reviews three studies in this area, then discusses acute altitude sickness (also called acute mountain sickness or AMS), the effects of altitude on glycemic control and on glucose meter performance, altitude-induced anorexia, altitude and temperature, and other concerns including the impact of long-distance travel, poor hygiene, gastrointestinal disturbances, food supplies, and isolation. The author concludes that there are no absolute contraindications to travel at high or extreme altitudes for the knowledgeable individual with type 1 diabetes who is free of complications. However, there is some risk, including the possible consequences of hypoglycemia, illness, or injury. Specific recommendations for individuals with type 1 diabetes traveling at altitude are summarized in a table. 1 figure. 3 tables. 78 references.

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Diabetes Educators and the Exercise Prescription. Diabetes Spectrum. 18(2): 108-113. Spring 2005.

Physical activity and the exercise prescription is an integral component of the diabetes self-management training (DSMT) plan for any patient with diabetes or anyone at risk for developing type 2 diabetes. This article provides guidance for diabetes educators (regardless of health care background) by defining the assessment process and the information required to develop the exercise prescription. Topics include managing diabetes complications such as retinopathy and nephropathy, orthopedic problems, cardiovascular considerations, problems with motivation and psychosocial factors, areas of responsibility for diabetes educators, and the role of physical therapists. The author cautions that the potential risks of beginning an exercise program often have to be balanced with the presence of other diseases, diabetes complications, and medication regimens. The author also examines the contributions of clinical exercise professionals to the diabetes team, specifically within the scope of practice for reimbursement potential. Professional resources are discussed and recommended. The author concludes that diabetes educators from a variety of health care professions are responsible for the successful inclusion of this component into lifestyle behaviors; the multidisciplinary team approach is the preferred delivery system for DSMT. 24 references.

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Finding Your Way to a Healthier You: Based on the Dietary Guidelines for Americans. Department of Health and Human Services. 2005. 12 p.

This brochure, based on the 'Dietary Guidelines for Americans 2005,' offers basic advice on how good dietary habits can promote health and reduce risk for major chronic diseases, such as heart disease, diabetes, osteoporosis, and certain cancers. The brochure has three sections: how to make smart choices from every food group; how to balance food and physical activity; and how to get the most nutrition out of the calories ingested. Specific topics include making good decisions at restaurants, incorporating fruits and vegetables into a daily meal plan, the role of exercise and daily activity, the different types of fats, the role of sodium and potassium, the information on the nutrition facts label and how to use it, safe food handling and storage, and the use of alcohol. The brochure is illustrated with simple line graphics.

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Fishes, Whales, and Fishing Tips: Hooking an Active Lifestyle. Diabetes Spectrum. 18(2): 114-118. Spring 2005.

Given that a physically active lifestyle is important to health and quality of life, health care professionals are faced with the challenge of guiding individuals as they attempt to increase their level of physical activity. This article shares the suggestions of several lifestyle interventionists (many of whom were part of the Diabetes Prevention Program) gleaned from their experiences with participants and patients whom they have encountered through the years. The authors first review the benefits of an active lifestyle for people with diabetes, then discuss the problem of many people who continue to choose a sedentary lifestyle. Other topics covered include public health recommendations, the Diabetes Prevention Program (DPP) and its findings, the importance of maintaining any exercise or activity program, the fun of exercising with friends, creative ways to incorporate exercise and activity into everyday life, and how to handle and overcome barriers to exercise. 13 references.

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Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial. Annals of Internal Medicine. 142(5): 313-322. March 2005.

Weight loss and increase physical exercise reduce the risk for diabetes in people with impaired glucose tolerance (IGT), however evidence on the effects of these interventions on people without IGT is lacking. This article reports on a study undertaken to examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without IGT and in a post hoc subgroup analysis by baseline cigarette smoking status. The study included 12,866 men aged 35 to 57 years, at risk for cardiovascular disease, who were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years. This article reports on 11,827 men from this group who were without diabetes or IGT at entry and for whom follow-up glucose measurements were available. Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group. Results showed that 11.5 percent of the special intervention group and 10.8 percent of the usual care group developed diabetes over 6 years of follow-up. The authors conclude that weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers. 1 figure. 5 tables. 52 references.

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Keeping Off Lost Weight. Diabetes Forecast. 58(2): 58-61. February 2005.

This article considers the difficulties of losing weight and keeping it off, and investigates some of the strategies that successful weight loss requires. The author shares some information from the National Weight Control Registry (NWCR) which includes people who have lost at least 30 pounds and kept it off for at least one year. Every year, the researchers at the NWCR ask the registrants questions about their weight, eating habits, and physical activity. The people who are most successful in maintaining weight loss have four factors in common: eat a reduced-calorie, low-fat, moderately high-carbohydrate diet, try to eat breakfast every day, check weight regularly, and exercise regularly. The author concludes by encouraging readers to continue with needed efforts to lose weight and to maintain weight loss. Changing eating habits and increasing physical activity can help people lose weight and keep it off. 3 figures.

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Management of Competitive Athletes with Diabetes. Diabetes Spectrum. 18(2): 102-107. Spring 2005.

This article describes an effective management plan for an athlete with type 1 diabetes. Such a plan must consider the energy demands of intense competition and training, the athlete's goals, factors related to competitive sports that may affect glucose homeostasis, and strategies that may be employed to allow safe, effective sports participation. One section addresses how to minimize risky behaviors, including omission of insulin for weight loss. The authors focus on nutrition, diet therapy and energy needs. They caution that the most common acute risks for competitive athletes with diabetes are exercise-induced hypoglycemia and deterioration of hyperglycemia and ketosis brought on by physical activity during periods of hypoinsulinemia. The authors conclude that athletes should be appropriately screened, counseled to avoid risky behaviors, and provided with specific recommendations for glucose monitoring and insulin and diet adjustments so that they may anticipate and compensate for glucose responses during sports competition. 1 figure. 38 references.

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Patient Information: Planning for Physical Activity. Clinical Diabetes. 23(4): 160 p. Fall 2005.

Despite the many demonstrated benefits of exercise for diabetes control, many patients with diabetes do not include regular exercise as an integral part of their diabetes management plan. This patient education fact sheet outlines ways to incorporate physical activity and exercise into daily life activities. The fact sheet first lists the benefits associated with regular exercise, including improved blood glucose control, reduced need for insulin and pills for diabetes management, improved body weight management, improved cholesterol, lowered blood pressure, maintenance of bone health, reduction of heart disease risks, and relief of depression and anxiety. The fact guided readers through an assessment of their typical day, physical activities that they enjoy, physical activities they are interested in trying, and any potential obstacles to exercising. Readers are encouraged to then discuss the answers with their health care provider and find physical activities they will enjoy.

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Physical Activity: The Magic of Movement. Diabetes Self-Management. 22(1): 7-12. January-February 2005.

This article explores the benefits of physical activity for people with diabetes. These benefits can include lower blood glucose readings, reduced stress, and decreased body fat. The authors explain how exercise can lower blood glucose by both burning glucose and by improving the body's ability to use insulin. This improvement in insulin sensitivity may even allow some people with Type 2 diabetes to reduce or discontinue blood-glucose-lowering medications. The cardiovascular benefits are also particularly important in a patient population at high risk for cardiovascular complications. Other topics covered include steps to take before undergoing an exercise program, how diabetes complications can affect one's choice of physical activities, the significant health benefits that can be obtained by a moderate amount of physical activity, the importance of warm-up and cool-down periods, foot care, use of medical identification tags, the need to have a carbohydrate source available during and after exercise, and hypoglycemia concerns. The authors conclude by recommending that patients make a commitment to physical activity and work with their doctor to plan a individualized exercise prescription.

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Postpartum Physical Activity and Related Psychosocial Factors Among Women with Recent Gestational Diabetes Mellitus. Diabetes Care. 28(11): 2650-2654. November 2005.

This article reports on a study undertaken to examine patterns of postpartum physical activity among women with recent gestational diabetes mellitus (GDM). The authors focused on psychosocial factors related to this physical activity that could be addressed in diabetes prevention interventions. The telephone survey included on a random sample of women who had attended diabetes clinics in Sydney, Australia, for treatment of GDM in the past 6 to 24 months. Of the 226 women (mean age 33.4 years) who completed the survey, 26.5 percent were classified as sedentary and only 33.6 percent reported sufficient physical activity as recommended by health authorities. Walking was the most popular physical activity and most women reported no other moderate- or vigorous-intensity activity. The most common barriers to physical activity noted were lack of assistance with child care (49.1 percent) and insufficient time (37.6 percent). The type of social support for physical activity most often reported was verbal encouragement (39.1 percent), with more than half of the women reporting they never receive assistance with housework or have others exercise with them. The authors conclude that the prevalence of sufficient physical activity was found to be low and strongly related to social support and self-efficacy. They suggest that emphasis should be given in patient educational interventions to the legitimacy of women taking time away from their day-to-day responsibilities to participate in physical activity. 3 tables. 32 references.

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Racial/Ethnic Differences in Leisure-Time Physical Activity Levels Among Individuals With Diabetes. Diabetes Care. 27(10): 2493-2494. October 2004.

Diabetes affects 18.2 million people or 6.3% of the U.S. population and is associated with significant morbidity, mortality, and health care costs. Regular physical activity is beneficial for the prevention and management of diabetes and established benefits include improvement in blood glucose control, reduction of cardiovascular risk factors, weight loss, and improvement in well-being. This article reports on a study undertaken to determine racial and ethnic variations in 23 leisure-time physical activities (LTPAs) among adults with diabetes and to assess the independent effects of activity limitations and comorbidity on racial and ethnic differences in this population. The LTPAs included walking, gardening or yard work, stretching exercise, weight lifting, jogging or running, aerobics, riding a bicycle, stair climbing, swimming, playing tennis, playing golf, bowling, playing baseball or softball, playing basketball, skiing, playing volleyball, playing soccer, and playing football. The study included 1,850 adults with diabetes who were interviewed in 1998. Overall, only 25 percent engaged in moderate or vigorous LTPA daily. This varied from 16 percent in blacks to 23 percent in Hispanics to 27 percent in whites. The major findings of this study are that levels of leisure-time physical activity are generally low across all racial/ethnic groups with diabetes, that blacks are less physically active than whites, and low levels of physical activity in black women account for essentially all of the observed racial differences between whites and blacks. 1 table. 11 references.

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Say Yes to Physical Activity. Diabetes Wellness News. 11(6): 4. June 2005.

This brief article lists the ten most common excuses for not being physically active and offers ways to address each of the barriers to exercise. The excuses are: not enough time; exercise hurts; exercise is boring; too tired to exercise; exercise is not safe; exercise may cause injury; too old to exercise; there is no benefit to exercise; walking causes shortness of breath or is uncomfortable; and joining a gym is too expensive. Readers are encouraged to incorporate physical activity into their everyday lives and to begin with small goals and changes. Any form of physical activity offers health benefits. 3 figures.

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Sneaking in Fitness: Put the 'Active' Into Your Family's Everyday Activities. Diabetes Forecast. 58(3): 54-58. March 2005.

This article helps readers increase their family's activities level through every day habits and practices. The author stresses that even modest amounts of physical activity can improve everyone's health. A combination of structured and daily activities that add up to at least 30 minutes of physical activity a day is recommended. Overall fitness includes strengthening exercises and flexibility, as well as cardiovascular exercise. Specific suggestions for family-friendly activities are provided. One section offers five healthy nutrition tips that can tailor into a busy family's quest for health. A final section addresses the problem of sedentary screen-based activities, such as watching television, surfing the net, or playing video games. 3 figures.

