Diabetes Canada Guidelines 2018 - Physical Activity

There is a ton of great, new information in the 2018 Diabetes Canada Physical Activity guidelines chapter.  Here are some of the highlights:


1. Avoid prolonged sitting. Try to get up briefly every 20 to 30 minutes.  Bluntly put, this is because we now know that habitual, prolonged sitting is associated with an increase risk of death and major cardiovascular events (eg heart attack).

2. While it is still recommended to engage in 150 minutes per week of aerobic exercise and at least 2 sessions per week of resistance exercise if possible, it is now recognized that smaller amounts of activity still provides some health benefits. Something is better than nothing!

3.  Make use of strategies that increase motivation, such as setting specific physical activity goals, and using self monitoring tools (eg a pedometer that counts steps). (My editorial comment - some of these devices can also remind you to get up if you've been sitting for too long.)

4.  Medical clearance: It was previously recommended that anyone with diabetes who is about to begin a program more vigorous than walking should have medical clearance first.  This has been relaxed a little - now, this need for clearance is more focussed on middle aged and older people who wish to undertake prolonged or very vigorous exercise, and of course, anyone with symptoms suggestive of cardiovascular disease.

People with more advanced diabetic eye disease should be treated and stabilized before vigorous exercise, and people with severe diabetic nerve disease in their feet/legs should inspect their feet daily and wear appropriate footwear.   It is also recommended to ideally see a qualified exercise specialist before starting strength training (eg weights) to avoid injury.

5.  There is a great list of suggested strategies to help people with type 1 diabetes reduce the risk of lows with exercise.


Bonus Practical Stuff: 

Resources for people with diabetes: (scroll down to Exercise) - including info on how to plan and maintain physical activity, videos on resistance exercises, and more!

Resources for health care providers: under 'Management' - scroll down to 'Physical Activity and Diabetes' - tools including how to write an exercise prescription


Enjoy - and have fun!

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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Sudden Death During Triathlons

Ever think that a triathlete seems invincible? They can swim, they can ride, they can run…. 

It turns out that the risk of sudden death during a triathlon is higher than the risk of sudden death in the general population.  

A recent study is the first to collect data on sudden deaths during triathlons.  (Triathlons consist of a swim, followed by cycling, followed by a run.)  The study reviewed race related deaths during 30 years of triathlons in USA, with data from over 9 million participants.  They identified 135 deaths, for a risk of death of 1.74 per 100,000 participants.  

Perhaps surprisingly, most of the sudden deaths and cardiac arrests (90) occurred during the swim (which starts the race), with 7 during cycling, 15 during the run, and 8 during the post race recovery.  Men age 60 and older were at the highest risk of death at 18.6 per 100,000.  There were also 15 trauma related deaths during cycling. 

Of the 135 deaths, 61 autopsies were performed.  At least 18 of these deaths were due to narrowing of the arteries of the heart.

Why do so many of these sudden deaths occur during the swim, which is at the start of the race?  This may be due to the adrenaline rush at the start of the race increasing the risk of heart arrhythmias, crashes in the water, and/or difficulty in identifying events and initiating rescue, defibrillation and CPR.  This contrasts with data in marathoners (a race of running only), which suggests that sudden deaths in marathons most commonly occur at the end of the race.  Cardiovascular disease accounts for the the majority of marathon-related cardiac arrests.

Bottom Lines:  

1.  Screening for cardiovascular disease when appropriate is important, and triathletes are no exception.  

2.  Organization of races to reduce risk is important: eliminating mass swim starts, and having coordinated safety responses to identify and help people in trouble are key.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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Children's Fitness Falls In Summer

You'd think that summertime would be a time of peak physical fitness for kids, right?  The weather is great, the days are long, school is out, and there is nothing but time for just being a kid... running, jumping, playing all day long.

Think again.

A study in the UK, which was presented recently at the Congress of the European College of Sport Science, tracked the fitness of over 400 children for just over a year.  They found that at the start of the school year in September, kids were not able to run as far as they could at the end of the prior school term in June.   They also found that body mass index (BMI) climbed between June and September (though BMI percentile would be the more appropriate measure).  The decrease in fitness was particularly evident in kids from areas of lower socioeconomic status.

These findings suggest that kids may be more often spending their summer holidays being inactive, perhaps in front of the TV or video games rather than being active in the great outdoors.  Active child care activities during the summer (eg summer camps) can be costly, so kids from less affluent homes may have less access to organized activities.

If you're having trouble keeping your young ones active this summer, here are some suggestions:

• Limit screen time.  Kids will find other things to do that are likely more active.
• Check out your local community facilities, parks and pools to see what is on offer.  
• Enjoy the warm weather and bright evenings with a family walk or bike ride! 
• Consider signing your kids up for a race (eg family fun run, or even a kids' triathlon!) and get them engaged to train for it.  

