New York Physical Therapy Ebook Continuing Education

most common cause is obesity (Demir et al., 2022; Devine et al., 2022). Obesity affects 604 million adults worldwide (Devine et al., 2022). Worldwide, 9.3% of adults live with diabetes, and it is predicted that by 2030 there will be 578 million people with diabetes (Demir et al., 2022). Older adults with diabetes are at an increased risk for heart disease and stroke as a result of vascular changes that occur with a sustained increase in blood glucose levels. Neuropathy (peripheral and autonomic), coronary artery disease (CAD), retinopathies, cataracts, peripheral artery disease, obesity, and joint pain are common comorbidities with type 2 diabetes (Demir et al., 2022; Devine et al., 2022; Liguori & American College of Sports Medicine, 2020). As discussed earlier, both aerobic and resistive exercise have numerous benefits for insulin sensitivity and glucose control, and they are key for managing diabetes, type 2 diabetes progression, prediabetes, and many diabetes-related health complications (Liguori & American College of Sports Medicine, 2020). The FITT principle for exercise prescription is generally appropriate for older adults with diabetes without complications. Exercises should be modified as appropriate for other conditions and complications. However, because type 2 diabetes is characterized by abnormal glycemic control, exercise may cause swings in blood glucose levels, resulting in either hyperglycemia (high blood glucose) or hypoglycemia (low blood glucose; Liguori & American College of Sports Medicine, 2020). While hyper- and hypoglycemia have many symptoms in common, in general hypoglycemia develops more quickly than hyperglycemia and is considered to be more immediately dangerous. Symptoms of both hyper- and hypoglycemia can be found in Table 15. When developing an exercise prescription for a person with type 2 diabetes, occupational and physical therapy practitioners must be aware of the individual’s current medications. Individuals on some oral blood glucose lowering drugs and individuals on insulin should monitor their blood sugar before and after each exercise session to ensure that they do not become hyper- or hypoglycemic during or after exercise (American Diabetes Association, 2016). Adjustments may also need to be made to eating habits before and/or after exercise to avoid these swings in blood glucose levels, such as having 10–15 grams of carbohydrate intake immediately prior to the proprioceptive and balance exercise described below (Demir et al., 2022). Older adults with blood glucose below 100 mg/dL should not start an exercise session unless they have had a small snack to prevent hypoglycemia (American Diabetes Association, 2016). FITT for improving proprioception and balance for diabetes As it relates to optimizing proprioception and balance in patients

Table 15: Signs of Hyperglycemia and Hypoglycemia Hyperglycemia Hypoglycemia • Confusion. • Increased thirst. • Headaches. • Blurred vision. • Frequent urination. • Fatigue. • Confusion. • Irritability. • Headache. • Sweating. • Increased heart rate. • Weakness. Note : Adapted from Ahren (2013). If a patient’s blood sugar is consistently above 250 mg/dL, they may require referral back to their physician to discuss other control options (American Diabetes Association, 2016). Older adults with diabetes should also be screened for peripheral neuropathy and educated about the need for appropriate footwear to avoid foot ulcers. Peripheral neuropathy is nerve damage that may occur with prolonged exposure to high blood glucose levels. Individuals with peripheral neuropathy may complain of numbness, tingling, or pain in their hands and feet—or they may have no symptoms. Peripheral neuropathy puts individuals at an increased risk for developing foot ulcers and infections in the feet (but it does not preclude them from participating in weight-bearing exercise; American Diabetes Association, 2016). Because buoyancy reduces the risk of pain and injury, clients who experience too much discomfort with weight-bearing exercises can choose to engage in water-based exercise, which provides a safe and protective way to exercise (Devine et al., 2022). Water-based exercise can allow individual who are overweight or obese to participate in moderate and vigorous levels of exercise that can generate weight loss and achieve fitness levels that may be more difficult to access on land due to heavy joint loads (Devine et al., 2022). People with diabetes should be especially encouraged to participate in resistance training, aiming for at least 8–10 exercises with 1–3 sets of 10–15 repetitions to near fatigue per set early in training (Liguori & American College of Sports Medicine, 2020). They may also benefit from proprioceptive and balance training, which are described in the FITT recommendations in Table 16 (as suggested by Demir et al. (2022) in their randomized control trial) and which have been shown to increase balance ability and prevent falls and somatosensory loss. • Nausea and vomiting. • Shortness of breath. • Coma. • Poor coordination. • Poor concentration. • Coma.

with diabetes, the FITT principle exercise prescription for proprioceptive balance exercises can be seen in Table 16. Table 16: Aerobic Exercise Recommendations for Improving Proprioception and Balance Function FITT Recommendations F requency • 3 days a week. • 8 weeks. I ntensity • Progress from supported to unsupported exercises. T ime • 30–45 minutes. T ype • Proprioceptive activities: ○ Ball rolling under foot. • Balance activities: ○ Standing on one leg. ○ Taking steps on bosu ball. ○ Antero-posterior and medio-lateral weight transfer on bosu ball.

○ Star excursion gait and balance exercises such as walking without support on different grounds, heel to side walking, cross-walking exercises.

Note: Adapted from Demir et al. (2022).

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Book Code: PTNY1024

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