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Socioeconomic Correlates of Global Complication Prevalence in Type 1 Diabetes (T1D): A Multinational Comparison. Diabetes Research and Clinical Practice. 70(2): 143-150. November 2005.

This article reports on a study that investigated the extent to which the geographic variation in the complications of type 1 diabetes (T1D) may reflect the socioeconomic status (SES) conditions and health care performance (HCP) of countries around the world. The World Health Organization (WHO) DiaMond complications study (DiaComp) is a multinational, cross-sectional study of complications in T1D. Information on complications was identified for 892 subjects from 14 clinical centers in 12 countries. All participants were diagnosed with diabetes in childhood (less than 15 years of age) and had disease duration of 5 to 24 years. Complications data were linked to center-specific information on the local social and economic landscape, health care access and diabetes management practices and health care costs. Country-specific indicators of social and economic development were also linked to the complications data. Results show that both diabetes complications and economic and health care factors vary widely across the DiaComp centers. Health system performance, as measured by disability adjusted life expectancy (DALE), gross national investment (GNI) per capita and purchasing power all showed strong consistent correlations with complications, and significant independent associations with complication prevalence after controlling for HbA1c and hypertension. The authors hypothesize that economic factors might be directly associated with complication prevalence given that the cost of treating diabetes is quite high. Higher treatment costs might preclude developing economies from having the ability to provide recommended levels of diabetes care. Physical activity may also be influenced by economics, with access to exercise and recreational facilities largely determined by the availability of individual and community resources. The authors conclude that health system performance, social distribution of wealth, and purchasing power may play important roles in explaining the geographic variation of diabetes complications. 1 appendix. 4 tables. 12 references.

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Walk, Cycle and Enjoy the Outdoors This Fall. Diabetes Vital. 1(3): 14. Fall 2005.

This brief article encourages readers to use the Fall weather as an impetus to get outside and exercise. Walking and cycling are both enjoyable in the Fall and provide benefits for patients with diabetes. These exercises can help readers lose weight, lower their blood glucose, respond better to insulin, reduce cholesterol levels and blood pressure, improve circulation, reduce stress, and lower their risks for heart disease. The author provides specific suggestions for strategies to safely incorporate walking and cycling into any regular program of exercise and physical activity.

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All About Physical Activity for People with Diabetes. Alexandria, VA: American Diabetes Association. 2004. 2 p.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on physical activity for people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet first reviews the importance of physical activity for people with diabetes, then suggests ways to begin incorporating physical activity into one's regular habits. The fact sheet defines a comprehensive physical activity routine as including four kinds of activities: being active throughout the day, aerobic exercise, strength training, and flexibility exercises (such as stretching). The fact sheet then offers practical suggestions in each of these four areas. Blank space is available for readers to record their plan for each area. 1 figure.

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Benefits and Risks of Exercise: From Heart-Healthy to Heartburn. Digestive Health and Nutrition. p. 12-14. March/April 2004.

The overall benefits of exercise are outstanding, however physical activity may be responsible for flare-ups of some gastrointestinal diseases. This article explores the benefits and risks of exercise, focusing on gastroesophageal reflux disease (GERD), gastrointestinal bleeding, ulcers, inflammatory bowel disease (IBD), and colorectal cancer. For each condition, the author outlines symptoms to watch for, strategies to prevent complications, and risk factors. The author encourages readers to incorporate physical activity into their everyday lifestyle, perhaps with preventive medicine or less vigorous workouts, if necessary. 1 figure. 3 references.

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Diabetes and Cardiovascular Disease Toolkit. Alexandria, VA: American Diabetes Association. 2004. (Instructional Packet).

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. Physicians are encouraged to talk with diabetes patients about their increased risk for heart disease and stroke. This CD-ROM offers a set of 26 reproducible patient education handouts on topics related to diabetes CVD. Topics include pre-diabetes, getting the best care for diabetes, taking care of type 2 diabetes, blood glucose levels in people with type 2 diabetes, insulin resistance, making wise food choices, choosing dietary fats wisely, cooking with heart healthy foods, how to read food labels, carbohydrate counting, weight loss, physical activity, how to begin a program of exercise, behavior change, recognizing and handling depression, treating high blood pressure (hypertension), treating high cholesterol (hypercholesterolemia), the signs of a heart attack, prevention strategies, taking aspirin, stroke, peripheral arterial disease, medical tests and procedures for finding and treating heart and blood vessel disease, managing medicines, and recordkeeping strategies. The CD-ROM requires Acrobat Reader to view each document.

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Getting Started with Physical Activity. Alexandria, VA: American Diabetes Association. 2004. 2 p.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on getting started with physical activity for people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet first reviews the importance of physical activity for people with diabetes, then suggests ways to begin incorporating physical activity into one's regular habits. The fact sheet recommends a visit to the health care provider before starting a program of physical activity. The fact sheet defines a comprehensive physical activity routine as including four kinds of activities: being active throughout the day, aerobic exercise, strength training, and flexibility exercises (such as stretching). Additional sections discuss how activity affects blood glucose levels, the symptoms of low blood glucose (hypoglycemia), planning for exercise, and the importance of medical identification tags. A checklist of suggestions for getting started with physical activity is also provided. 2 figures.

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It's Not Too Late to Prevent Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2004. 4 p.

This brochure, from the National Diabetes Education Program (NDEP), is part of a program urging adults age 60 and over who are at risk for type 2 diabetes to increase their physical activity to prevent the disease. The brochure offers three easy steps for readers to follow, incorporating strategies for warming up, walking, stretching, adding exercise to every day activities, and dancing. One of the steps focuses on the importance of making healthy food choices and cutting down on the amount of food eaten to help manage body weight and prevent type 2 diabetes. A final section of the brochure encourages readers to work closely with their health care providers, to make small changes in their lifestyle, and to persist because even small changes can make a big change in health and diabetes prevention. The brochure is illustrated with full-color photographs of seniors engaged in a wide variety of activities. The contact information for two resources is also provided: the NDEP (800-438-5383) and the Weight Control Information Network (WIN; 877-946-4627 or www.niddk.nih.gov).

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Nutrition and Physical Activity in Diabetes. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 49-69.

Medical nutrition therapy (MNT) and physical activity have been considered the cornerstones of metabolic control in both type 1 and type 2 diabetes for decades. More recently, these lifestyle components have proven valuable in preventing type 2 diabetes. This chapter on nutrition and physical activity in diabetes mellitus is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. The author notes that the challenge for health professionals in implementing MNT and exercise guidelines is recognizing that the person with diabetes is responsible for 99 percent of the day-to-day management of diabetes, and ultimately makes the choice of what, when, and how much to eat and exercise. Helping patients prioritize strategies and develop critical thinking to problem solve around day-to-day hassles of diabetes is crucial to achieving metabolic control. Topics include healthy eating, glycemic control, body weight, minimizing weight gain, calorie restriction and weight, nutrient composition and weight, exercise and weight, carbohydrates, quantity of carbohydrate, type of carbohydrate and glycemic index, carbohydrate counting, physical activity and glycemic control, protein and renal (kidney) function, fat and cardiovascular risk, and alcohol. 1 figure. 3 tables. 106 references.

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Physical Activity-Exercise and Type 2 Diabetes. Diabetes Care. 27(10): 2518-2539. October 2004.

Exercise has been a cornerstone of diabetes management, along with diet and medication. This review article examines areas of major advances that have occurred since the last American Diabetes Association technical review of exercise and Type 2 diabetes in 1990. Advances in basic science have increased the understanding of the effects of exercise on glucoregulation. Large clinical trials demonstrating that lifestyle interventions (diet and exercise) reduce incidence of Type 2 diabetes in people with impaired glucose tolerance (IGT). Studies of structured exercise interventions in Type 2 diabetes have shown the effectiveness of exercise in reducing HbA1c (glycosylated hemoglobin, a measure of blood glucose over time), independent of body weight and the association between exercise training intensity and change in HbA1c. Large cohort studies have shown that low aerobic fitness and low physical activity level predict increased risk of overall and cardiovascular disease (CVD) mortality in people with diabetes. Clinical trials have shown the effectiveness and safety of resistance training (such as weight lifting) for improving glycemic control in Type 2 diabetes. 2 figures. 2 tables. 190 references.

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Annual Review of Diabetes 2003. Alexandria, VA: American Diabetes Association. 2003. 168 p.

This issue of the Annual Review of Diabetes includes twenty research articles in three categories: epidemiology and pathogenesis, treatment, and complications. Specific topics include the rise of childhood type 1 diabetes in the 20th century; immunological markers in the diagnosis and prediction of autoimmune type 1a diabetes; adults with prediabetes; the energy homeostasis system and weight gain; the metabolic syndrome and incidence of type 2 diabetes; the peroxisome proliferator; the use of oral glucose tolerance tests in clinical practice; the economic costs of diabetes in the United States; diet and exercise among adults with type 2 diabetes; trends for achieving weight loss and increased physical activity; postprandial (after a meal) glucose control; strategies for the treatment of dyslipidemia; self-management education of adults with type 2 diabetes and its impact on glycemic control; common drug pathways and interactions; the interactions of prescribed medications and over-the-counter medications; obstructive sleep apnea in patients with diabetes; gestational diabetes and the incidence of type 2 diabetes; glucose monitoring in gestational diabetes; genetic studies of late diabetes complications; and eating disorders in adolescent girls and young adult women with type 1 diabetes. Each article concludes with a list of references.

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Approach to the Patient with Obesity. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 752-760.

Obesity is an overabundance of adipose tissue that arises from an excess of energy intake compared to expenditure. Obesity is not simply the result of gluttony and a lack of willpower. Rather, each individual inherits a set of genes that control appetite and metabolism, and a genetic tendency to gain weight that may be exacerbated by environmental conditions such as food availability, level of physical activity, and individual psychology and culture. This chapter on the approach to patients with obesity is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include molecular circuitry of body weight regulation, comorbidities of obesity, history and physical examination, and treatment strategies. The authors conclude that obesity is a common chronic disorder associated with multiple gastrointestinal comorbidities. Current nonsurgical treatments for obesity produce mean losses of 5 to 10 percent of body weight, enough to relieve many of these comorbidities. Diet, exercise, and behavior therapy form the cornerstone of treatment for obesity. In certain individuals, the addition of drug therapy or surgery is indicated if a more conservative approach has failed. 1 figure. 5 tables. 59 references.

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Core Curriculum for Diabetes Education. 5th ed.: (Volume 2) Diabetes Management Therapies. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. 341 p.

This guidebook is the second in a series of four handbooks in the CORE Curriculum, a project originally planned to help educators prepare for the Certified Diabetes Educators (CDE) exam. However, the use and scope of the CORE Curriculum has expanded; it is both a key reference for the Advanced Diabetes Management credential exam and an authoritative source of information for diabetes education, training, and management. This first volume covers diabetes management therapies. Topics include medical nutrition therapy for diabetes; physical activity and exercise; pharmacologic (drug) therapies for glucose management; pharmacologic therapies for hypertension (high blood pressure) and dyslipidemia (altered levels of blood fats, including cholesterol); monitoring; pattern management of blood glucose; insulin pump therapy and carbohydrate counting for pump therapy, including the use of insulin-to-carbohydrate ratios; hypoglycemia (low blood glucose levels); and coping with illness and surgery. Each chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). The handbook concludes with a subject index.

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Exercise in Dialysis: Magic Bullet or Unnecessary Risk?. Nephrology Nursing Journal. 30(5): 580-581. October 2003.

