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Physical activity and exercise should be recommended and prescribed to all individuals with diabetes as part of management of glycemic control and overall health.The American College of Sports Medicine recently proposed a new model for exercise preparticipation health screening on the basis of 1) the individual's current physical activity levels.~ Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual.~ Performing high-intensity bouts intermittently during moderate aerobic exercise also slows blood glucose declines, as can resistance exercise done immediately prior to aerobic.The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes.In relatively young adults with type 1 diabetes, temperature regulation is only impaired during high-intensity exercise.Those who wish to perform HIIT should be clinically stable, have been participating at least in regular moderate-intensity exercise, and likely be supervised at least initially.~ Individuals with diabetes or prediabetes are encouraged to increase their total daily incidental physical activity to gain additional health benefits.~ This position statement was reviewed and approved by the American Diabetes Association Professional Practice Committee in June 2016 and ratified by the American Diabetes Association Board of Directors in September 2016.To prevent hypoglycemia during prolonged, predominantly aerobic exercise, additional carbohydrate intake and/or reductions in insulin are typically required.Insulin regimen and carbohydrate intake changes should be used to prevent exercise-related hypoglycemia.Targeted behavior-change strategies should be used to increase physical activity in adults with type 2 diabetes.~ All adults, and particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior.Impact of single and multiple sets of resistance exercise in type 1 diabetes.~ Effects on acute and late glycaemia in athletes with type 1 diabetes mellitus.Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to enhance insulin action.Adults with diabetes should engage in 2−3 sessions/week of resistance exercise on nonconsecutive days.Children and adolescents with type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general.Regular stretching and appropriate progression of activities should be done to manage joint changes and diabetes-related orthopedic limitations.Target-seeking behavior of plasma glucose with exercise in type 1 diabetes.Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM.~ Flexibility and balance exercises are likely important for older adults with diabetes.If enhanced insulin action is a primary goal, then daily moderate- or high-intensity exercise is likely optimal.Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes.Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes.Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes.In this Position Statement, we provide a clinically oriented review and evidence-based recommendations regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes.However, their recommendation is that anyone with diabetes who is currently sedentary and desires to begin physical activity at any intensity should obtain prior medical clearance from a health care professional.Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities.The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus.Therefore, adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes.Regular exercise has considerable health benefits for people with type 1 diabetes.~ Any pregnant women using insulin should be aware of the insulin-sensitizing effects of exercise and increased risk of hypoglycemia, particularly during the first trimester.Carbohydrate intake required will vary with insulin regimens, timing of exercise, type of activity, and more, but it will also depend on starting blood glucose levels.~ A systematic review and meta-analysis.~ A systematic review and meta-analysis.Children and adolescents with type 1 or type 2 diabetes should engage in 60 min/day or more of moderate or vigorous intensity aerobic activity, with vigorous, muscle-strengthening, and bone-strengthening activities included at least 3 days/week.Most adults with diabetes should engage in 150 min or more of moderate-to-vigorous intensity activity weekly, spread over at least 3 days/week, with no more than 2 consecutive days without activity.~ The ACSM no longer includes risk factor assessment in the exercise preparticipation health screening process.~ Moderate to high volumes of aerobic activity are associated with substantially lower cardiovascular and overall mortality risks in both type 1 and type 2 diabetes.This trial provided very strong evidence of profound health benefits from intensive lifestyle intervention.Older adults with diabetes or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary disease should avoid exercising outdoors on very hot and/or humid days to prevent heat-related illnesses.~ Older adults with diabetes or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary disease should avoid exercising outdoors on very hot and/or humid days.More evidence is needed regarding social media approaches, given the importance of social and peer support in diabetes self-management.~ Youth experience many health benefits from physical activity participation.Updating ACSM's recommendations for exercise preparticipation health screening.Effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: A systematic review and meta-analysis.Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis.~ A systematic review and meta-analysis of behavioral interventions.~ In adults with type 2 diabetes, interrupting prolonged sitting with 15 min of postmeal walking and with 3 min of light walking and simple body-weight resistance activities every 30 min improves glycemic control.~ A novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes.