Deck 17: Exercise for Special Populations

Question 1

Provide general recommendations regarding changes in insulin and diet for diabetics who engage in exercise.

Answer 1

For those individuals who suffer from type I diabetes, the primary concern during exercise is to prevent hypoglycemia. In order to prevent hypoglycemia, the following care is required:
• Careful self monitoring of blood glucose levels before, during, and after exercise
• Vary carbohydrate and insulin intake based on the exercise intensity and duration, and fitness of the individual
The following precautions must be taken by an individual suffering from type-I diabetes:
• Refrain from physical activity if fasting glucose levels are more thaN₂50 mg/ dl and if ketosis is present
• If glucose level is above 300 mg/ dl without ketosis, care should be taken during exercise
• Carbohydrates must be ingested if glucose level is below 100 mg/ dl
• The person should be aware of changes in insulin dose and food intake according to the blood glucose levels
• If weakness if experienced during exercise, the person should consume added carbohydrate to prevent hypoglycaemia
• Carbohydrate rich foods should be kept readily available during and after physical activity
• Frequent monitoring of blood glucose and fine tuning of insulin dose accordingly is very crucial to maintain glucose levels within a narrow range

Question 2

How is exercise-induced asthma triggered, and how do medications reduce the chance of an attack

Answer 2

Asthma is a chronic response inflammation of the airways and a reversible airway obstruction. People suffering from asthma feel difficulty in breathing and produce a wheezing sound while they breathe. The hyper secretion of mucus, the swelling of the mucous cells, and the contraction of smooth muscle around the airways is responsible for this wheezing sound.
The main contributing factor to asthma is allergy or hypersensitivity. Exercise may also induce asthma in several people. Asthma attacks may occur within 15 min to about 6 hours after exercise. The prevalence of exercise induced asthma (EIA) is more during winter seasons and those who participate in summer endurance sports.
The factors that trigger EIA are given below:
• Cold air
• Hypocapnia
• Respiratory alkalosis
• Certain intensities and duration of exercise
During exercise, large volume of cool and dry air is taken in which results in cooling and drying of the respiratory tract. Dry air that is inhaled is moistened in the lungs and when exhaled, moisture is constantly lost along. This also causes drying of mast cells that are present in the respiratory tract. Drying increases osmolarity in the cells, which triggers the release of chemical mediators called vaso-active substances that cause narrowing of the airways.
The attack of EIA depends on the intensity of exercise, time interval between bouts, and interval since medication was taken. Running induces EIA more easily than swimming, cycling, or walking. Asthma is more frequently observed in elite athletes.
Exercise induced asthma can be controlled by observing the following measures:
• Taking ingested salbutamol (a 2 agonist) at a dose 10 - 20 times that of inhaled dose
• Reduction in salt intake
• Increased intake of omega-3 fatty acids
• Consumption of caffeine
Along with these, affected persons should carry an inhaler with 2 - agonist and use it when the first sign of wheezing is observed.

Question 3

Why are exercise and diet recommended as nonpharmacological treatments for those with borderline hypertension

Answer 3

Hypertension is the condition in which the arterial blood pressure is persistently elevated. Though medication is available to treat the condition, nonpharmacological approaches are recommended for persons with mild or borderline hypertension, due to the side-effects associated with medication and the behavioral changes that are associated with classifying a person as "patient."
The following are the exercise and dietary recommendations for people with mild or borderline hypertension:
• Reduction in sodium intake
• Reduced calorie intake for overweight persons
• Diet rich in fruits, vegetables, and low fat
• Exercise in the moderate intensity range, that is, 40% - 59% of heart rate reserve
• At least 30 min of exercise in the said range
• The weekly physical activity should account for energy expenditure of 700 tO₂000 kcal

Question 4

What is COPD, and where does exercise fit in as a part of a rehabilitation program

Question 5

What are angina pectoris, CABGS, and angioplasty

Question 6

What additional measurements are made during a GXT of a cardiac patient, as compared to an apparently healthy individual

Question 7

How do elderly people respond to exercise training compared to younger subjects

Question 8

What are the concerns about exercise during pregnancy, and what are the guidelines recommended for a pregnant woman who wants to begin an exercise program

Question 9

What is the difference between type 1 and type 2 diabetes

Question 10

If a type 1 diabetic does not take an adequate amount of insulin, what happens to the blood glucose concentration during prolonged exercise Why

Question 11

If exercise is helpful in controlling blood glucose, how could it complicate the life of a type 1 diabetic