Restoring dialysis patients to the level of functional ability and physical activity they had prior to the onset of kidney disease has always been a key goal in the care of the patient with end stage renal (kidney) disease (ESRD). The typical ESRD patient exhibits a much lower tolerance of physical activity than normal, which can be attributed to deconditioning usually caused by sedentary lifestyle, chronic disease, and multiple comorbidities. This article considers the risks and benefits of exercise for patients on dialysis. Topics include the barriers to exercise that dialysis patients face, and the implementation of an exercise program during dialysis therapy. The authors conclude that one of the biggest advantages of such a program is to witness positive functional changes in the patients' lives after starting the exercise program and to see the impact on their independence. The patients are self-motivated to continue the in-chair dialysis exercise program as their quality of life improves. 9 references.

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Healthy Habits for Healthy Kids: A Nutrition and Activity Guide for Parents. Chicago, IL: American Dietetic Association. 2003. 13 p.

This pamphlet helps parents of children who are overweight or who are at risk of becoming overweight, outline and reach wellness goals by making healthy changes at home. Parents are reminded that healthy eating and physical activity do not become habits overnight; it takes time and effort to make them part of a daily routine. This guide offers recommendations that are most appropriate for children ages 4 to 12 years. Topics include the importance of involving the whole family in healthy behaviors, how to set realistic goals, the use of a daily food and activity log, the role of family mealtimes, the food pyramid as a tool for establishing a balanced diet, exercise and activity options for the whole family, and healthy hints for eating out at restaurants with kids. The pamphlet includes many interactive sections, with space for parents and children to fill in their present activities, their goals for behavior change, and how they will approach those goals. The website addresses for a number of resource organizations are also provided. The pamphlet is also available in Spanish.

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Increasing Physical Activity in People With Type 2 Diabetes. Diabetes Care. 26(4): 1186-1192. April 2003.

This article reports on a study undertaken to evaluate the effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes. A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n = 35) or no (n = 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Between-group differences were recorded for the change in minutes of moderate activity and activity counts per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week. The control group recorded no significant changes. More experimental participants increased stage of change. Between-group differences were recorded for the change in total exercise duration and peak gradient, systolic blood pressure, and fibrinogen. The authors conclude that exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes. 2 figures. 1 table. 29 references.

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Jump Into Summer New Exercise Routines To Get You Going. Diabetes Forecast. 56(6): 33-36. June 2003.

This article helps readers with diabetes to get motivated to start or revitalize their exercise program in the springtime. The author focuses on a variety of outside activities that may not even feel like exercise. Yet these activities can be great ways to shed unwanted calories, keep waistlines trim and hearts healthy, spend time with family and friends, and have fun. The author discusses hiking, tennis, and golf. One chart lists the average calories expended during one hour for various activities, including bicycling, canoeing, dancing, gardening, playing with children, jumping rope, swimming, softball, tennis, and volleyball. One sidebar encourages readers to consult with their health care providers before starting any program of physical activity. 1 table.

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Myth of Brittle Diabetes. Diabetes Self-Management. 20(4): 64, 66-67, 70, 73. July/August 2003.

This article contends that the 'diagnosis' of brittle diabetes is a myth, that there is really no such diagnosis and there is usually a logical explanation for variations in blood glucose readings. The author encourages readers to keep good records as the first step in demystifying seemingly outrageous blood glucose variations. A good set of records should include blood glucose values, insulin or oral medicine doses, the amount of carbohydrate eaten at meals and snacks (with notes about high fat or extra-large meals), and physical activities, including both formal exercise and daily activities such as shopping, yard work, and extended walking. Other topics covered include sources of variability, the different types of insulin (and their activity profiles), food intake, types of food, physical activity, hormones (related to stress, illness, menstruation, puberty), the role of additional SMBG during times of difficult blood glucose management, disease progression, and the impact of sleep, caffeine, alcohol, medications, and travel on blood glucose levels.

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Physical Activity/Exercise. In: Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 2) Diabetes Management Therapies. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. p. 59-92.

Implementing and maintaining an exercise program is a primary component of diabetes management. This chapter on physical activity and exercise is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. In this chapter, the authors use the term 'physical activity' when discussing options that can lead to health and diabetes benefits. Topics include the benefits of physical activity; the physiological response to increased physical fitness in individuals with and without diabetes; the risks associated with physical activity and ways to minimize risks; the principles of increasing physical activity levels for people with diabetes; appropriate physical activity options for special populations; and strategies for self-directed physical fitness programs. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 9 tables. 88 references.

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Physical Activity: The Best Move You Can Make. Alexandria, VA: American Diabetes Association. 2003. 3 p.

This brochure helps people with diabetes understand the vital role of exercise as part of their complete program of diabetes management. The brochure encourages readers to commit to a regular 30 minute program five days a week, explaining the many health benefits of such an approach. The brochure walks readers through the beginning steps of introducing physical activities into their lives. One chart lists some standard activities, including housework, recreational activities, sports and exercise, and the corresponding number of calories burned per hour. Practical strategies for healthy physical activity are presented. One section outlines a walking program that can be the key to a successful weight loss and fitness plan. Readers are advised to work closely with their health care providers and to contact the American Diabetes Association (www.diabetes.org) for more information. 2 tables.

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Take the 10-G Challenge. Diabetes Forecast. 56(9): 97-98. September 2003.

This article encourages readers who already undergo a regular walking program to add in some new challenges. The authors suggest that readers personalize their walking regimen to build on individual accomplishments, map out favorite routes, and add new challenges. The authors focus on one strategy: the goal of 10,000 steps a day (roughly five miles). The authors remind readers that physical activity does not have to be structured in order to be beneficial. Every step counts, whether it takes place on a planned exercise walk or just happens in the course of the day. The authors discuss the use of a pedometer to help keep track of the steps taken. They also offer a suggestion for gradually increasing the amount of steps taken each day.

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Type 2 Diabetes. Yardley, PA: The StayWell Company: KRAMES Health and Safety Education. 2003. 13 p.

This booklet helps readers recently diagnosed with type 2 diabetes understand and manage the disease. Type 2 diabetes is a chronic and progressive condition that makes it hard for the body to break food down into energy. The booklet first describes the professionals who may be a part of the patient care team, including an endocrinologist, a registered dietitian, a diabetes educator, and a psychologist or social worker. The booklet then discusses the pathology of type 2 diabetes, the importance of managing the disease, how to check one's blood glucose (sugar), healthy eating, the role of physical activity and exercise, medications and drug therapy, treating high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia) levels, the need for regular doctor's visits, self care, preventive strategies (i.e., preventing hypoglycemia while driving, preparing for emergencies), preparing for special situations (sick days, travel), and where to find emotional support. The brochure is illustrated with full-color drawings of patients and health care providers. The brochure concludes with the contact information for four resource organizations that can provide assistance. The brochure is also available in Spanish. 39 figures.

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Validation of a Counseling Strategy to Promote the Adoption and the Maintenance of Physical Activity by Type 2 Diabetic Subjects. Diabetes Care. 26(2): 404-408. February 2003.

There is enough evidence that physical activity is an effective therapeutic tool in the management of type 2 diabetes. This article reports on a study designed to validate a counseling strategy that could be used by physicians in their daily outpatient practice to promote the adoption and maintenance of physical activity by people with type 2 diabetes. The long term (2 year) efficacy of the behavioral approach (n = 182) was compared with usual care treatment (n = 158) in two matched, randomized groups of patients with type 2 diabetes who had been referred to the authors' Outpatient Diabetes Center. After 2 years, 69 percent of the patients in the intervention group and 18 percent of the control group achieved the target with significant improvements in body mass index (BMI) and HbA1c (glycosylated hemoglobin, a measure of blood glucose over time). The authors conclude that these results show that physicians can motivate most patients with type 2 diabetes to exercise long term and emphasize the value of individual behavioral approaches in daily practice. 3 tables. 25 references.

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Best and Worst Exercises for Weight Loss. Diabetes Forecast. 55(4): 69-70, 72, 74. April 2002.

This article, one in a series of six articles on healthy weight loss, summarizes the best and worst exercise for weight loss. Written for people with diabetes, the article notes that improvements in blood glucose (sugar) levels can occur even with relatively modest weight losses of from 5 to 15 percent of body weight. The author emphasizes that physical activity is an important piece of a larger program; optimizing weight loss efforts requires a combination of healthy diet and physical activity. The author also discusses the special situation of readers with diabetes who would like to implement an exercise program; readers are encouraged to work closely with their health care team in any major change of their diabetes management plan. The author then discusses the different activities that may be a part of one's exercise program, including aerobic activities, anaerobic activities, resistance exercises, sports, and lifestyle activities. The author concludes by recommending at least 30 minutes and preferably 60 or more minutes of aerobic activity most days of the week, combined with some resistance activities at least two days each week.

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Children and Adolescents. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.547-566.

Children and adolescents with type 1 diabetes may have a number of health and fitness related impairments, including lowered physical working capacity, reduced maximal aerobic power, impaired skeletal muscle blood flow, and elevated perceived exertion, particularly if they are in poor metabolic control. Physical training can improve many of these impairments, and youth with diabetes should be encouraged to participate in regular physical activity. This chapter on children and adolescents with type 1 diabetes is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Children and adolescents with type 1 diabetes should delay participation in physical activity if blood glucose levels are less than 60 milligrams per deciliter or greater than 270 milligrams per deciliter with detectable urine ketones. Exercise is also contraindicated in the event that a child or adolescent has not taken, or will not take, any insulin on the day of the activity. Blood glucose responses to exercise are highly individualized, and levels can either decrease (particularly when plasma insulin levels are elevated after subcutaneous injection) or increase (if plasma levels are low or if the activity is of a particularly strenuous nature). Hypoglycemia (low blood glucose) frequently occurs up to 6 to 10 hours after the cessation of exercise in children with type 1 diabetes, and extra complex carbohydrates may be necessary, particularly at bedtime, to prevent nocturnal hypoglycemia. However, regular physical activity must be considered an important component in the management of youth with diabetes. 2 figures. 2 tables. 75 references.

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Determinants of the Response to Regular Physical Activity: Genetic Versus Environmental Factors. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 135-141.

This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the authors consider genetic versus environmental factors as determinants of the response to regular physical activity. They note that there are marked interindividual differences in responsiveness to exercise training; in a group of subjects following an identical training program, some show no or only minor changes, whereas others show marked improvements in risk factor levels. Age, sex, and race do not seem to contribute to these individual differences. Pretraining phenotype levels are strong determinants of training responses for some phenotypes, such as blood pressure and heart rate, but have little effect on others, such as HDL (high density lipoprotein) cholesterol. Training response phenotypes are characterized by significant familial aggregation, suggesting the contribution of genetic factors and a shared environment. There is no evidence that some subjects are 'general non-responders.' Thus, effectiveness of a training program should be evaluated using several response indicators. Failure to normalize a patient's risk factor level with an exercise program is not necessarily only due to noncompliance. Even if a diabetic patient's blood glucose concentration does not decrease in response to training, it is likely that the exercise program has beneficial effects on other risk factors. 20 references.

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Diet and Exercise Among Adults with Type 2 Diabetes. Diabetes Care. 25(10): 1722-1728. October 2002.