~ For glycemic control, combined training is superior to either type of training undertaken alone.Recommendations and precautions vary depending on individual characteristics and health status.Exercise programs including at least 20−30 min of moderate-intensity exercise on most or all days of the week are recommended.Over time, activities should progress in intensity, frequency, and/or duration to at least 150 min/week of moderate-intensity exercise.~ Alternatively, high-intensity interval training promotes rapid enhancement of skeletal muscle oxidative capacity, insulin sensitivity, and glycemic control in adults with type 2 diabetes and can be performed without deterioration in glycemic control in type 1 diabetes.It should not substitute for other recommended activities, as flexibility training does not affect glucose control, body composition, or insulin action.~ Blood glucose responses to physical activity in type 1 diabetes are highly variable.Additional carbohydrate intake and/or insulin reductions are typically required to maintain glycemic balance during and after physical activity.Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes.Youth and adults with type 1 diabetes can benefit from being physically active, and activity should be recommended to all.The above two recommendations are additional to, and not a replacement for, increased structured exercise and incidental movement.All adults should be encouraged to decrease the total amount of daily sedentary time and to break up sitting time with frequent bouts of activity.Youth with type 1 or type 2 diabetes should follow general recommendations for children and adolescents.Physical activity done with peripheral neuropathy necessitates proper foot care to prevent, detect, and prevent problems early to avoid ulceration and amputation.~ Systematic review and meta-analysis.~ A systematic review and meta-analysis.~ Mixed activities are associated with better glucose stability than those that are predominantly aerobic, although variable results have been reported for intermittent, high-intensity exercise.Structured lifestyle interventions that include at least 150 min/week of physical activity and dietary changes resulting in weight loss of 5%–7% are recommended to prevent or delay the onset of type 2 diabetes in populations at high risk and with prediabetes.Increasing nonexercise activity, even in brief bouts, is effective in acutely reducing postprandial hyperglycemia and improving glycemic control in those with prediabetes and type 1 and type 2 diabetes, most prominently after meals.~ A systematic review of high-intensity interval exercise for patients with cardiovascular and metabolic diseases.Prolonged sitting should be interrupted with bouts of light activity every 30 min for blood glucose benefits, at least in adults with type 2 diabetes.As recommended in Table 1, blood glucose concentrations should always be checked prior to exercise undertaken by individuals with type 1 diabetes.Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes and prediabetes.Adults with type 2 diabetes should ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes.Pregnant women with or at risk for gestational diabetes mellitus should be advised to engage in 20–30 min of moderate-intensity exercise on most or all days of the week.As an alternative or a complement to carbohydrate intake, reductions in basal and/or bolus insulin dose should be considered for exercise-induced hypoglycemia prevention.~ Continuous subcutaneous insulin infusion users can reduce or suspend insulin delivery at the start of exercise, but this strategy does not always prevent hypoglycemia.Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin.Behavioral interventions can significantly increase physical activity in adults with type 2 diabetes, and A1C reductions produced by such interventions have been sustained to 24 months.~ A systematic review and meta-analysis of randomized controlled trials.Variable glycemic responses to physical activity make uniform recommendations for management of food intake and insulin dosing difficult.Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus.Given the limited data in youth with type 2 diabetes, it is recommended that children and adolescents with type 2 diabetes meet the same physical activity goals set for youth in general: A minimum 60 min/day of moderate-to-vigorous physical activity, including strength-related exercise at least 3 days/week.Thus, supervised training is recommended when feasible, at least for adults with type 2 diabetes.Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to decrease insulin resistance, regardless of diabetes type.Impact of diabetes on muscle mass, muscle strength, and exercise tolerance in patients after coronary artery bypass grafting.Increasing unstructured physical activity should be encouraged as part of a whole-day approach, or at least initially as a stepping stone for individuals who are sedentary and unable/reluctant to participate in more structured exercise.Women with preexisting diabetes of any type should be advised to engage in regular physical activity prior to and during pregnancy.The Look AHEAD trial was the largest randomized trial evaluating a lifestyle intervention in older adults with type 2 diabetes compared with a diabetes support and education control group.Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications.Effect of exercise intensity on glucose requirements to maintain euglycaemia during exercise in type 1 diabetes.~ No current evidence suggests that any screening protocol beyond usual diabetes care reduces risk of exercise-induced adverse events in asymptomatic individuals with diabetes.~ Results of a randomized trial and meta-analysis assessing the effectiveness of systematic screening.Adults with diabetes should do exercises that maintain/improve balance 2−3 times/week, particularly if they have peripheral neuropathy.To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs.Blood glucose responses to physical activity in all people with type 1 diabetes are highly variable based on activity type/timing and require different adjustments.