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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An 86 Year Old Ironman Inspiration!

In line with last week's post about the amazing Olympic athletes, here's a woman who inspires me to the ends of the earth - meet Madonna Buder, who holds the world record for the oldest person to ever complete an Iron Man triathlon, at the age of... 82!

Buder caught the triathlon bug a little later in life, completing her first triathlon at age 52 and her first Ironman at age 56.  She has completed over 325 triathlons, including 45 Ironman distances (an Ironman is a 3860m swim, 180km bike, followed up by a 42km marathon run).

Now 86 years old, Buder is an inspiration to athletes everywhere, and was even featured in a Nike ad that was aired during the Olympics.

Way to go!!  Thanks so much to my friend Chantelle for telling me about this amazing woman.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Olympic Games - Best Weight At All Sizes

It has been a real inspiration and thrill to watch the elite athletes of the world compete at the Rio 2016 Summer Olympic Games.  Over the last couple of weeks, we have enjoyed watching a wide range of sports, from swimming, to basketball, to gymnastics, to track & field, and so much more.

Take a moment and consider the variation in body shapes and sizes amongst this year's incredible athletes:

Each of these sports have a fierce demand for the highest level of physical ability, the nature of which is unique to each individual sport.  Some require intense upper body strength, while others are more lower body oriented; some high anaerobic capacity; others are all about endurance.

I see a similar diversity in body shape and size in the athletes in my clinical practice as an endocrinologist: marathoners, crossfitters, cyclists, swimmers, football players, and so many others.  The sad reality is that those who are of larger body size will often tell me that they feel judged and assumed to be inactive or 'lazy' based on their shape and size by people who have absolutely no idea what that person is all about.

There is no more poignant reminder than watching these incredible Olympic athletes to never judge a book by its cover.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Do Electric Assist Bikes Count As Exercise?

While highly frowned upon when snuck into the Tour de France (are you kidding me?!), electric bikes can be a very useful piece of equipment to zip around town.  These are bicycles that are equipped with electrical assistance, which is activated only when the rider is actively pedalling.  You may wonder – does using these bikes still count as exercise?  A recent study tells us – yes!

The study, published in the European Journal of Applied Physiology, enrolled 20 people who led sedentary lifestyles, and evaluated several measures of health after 4 weeks of using the electrically assisted bike for at least 40 minutes, three days per week. 

They found that using the ‘pedelec’ bikes provided a moderate level of exertion, similar to walking (4.9 METs on average).  After just 4 weeks, there was an improvement in their glucose tolerance, and an increase in their power output and VO2max (a measure of maximal aerobic capacity).    Participants also found the bikes to be fun, to the point where over half of participants ended up cycling over 50% more than the required amount.

So, while using a regular bicycle would provide more exercise, a pedelec bike is a great option for people who have knee problems, struggle to get uphill on a bike, or if you want to get further in a day than you otherwise would on a regular bike.  (We used them on a trip Kyoto last year so we could make it to all the far flung temples we wanted to see – fantastic!)    Pedelecs remove the potential deterrents of cycling such as longer distances or hills, and they can be incorporated into daily life as a means of transport when the weather/climate permits (rather than having to find specific extra time in the day to exercise).  

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Does Exercise Improve Fatty Liver Disease?

Nonalcoholic fatty liver disease is a potential consequence of carrying excess body weight, and is essentially caused by extra fat being stored in the liver. It is the third most common cause of liver cirrhosis, and affects up to 30% of the world’s population. 

Weight loss has been clearly established as the first line treatment for NAFLD, and we know that most successful weight loss strategies focus most attention on reducing calorie intake, with exercise playing only a minor part.  However, we know that exercise can have many cardiometabolic benefits even if a person doesn’t lose weight because of it, so it would be interesting to know if exercise itself could improve NAFLD.

A study was recently published in JAMA Internal Medicine which addresses this question.  In the study, 220 participants with NAFLD were randomly assigned to moderate exercise (brisk walking for 30 mins, 5 days per week) for a year, vigorous exercise for 6 months followed by moderate exercise for 6 months, or no additional exercise for a year.

They found that moderate and vigorous exercise were equally effective to reduce fat content in the liver, and that most (but not all) of the effect was mediated by weight loss. 

So, while actual reduction in weight remains the key factor in improving fatty liver, exercise may play some role even if the exercise itself doesn’t shed a whole bunch of pounds.  And it is good news that moderate activity is just as good as intense activity, as moderate exercise regimens like walking are more likely to be adhered to in the long run.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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