This article reports on a study undertaken to describe diet and exercise practices from a nationally representative sample of United States adults with type 2 diabetes. The authors analyzed data from 1,480 adults older than 17 years with a self-reported diagnosis of type 2 diabetes in the Third National Health and Nutrition Examination Survey (NHANES III). Of individuals with type 2 diabetes, 31 percent reported no regular physical activity and another 38 percent reported less than recommended levels of physical activity. Sixty-two percent of respondents ate fewer than five servings of fruits and vegetables per day. Almost two thirds of the respondents consumed greater than 30 percent of their daily calories from fat and 10 percent of total calories from saturated fat. Mexican Americans and individuals over the age of 65 years ate a higher number of fruits and vegetables and a lower percentage of total calories from fat. Lower income and increasing age were associated with physical inactivity. Thirty-six percent of the sample were overweight and another 46 percent were obese. The majority of individuals with type 2 diabetes were overweight, did not engage in recommended levels of physical activity, and did not follow dietary guidelines for fat and fruit and vegetable consumption. The authors conclude that additional measures are needed to encourage regular physical activity and improve dietary habits in this population. 4 tables. 45 references.

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Exercise and Aging. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.567-585.

The primary aspects of body composition that change with advancing age are decreased skeletal muscle mass, termed sarcopenia, and increased body fatness. This chapter on exercise and aging is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Sarcopenia results in muscle weakness, which has been associated with late life disability and risk of falling among elderly people. Muscle weakness may limit activities of daily living in many older individuals. Therefore, strength training should be the primary recommendation for elderly people. Strength training has a number of positive benefits, including increased muscle strength and size, improved bone health, increased energy requirements, and increased levels of physical activity. Strength training is safe for almost all elderly people and has been demonstrated to be highly effective, even into the tenth decade of life. Relatively low intensity aerobic exercise has been demonstrated to improve insulin action in older people. 54 references.

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Exercise Prescription. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 269-288.

This chapter on the exercise prescription is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. To optimize the likelihood of a safe and effective response, the exercise prescription should take into consideration safety aspects as well as the mode, frequency, duration, intensity, rate of progression, and timing of physical activity. The foremost priority in compiling the exercise prescription is to minimize the potential adverse effects of exercise via appropriate screening, program design, monitoring, and patient education. Before embarking on an exercise program, all people with diabetes should undergo a complete medical history and physical examination aimed at the identification of macrovascular, microvascular, and neurological complications. A continuing care plan with follow up medical evaluations is also necessary. An exercise electrocardiogram is recommended for individuals with one or more of the following: known or suspected coronary artery disease, type 1 diabetes of greater than 15 years' duration or type 2 diabetes of longer than 10 years duration, age older than 35 years, any additional risk factor for coronary artery disease, microvascular disease (proliferative retinopathy, a type of eye disease, or nephropathy, a type of kidney disease), peripheral vascular disease, or autonomic neuropathy (nerve disease). In the absence of an exercise electrocardiogram, light to moderate rather than vigorous exercise should be prescribed for these individuals. The type, frequency, duration and intensity of exercise training should be modulated to achieve an energy expenditure of 700 to 2,000 calories per week. Generally, to accomplish the desired weekly energy expenditure, aerobic exercise should be performed for 20 to 60 minutes, 3 to 5 days a week, at an intensity corresponding to 55 to 79 percent of maximum heart rate. Exercise training should begin at a comfortable intensity and gradually progress in accordance with baseline cardiorespiratory fitness level, age, weight, health status, personal preferences, and individual goals. Exercise participation should be timed so that it does not coincide with periods of peak insulin absorption. And specific steps should be taken to enhance compliance with exercise training. 7 tables. 24 references.

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Exercise. In: Edelman, S.V. and Henry, R.R. Diagnosis and Management of Type 2 Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p. 65-68.

Many adults with diabetes are sedentary and obese, which can contribute to the development of glucose intolerance. Therefore, physical activity should be included as an essential treatment component in the diabetes management plan unless contraindicated in a given individual. This chapter on exercise is from a handbook for primary care providers that offers a concise overview of the diagnosis and management of type 2 diabetes. The authors describe the benefits of exercise, precautions and considerations, and a recommended exercise prescription. 2 tables. 2 references.

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Getting Physical. Diabetes Forecast. 55(5): 35-37. May 2002.

This article helps female readers with diabetes understand why exercise is such an important aspect of their diabetes care. The author notes that women often say they do not want to be a burden to others, disabled, or live in pain. The author proposes that physical activity is the best way to achieve these goals. The stronger and more fit one's body, the more capable one is of handling stress and illness. The more flexible a woman is, the better she is able to recover from a fall and prevent muscle strain. The author reviews the specific health benefits that women can gain from exercise, then explores reasons why some women do not undertake physical activity. A final section in the article addresses the interplay between physical activity and emotional balance and offers practical strategies for incorporating exercise into a busy life.

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Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. 699 p.

This book provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. The book reflects the interests and opinions of the American Diabetes Association's Council on Exercise and the American College of Sports Medicine. Forty chapters are provided in eight sections: introduction, basic considerations, exercise and diabetes prevention, the treatment plan, exercise in patients with diabetic complications, exercise in special patient groups, practical advice and experience regarding sports, and reimbursement and resources. Topics include exercise physiology, the risk benefit profile of diabetes and exercise, adaptations to training, fuel metabolism during exercise in health and diabetes, signal transduction and glucose transport in muscle, psychological benefits of exercise, physical activity in the prevention of type 2 diabetes, reduction in risk of coronary heart disease (CHD) and diabetes, primary prevention of type 2 diabetes with lifestyle modification, guidelines for the evaluation of the patient with diabetes before recommending an exercise program, the exercise prescription, initiation and maintenance of exercise in patients with diabetes, resistance training, nutrition and physical activity, nutritional strategies to optimize athletic performance, exercise and weight control, adjustment of insulin and oral agent therapy, insulin pump therapy, the diabetic foot, retinopathy (eye disease), cardiovascular complications, early and advanced nephropathy (kidney disease), neuropathy (nerve disease), musculoskeletal disorders and sports injuries, women and exercise, exercise and gestational (a type of diabetes that occurs during pregnancy) diabetes, children and adolescents, exercise and aging, patients on various drug therapies, exercise in diabetic patients with disabilities, the diabetic athlete as role model, strength training and nutritional supplements, scuba diving, mountain hiking, fitness facility guidelines for diabetes and exercise, and medical reimbursement and managed care issues. Each chapter concludes with a list of references and the book concludes with a list of resources and a subject index.

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Health/Fitness Facility Guidelines for Diabetes and Exercise. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.655-670.

The projected increase in the prevalence of diabetes and the emerging trend of patients with chronic diseases joining health clubs suggest that substantially more individuals with diabetes will join the nearly 30 million adults in the United States who already exercise at fitness facilities. This chapter on health and fitness facility guidelines for diabetes and exercise is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. The authors stress that appropriately prepared fitness staff at health clubs and fitness centers can be a resource for promoting physical activity and providing exercise leadership to individuals with diabetes. The incidence of a cardiovascular event during exercise among patients with diabetes is greater than that among otherwise healthy individuals primarily because of the higher prevalence of coronary disease in these individuals. Potential medical complications associated with diabetes and exercise warrant special consideration. The American Heart Association (AHA) and the American College of Sports Medicine (ACSM) have developed recommendations for cardiovascular screening, staffing, and emergency policies at health and fitness centers. These recommendations call for all facilities offering exercise equipment or services to conduct a cardiovascular screening of all new members or prospective users. A medical evaluation and supervised exercise test should be conducted for anyone identified as having diabetes. Written and active communication by facility staff with the individual's personal health care provider is strongly recommended. 7 tables. 19 references.

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Irritation and Maintenance of Exercise in Patients with Diabetes. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 289-309.

This chapter on the initiation and maintenance of exercise in patients with diabetes is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. The author stresses that it is important for the health care provider to give specific recommendations concerning types of exercise and its frequency, intensity, and duration. Moreover, this prescription should account for the patient's personal health status and situation. An effective exercise program should include activities that result in expending a minimum cumulative total of 1,000 kilocalories per week in aerobic activity. To improve muscular strength and endurance as well as body composition, a well-rounded resistance training program should also be incorporated. To develop and maintain cardiorespiratory endurance as well as desirable caloric expenditure, individuals with diabetes should exercise at least 3 nonconsecutive days and up to 5 days each week. The duration of physical activity for individuals with diabetes is directly related to the caloric expenditure needs and inversely related to the intensity. There are potential risks associated with exercise for the person with diabetes and some limitations for those who have preexisting diabetic complications. These include hypoglycemic reactions resulting from exercise and the risk of worsening specific diabetic complications and provoking musculoskeletal injuries. To help motivate the person to do regular exercise, the program must be viewed as desirable and intrinsically reinforcing. Several factors can help individuals maintain an exercise program. These include using appropriate training and equipment to avoid injury, progressing slowly in exercise intensity and duration, setting realistic training goals, learning to identify and treat hypoglycemia, setting a training schedule in advance and sticking to it, using a training partner, encouraging self-rewards, identifying alternative exercise activities to reduce boredom, and understanding the difference between failure and backsliding. 1 figure. 1 table. 42 references.

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Lowering your Risk of Cardiovascular Disease. Diabetes Self-Management. 19(2): 24-31. March-April 2002.

This article encourages people with diabetes to incorporate physical activity into their daily lives in order to lower their risk of cardiovascular disease. The author stresses that regularly getting up and moving (being physically active) is probably the single most important thing one can do to protect and improve health. In addition to strengthening bones and muscles, regular physical activity helps boost the immune system, preserve mental agility, resolve sleep difficulties, reduce stress, and improve self image and psychological well-being. Perhaps the most important benefit of exercise is its ability to strengthen the most vital of muscles, the heart. The author discusses the incidence of cardiovascular disease as a complication of diabetes, the different types of cardiovascular diseases, how physical activity helps the heart, the role of blood pressure, the importance of good blood glucose (sugar) control, the effects of exercise on blood lipids (fats, including cholesterol), news about preventing diabetes, and strategies for incorporating exercise into one's life. One side bar offers specific tips for increasing activity; another explains how to use a pedometer (a small device for recording the distance walked). Appended to the article is a list of diabetes resource organizations; each is briefly described and the appropriate contact information (including web sites) is provided.

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Musculoskeletal Disorders and Sports Injuries. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.497-507.

It is unknown whether an athlete with diabetes is at a greater risk for musculoskeletal injury than an athlete without this disease. This chapter on musculoskeletal disorders and sports injuries is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. The author notes that precautionary measures that alter or modify training methods, sports equipment, or mode of physical activity may reduce the risk of an athletic injury. Individuals with diabetes should be encouraged to participate in regular exercise involving competitive or recreational sports or physical fitness for enjoyment and health. Realistic goals and objectives can be established so that people with diabetes can participate safely in competitive and recreational sports and exercise activities such as jogging, which have the potential to traumatize lower limbs, especially the feet. People with diabetes who routinely exercise in their young and middle age years may increase peak bone mineral density (BMD) in early years, maintain it through midlife, and delay or prevent the severity of osteoporosis and prevalence of fractures in later years. 1 table. 24 references.

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Nutrition, Physical Activity, and Diabetes. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.321-337.

This chapter on nutrition, physical activity and diabetes is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In individuals with diabetes, many factors influence the glycemic (blood glucose or sugar) response to physical activities, making it impossible to give precise nutrition (and insulin) guidelines that will apply to everyone with diabetes. Furthermore, few studies have been done examining the need for carbohydrate, fluids, and calories for exercise in individuals with diabetes. Therefore, recommendations are usually extrapolated from studies on exercisers without diabetes. To meet individual needs, frequent blood glucose monitoring is important to modify general guidelines to ingest carbohydrate after (or before) exercise and to reduce insulin doses before (and possibly after) exercise. A higher carbohydrate intake (about 60 percent of daily calories) on a fairly consistent basis during training with adequate blood glucose control is necessary to maintain maximal muscle and liver glycogen stores. Consuming carbohydrate immediately after exercise optimizes repletion of these muscle and liver glycogen stores. In addition, fluids are important for all exercisers. An adequate caloric intake should be planned for the person with diabetes who participates in regular exercise. A nutrition assessment of usual food intake followed by monitoring of weight, growth (if pertinent), and appetite (hunger) is the best way to judge adequacy of caloric intake. 4 tables. 33 references.