The Syncopal Athlete - American College of CardiologyThe Syncopal AthleteApr 29, 2016 | Shivanshu Madan, MD; Eugene H. Chung, MD, FACCExpert AnalysisShare via:Font SizeAAABackgroundMarch 4, 2016 marked the 26thanniversary of the death of an elite college basketball player at Loyola Marymount University who suddenly collapsed and died during a televised intercollegiate basketball game at the age of 23. At 6’7” and 210 lbs, was leading the NCAA 1989-89 basketball season in both scoring (32.7 PPG) and rebounds (13.7 RPG).1Noteworthy, a few months before his death, he had syncope during a game. Extensive testing including cardiac catheterization, electrophysiology (EP) studies, and ambulatory cardiac event monitoring revealed underlying exercise-related complex ventricular tachyarrhythmias for which he was treated with propranolol. Unfortunately, due to increased fatigue and reduced performance capacity, he did not tolerate higher doses of the medication and dosing was gradually weaned. In fact, some reports suggest he had not been taking any medication on game days.2This tragic story, alongside other famous athletes who died unexpectedly, has served as an impetus to research and better understand cardiac evaluation of athletes over the last three decades. In 1993, Dr. Barry Maron published an article in the New England Journal of Medicine calling for standardized criteria to better risk stratify and appropriately disqualify athletes at increased risk for sudden death.3Since the publication of that article, the scientific community has made large strides toward meeting that charge in the form of the 16th, 26th, 36thBethesda conferences, and most recently the Eligibility and Disqualification Recommendations for Competitive Athletes with Cardiovascular Abnormalities published in December 2015.4In this expert analysis, the authors will review the management of the athlete presenting with syncope.DiscussionSyncope, defined as a transient loss of consciousness due to global cerebral hypoperfusion, is characterized by spontaneous and complete recovery.5Presyncope, in contrast to syncope, is the presence of lightheadedness, dizziness, or weakness that almost results in loss of consciousness. It is also important to distinguish syncope from other causes of loss of consciousness such as seizures, metabolic disorders and stroke or transient ischemic attacks.Syncope is a common and often challenging clinical problem with an estimated lifetime prevalence of ~40% in the general population.6As such, syncopal spells account for a significant portion of emergency department visits and hospitalizations placing a substantial burden on the American healthcare system. The athlete represents a unique population in the context of the evaluation and management of syncope for two important reasons. First, since athletes are considered symbols of exceptional health, sudden deaths − let alone syncope − are especially shocking and frequently make headlines. Second, long-term removal from athletic activities can result in dramatic emotional and psychological distress. Thus, an accurate and comprehensive understanding of syncope in athletes is crucial in order to avoid tragic outcomes and prevent placement of undue restrictions on healthy individuals.Classification of SyncopeOne study of athletes undergoing preparticipation screening reported 474 out of 7,568 (6.2%) athletes experienced syncope in the preceding five years.7The differential diagnosis for a syncopal event is broad, with the large majority of episodes secondary to a benign cause, and only a small subset attributable to the presence of underlying structural heart disease. It is helpful to classify athletes with syncope into three cohorts based on the chronological context of the syncopal episode: syncope unrelated to exercise, post-exertional syncope, and exertional syncope.Syncope unrelated to exercise is the most common presentation, accounting for more than 85% of cases.7This form of syncope (frequently referred to as neurocardiogenic, or reflex or vasovagal syncope) is largely neurally mediated with poorly understood pathophysiology.8Vasovagal syncope, considered a benign condition, typically occurs when going from a sitting to standing position, or experiencing fear or emotional distress with specific triggers such as sight of blood or trauma.9Frequently, these patients describe a prodrome of lightheadedness, pallor, a feeling of warmth, diaphoresis, and nausea or epigastric pain. Situational syncope, as the name implies, tends to be reproducible with certain behaviors or activities such as coughing, bearing down to pass stool, or micturition. Dehydration and reduced intravascular volume can induce a state of orthostatic hypotension and induce a presyncopal event with many of the same prodromal features of reflex syncope but importantly no loss of consciousness.Post-exertional syncope frequently occurs when exercise is stopped suddenly and reduction of lower extremity muscle pumping results in less cardiac venous return and cardiac output.10In such a circumstance, an acute increase in myocardial contractility can lead to activation of the cardiac depressor reflex inducing concomitant paradoxical bradycardia. As a result, the athlete may develop acute loss of postural tone, hypotension, and therefore transient global cerebral hypoperfusion – this is termed the Bezold-Jarisch reflex.11Contributing factors likely include dehydration and reduction in plasma volume. Syncope immediately post-exercise which occurs when the subject is still standing, is usually less concerning than syncope during exercise.7Syncope which occurs during exercise raises concern for structural heart disease and can serve as the only symptom that precedes sudden cardiac death.12The differential diagnosis for life-threatening causes of syncope in athletes includes hypertrophic cardiomyopathy (HCM), anomalous coronary artery, arrhythmogenic right ventricular dysplasia (ARVD), ion channelopathies such as Long QT Syndrome (LQTS) or the Brugada Syndrome, myocarditis, and even previously undiagnosed congenital heart disease such as noncompaction cardiomyopathy.13-17Although not necessarily associated with underlying native structural heart disease, commotio cordis is an important cause of syncope and is characterized by sudden cardiac death attributable to cardiac contusion from trauma to the precordium.18Heat stroke or hyponatremia must also be considered in patients with exercise related syncope.12Evaluating an Athlete with SyncopeA comprehensive history is the cornerstone of approaching the syncopal athlete.19Specifics regarding the circumstances and timeline of the event are critical. In fact, an athlete with loss of consciousness during an athletic practice or event should be immediately removed from further activities until a detailed workup is completed. Figure 1 demonstrates an algorithmic approach to evaluating an athlete with a syncopal event.Athletes may not recall all events and it is often helpful to speak with family members or witnesses, including the athletic training staff in particular. The patient’s clinical status after the syncopal episode is also a vital aspect of making a diagnosis. For example, myoclonic jerking or bowel or bladder incontinence may suggest seizure activity (although global cerebral hypoperfusion can also mimic these signs). Other peri-syncopal events, such as the presence of a loud noise preceding syncope, can suggest the diagnosis of LQTS.20Asking specifically for the presence of preceding lightheadedness or presyncopal symptoms, as well as more “red flag” symptoms such as chest pain, palpitations, or shortness of breath is also essential. It is important to highlight that some athletes may minimize symptoms during the interview in an effort to preserve medical permission to continue athletic activities.Finally, obtaining accurate family and social histories is also important. A family history significant for unexplained deaths or known genetic disorders should initiate further investigation. Use of either recreational illicit drugs or performance-enhancing substances should be excluded.21In addition to assessing general appearance and obtaining vital signs, a vigilant physical exam including auscultation for heart murmurs with special maneuvers can suggest the presence of congenital heart disease or HCM. All peripheral pulses should be examined as abnormalities can hint toward subclinical valvular or aortic diseases.If a thorough history and physical reveals concerning findings (i.e. chest pain, shortness of breath, palpitations, any episode of exertional syncope), second tier testing should be performed. A twelve-lead ECG performed at rest may show depolarization or repolarization abnormalities such as left ventricular hypertrophy, Wolfe-Parkinson-White Syndrome (WPW), atrial fibrillation, ischemia, Brugada syndrome or LQTS.22,23Although the sensitivity and specificity of ECG as a screening tool has improved, many high-risk causes of syncope may be electrocardiographically silent.24Echocardiography may be used to confirm findings suggested on an ECG, and better assess cardiac structure (for example, to make a diagnosis of either HCM or ARVD). The athlete echocardiogram should also include imaging of the origin and proximal course of the coronary arteries. If structural disease needs to be better imaged, advanced tools such as Cardiac MRI or Cardiac CT can be used. Patterns of gadolinium enhancement can help to