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Obesity. Hudson, OH: Lexi-Comp, Inc. 2002. (poster).

Obesity is the term used to describe people who are clinically overweight. This laminated poster describes obesity and the health problems that are encountered in people with obesity. The poster has sections discussing the causes of obesity, the contribution of obesity to other symptoms (including hypertension, diabetes, gallbladder disease, stroke, sleeping problems), diagnostic tests used to determine obesity (i.e., the Body Mass Index, BMI), and treatment options, including diet therapy, exercise, behavior therapy, medication, and surgery. Another section describes the four major food components (proteins, fats, carbohydrates, and fiber) and the importance of reading food labels. The poster emphasizes that weight loss should be gradual, incorporating permanent changes in diet and lifestyle. Physical activity should be increased gradually and under the guidance of a health care provider. The poster is illustrated with full color depictions of obese people, as well as a BMI chart and an illustration of how the body cells retain fats and sugars. The poster notes that the same information is available online (www.diseases-explained.com). 7 figures.

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Patient's View on Health: Spring Training: A Thoughtful Approach. Nephrology News and Issues. 16(7): 20-21. June 2002.

This article reviews the importance of regular exercise and a fitness program for people who are on dialysis. The author explains his own approach to physical fitness, focusing on how to begin or re-start a regular program of exercise. The author offers a set of suggestions for first-time or returning exercisers: consult a physician, train with a friend, set realistic goals, incorporate lots of stretching, and have fun. One sidebar describes pilot physical activity programs to increase physical activity among Americans age 50 and over; these programs are sponsored by the American Association for Retired Persons (AARP) and the Robert Wood Johnson Foundation (RWJF). For more information, readers are encouraged to visit www.aarp.org/activeforlife.

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Physical Activity Could be Beneficial in IBS Management. Digestive Health and Nutrition. p. 8. July-August 2002.

This brief article explores the role of physical activity in a comprehensive approach to managing irritable bowel syndrome (IBS). In general, regular exercise improves physical endurance, increases flexibility and mobility, lowers cholesterol, improves appearance, and heightens general feelings of self-confidence and esteem. Physicians commonly recommend physical activity as a behavioral modification to relieve physiological and psychological symptoms associated with stress-related health conditions. The author questions why exercise has often been overlooked as an option in standard IBS management, focusing on poor patient adherence as the probable cause. The author explains how to incorporate exercise gradually as part of the daily routine for the person with IBS. The author concludes by reminding readers to work closely in tandem with their health care providers. The article ends with a list of web site addresses for additional information.

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Physical Activity in the Prevention of Type 2 Diabetes: The Epidemiological Evidence Across Ethnicity and Race. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 145-153.

Physical activity has the potential to prevent or delay progression to type 2 diabetes in many individuals. This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the authors consider the epidemiological evidence across ethnicity and race regarding physical activity in the prevention of type 2 diabetes. The level of physical activity recommended is relatively feasible for individuals of all ages, income groups, races, and ethnic backgrounds. The major thrust of these recommendations is to encourage sedentary individuals to increase their levels of moderate physical activity, such as walking, for 20 to 30 minutes throughout the day (on most days of the week). Physical activity that is incorporated into an individual's lifestyle has the potential for being maintained over the years, and maintenance of adequate physical activity levels appear to be necessary to exert a lasting impact on type 2 diabetes. 1 figure. 19 references.

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Playing Soccer: What's Your Game Plan?. Diabetes Self-Management. 19(2): 106-112. March-April 2002.

Soccer leads all team sports as the number one supervised activity for youths age 18 and younger in the United States. This article provides parents of children with diabetes a guide to soccer and determining if this is a good activity for their child. For boys and girls with diabetes, soccer offers all the benefits of physical activity, such as improved blood glucose control and better cardiovascular health, as well as an opportunity to participate in the fun of being part of a team. Soccer is an activity that mixes short periods of intense activity with periods of low to moderate intensity exercise and occasional rest periods. The authors offer strategies for pregame preparation, including steps to prevent hypoglycemia and determining the need for carbohydrate supplementation; factors to consider during the soccer game, notably hydration and blood glucose levels; and post game suggestions, including the need for frequent monitoring of blood glucose levels. The author concludes that the benefits of participating in soccer are well worth the extra time that parents and child may spend to prepare for and monitor the diabetes. One chart lists super soccer snacks; another offers a soccer bag checklist for the soccer player with diabetes. One side bar reports on research that showed that even the act of cheering on a sports team from the sidelines may deliver an increase in blood glucose levels, perhaps due to a rapid rise in stress hormones. 2 figures.

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Primary Prevention of Type 2 Diabetes by Lifestyle Modification: Convincing Evidence From the Finnish Diabetes Prevention Study. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 183-195.

The incidence of type 2 diabetes is increasing rapidly worldwide. Physical inactivity and obesity are the main environmental determinants of the disease. Based on epidemiological data, it has been estimated that the risk of type 2 diabetes may be reduced by 50 percent when controlling obesity and increasing physical activity. Until recently, it was not proven scientifically if type 2 diabetes could be prevented by lifestyle intervention in high risk subjects. This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the authors present evidence from the Finnish Diabetes Prevention Study, undertaken to find out whether the onset of type 2 diabetes could be prevented by lifestyle intervention in high-risk individuals. A total of 522 middle-aged overweight subjects with impaired glucose tolerance (IGT) were randomized into an intervention or control group. The intervention goals included reduction in weight of greater than 5 percent, total fat intake less than 30 percent of energy consumed, saturated fat intake less than 10 percent of energy consumed, fiber intake of 15 grams per 1,000 kcalories, and moderate exercise for more than 30 minutes per day. The overall incidence of type 2 diabetes was reduced 58 percent by the lifestyle intervention program. The findings emphasize the importance of modest weight reduction (5 to 10 percent) combined with exercise in the prevention of type 2 diabetes. An optimal exercise program for individuals with IGT should include components that improve cardiorespiratory fitness, muscles strength, and endurance. The authors conclude that the primary prevention of type 2 diabetes is possible by a nonpharmacological intervention. 3 tables. 24 references.

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Reduction in Risk of Coronary Heart Disease and Diabetes. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 155-181.

This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the authors consider strategies that may result in a reduction in risk of coronary heart disease (CHD) and type 2 diabetes. Increased physical activity improves the cardiovascular risk factor profile; its effects include reducing adiposity, blood pressure, dyslipidemia, and platelet adhesives, as well as enhancing fibrinolysis. Increased physical activity may also reduce CHD risk independently of favorably alterations in traditional coronary risk factors. The estimated reduction in the risk of CHD with the maintenance of an active, compared with a sedentary, lifestyle is estimated to be 35 to 55 percent. Physical activity improves insulin sensitivity and glycemic control among nondiabetic individuals, as well as among those with impaired glucose tolerance (IGT) or overt type 2 diabetes. The addition of exercise to caloric restriction facilitates loss of adipose tissue, assists in maintenance of reduced body weight, and may independently improve insulin sensitivity. The potential reduction in the risk of type 2 diabetes associated with an active, compared with a sedentary, lifestyle is 30 to 50 percent. 2 tables. 101 references.

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Target Population for Diabetes Prevention: The Metabolically Obese, Normal-Weight Individual. In: Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 235-249.

Epidemiological evidence suggests that regular physical activity may prevent, or at least retard, the development of type 2 diabetes and coronary heart disease. This benefit of exercise is likely to be most prominent in individuals predisposed to the insulin resistance syndrome. Individuals with insulin resistance often have generalized obesity; however, they also may not be obese or even overweight by present standards. The latter have been referred to as metabolically obese, normal-weight (MONW) individuals. This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the author considers the MONW group as a target population for diabetes prevention. Exercise may be therapeutically more efficacious in MONW individuals than in patients with established type 2 diabetes and overt obesity. People at risk for type 2 diabetes and the insulin resistance syndrome, including MONW individuals, may be identified early by such factors as family history, birth weight, and the presence of gestational diabetes (a type of diabetes that occurs during pregnancy), polycystic ovarian syndrome, and central adiposity (the tendency to add fat in the middle of the body). Whether lifestyle modification programs of diet and exercise should be targeted specifically at these high risk individuals or aimed at the general population is a major public health issue. 2 figures. 6 tables. 37 references.

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Weight Loss. In: Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 49-58.

Patients' weight loss is a common complaint that often challenges the primary care physician. Fluctuations in weight over a period of time can often be attributed to diet, exercise, or intrinsic body rhythms; yet involuntary weight loss is of significant concern. This chapter on weight loss is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include the incidence of weight loss; principal diagnoses, including decreased food intake, increased metabolism, increased loss of energy, medications, and psychological causes; typical presentation; key points in the patient history, including food intake, physical activity and review of symptoms; the physical examination; ancillary tests, including lab studies for malabsorption and testing for occult (hidden) malignancy; treatment strategies, including the documentation of nutritional status, increase oral intake, the use of enteral supplementation, and the use of hyperalimentation (including total parenteral nutrition or TPN); common clinical errors; and controversies. The chapter includes a chapter outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 1 figure. 4 tables. 22 references.

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Active at any Size. Bethesda, MD: Weight-control Information Network. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2001. 11 p.

Very large people face special challenges in trying to be active. They may not be able to bend or move in the same way that other people can. It may be hard to find clothes and equipment for exercising. Larger people may feel self-conscious being active around other people. This booklet helps large people face these challenges and incorporate more activity into their daily lives. Topics include the benefits of exercise and physical activity, how to start an exercise program, the importance of keeping records of one's progress, the psychosocial benefits of exercising, the types of physical activities that may be appropriate for a very large person to do, the differences between weightbearing and non-weightbearing exercises, walking, dancing, water workouts, weight training, bicycling, stretching, lifestyle activities, and tips for safe exercise and activity. The booklet includes a list of additional reading, videos, organizations and programs, and websites. The booklet concludes with description of the Weight-control Information Network (WIN), a service of the National Institutes of Health (NIH) that provides the general public, health professionals, the media, and Congress with up to date, science-based health information on weight control, obesity, physical activity, and related nutritional issues. The booklet is illustrated with black-and-white photographs of larger people engaged in a variety of physical activities.

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Breeding Fitness in the New Millennium: From Genetic Switches to Pills in a Bottle. Diabetes Forecast. 54(4): 27-29. April 2001.

This article reports on the latest technologies that may one day eliminate the need for physical activity to manage diabetes. Researchers have discovered that genetically engineered mice lacking a gene that produces an enzyme called protein tyrosine phosphatase-1B (PTP-1B) gained only half as much weight as mice with the PTP-1B gene when fed the same high fat diet. The mutant mice also maintained normal blood sugar levels after a high calorie meal while the mice with the gene had high blood sugars characteristic of type 2 diabetes. This discovery raises the prospect of future obesity and diabetes therapies that control the PTP-1B gene. Muscle building vaccines based on engineered genes have also been the subject of various experiments. Vaccines were found to increase muscle mass in the legs of mice by 15 to 27 percent without any leg exercise at all. Although genetic engineering will lead to impressive and life saving therapies, moral and ethical dilemmas will arise with the commercialization of these technologies.

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Diabetes: A Guide to Shopping and Meal Planning. Landover, MD: Giant Brands, Inc. 2001. 16 p.

Diabetes is a disease in which the body does not produce any or enough insulin, or is not able to use insulin effectively. Insulin is a hormone that combines with glucose (sugar) in the blood and helps the glucose to enter the body's cells to be used for energy. This booklet reviews the basic care of people with diabetes, then focuses on shopping and meal planning as one aspect of diabetes management. Topics include the three major types of diabetes (type 1, type 2, and gestational diabetes), the diabetes food guide pyramid, sample meal plans at 4 calorie levels, how to recognize portion sizes and choose proportionally by food group, how to control carbohydrate intake, the use of sugar substitutes, nutrition facts labels on food, shopping hints, and the importance of incorporating physical activity (exercise) into a regular program of diabetes management. The booklet is illustrated with colorful photographs and charts. A resource list of organizations, books, and magazines, concludes the booklet. 18 figures. 4 tables.

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Diet of Champions. Diabetes Forecast. 54(9): 43-46. September 2001.

This article discusses the discusses the importance of diet in maintaining physical performance during an endurance event. The body obtains energy from carbohydrates, fat, and protein in the diet. Carbohydrates are needed to maintain blood glucose levels during exercise and provide energy to metabolically active muscles. The week before a major endurance event, participants need to start building their stores of carbohydrates. One to two hours before the race, they should have a small meal that is high in carbohydrates, moderate in protein, and low in fat and fiber. People whose blood glucose is at a desirable level will also need to replenish their carbohydrates during the event itself if it continues for more than an hour. Current recommendations call for 30 to 60 grams of easily digested carbohydrate per hour of prolonged activity. In addition, dehydration is one of the most common causes of poor performance in an endurance event, so adequate fluid needs to be consumed in the week before the endurance event, one to two hours prior to the event, and during the event. Although changes to the diet are needed to meet the demands of increased physical activity, they may not be recommended if certain conditions are present. For example, people who are vigorously active generally require higher dietary protein than those who are inactive, but some studies indicate that mild daily protein restriction may slow the progression of kidney disease among people with type 1 diabetes. Defining the goals of an exercise program can help people who have diabetes determine if they need to change their diet. The article includes guidelines on precautions people need to take prior to beginning an exercise program.

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Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women. New England Journal of Medicine. 345(11): 790-797. September 13, 2001.

Previous studies have examined individual dietary and lifestyle factors in relation to type 2 diabetes, but the combined effects of these factors are largely unknown. This article reports on a study that followed 84,941 female nurses from 1980 to 1996; these women were free of diagnosed cardiovascular disease, diabetes, and cancer at baseline. Information about their diet and lifestyle was updated periodically. A low risk group was defined according to a combination of five variables: body mass index less than 25; a diet high in cereal fiber and polyunsaturated fat and low in trans fat and glycemic load (which reflects the effect of diet on the blood glucose level); engagement in moderate to vigorous physical activity for at least half an hour per day; no current smoking; and the consumption of an average of at least half a drink of an alcoholic beverage per day. During 16 years of follow up, the researchers documented 3,300 new cases of type 2 diabetes. Overweight or obesity was the single most important predictor of diabetes. Lack of exercise, a poor diet, current smoking, and abstinence from alcohol use were all associated with a significantly increased risk of diabetes, even after adjustment for the body mass index. As compared with the rest of the cohort, women in the low risk group (3.4 percent of the women) had a relative risk of 0.09. A total of 91 percent of the cases of diabetes in this cohort could be attributed to habits and forms of behavior that did not conform to the low risk pattern. The authors conclude that their findings support the hypothesis that the majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle. 1 figure. 5 tables. 40 references.

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Exercise Therapy in the Management of Diabetes. Practical Diabetology. 20(1): 38, 40-42, 44. March 2001.

This article examines the benefits of exercise for people who have diabetes. Evidence supports the concept that habitual physical activity can significantly reduce the incidence of type 2 diabetes. Exercise and nutrition therapy are the cornerstones of managing type 2 diabetes, and they constitute two of the three elements of the diet-exercise-insulin triad that is the basis of managing type 1 diabetes. Regular exercise significantly reduces the incidence of atherosclerotic cardiovascular disease. Other benefits of exercise include enhancing insulin sensitivity, improving cardiovascular risk factors that are elevated in people with type 2 diabetes, improving long term glycemic control in people with type 2 diabetes, and enhancing mood and sense of well being. Risks of exercise for people who have diabetes include the occurrence of hypoglycemia or hyperglycemia and the worsening of microvascular complications. The article also explains how physicians can assess the risks for each patient and provides guidelines on prescribing an appropriate exercise regimen. 6 figures. 8 references.

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Exercise Your Right to A Healthy Body. Diabetes Forecast. 54(8): 65-67. August 2001.

This article provides African American women who have diabetes with information on becoming healthy and fit through exercise. Physical activity can improve health or make a person more fit. Working out to get healthy involves doing moderate activities, whereas working out to get fit involves a more structured program. The key to becoming healthy is to work physical activity into the day. The article offers ways to incorporate exercise into various daily activities, including doing housework, going shopping, watching television, doing yardwork, washing the car, doing laundry, talking on the telephone, commuting, and working in an office.

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Fit and Fabulous as You Mature!. Bethesda, MD: Weight-control Information Network. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2001. 8 p.

Sisters Together: Move More, Eat Better is a program for Black women to help maintain a healthy weight by being active and making healthy food choices. This booklet offers tips on how to get moving, how to prepare healthy, tasty meals, and how to eat right while living a fast-paced, busy lifestyle. The booklet explains some of the risk factors associated with being overweight and inactive, including a greater chance of getting type 2 diabetes, heart disease, high blood pressure (hypertension), stroke, and breast or colon cancer. The booklet offers specific strategies for incorporating more exercise and movement into one's daily activities, for eating healthier foods on a budget (including enough fruit, vegetables, and protein), reading food labels, eating away from home, and assessing serving sizes accurately. The booklet lists two cookbooks that are recommended. The booklet concludes with the contact information for the Weight-control Information Network (WIN), a service of the National Institutes of Health (NIH) that provides the general public, health professionals, the media, and Congress with up to date, science-based health information on weight control, obesity, physical activity, and related nutritional issues. The booklet is illustrated with bold, colorful graphics. 1 figure.

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Healthy Eating and Physical Activity Across Your Lifespan: Better Health and You. Bethesda, MD: Weight-control Information Network. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2001. 13 p.

A balanced diet and regular physical activity are the building blocks of good health. Poor eating habits and too little physical activity can lead to overweight and related health problems. This booklet offers tips on how to get moving, how to prepare healthy, tasty meals, and how to eat right while living a fast-paced, busy lifestyle. The booklet offers specific strategies for incorporating more exercise and movement into one's daily activities, for eating healthier foods on a budget (including enough fruit, vegetables, and protein), reading food labels, eating away from home, and assessing serving sizes accurately. Topics include tips for healthy eating, quick breakfast ideas, easy snack ideas, how to determine a healthy weight, the causes of overweight and obesity, weight loss, and stress reduction. The booklet includes a list of additional reading, a list of resource organizations, and a description of the Weight-control Information Network (WIN), a service of the National Institutes of Health (NIH) that provides the general public, health professionals, the media, and Congress with up to date, science-based health information on weight control, obesity, physical activity, and related nutritional issues. The booklet is illustrated with bold, colorful graphics and black-and-white photographs. 3 figures. 1 table.

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Mediators of Lifestyle Behavior Change in Native Hawaiians. Diabetes Care. 24(10): 1770-1775. October 2001.

This article reports on a study undertaken to examine the association of stage of change with diet and exercise behaviors in response to a lifestyle intervention for Native Hawaiians (NHs). A family ('ohana) support lifestyle intervention was compared with a standard intervention in NHs with or at risk for diabetes in two rural communities in Hawaii (n = 147). Stage of change, as a hypothesized mediator of behavior change, and dietary and exercise behaviors were measured at baseline and at 1 year postintervention. Stage of change was significantly associated with positive dietary and exercise behaviors. NHs receiving the 'ohana support (OS) intervention were more likely to advance from pre action to action or maintenance for fat intake and physical activity than the group who received the standard intervention. Participants in the OS group who advanced from pre action to action or maintenance showed more improvement in fat intake and physical activity than those in the standard group. The authors conclude that these initial findings suggest that stage of change is an important factor in mediating lifestyle behavior changes in persons with or at risk for diabetes and merits further study among minority populations at high risk for diabetes. One appendix summarizes the lifestyle intervention protocol used in the study. 1 figure. 3 tables. 33 references.

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Optimal Exercise Intensity for Individuals with Impaired Glucose Tolerance. Diabetes Spectrum. 14(2): 93-97. May 1, 2001.

This article discusses optimal exercise intensity for people with impaired glucose tolerance (IGT). IGT is a transitory state between normoglycemia and frank diabetes. One in three people with IGT will develop type 2 diabetes within 10 years if left untreated. A strong rationale exists for the implementation of strategies designed to reverse or stabilize the deterioration in glucose homeostasis in people with IGT. Recent physical activity guidelines from the Centers for Disease Control and Prevention and the American College of Sports Medicine have suggested that intermittent moderate intensity exercise is beneficial and can improve the health status of these people. Specifically, the guidelines recommend that every American should accumulate 30 minutes of moderate intensity physical activity per day. The current guidelines are based predominantly on epidemiological data, and very little clinical evidence exists that this level of physical activity can significantly improve glycemic status. More intense exercise prescriptions would appear to be needed to improve glucose tolerance and insulin action. Although higher exercise intensity is a key determinant for improvements in glucose homeostasis, it may produce mechanical and oxidative damage that can result in transitory impairments in insulin action and glucose tolerance. Therefore, the optimal exercise intensity for a person with IGT appears to lie between these two extremes. 1 figure. 25 references. (AA-M).

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Physical Activity and Exercise. Cleveland, OH: Diabetes Association of Greater Cleveland. 2001. 2 p.

Regular physical activity or exercise is important for people with diabetes. A regular physical activity or exercise routine helps the body's cells respond better to insulin, whether it is the body's own insulin or injected insulin. This fact sheet describes the role of physical activity and exercise as a crucial part of any diabetes management program. The fact sheet discusses the metabolic benefits of exercise, including for insulin and blood lipids. The fact sheet then lists the different activities that are considered exercise. Other topics include self-testing of blood glucose (SMBG), hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), guidelines for exercising based on blood glucose levels, and the importance of working with a health care provider before implementing an exercise program. The fact sheet concludes with the contact information for the Diabetes Association of Greater Cleveland (www.dagc.org). 2 references.

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Sequencing Diet and Exercise Programs for African American Women with Diabetes. Diabetes Educator. 27(2): 245-251. March-April 2001.

This article describes a study that compared the effects of two programs that present diet and exercise components in a different sequence to gain insight into which sequence may be more effective. At an urban YMCA, African American women with type 2 diabetes, aged 30 to 65 years, were randomly assigned to either 10 weekly sessions about healthy eating followed by six weekly sessions about exercise or to the reverse sequence. Sessions consisted of small group discussions and physical activity or food tasting. Primary outcomes were attendance, percent of calories consumed from fat, fruit and vegetable intake, and minutes of exercise per week. Measures were taken at baseline and at 4 and 12 months after the program. Overall, attendance was very good and did not differ by group. The only group difference found at the 12 month follow up was in diastolic blood pressure. Time effects for both groups combined included an increase in minutes of activity, an increase in vegetable intake, and a decrease in percent of calories consumed from fat. The article concludes that the study does not provide definitive evidence of which sequence may be best to bring about behavior change. The effects of sequencing difficult behavioral changes such as diet modification and establishing an exercise habit deserve further study. 1 table. 26 references. (AA-M).