make a diagnosis of HCM, myocarditis, noncompaction cardiomyopathy, or previously undiagnosed infiltrative cardiomyopathies such as hemochromatosis or sarcoidosis.25,26If resting ECG and echocardiography are both unrevealing, but an arrhythmic etiology for syncope is still suspected, exercise testing to invoke the arrhythmia may be helpful. The goal of such testing would be to best mimic the exercise during which the syncopal event occurred – a long distance runner may need to exercise a consistent pace over a long period of time, whereas a basketball player may need to engage in interval training exercises such as sprinting and resting. Close monitoring of ECG changes during the exercise and recovery periods would be crucial. Ambulatory cardiac event monitors should also be used, and the choice of monitor depends on the frequency of episodes. For very rare occurrences, an implantable loop recorder may be required to capture the heart rhythm during a syncopal episode. With respect of athletes, it is noteworthy that many event monitors require adhesive, which can be troublesome to manage in a group of subjects that are prone to active perspiration. Finally, EP testing and radiofrequency ablation can be performed to confirm and treat patients with suspected accessory pathways or ventricular arrhythmias.A relatively new and potentially useful tool to evaluate patients is the cell phone application that functions as a monitoring device. This device allows “real-time” smartphone-based recording and transmission of tracings in symptomatic athletes to consultants.27This technology has the potential to make quicker diagnoses and return athletes to back to activity.According to the most recent AHA/ACC guidelines, recognizing athletes with cardiovascular disease should include systematic screening of families with known genetic disease, incidental findings on fortuitous exams, and systematic screening of large populations of athletes (high school and college athletes).23ConclusionUltimately, the goals of an evaluation for the athlete with syncope are to determine whether underlying heart disease is present, and whether athletic activity can safely be continued. Missing or improperly treating a potentially life-threatening etiology of syncope can have devastating consequences, and the cost of misdiagnosing a benign condition as a dangerous or life-threatening one can lead to unnecessary restriction of activity as well as negative monetary and psychosocial ramifications. Although most causes of syncope in the athlete are benign, high profile stories such as the example above underscore the importance of performing a comprehensive evaluation beginning with a detailed history.

Hello I Can Read Audiobook PPE Preparticipation Physical Evaluation Full Page. You Must Subcribe To Start Free Mounth. You Also Can Cancel Anytime. Thanks For AllDetails Books :Author American Academy of Family PhysiciansISBN 9781581103762Format Paperback , 168 pagesPublished Published May 1st 2010 by American Academy of PediatricsLanguage EnglishRead or Download eBooks :https://bestbookslibrary.net/books/PPE-Preparticipation-Physical-EvaluationDescription Books :Must-have resource guides health care professionals through the PPE process for young athletes from middle school through college. The explosive growth of children's athletics makes the preparticipation physical evaluation (PPE) an important part of many pediatric practices. The new 4th edition guides physicians through the PPE process for young athletes from middle school Must-have resource guides health care professionals through the PPE process for young athletes from middle school through college. The explosive growth of children's athletics makes the preparticipation physical evaluation (PPE) an important part of many pediatric practices. The new 4th edition guides physicians through the PPE process for young athletes from middle school through college. Included are recommendations on PPE timing, setting, and structure; medical history questions; and how to determine participation clearance; lists return-to-play guidelines; addresses medicolegal and ethical concerns; and explores future research and use of electronic formats. Includes: History Form, Supplemental History Form, Physical Examination Form, Clearance Form. Contents: Goals and Objectives, Timing, Setting and Structure, Administrative, Ethical, and Legal Concerns, General Considerations of the History, Physical Examination, and Clearance Systems-Based Examinations, Cardiovascular Problems, Central Nervous System, General Medical, Pulmonary System, Gastrointestinal, Genitourinary, Dermatologic Conditions, Musculoskeletal, The Female Athlete, The Athlete with Special Needs, Research Considerations.