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Tips on Preventing Hypertension. Consultant. 41(12): 1662, 1664. October 2001.

In this article, the physician author addresses a question commonly encountered by family practice doctors, i.e., how to prevent hypertension (beyond the traditional strategy of maintaining an appropriate weight). The responding author notes that a population-wide strategy to prevent an increase in blood pressure with age and to reduce overall blood pressure levels could have as much or even more of an impact on overall cardiovascular morbidity (illness) and mortality (death) than does treatment of only those patients with established hypertension (high blood pressure). Lifestyle modifications are strongly recommended as an integral part of the management of sustained hypertension. However, lifestyle changes can be difficult to achieve and maintain; a systematic approach that involves the physician, office nurse, nutritionist, and exercise physiologist can provide the education, support, and followup that many patients require. The author also discusses weight reduction, physical activity, moderating alcohol intake, dietary sodium intake, and potassium intake. The author concludes that lifestyle modification clearly plays a pivotal role in the primary prevention of hypertension. However, it will continue to represent an important adjunctive therapy to pharmacologic (drug) treatment of patients with hypertension. 1 table. 5 references.

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Type 2 Diabetes in Children and Adolescents: An Emerging Disease. Journal of Pediatric Health Care. 15(4): 187-193. July-August 2001.

This review article presents pediatric nurse practitioners with the most recent information about type 2 diabetes in children and adolescents, summarizes current understanding about diagnosis, and outlines treatment options. Although children and adolescents are usually diagnosed with type 1 diabetes, within the past 10 years children as young as 8 years old have been diagnosed with the type 2 diabetes. Type 2 diabetes in youth is an emerging disease, so its natural history is not well understood. Risk factors for type 2 diabetes in children and adolescents are similar to those in adults, including non-European ancestry, family history of type 2 diabetes, obesity, insulin resistance, and age. African American and Hispanic youth are at greater risk than white youth. The initial assessment of children and adolescents with a potential diagnosis of diabetes is critical. Although youth with type 2 diabetes may or may not have the classic symptoms of polydipsia, polyuria, and polyphagia, they often have features associated with insulin resistance syndrome such as dyslipidemia, hyperglycemia, obesity, hypertension, polycystic ovarian syndrome, and acanthosis nigricans. Blood glucose levels are essential to the diagnosis of diabetes, but additional laboratory measures are also important. The aim of treatment is to normalize blood glucose and glycosylated hemoglobin values. Fundamental to this aim is an individualized plan for nutrition and activity. The choice of pharmacologic management will depend on the child's clinical presentation. Currently, insulin and metformin are the only drugs approved by the Food and Drug Administration for the treatment of diabetes in children; however, selected oral medications have been used with success. Diabetes self management education is also an essential component in the management of diabetes. Education must focus on psychomotor skills, medical nutrition therapy, and physical activity. Routine follow up care should occur every 3 to 4 months. Primary prevention activities include counseling all patients about the importance of a healthy diet and exercise and monitoring physical development. The article presents a case study and discusses the nursing and research implications of type 2 diabetes in youth. 1 figure. 2 tables. 28 references. (AA-M).

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Type 2 Diabetes in Children and Teens. Diabetes Self-Management. 18(5): 75-77. September-October 2001.

This article reports on the current epidemic of type 2 diabetes in youth in the United States. The author estimates that between 15 and 20 percent of children and teens newly diagnosed with diabetes have type 2. The incidence of type 2 diabetes is particularly high within some racial and ethnic groups, including African Americans, Latinos, Native Americans, and Asians. An explosion of type 2 diabetes in adults and children appears to be developing in many countries where obesity, decreased physical activity, and increased consumption of high calorie, high fat foods are common. People with type 2 diabetes generally make quite a bit of insulin initially, but their cells are resistant to it, so they need more insulin than normal to use glucose for energy. Eventually the pancreas loses the ability to compensate with this higher level of insulin, so blood glucose levels rise. The author reviews the risk factors for diabetes, diagnostic approaches, and treatment options. Treatment is usually based on the child's condition at diagnosis. If the child is not sick at diagnosis, diet and exercise therapy should be initiated. However, lifestyle measures are often not enough to control blood glucose levels; eventually diabetes drugs may need to be added. Metformin (Glucophage) is approved for use in children ages 10 to 16 and is recommended as the first oral agent to be used in children. Self management education is a crucial part of any treatment regimen for a young person with diabetes. The author concludes with a list of screening recommendations and preventive strategies. One sidebar lists symptoms or signs that indicate a call to the health care provider is necessary.

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Combating Sloth as Well as Gluttony: The Role of Physical Fitness in Mortality Among Men with Type 2 Diabetes (editorial). Annals of Internal Medicine. 132(8): 669-670. April 18, 2000.

This editorial comments on the role of physical fitness in type 2 diabetes. A study of physical activity among men who had type 2 diabetes found a strong relationship between measures of cardiovascular fitness and mortality. Another study found that diabetes control was significantly improved in experimental participants who engaged in physical activity and who developed diabetes during the study. Evidence also suggests the value of an exercise program in the prevention of type 2 diabetes in high risk people. Several studies have demonstrated a reduction in the progression to frank diabetes in high risk people. In addition, findings from several studies suggest that the amount of exercise needed to achieve a cardioprotective benefit is modest. Weight gain during adulthood in genetically susceptible people is one of the most powerful predictors of the development of diabetes. Although caloric intake has not changed over the past two decades in the United States, obesity is increasing. This increase in obesity is most likely the result of a reduction in physical activity. Thus, a comprehensive program of exercise should be an integral part of diabetes care for children, adolescents, and adults. 18 references.

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Community Diabetes Education and Gardening Project to Improve Diabetes Care in a Northwest American Indian Tribe. Diabetes Educator. 26(1): 113-120. January-February 2000.

This article describes a study that used a community based approach to design a culturally appropriate diabetes education program for a Northwest Indian American tribe. Needs assessment revealed that a community approach rather than clinic based education would address multiple barriers to diabetes care. The intervention design consisted of community diabetes workshops that represented a traditional holistic view of health. The workshops included the specific themes of taking care of the body, with an emphasis on diabetes care and physical activity; mental health needs; foods for healthy living; and spirituality and healing the whole person. Workshops were designed to be social and informational and involve all community members. A community garden was established to improve access to fresh produce and encourage exercise. Plans for diabetes community workshops, materials, and evaluations were developed but not implemented because of a decision by the tribal government to discontinue receiving federal funding due to a disagreement with the funding agency. Alternative state funding will allow the community to implement portions of the program. The community garden was established prior to the decision of the tribal government. 2 tables. 33 references. (AA-M).

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Diabetes Home Video Guide: Skills for Self-Care. Timonium, MD: Milner-Fenwick. 2000. (videocassette).

This videotape provides people who have diabetes with information on the basic skills needed to keep blood glucose in the target range and offers tips for incorporating these skills into daily life. Part one focuses on diabetes and related health concerns. One chapter in this segment of the tape explains how diabetes affects the body, what the long term complications are, and how to determine an appropriate blood glucose range. Another chapter examines related health concerns such as smoking, high blood cholesterol, high blood pressure, and excess body weight. Part two deals with blood glucose management, focusing on education, diet, exercise, monitoring, and medications. The chapter on education discusses the importance of education, the diabetes care team, and other resources. The chapter on nutrition provides nutrition guidelines and discusses other aspects of healthy eating. The chapter on exercise explains how to create an exercise plan. Other topics include doing aerobic and weight bearing exercises, keeping exercise fun and safe, and maintaining physical activity. The chapter on blood glucose monitoring focuses on laboratory testing, blood glucose self testing, and self testing techniques. Other topics include blood glucose records, medical emergencies, and equipment and supplies. The chapter on medications focuses on oral medications and insulin. Topics include insulin care, injection, and supplies; hypoglycemia; and medication tracking systems. Part three addresses the challenges of self management and offers strategies to help the viewer balance diabetes management with living. One chapter in this segment focuses on understanding the importance of pattern management, recognizing patterns, and adjusting a treatment plan. Another chapter deals with solving problems associated with sick days, dining out, unusual schedules, travel, special occasions, and holidays. A third chapter discusses lifestyle changes and emotions, focusing on incorporating change into daily life, managing emotions, handling sexual dysfunction and stress, dealing with close relationships, and finding support. The final chapter of the segment offers suggestions on maintaining good health, focusing on foot, skin, eye, and dental care; immunizations; and medical appointment and test scheduling. The video is accompanied by a foldout guide that provides an overview of diabetes self care skills.

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Exercise and Diabetes Control: A Winning Combination. Physician and Sportsmedicine. 28(4). April 2000.

This article discusses the benefits of exercise in the management of diabetes. Exercise is a cornerstone of diabetes management and conveys many health benefits. Different forms of exercise can have varying effects on the blood sugar response, especially in individuals using insulin. Before beginning an exercise program, people who have diabetes should have a medical evaluation to screen for macrovascular and microvascular complications that may be exacerbated by exercise. The American College of Sports Medicine recommendations for all people, including those who have diabetes, is that aerobic physical activity be done a minimum of three to five days a week, for 20 to 60 minutes and at 40 percent to 85 percent of maximum oxygen uptake reserve or at 55 percent to 90 percent of maximal heart rate. Resistance or weight training that includes at least one set of each of 8 to 10 different exercises using the major muscle groups is also recommended two to three days a week. No matter what type of activity is done, the standard recommendation for all people is to include proper warm up and cooldown periods. Appropriate exercise for effective management of blood sugar levels and published clinical exercise recommendations for individuals who have type 1 and type 2 diabetes include metabolic control before exercise, additional blood glucose monitoring, modified insulin doses, and supplemental carbohydrate intake. Physicians who treat exercising patients who have diabetes should tailor programs to meet individual requirements. 1 figure. 4 tables. 27 references. (AA-M).

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Exercise Therapy in Diabetes. In: Leahy, J.L.; Clark, N.G.; Cefalu, W.T. Medical Management of Diabetes Mellitus. Monticello, NY: Marcel Dekker, Inc. 2000. p. 255-266.

Epidemiological studies have documented the strong relationship between levels of physical activity and reduced rates of cardiovascular mortality in both type 1 and type 2 diabetes. Because macrovascular disease is the major cause of mortality (death) in these individuals, exercise therapy plays a pivotal role in their health and well-being. This chapter provides primary care physicians with guidelines to enhance the use of exercise therapy in patients with diabetes. The chapter is from a textbook for practicing providers and for physicians in training that offers a comprehensive, up-to-date overview of diabetes mellitus. The author of this chapter discusses the benefits of physical exercise in diabetes, including reduction in cardiovascular mortality, prevention of type 2 diabetes, visceral fat stores, serum lipids, and blood pressure, and the effects of exercise training on glycemic control; the risks of exercise in diabetes, including hypoglycemia, metabolic decompensation, hyperglycemia and ketosis, and risks of exercise in those with microvascular complications; the exercise prescription; general guidelines for safe exercise; and resources for the person with diabetes. 5 tables. 11 references.

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Fitting in Fitness. Successful Living with Diabetes. 2(1): 26-27. 2000.

This article explains the use of an activity diary, in conjunction with a food diary, to teach people about their health behavior. These diaries give people information about the true amount of food they eat and how active or inactive they are. Recording food intake is the main predictor of success in weight loss, and exercise is the main predictor of weight maintenance. The article describes the activity pyramid and how to increase daily physical activity using the guide. In addition, the article includes a sample exercise log for readers to use to track their daily activity.

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Getting Started and Staying Motivated. Diabetes Self-Management. 17(4): 14, 16-17, 19-20. July-August 2000.

This article provides people who have diabetes with suggestions for starting and maintaining an exercise program. The article explains the difference between physical activity and exercise and presents the latest activity guidelines from the U.S. Surgeon General. This is followed by a discussion of the common obstacles that prevent people from exercising, including lacking time and equipment, and finding exercise painful or boring. The article then explains how people should determine what type of activity is right for them. Other topics include ideas for overcoming common fears and frustrations about exercise, including setting realistic goals and building up to them gradually and finding a workout partner. In addition, the article outlines ways people can stay motivated once they start exercising, including setting aside special time for exercise, keeping an exercise log, sharing plans about an exercise program with only a few people, varying an exercise routine, considering weight lifting, avoiding trying to make up missed exercise sessions, focusing on what has been achieved rather than on what has not been achieved, and returning slowly to exercise after a break from an exercise routine. The article concludes with information on special considerations, including exercising in extreme weather conditions, coping with depression, and handling hypoglycemia. The article includes sidebars that list the benefits of exercise and present an activity assessment questionnaire.

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I Hate to Exercise Book for People with Diabetes. Alexandria, VA: American Diabetes Association. 2000. 123 p.

This book helps people who have diabetes stay active by making the most of the activities they do daily such as walking, performing household chores, or gardening. The book begins by identifying the benefits of exercise, including improving blood glucose control, preventing heart disease, and controlling weight, and explaining how to begin incorporating activity into a daily routine. This is followed by a chapter that focuses on setting activity goals, making a plan to achieve them, and staying committed to a plan. Other chapters offer guidelines on building an activity program; identify ways to be more active at home, at play, and on the job; and discuss setting goals for a lifetime of physical activity and using the FITT Principle to set out exercise goals. In addition, the book provides guidelines on monitoring the effect of activity on blood glucose levels and presents sample exercises in a sit, stretch, and strengthen routine. 1 appendix. 8 figures. 16 tables.

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Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes. Annals of Internal Medicine. 132(8): 605-611. April 18, 2000.

This article describes a prospective cohort study that evaluated the prospective association of cardiorespiratory fitness and physical inactivity with mortality in men who have type 2 diabetes. The study population consisted of 1,263 men with type 2 diabetes who received a thorough medical examination between 1970 and 1993 and were followed for mortality up to December 31, 1994. Measurements included cardiorespiratory fitness as determined by a maximal exercise test, self reported physical inactivity at baseline, and subsequent death determined by using the National Death index. During an average followup of 12 years, 180 patients died. The prevalence of self reported physical inactivity was 50 percent in men with diabetes and 33 percent in men without diabetes. The association between low fitness and mortality was present in men with known or unknown diabetes, men who were normal weight or overweight, and men with or without a parental history of cardiovascular disease. After adjustment for age, baseline cardiovascular disease, fasting plasma glucose level, high cholesterol level, overweight, current smoking, high blood pressure, and parental history of cardiovascular disease, men in the low fitness group had an adjusted risk for all cause mortality compared with fit men. Men who reported being physically inactive had an adjusted risk for mortality that was 1.7 fold higher than that in men who reported being physically active. There was an excess number of deaths in unfit men with diabetes from the underlying causes of cardiovascular disease, cancer, diabetes, gastric disease, and injury. The article concludes that low cardiorespiratory fitness and physical inactivity are independent predictors of all cause mortality in men with type 2 diabetes. Physicians should encourage patients who have type 2 diabetes to participate in regular physical activity and improve cardiorespiratory fitness. 1 figure. 4 tables. 43 references. (AA-M).

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Physical Activity and Exercise. In: Michigan Diabetes Research and Training Center; Funnell, M.M., et al. Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 133-156

This teaching outline, part of a series of teaching outlines on living with diabetes, provides information about the effects of physical activity on blood glucose. The outline includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; a skills checklist; an evaluation and documentation plan; and suggested readings. Concepts covered in the outline include the benefits of regular exercise, the effects of exercise on blood glucose, the selection of an exercise program, and the level and duration of exercise. Other topics include planning and starting an exercise program, recognizing and treating hypoglycemia, planning snacks for different levels of activity, and balancing snacks with activities. The outline also provides general information about exercise and offers tips for staying with an exercise program. In addition, a visual and handouts are included.

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Playing Games and Sports Safely. In: Siminerio, L.M. and Betschart, J. American Diabetes Association Guide to Raising a Child with Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 72-76.

This chapter, part of a book on raising a child with diabetes, offers guidelines for making physical activity and exercise as safe as possible for the child who has diabetes. Exercise is important for everyone, but, for a child who has diabetes, exercise can reduce the amount of insulin needed to maintain blood glucose levels and help the child develop social skills and make friends. A health care provider can help parents make regular, planned exercise an enjoyable and safe part of their child's life. A drop in blood glucose levels resulting from unplanned activity can be prevented by having the child always carry snack food and eat the food before taking part in any unplanned physical activity. In addition, a child should carry a backup source of glucose to guard against hypoglycemia. A child's insulin dosage may need to be decreased if he or she experiences hypoglycemia while participating in a vigorous sport. The chapter includes guidelines for snacks and exercise and precautions for safe physical activity.

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Treating Type 2 Diabetes with Diet and Exercise. Diabetes Self-Management. 17(4): 34, 36-38, 40. July-August 2000.

This article explains how type 2 diabetes can be treated with diet and exercise. Although some people who have type 2 diabetes can manage their condition with a combination of diet and exercise, few of them receive useful advice on how to change their diet and exercise habits. Both a diabetes meal plan and exercise are designed primarily to keep blood sugar levels stable. In addition, diet and exercise can help a person lose weight and keep it off, which makes insulin more effective. The first step in managing diabetes with diet and exercise involves learning as much as possible about diabetes and blood glucose self monitoring. Ways to learn about diabetes include meeting with a certified diabetes educator and attending diabetes classes. A diet plan needs to be tailored to the individual. The types of nutrients from which the body receives energy are carbohydrate, protein, and fat. Carbohydrate is the source of energy that has the greatest impact on blood sugar levels. Eating a little carbohydrate at a time and combining each serving of carbohydrate with protein and fat will lessen the impact of carbohydrate consumption on blood glucose. Adding physical activity to a daily routine is also important for maintaining as near to normal blood sugar levels as possible. Everyone should accumulate at least 30 minutes of moderate physical activity on most days of the week. Exercise sessions should begin with a warm up and end with a cool down period. Checking blood sugar levels both before and after exercise sessions is important to determine the effect of exercise on one's blood sugar. The article includes tips for good nutrition and examples of moderate intensity physical activity.

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Viral Hepatitis and Exercise. Medicine and Science in Sports and Exercise. 32(7 Supplement): S422-S430. July 2000.

Increased awareness and publicity of human immunodeficiency virus (HIV) has fostered a heightened sense of concern regarding the transmission of infectious agents during sports and athletic competition. Although the potential risk is low, there are other unanswered questions and issues regarding infectious disease and sports. Viral hepatitis is a common infection and predominantly affects the young who are most likely to lead active lives and engage in both amateur and competitive sport related activity. This article summarizes the common forms of viral hepatitis and the associated clinical syndromes. In addition, the author presents a review of the literature addressing the effect of exercise and the various states of liver disease. The author finally addresses the question regarding participation and return to physical activity following acute viral hepatitis, as well as during chronic hepatitis. Athletes are likely to acquire viral hepatitis as a result of their off the field activity and not from on the field or locker room contact. Teenaged and college aged youth at risk are those who are sexually active, share personal items, use intravenous drugs, or get tattoos or body piercings. In addition, competitive athletes may be exposed to enteric pathogens by consumption of infected food material, especially during travel. Persons with acute viral hepatitis may continue physical activity and mild to moderate training as tolerated by overall well being and clinical condition, but should not participate in strenuous activity or competitive sports until liver function tests have returned to normal. Persons with chronic persistent hepatitis should be allowed to participate in moderate physical activity. Persons with chronic active hepatitis and cirrhosis (liver scarring) should not participate in strenuous competitive sports but should be encouraged to partake in a low level and graduated training program under the supervision of an experienced physician. 4 figures. 4 tables. 27 references.

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What You Can Do to Prevent Diabetes: Simple Changes to Improve Your Life. Somerset, NJ: John Wiley and Sons, Inc. 2000. 146 p.

This book outlines lifestyle changes that people can make to prevent diabetes. Steps that people can take to reduce their chance of getting type 2 diabetes include managing body weight, becoming active, and establishing healthier eating habits. In part one, readers rate their risk for developing diabetes and learn how diabetes develops. Part two provides guidelines and encouragement for helping people make lasting lifestyle changes. Part three focuses on managing body weight. Topics include understanding the connection between diabetes and excess body weight, using body mass index and body shape to determine if one's current weight is healthy, avoiding the use of over the counter appetite suppressants, and dealing with binge eating. Part four provides nutrition guidelines that people can use to achieve better health, including following the 80/20 rule that advocates making healthful food choices 80 percent of the time and allowing less desirable choices on holidays, vacations, and special occasions; getting less than 30 percent of each day's calories from fat; establishing consistent eating habits; keeping calories in check; monitoring portion size; assessing one's hunger; eating intuitively; learning one's food triggers; and eating five servings of fruits and vegetables throughout the day. Part five stresses the importance of exercise and offers suggestions for incorporating more physical activity into daily living. Topics include performing aerobic exercises, adding strength training to an exercise program, and balancing a fitness routine with both aerobic exercise and strength training. Part six focuses on balancing one's lifestyle by monitoring and managing stress, finding support, thinking positively, and visualizing success. The final two parts discuss the advantages of getting the entire family involved in making positive lifestyle changes and offer guidelines for staying on track with a diabetes prevention plan. The book concludes with an index. 30 references.

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When It's Barely Considered Exercise. Diabetes Forecast. 53(4): 33-35. April 2000.

This article discusses the benefits that people who have diabetes can reap by incorporating more physical activity into their daily routines. Although the health benefits a person derives grow as the level and intensity of exercise increase, these benefits begin to manifest themselves at low intensity levels of exertion. Evidence suggests that low intensity exercise is better than none at all and that improvements in glucose tolerance and insulin sensitivity occur almost immediately after low intensity exercise. Other benefits of exercise, regardless of intensity, include improvements in basal metabolic rate and blood pressure and increases in levels of high density lipoprotein. The article presents low intensity activities that people can do at work and at home and with the family to improve their physical fitness. The article also lists precautions people should take before beginning an exercise program.

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Working to Mend a Broken Heart. Diabetes Forecast. 53(8): 29-31. August 2000.

This article, from a magazine for people with diabetes, discusses the role of physical activity in restoring health after a heart attack. Evidence shows that early mobility and a gradual return to independent activity improves psychological and cardiovascular health. People who are diagnosed as having a heart attack should be admitted to a coronary care unit as soon as possible because it allows heart attack related complications to be treated and provides the patient with complete rest. Within 24 hours after an uncomplicated heart attack, the patient may be allowed to move from the bed to a chair for a few hours. Over the next few days, the patient will begin assuming self care tasks. By the fourth day, the patient may walk down the hospital hall with assistance. Prior to discharge, usually on the fifth day, the patient may undergo a submaximal stress test. Two to 4 weeks following discharge, the patient may undergo a regular stress test. A patient who passes this test may be advised to gradually resume regular activities and begin a formal cardiac rehabilitation program. The goals of most rehabilitation programs are to monitor patients and to return them to their previous vocational or recreational activities. The article outlines precautions that people who have diabetes should take before they start such a program and highlights the components of an exercise routine.

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